Any mood disorder represents a category of mental illnesses in which the underlying problem primarily affects a person’s persistent emotional state (their mood).

Some of these disorders include depression, bipolar disorder and seasonal affective disorder.

Prevalence of Any Mood Disorder Among Adults

• Based on diagnostic interview data from National Comorbidity Survey Replication (NCS-R), past year prevalence of any mood disorder among U.S. adults aged 18 or older:
  • An estimated 9.7% of U.S. adults had any mood disorder in the past year.
  • Past year prevalence of any mood disorder among adults was higher for females (11.6%) than for males (7.7%).
• An estimated 21.4% of U.S. adults experience any mood disorder at some time in their lives.

Any Mood Disorder with Impairment Among Adults

• Of adults with any mood disorder in the past year, degree of impairment ranged from mild to serious. Impairment was determined by scores on the Sheehan Disability Scale.
• An estimated 45.0% had serious impairment, 40.0% had moderate impairment, and 15.0% had mild impairment.

Prevalence of Any Mood Disorder Among Adolescents

• Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement (NCS-A), lifetime prevalence of any mood disorder among U.S. adolescents aged 13-18:
  • An estimated 14.3% of adolescents had any mood disorder, and an estimated 11.2% had severe impairment. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria were used to determine impairment.
  • The prevalence of any mood disorder among adolescents was higher for females (18.3%) than for males (10.5%).

Mood disorders have been shown to have a strong genetic and biological basis. Relatives of those with major depressive disorder have double the risk of developing major depressive disorder, whereas relatives of patients with bipolar disorder have over nine times the risk (Merikangas et al., 2011). The rate of concordance for major depressive disorder is higher among identical twins than fraternal twins (50% vs. 38%, respectively), as is that of bipolar disorder (67% vs. 16%, respectively), suggesting that genetic factors play a stronger role in bipolar disorder than in major depressive disorder (Merikangas et al. 2011).

People with mood disorders often have imbalances in certain neurotransmitters, particularly norepinephrine and serotonin (Thase, 2009). These neurotransmitters are important regulators of the bodily functions that are disrupted in mood disorders, including appetite, sex drive, sleep, arousal, and mood. Medications that are used to treat major depressive disorder typically boost serotonin and norepinephrine activity, whereas lithium—used in the treatment of bipolar disorder—blocks norepinephrine activity at the synapses.

Depression is linked to abnormal activity in several regions of the brain (Fitzgerald, Laird, Maller, & Daskalakis, 2008) including those important in assessing the emotional significance of stimuli and experiencing emotions (amygdala), and in regulating and controlling emotions (like the prefrontal cortex, or PFC) (LeMoult, Castonguay, Joormann, & McAleavey, 2013). People with depression show elevated amygdala activity (Drevets, Bogers, & Raichle, 2002), especially when presented with negative emotional stimuli, such as photos of sad faces (Surguladze et al., 2005). Interestingly, heightened amygdala activation to negative emotional stimuli among depressed persons occurs even when stimuli are presented outside of conscious awareness (Victor, Furey, Fromm, Öhman, & Drevets, 2010), and it persists even after the negative emotional stimuli are no longer present (Siegle, Thompson, Carter, Steinhauer, & Thase, 2007). Additionally, depressed individuals exhibit less activation in the prefrontal, particularly on the left side (Davidson, Pizzagalli, & Nitschke, 2009). Because the PFC can dampen amygdala activation, thereby enabling one to suppress negative emotions (Phan et al., 2005), decreased activation in certain regions of the PFC may inhibit its ability to override negative emotions that might then lead to more negative mood states (Davidson et al., 2009). These findings suggest that people with depression are more prone to react to emotionally negative stimuli, yet have greater difficulty controlling these reactions.

Since the 1950s, researchers have noted that depressed individuals have abnormal levels of cortisol, a stress hormone released into the blood by the neuroendocrine system during times of stress (Mackin & Young, 2004). When cortisol is released, the body initiates a fight-or-flight response in reaction to a threat or danger. Many people with depression show elevated cortisol levels (Holsboer & Ising, 2010), especially those reporting a history of early life trauma such as the loss of a parent or abuse during childhood (Baes, Tofoli, Martins, & Juruena, 2012). Such findings raise the question of whether high cortisol levels are a cause or a consequence of depression. High levels of cortisol are a risk factor for future depression (Halligan, Herbert, Goodyer, & Murray, 2007), and cortisol activates activity in the amygdala while deactivating activity in the PFC (McEwen, 2005)—both brain disturbances are connected to depression. Thus, high cortisol levels may have a causal effect on depression, as well as on its brain function abnormalities (van Praag, 2005). Also, because stress results in increased cortisol release (Michaud, Matheson, Kelly, Anisman, 2008), it is equally reasonable to assume that stress may precipitate depression.

