The Mood Disorders

INTRODUCTION

The everyday moods of happiness, flatness and sadness enhance and reduce pleasure influencing our behaviour and the meaning given to life. Such moods are part of being human, for most, they are non - impairing and transient. In contrast, the mood disorders are chronic, disabling and permeate all facets of life tampering with one’s body, thoughts, feelings and behaviour; for some they are lethal, for others they compromise physical health and shorten life. The mood disorders are not unique to our times. They were recognised in Ancient Greece by Hippocrates who reported their burden and suggested they were disorders of the mind, body and brain.

Tantalising evidence now shows that the mood disorders are neurobiological, stemming from changes in brain chemistry and structure. This evidence is supported, in part, by modern high-tech neuro-imaging studies that enable examination of the brain’s structure and function, findings that show a difference between those who are depressed and those who are not. Using modern tools of human genetics, disease-causing DNA sequences (Deoxyribonucleic acid, the genetic material in our cells) linked to the mood disorders have been identified providing additional evidence for these disorders being neurobiological. Research is zeroing in on identifying specific causative genes for the different mood disorders. That genetic factors underlie the mood disorders is suggested by the familial nature of these illnesses, i.e., other family members often share the same illness. It will be a surprise for some and a shock for others that these disorders are neurobiological thus a “mind-shift” is necessary, hopefully promoting a better understanding of the symptoms, pain, burden and the need for effective treatment.

BURDEN

Abundant evidence now highlights the burden of the mood disorders, their impact on quality of life, the human cost on self, family and others, and the increasing social and financial costs to society. It is now also recognised that the mood disorders have a psychological and physical impact in ways not yet explained that predisposes one to the onset of medical illnesses including heart disease, stroke, certain cancers and osteoporosis. Moreover, the mood disorders, particularly major depression have been shown to follow the onset of numerous medical illnesses adversely affecting outcome. Under-recognised is that the mood disorders may initiate or exacerbate unhealthy behaviours such as smoking, drug and alcoholic abuse, dietary neglect and physical inactivity, behaviours that collectively add to the burden and delay of recovery. That the burden and risks of the mood disorders is such, argues for early recognition and effective treatment.

RECOGNITION

Despite awareness campaigns, the mood disorders sadly continue to go under - recognised whether they occur in children, adolescents, adulthood or the elderly. For many, prior to the onset of a mood disorder, there is a prodromal phase defined as when there are insufficient symptoms for diagnosis; this phase is also under - recognised. For some, under - recognition stems from shame in revealing symptoms or an absence of knowledge that their symptoms are of a mood disorder. That health care professionals often fail to assess mood status or consider the symptoms as those of another illness, also leads to under - recognition.

TREATMENT

The mood disorders ought to be treated as medical illnesses. Most who have a mood disorder are today untreated or under - treated despite the availability of efficacious and well - tolerated treatments. Current pharmacological therapies surpass treatments of a decade ago and are now the most common treatment intervention. One study for major depression showed that in 1987 only 37% chose the drug option and in 1997, the drug option had increased to 75%. Historically, psychological therapies were considered an effective solitary treatment of the mood disorders. Current studies now suggest that their efficacy may have been over - stated and thus should now be used with caution, particularly when used alone. Experience suggests that the combination of therapies produces the best result. Studies now show that those with a mood disorder ought to be optimistic as outcome studies clearly show that the burden of these disorders can be banished when treatment is effective. Table 1 lists the mood disorders described in this guide.