The Exciting World of Mood Disorders

Mood disorders, including depression and bipolar, are more common than most physical diseases, yet most of us have a poor grasp on what they actually are. Emotional disregulation is the most obvious outward symptom, but that's just one effect of broader neurological dysfunction. Let's explore the exciting world of mood (or affective) disorders!

Doesn't this look like fun?!

Traditionally, mood disorders are presented on a model with one axis, like the figure below:

Image: Mayo Clinic

Euthymia is the x-axis, and mood disorders depart from there, either going high (mania) or low (depression). There is a major flaw with this model, especially when we talk about suicide risk. Recent research has found that most of the time bipolar people are actually experiencing mixed episodes, or moods with both manic and depressive features. The model above cannot represent mixed episodes, leading many to believe they are rare.

I developed a different 2-axis model to better represent these mixed episodes and to help bipolar people talk about their experiences more easily. Let me show you.

Mood is not the same as emotion. Any emotion is possible within any of the states represented on this grid. Euthymic moods are within the range of “normal.” Most people who do not have affective disorders experience the vast majority of their life within euthymia, only dipping into depression or mania during times of crisis or grief.

Depression Axis

Mild depressive symptoms may be considered a diagnosable disorder if they persist nearly every day for a period of 2 or more years. For a diagnosis of dysthymia, at least two symptoms must be present:

• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

Major Depressive Disorder may be diagnosed if symptoms persist for at least 2 weeks. At least five symptoms must be present:

• Depressed mood most of the day, every day
• Diminished interest or pleasure in things you once enjoyed
• Significant weight loss or gain
• Insomnia or hypersomnia
• Restlessness
• Fatigue
• Feelings of worthlessness
• Diminished ability to think or concentrate
• Recurrent thoughts of death

Someone may be diagnosed with double depression if his or her mood oscillates between major depression and dysthymia.

Mania Axis

Hypomania is a mood state characterized by euphoria and disinhibition. The DSM attributes the same symptoms to mania and hypomania, but hypomania does not impair functioning.

In reality, hypomania often improves functioning. People usually feel more motivated, creative, and energetic. I honestly wish I could live my life in hypomania. YouTube is full of (bad idea) videos about how to trigger hypomania in bipolar people. Don't try that, because if you're successful you may overshoot and end up in....

For a diagnosis of mania under the DSM, symptoms must be present for at least a week. At least three of the following symptoms must be present:

• Grandiosity
• Decreased need for sleep
• Pressure to keep talking
• Flight of ideas
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities that have a high potential for painful consequences
• Psychotic symptoms may also be present. 

Mania is a terrifying place. Your brain is running too fast for you to keep up with it, so you only get weird shards of thought. You can't stop moving, but typically you can't focus on anything. Really bad ideas suddenly seem like great ideas, and people have risky sex, gamble away their rent, quit going to work, etc. You get so overloaded that you can't really process emotions, so manic people are often irritable or angry. A single week of mania can ruin your life. When it ebbs it feels like you were body snatched. Since you can't sleep when manic you can't create long-term memories. Often you forget the awful things you did. Everyone else remembers.

Hypomania is like the most fun state fair that ever was, and mania is like realizing it's been a Ryan Murphy terror carnival the entire time. 

Or the very real abandoned Six Flags outside of New Orleans. Photo: lostlosangles

Mixed Episodes

A person can experience both mania or hypomania and depression at the same time. This is called a mixed episode.

There's an infinite number of ways a mixed episode can go. However, since manic states are characterized by goal directed activity and depression is often about worthlessness, hopelessness, and self-hatred, suicide risk is highest during severe mixed episodes. Someone experiencing a mood located in the top right corner of the grid is in a lot of danger. The traditional single-axis model does not even recognize the existence of this state.

Bipolar Disorders

There are three bipolar disorders: cyclothymia, Bipolar 2, and Bipolar 1. The differences between them can  be shown easily on the two-axis model.

People with cyclothymia experience dysthymia, hypomania, and possible dysthymic-hypomanic mixed episodes. Someone with cyclothymia may or may not also experience long periods of eurythmia.

A diagnosis of bipolar 2 encompasses the entire depression spectrum as well as hypomania and any sub-mania mixed states.

Bipolar 1 is the “cover all” disorder. Only people with bipolar 1 experience full mania, major depression, and any combination of mixed states. 

Another benefit of the grid model, compared to the sine wave model, is that we can represent the different courses bipolar disorder might take. If the traditional model was true, people would have to pass through euthymia when moving from mania to depression. Here, we see that may not be the case.

Life's tough if you're stuck on that outside path.

Tomorrow I'll talk more about what it actually feels like to experience these moods, but introducing the diagnostic criteria for the entire affective disorder family is probably enough for one day. 

via GIPHY

If you read this and recognize something about yourself, you may want to take an online screening for more information. It's better to know what you're dealing with than wandering around in the dark.