A Diathesis-Stress Model and Major Depressive Disorders

Indeed, it has long been believed that stressful life events can trigger depression, and research has consistently supported this conclusion (Mazure, 1998). Stressful life events include significant losses, such as death of a loved one, divorce or separation, and serious health and money problems; life events such as these often precede the onset of depressive episodes (Brown & Harris, 1989). In particular, exit events—instances in which an important person departs (e.g., a death, divorce or separation, or a family member leaving home)—often occur prior to an episode (Paykel, 2003). Exit events are especially likely to trigger depression if these happenings occur in a way that humiliates or devalues the individual. For example, people who experience the breakup of a relationship initiated by the other person develop major depressive disorder at a rate more than 2 times that of people who experience the death of a loved one (Kendler, Hettema, Butera, Gardner, & Prescott, 2003).

Likewise, individuals who are exposed to traumatic stress during childhood—such as separation from a parent, family turmoil, and maltreatment (physical or sexual abuse)—are at a heightened risk of developing depression at any point in their lives (Kessler, 1997). A recent review of 16 studies involving over 23,000 subjects concluded that those who experience childhood maltreatment are more than 2 times as likely to develop recurring and persistent depression (Nanni, Uher, & Danese, 2012).

Of course, not everyone who experiences stressful life events or childhood adversities succumbs to depression—indeed, most do not. Clearly, a diathesis-stress interpretation of major depressive disorder, in which certain predispositions or vulnerability factors influence one’s reaction to stress, would seem logical. If so, what might such predispositions be? A study by Caspi and others (2003) suggests that an alteration in a specific gene that regulates serotonin (the 5-HTTLPR gene) might be one culprit. These investigators found that people who experienced several stressful life events were significantly more likely to experience episodes of major depression if they carried one or two short versions of this gene than if they carried two long versions. Those who carried one or two short versions of the 5-HTTLPR gene were unlikely to experience an episode, however, if they had experienced few or no stressful life events. Numerous studies have replicated these findings, including studies of people who experienced maltreatment during childhood (Goodman & Brand, 2009). In a recent investigation conducted in the United Kingdom (Brown & Harris, 2013), researchers found that childhood maltreatment before age 9 elevated the risk of chronic adult depression (a depression episode lasting for at least 12 months) among those individuals having one (LS) or two (SS) short versions of the 5-HTTLPR gene. Childhood maltreatment did not increase the risk for chronic depression for those have two long (LL) versions of this gene. Thus, genetic vulnerability may be one mechanism through which stress potentially leads to depression.

Figure 15.18 A study on gene-environment interaction in people experiencing chronic depression in adulthood suggests a much higher incidence in individuals with a short version of the gene in combination with childhood maltreatment (Brown & Harris, 2013).

Cognitive Theories of Depression

Cognitive theories of depression take the view that depression is triggered by negative thoughts, interpretations, self-evaluations, and expectations (Joormann, 2009). These diathesis-stress models propose that depression is triggered by a “cognitive vulnerability” (negative and maladaptive thinking) and by precipitating stressful life events (Gotlib & Joormann, 2010). Perhaps the most well-known cognitive theory of depression was developed in the 1960s by psychiatrist Aaron Beck, based on clinical observations and supported by research (Beck, 2008). Beck theorized that depression-prone people possess depressive schemas, or mental predispositions to think about most things in a negative way (Beck, 1976). Depressive schemas contain themes of loss, failure, rejection, worthlessness, and inadequacy, and may develop early in childhood in response to adverse experiences, then remain dormant until they are activated by stressful or negative life events. Depressive schemas prompt dysfunctional and pessimistic thoughts about the self, the world, and the future. Beck believed that this dysfunctional style of thinking is maintained by cognitive biases, or errors in how we process information about ourselves, which lead us to focus on negative aspects of experiences, interpret things negatively, and block positive memories (Beck, 2008). A person whose depressive schema consists of a theme of rejection might be overly attentive to social cues of rejection (more likely to notice another’s frown), and they might interpret this cue as a sign of rejection and automatically remember past incidents of rejection. Longitudinal studies have supported Beck’s theory, in showing that a preexisting tendency to engage in this negative, self-defeating style of thinking—when combined with life stress—over time predicts the onset of depression (Dozois & Beck, 2008). Cognitive therapies for depression, aimed at changing a depressed person’s negative thinking, were developed as an expansion of this theory (Beck, 1976).

Another cognitive theory of depression, hopelessness theory, postulates that a particular style of negative thinking leads to a sense of hopelessness, which then leads to depression (Abramson, Metalsky, & Alloy, 1989). According to this theory, hopelessness is an expectation that unpleasant outcomes will occur or that desired outcomes will not occur, and there is nothing one can do to prevent such outcomes. A key assumption of this theory is that hopelessness stems from a tendency to perceive negative life events as having stable (“It’s never going to change”) and global (“It’s going to affect my whole life”) causes, in contrast to unstable (“It’s fixable”) and specific (“It applies only to this particular situation”) causes, especially if these negative life events occur in important life realms, such as relationships, academic achievement, and the like. Suppose a student who wishes to go to law school does poorly on an admissions test. If the student infers negative life events as having stable and global causes, they may believe that their poor performance has a stable and global cause (“I lack intelligence, and it’s going to prevent me from ever finding a meaningful career”), as opposed to an unstable and specific cause (“I was sick the day of the exam, so my low score was a fluke”). Hopelessness theory predicts that people who exhibit this cognitive style in response to undesirable life events will view such events as having negative implications for their future and self-worth, thereby increasing the likelihood of hopelessness—the primary cause of depression (Abramson et al., 1989). One study testing hopelessness theory measured the tendency to make negative inferences for bad life effects in participants who were experiencing uncontrollable stressors. Over the ensuing six months, those with scores reflecting high cognitive vulnerability were 7 times more likely to develop depression compared to those with lower scores (Kleim, Gonzalo, & Ehlers, 2011).

A third cognitive theory of depression focuses on how people’s thoughts about their distressed moods—depressed symptoms in particular—can increase the risk and duration of depression. This theory, which focuses on rumination in the development of depression, was first described in the late 1980s to explain the higher rates of depression in women than in men (Nolen-Hoeksema, 1987). Rumination is the repetitive and passive focus on the fact that one is depressed and dwelling on depressed symptoms, rather that distracting one’s self from the symptoms or attempting to address them in an active, problem-solving manner (Nolen-Hoeksema, 1991). When people ruminate, they have thoughts such as “Why am I so unmotivated? I just can’t get going. I’m never going to get my work done feeling this way” (Nolen-Hoeksema & Hilt, 2009, p. 393). Women are more likely than men to ruminate when they are sad or depressed (Butler & Nolen-Hoeksema, 1994), and the tendency to ruminate is associated with increases in depression symptoms (Nolen-Hoeksema, Larson, & Grayson, 1999), heightened risk of major depressive episodes (Abela & Hankin, 2011), and chronicity of such episodes (Robinson & Alloy, 2003).

Suicide

For some people with mood disorders, the extreme emotional pain they experience becomes unendurable. Overwhelmed by hopelessness, devastated by incapacitating feelings of worthlessness, and burdened with the inability to adequately cope with such feelings, they may consider suicide to be a reasonable way out. Suicide, defined by the CDC as “death caused by self-directed injurious behavior with any intent to die as the result of the behavior” (CDC, 2013a), in a sense represents an outcome of several things going wrong all at the same time (Crosby, Ortega, & Melanson, 2011). Not only must the person be biologically or psychologically vulnerable, but he must also have the means to perform the suicidal act, and he must lack the necessary protective factors (e.g., social support from friends and family, religion, coping skills, and problem-solving skills) that provide comfort and enable one to cope during times of crisis or great psychological pain (Berman, 2009).

Suicide is not listed as a disorder in the DSM-5; however, suffering from a mental disorder—especially a mood disorder—poses the greatest risk for suicide. Around 90% of those who complete suicides have a diagnosis of at least one mental disorder, with mood disorders being the most frequent (Fleischman, Bertolote, Belfer, & Beautrais, 2005). In fact, the association between major depressive disorder and suicide is so strong that one of the criteria for the disorder is thoughts of suicide, as discussed above (APA, 2013).

Suicide rates can be difficult to interpret because some deaths that appear to be accidental may in fact be acts of suicide (e.g., automobile crash). Nevertheless, investigations into U.S. suicide rates have uncovered these facts:

• Suicide was the 10th leading cause of death for all ages in 2010 (Centers for Disease Control and Prevention [CDC], 2012).
• There were 38,364 suicides in 2010 in the United States—an average of 105 each day (CDC, 2012).
• Suicide among males is 4 times higher than among females and accounts for 79% of all suicides; firearms are the most commonly used method of suicide for males, whereas poisoning is the most commonly used method for females (CDC, 2012).
• From 1991 to 2003, suicide rates were consistently higher among those 65 years and older. Since 2001, however, suicide rates among those ages 25–64 have risen consistently, and, since 2006, suicide rates have been greater for those ages 65 and older (CDC, 2013b). This increase in suicide rates among middle-aged Americans has prompted concern in some quarters that baby boomers (individuals born between 1946–1964) who face economic worry and easy access to prescription medication may be particularly vulnerable to suicide (Parker-Pope, 2013).
• The highest rates of suicide within the United States are among American Indians/Alaskan natives and Non-Hispanic Whites (CDC, 2013b).
• Suicide rates vary across the United States, with the highest rates consistently found in the mountain states of the west (Alaska, Montana, Nevada, Wyoming, Colorado, and Idaho) (Berman, 2009).

Contrary to popular belief, suicide rates peak during the springtime (April and May), not during the holiday season or winter. In fact, suicide rates are generally lowest during the winter months (Postolache et al., 2010).

Risk Factors For Suicide

Suicidal risk is especially high among people with substance abuse problems. Individuals with alcohol dependence are at 10 times greater risk for suicide than the general population (Wilcox, Conner, & Caine, 2004). The risk of suicidal behavior is especially high among those who have made a prior suicide attempt. Among those who attempt suicide, 16% make another attempt within a year and over 21% make another attempt within four years (Owens, Horrocks, & House, 2002). Suicidal individuals may be at high risk for terminating their life if they have a lethal means in which to act, such as a firearm in the home (Brent & Bridge, 2003). Withdrawal from social relationships, feeling as though one is a burden to others, and engaging in reckless and risk-taking behaviors may be precursors to suicidal behavior (Berman, 2009). A sense of entrapment or feeling unable to escape one’s miserable feelings or external circumstances (e.g., an abusive relationship with no perceived way out) predicts suicidal behavior (O’Connor, Smyth, Ferguson, Ryan, & Williams, 2013). Tragically, reports of suicides among adolescents following instances of cyberbullying have emerged in recent years. In one widely-publicized case a few years ago, Phoebe Prince, a 15-year-old Massachusetts high school student, committed suicide following incessant harassment and taunting from her classmates via texting and Facebook (McCabe, 2010).

Suicides can have a contagious effect on people. For example, another’s suicide, especially that of a family member, heightens one’s risk of suicide (Agerbo, Nordentoft, & Mortensen, 2002). Additionally, widely-publicized suicides tend to trigger copycat suicides in some individuals. One study examining suicide statistics in the United States from 1947–1967 found that the rates of suicide skyrocketed for the first month after a suicide story was printed on the front page of the New York Times (Phillips, 1974). Austrian researchers found a significant increase in the number of suicides by firearms in the three weeks following extensive reports in Austria’s largest newspaper of a celebrity suicide by gun (Etzersdorfer, Voracek, & Sonneck, 2004). A review of 42 studies concluded that media coverage of celebrity suicides is more than 14 times more likely to trigger copycat suicides than is coverage of non-celebrity suicides (Stack, 2000). This review also demonstrated that the medium of coverage is important: televised stories are considerably less likely to prompt a surge in suicides than are newspaper stories. Research suggests that a trend appears to be emerging whereby people use online social media to leave suicide notes, although it is not clear to what extent suicide notes on such media might induce copycat suicides (Ruder, Hatch, Ampanozi, Thali, & Fischer, 2011). Nevertheless, it is reasonable to conjecture that suicide notes left by individuals on social media may influence the decisions of other vulnerable people who encounter them (Luxton, June, & Fairall, 2012).

One possible contributing factor in suicide is brain chemistry. Contemporary neurological research shows that disturbances in the functioning of serotonin are linked to suicidal behavior (Pompili et al., 2010). Low levels of serotonin predict future suicide attempts and suicide completions, and low levels have been observed post-mortem among suicide victims (Mann, 2003). Serotonin dysfunction, as noted earlier, is also known to play an important role in depression; low levels of serotonin have also been linked to aggression and impulsivity (Stanley et al., 2000). The combination of these three characteristics constitutes a potential formula for suicide—especially violent suicide. A classic study conducted during the 1970s found that patients with major depressive disorder who had very low levels of serotonin attempted suicide more frequently and more violently than did patients with higher levels (Asberg, Thorén, Träskman, Bertilsson, & Ringberger, 1976; Mann, 2003).

Suicidal thoughts, plans, and even off-hand remarks (“I might kill myself this afternoon”) should always be taken extremely seriously. People who contemplate terminating their life need immediate help. Below are links to two excellent websites that contain resources (including hotlines) for people who are struggling with suicidal ideation, have loved ones who may be suicidal, or who have lost loved ones to suicide: http://www.afsp.org and http://suicidology.org.

Have you ever had a bad mood you just couldn’t shake? Everyone feels grouchy or irritable some days. But a bad mood or major mood swings that go on too long may signal a bigger problem. The good news is that certain healthy habits can help you boost your mood.

“Some people are more moody than other people. Normal mood actually varies from person to person,” explains Dr. Carlos Zarate, chief of NIH’s mood disorders group.

That’s because we all have different “temperaments,” or combinations of personality traits that are biologically based. These are fairly stable over time.

“Considerable research shows that people really differ in their basic temperament,” says Dr. Maria Kovacs, an NIH-funded psychologist at the University of Pittsburgh. “There are some people who temperamentally are always in a ‘good’ mood. And there are people who are temperamentally always in a ‘bad’ mood.”

For example, Zarate says, some people don’t seem to be fazed no matter what happens. Others worry about minor things and tend to overblow them.

People who have a more negative temperament tend to have a higher risk for mood and anxiety disorders.

Changing Moods

It’s not only temperament that affects how you feel each day. Daily habits that affect your ability to manage stress—like diet, exercise, sleep, or how much alcohol you drink—play an important role, too.

“If you address those factors—have good diet, good exercise, good sleep-wake habits, regular activities, routines, and try to disconnect from work and other stressors—those do have beneficial effects on mood and keeping you healthy,” Zarate says.

Other biological factors can affect your mood too, like hormones. Women may experience shifts in hormones during their menstrual cycles, pregnancy, and menopause that cause mood changes. Men can have decreases in testosterone as they age, which has been linked to depression.

Certain medical conditions, such as a vitamin deficiency, can make you feel “down” or lack energy. Mental health conditions like depression and bipolar disorder can also cause you to feel very sad and have low energy.

Other mental health conditions can cause mood issues as well—for example, anxiety disorders, obsessive compulsive disorder, and personality disorders.

It’s okay once in a while for people not to have a good mood, Zarate explains. “Moods that fluctuate occasionally are a normal thing. It’s when it’s combined with other symptoms—like significant distress and/or impairment of function or relationships—that it becomes an issue.”

People may not know when their mood has become a problem. “Friends and family members should be open and honest with each other and let them know what they’re seeing,” he says, “because it can lead to strain on family relationships, other relationships, or work issues.”

Bouncing Back

“Mood is a normal part of life, and having emotions is a normal part of life,” Kovacs says. “Sometimes you feel more negative than other times. That’s not necessarily bad.”

Kovacs studies the strategies people use to repair their mood when feeling down. Her team and others have shown that what you do when feeling down can boost your mood or spiral you into feeling worse.

“One of the most common strategies that both children and adults use is what I call ‘attention refocusing,’” she explains. “Meaning that they stop paying attention to whatever is making them miserable or unhappy and they start putting their attention elsewhere.”

For kids, this may mean finding a specific task to do when they’re upset, like helping a parent with chores or finding someone to play with. For adults, it may mean having a conversation with a friend or going for a walk or to see a movie.

Kovacs has found that people with depression or other mental health conditions tend to turn to coping strategies that worsen their mood rather than lift it. For example, thinking about what’s bothering them over and over again or avoiding or hiding their feelings. These strategies can make negative feelings stronger or last longer.

Her research has shown that people often use the same strategies that their parents or older siblings use. It can be hard to change the strategies to manage emotions because people are not always aware of them. For those with mood problems, talking with a mental health professional can help to identify negative patterns and choose healthier coping skills.

“If you come from a family that has a history of depression, it’s incredibly important to try to create an environment for yourself that can maximize the likelihood that you’re not going to get into a depression,” Kovacs says. That means avoiding things that can trigger depression or anxiety, like not getting enough sleep or exercise.

Keeping Track

Charting your moods can help you figure out what’s affecting how you feel. There are even apps that help.

Dr. David C. Mohr, who studies technology-based mental health interventions at Northwestern University, has found that people want to do more than just track their moods using apps. They want to see how their activities and moods are related, to help them take action to feel better.

“That sounds like a simple task, but it’s difficult to do in a way—and provide information back in a way— that’s understandable and reliable,” Mohr explains. “That’s one of the directions we’re working on right now.”

Mohr’s team is developing ways to teach coping skills and deliver mental health services remotely. They’ve designed a set of apps called IntelliCare that give strategies for improving mental health. They also created a “hub” app, IntelliCare Hub, that recommends which of the apps to try based on how you’re feeling.

The team tested whether using the hub app could improve symptoms of depression and anxiety in over 90 people. The participants used the app for eight weeks and had a coach who texted them a few times a week to check in.

“What we see is that we get significant drops in depression and anxiety, similar to what you’d see in psychotherapy or medications,” Mohr says. But more studies are needed to understand the effects of mental health apps like these.

If your mood is making it hard to cope with daily life, talk with your health care provider. If you’re having suicidal thoughts, call your doctor immediately or the National Suicide Prevention Lifeline at 1-800-273-TALK.

Signs and Symptoms of a Mood Disorder

If you’ve been feeling down or lacked energy for a while, talk with your doctor. Here are some things to look for:

• Continuously feeling sad, anxious, “empty,” or irritable
• Feeling guilty, worthless, helpless, or hopeless
• Losing interest or pleasure in hobbies and activities
• Low energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Thoughts of death or suicide, or suicide attempts
• Difficulty controlling worries
• Aches or pains, headaches, or digestive problems without a clear physical cause

Bipolar disorder is a serious mental illness that causes unusual shifts in mood, ranging from extreme highs (mania or “manic” episodes) to lows (depression or “depressive” episode).

A person who has bipolar disorder also experiences changes in their energy, thinking, behavior, and sleep. During bipolar mood episodes, it is difficult to carry out day-to-day tasks, go to work or school, and maintain relationships.

What Causes Bipolar Disorder?

Bipolar disorder affects millions of adults in the U.S. Most people are diagnosed with bipolar disorder in their teens or twenties, however, it can occur at any age and although the symptoms can persist, many find ways to manage their symptoms successfully. People are at a higher risk if they have a family history of bipolar disorder, experienced a traumatic event, and/or misused drugs or alcohol. Differences in brain structure and function may also play a role. If you think you may have it, tell your health care provider.

Signs and Symptoms of Bipolar Disorder

When a person has a manic episode, they feel overly excited, productive, and even invincible. On the other hand, when a person has a depressive episode, they feel extremely sad, hopeless, and tired. They may avoid friends, family, and participating in their usual activities. A severe manic or depressive episode may trigger psychotic symptoms, such as delusions (false beliefs) or hallucinations (seeing or hearing things that others do not see or hear). These drastic behavior changes usually cause concern among friends and family. Everyone’s experience with bipolar disorder is different, and the signs and symptoms vary:

A "manic" episode may include

A "manic" episode may include:

• Intense feelings of euphoria, excitement, or happiness
• Appearing abnormally jumpy or wired
• Having excessive energy
• Insomnia or restlessness (a decreased need for sleep)
• Speaking fast or being unusually talkative
• Having racing or jumbled thoughts
• Distractibility
• Inflated self-esteem
• Doing impulsive, uncharacteristic, or risky things like having unsafe sex or spending a lot of money
• Increased agitation and irritability
• Hypomania

A "depressive" episode may include

A "depressive" episode may include:

• Feeling down, sad, worried, worthless, anxious, guilty, empty, or hopeless
• Lack of interest, or no interest, in activities
• Feeling tired, low energy
• Forgetfulness
• Indecisiveness
• Difficulty concentrating
• Changes in sleep, either sleeping too much or too little
• Changes in appetite, either eating too much or too little
• Thoughts of death and/or suicide

Types & Treatment Bipolar Disorder

Types of Bipolar Disorder

Each type of bipolar disorder includes periods between manic or depressive episodes when symptoms lessen, or people feel stable. The major difference between the types of disorder is how extreme the mood states are and how long they last.

• Bipolar I Disorder: having a history of at least one manic episode, but sometimes also having depressed or hypomanic episodes as well.
• Bipolar II Disorder: mood states that vary from an even mood to high to low, but the highs are less extreme and are called hypomanic states. The depressive episodes may be just as severe as those in Major Depressive Disorder and/or Bipolar I Disorder.
• Cyclothymic Disorder: more chronic mood instability (both highs and lows) that are not as long, severe, or frequent as those experienced in bipolar I or II disorder.

Treatment for Bipolar Disorder

Bipolar disorder is a lifelong condition that doesn’t go away on its own. While it can feel overwhelming and isolating at first, an early, accurate diagnosis is the first step toward getting better. Proper treatment, along with support and self-care, helps people with bipolar disorder live healthy, fulfilling lives.

If you think you may have bipolar disorder, tell your health care provider. A medical checkup can rule out other illnesses that might cause your mood changes.

Bipolar disorder is treatable with a combination of medication and therapy.

• Medications. Mood stabilizers, antipsychotics, and antidepressants can help manage mood swings and other symptoms. It is important to understand the benefits and risks of medications. People may need to try different medications before determining which works best for them. They should never stop taking a medication without their doctor’s guidance.
• “Talk therapy” (psychotherapy). Therapy helps people accept their disorder, recognize the warning signs of a manic or depressive episode, develop coping skills for handling stress, and stick with a medication schedule. Therapy also improves communication and relationships among families.
• Long-term, continuous treatment. While there may be times between episodes where a person feels fine, a long-term, continuous treatment plan can reduce the severity and frequency of mood swings.

These healthy lifestyle habits, along with professional treatment, can help manage the symptoms of bipolar disorder:

• Keep a consistent sleeping schedule. Go to sleep and wake up at the same time each day. Being sleep deprived can put people at risk for manic or depressive episodes. Sleeping more than usual may be a sign of a depressive episode. Limit caffeine, which can disrupt sleep.
• Eat well and get regular exercise. A healthy diet will give your body proper nutrition, and exercise may help improve your mood.
• Always take your medicine as prescribed. You should do this even when your mood is stable.
• Check with your doctor before taking over-the-counter supplements or any medications prescribed by another doctor.
• Keep a mood journal. By tracking how you feel day-to-day, you can notice triggers, monitor how your treatment is working, and spot changes in your eating or sleeping patterns. This written information can be especially helpful to your doctor if your medication needs to be adjusted.
• Keep your primary care physician updated. They are an important part of the long-term management of bipolar disorder, even if you also see a psychiatrist.
• Avoid using alcohol and other drugs.
• Minimize stress. Simplify your life when possible. Try relaxation activities, like meditation or yoga.
• Maintain a support network, of family and friends there to help during a crisis. Educate your loved ones about bipolar disorder so they can best support you. Ask them to help you recognize the warning signs of manic or depressive episodes.

Depression is a disorder of the brain. It is a serious mental illness that is more than just a feeling of being "down in the dumps" or "blue" for a few days.

For more than 20 million people in the United States who have depression, the feelings persist and can interfere with everyday life.

Types of Depression

The types of depression include:

• Major Depressive Disorder, also known as clinical depression, is where people feel that a consistent dark mood is consuming them. It can inhibit daily functions and cause them to lose interest in activities which usually provide them pleasure.
• Persistent Depressive Disorder refers to when a low mood lasts for two or more years in adults and at least one year in children an adolescents. A person with this disorder may experience episodes of major depressive disorder along with periods of less severe symptoms where they are typically able to function day-to-day.
• Postpartum Depression affects women after having a baby. It causes intense, long-lasting feelings of anxiety, sadness, and fatigue, making it difficult for mothers to care for themselves and/or their babies, as well as handle daily responsibilities. Postpartum depression can start anywhere from weeks to months after childbirth.
• Psychotic Depression is a form of depression with psychosis that comes when people get very depressed, such as delusions (false beliefs) and/or hallucinations (hearing or seeing things that are not there).
• Seasonal Affective Disorder is associated with changes in seasons. This form of depression usually occurs during the fall and winter months when there is less sunlight.
• Bipolar Disorder is different than depression, but a person diagnosed with bipolar disorder can experience episodes of major depression.

What Causes Depression?

There are a variety of causes of depression, including genetic, environmental, psychological, and biochemical factors.

A person has an increased risk of depression if their family has a history of depression, they have experienced trauma, major life changes, stress, or certain physical illnesses (such as diabetes, cancer, or Parkinson’s), or as a side effect to certain medications.

Signs and Symptoms of Depression

Depression symptoms vary from person to person, and anyone who has questions about symptoms and signs should consult a doctor. To receive a diagnosis of Major Depressive Disorder, some of these signs and symptoms must be present nearly every day for at least two weeks:

• Continued feelings of sadness, hopelessness, pessimism, emptiness
• Fatigue, lack of energy
• Insomnia or other sleep issues, such as waking up very early or sleeping too much
• Anxiety, irritability, restlessness
• Feeling worthless or guilty
• Lack of interest or joy in hobbies and activities
• Changes in appetite, leading to weight loss or weight gain
• Moving, talking, or thinking more slowly or feeling extra fidgety
• Forgetfulness
• Trouble concentrating, thinking clearly, or making decisions
• Thoughts of not wanting to live, death or suicide, suicide attempts, or self-harm behaviors

Depression Treatment and Help

Living with depression can feel lonely. People may be fearful or ashamed of being labeled with a serious mental illness, causing them to suffer in silence, rather than get help. In fact, most people with major depression never seek the right treatment. But those struggling with this illness are not alone. It’s one of the most common and most treatable mental health disorders. With early, continuous treatment, people can gain control of their symptoms, feel better, and get back to enjoying their lives.

There are effective treatments for depression, including medications (such as antidepressants), along with talk therapy. Most people do best by using both. If standard treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies are also options that may be explored.

To be diagnosed with depression, the symptoms must be present for at least two weeks. Some tests are used to rule out other serious medical conditions that may cause similar symptoms. Also, some central nervous system injuries and illnesses may also lead to depression.

In addition to clinical treatments, if you are one of the millions of people living with depression, there are also healthy lifestyle habits that can help you feel better:

• Focus on self-care. Control stress with activities such as meditation or tai chi. Eat healthy, exercise, and get enough sleep. Most adults need 7-9 hours of sleep per night. Avoid using alcohol and recreational drugs, which can worsen symptoms and make depression harder to treat.
• Set small, achievable goals. Set realistic goals to build confidence and motivation. A goal at the beginning of treatment may be to make your bed, have lunch with a friend, or take a walk. Build up to bigger goals as you feel better.
• Know the warning signs. Recognize your depression triggers and talk to your doctor and/or mental health professional if you notice unusual changes in how you feel, think, or act. If needed, your doctor can safely adjust your medication. Write down how you feel day-to-day (moods, feelings, reactions) to spot patterns and understand your depression triggers.
• Educate family and friends about major depression. They can help you notice warning signs that your depression may be returning.
• Seek support. Whether you find encouragement from family members or a support group, maintaining relationships with others is important, especially in times of crisis or rough spells.
• Stick to your treatment plan. Even if you feel better, don’t stop going to therapy or taking your medication. Abruptly stopping medication can cause withdrawal symptoms and a return of depression. Work with a doctor to adjust your doses or medication, if needed, to continue a treatment plan

Participating in a self-management education (SME) program can help patients manage depression and take control of their symptoms, such as anxiety, depressed mood, tiredness, and appetite changes.

Seasonal affective disorder, or SAD, is a condition in which some people experience a significant mood change when the seasons change. SAD is not considered a separate disorder but is a type of depression.

Causes

Seasonal Affective Disorder (SAD) is triggered by changes in seasons. This form of depression usually occurs during the fall and winter months when there is less sunlight, and the days get shorter. SAD usually lifts during the spring and summer months.

Symptoms

Not everyone with SAD has the same symptoms, but they can include:

• Sad, anxious, or "empty" feelings
• Feelings of hopelessness, guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities you used to enjoy
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making decisions
• Thoughts of death or suicide
• Oversleeping
• Overeating, particularly with a craving for carbohydrates
• Weight gain
• Social withdrawal (feeling like “hibernating”)
• Difficulty sleeping
• Lack of appetite
• Irritability and agitation

Testing for SAD

Talk to your health care provider or mental health specialist if you are concerned and think you may be suffering from SAD.

Get Help

SAD may be effectively treated with a specific type of light therapy for many. Antidepressant medicines and talk therapy may also be needed reduce SAD symptoms, either alone or combined with light therapy. Additionally, vitamin D supplements may improve symptoms.

Concerned that you or a loved one may be experiencing mental illness? You are not alone. Get professional help. Mental health is an important part of overall health and well-being, yet mental illness affects millions of people and their families nationwide. Know that treatment for mental illness is effective—and help is a phone call away.

Mental Illness Is Common, But Too Often Not Treated

Before the COVID-19 pandemic, about one in five adults had a mental illness. Without a doubt, the pandemic has affected the state of mental health in our country and made mental illness even more common. It is rare that a family is not touched by a mental health condition, one that can interfere with your or a loved one’s ability to work, sleep, eat, and enjoy life.

Mental health disorders include anxiety, depression, seasonal affective disorder, or more serious illnesses as bipolar disorder, major depression, schizophrenia, post-traumatic stress disorder (PTSD), and more. Unfortunately, most people with mental illness do not receive mental health services that they need.

People with mental illness can have symptoms that include a range of feelings, emotions, or experiences, including:

• Shifts in mood
• Sadness
• Anxiety
• Irritability
• Low energy
• Delusions
• Hallucinations
• Sleep problems

Mental illness is not always easy to detect. Someone does not need to have all these symptoms, perhaps just one or two.

Treating a mental illness is not something to attempt on your own. Like many health conditions, help for mental illness takes professional diagnosis and treatment.

Treatment Works, Treatment Is Available

The good news: Research shows treatment for mental illness works. With appropriate treatment, people can manage their illness, overcome challenges, and lead productive lives.

Treatment for mental illness is effective. Mental health services also are covered by most health plans—by law. And like physical health conditions, it’s clear the earlier you get treatment for mental illness, the better—and the better you or your loved one will feel and do.

What are mood stabilizers?

Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression. Lithium, which is an effective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder. A number of cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat:

• Depression (usually along with an antidepressant)
• Schizoaffective Disorder
• Disorders of impulse control
• Certain mental illnesses in children

Anticonvulsant medications are also used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control unstable moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid (also called divalproex sodium). For some people, especially those with "mixed" symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than lithium. Other anticonvulsants used as mood stabilizers include:

• Carbamazepine
• Lamotrigine
• Oxcarbazepine

What are the possible side effects of mood stabilizers?

Mood stabilizers can cause several side effects, and some of them may become serious, especially at excessively high blood levels. These side effects include:

• Itching, rash
• Excessive thirst
• Frequent urination
• Tremor (shakiness) of the hands
• Nausea and vomiting
• Slurred speech
• Fast, slow, irregular, or pounding heartbeat
• Blackouts
• Changes in vision
• Seizures
• Hallucinations (seeing things or hearing voices that do not exist)
• Loss of coordination
• Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.

If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her blood, and make sure the kidneys and the thyroid are working normally.

Lithium is eliminated from the body through the kidney, so the dose may need to be lowered in older people with reduced kidney function. Also, loss of water from the body, such as through sweating or diarrhea, can cause the lithium level to rise, requiring a temporary lowering of the daily dose. Although kidney functions are checked periodically during lithium treatment, actual damage of the kidney is uncommon in people whose blood levels of lithium have stayed within the therapeutic range.

Mood stabilizers may cause other side effects that are not included in this list. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each individual medication, please see Drugs@FDA .

For more information on the side effects of Carbamazepine ,Lamotrigine , and Oxcarbazepine , please visit MedlinePlus Drugs, Herbs and Supplements .

Some possible side effects linked anticonvulsants (such as valproic acid) include:

• Drowsiness
• Dizziness
• Headache
• Diarrhea
• Constipation
• Changes in appetite
• Weight changes
• Back pain
• Agitation
• Mood swings
• Abnormal thinking
• Uncontrollable shaking of a part of the body
• Loss of coordination
• Uncontrollable movements of the eyes
• Blurred or double vision
• Ringing in the ears
• Hair loss

These medications may also:

• Cause damage to the liver or pancreas, so people taking it should see their doctors regularly
• Increase testosterone (a male hormone) levels in teenage girls and lead to a condition called polycystic ovarian syndrome (a disease that can affect fertility and make the menstrual cycle become irregular)

Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression may interact badly with anticonvulsants. In this case, a doctor can offer other medication options.