Senior Clinical Psychologist
St. James’s Hospital
Mood disorder is the term designating a
group of diagnoses in the Diagnostic and
Statistical Manual of Mental Disorders
(DSM IV TR) classification system where a
disturbance in the person's mood is the main
Two groups of mood disorders are broadly
Depressive disorders, of which the best known is
Major Depressive Disorder (MDD) commonly
called clinical depression or major depression; and
Bipolar disorder (BD), formerly known as manic
‘Depression is an affective state characterised
by sad mood, anhedonia the inability to
derive pleasure from activities such as eating
or sex, and in psychomotor, sleeping, and
American Psychiatric Association (APA), 2000
Depression ranks as the primary emotional problem
for which help is sought which severe, complex
problems, and rumination is a common feature.
Depressed people often believe that their ruminations
give them insight into their problems, but clinicians
often view depressive rumination as pathological
because it is difficult to disrupt and interferes with the
ability to concentrate on other things.
Abundant evidence indicates that depressive
rumination involves the analysis of episode-related
problems. Because analysis is time consuming and
requires sustained processing, disruption would
interfere with problem-solving.
constant feelings of sadness, irritability, or tension
decreased interest or pleasure in usual activities or hobbies
loss of energy, feeling tired despite lack of activity
a change in appetite, with significant weight loss or weight gain
a change in sleeping patterns, such as difficulty sleeping, early
morning awakening, or sleeping too much
restlessness or feeling slowed down
decreased ability to make decisions or concentrate
feelings of worthlessness, hopelessness, or guilt
thoughts of suicide or death
Where a person has one or more major
After a single episode, Major Depressive Disorder
(Single Episode) would be diagnosed.
After more than one episode, the diagnosis
becomes Major Depressive Disorder (Recurrent).
Depression without periods of mania is
sometimes referred to as unipolar depression
because the mood remains at one emotional
state or "pole".
Diagnosticians recognize several
subtypes or course specifiers:
Psychotic major depression
Seasonal affective disorder
Depression is commonly considered to be a
neurochemical disorder, and it is often treated
with antidepressant medications.
Psychotherapy try to help people solve problems
in their lives, and controlled experiments have
shown that they work just as well as medications
in the acute phase and have lasting posttreatment effects:
Cognitive behavioural therapy (CBT)
Enhanced behavioural activation therapy (EBA)
Interpersonal therapy (IPT)
CBT has positive effects in the acute and
post-treatment phases. In CBT, intervention
is possible at a number of points, including:
helping depressed people solve the problems that
cause their cognitions
helping depressed people stay engaged in their
social environment so they can test the veracity of
directly helping them change the way they think
The goal of EBA is to identify the punishing or
non-rewarding aspects of the environment that
the depressed person attempts to avoid and
help the person find ways to make them more
In the acute phase, EBA worked better than CBT
and just as well as antidepressants, and just as
well as CBT in the post-treatment phase.
Moreover, this study found that patients with
severe, chronic depression did not respond well
to CBT, whereas they responded better to EBA.
Another effective psychotherapy is
interpersonal therapy (IPT), and one of its
primary goals is to assess the interpersonal
problems that depressed people face and
help them develop strategies and skills for
Like EBA, there is some evidence that IPT
may work better than CBT, and IPT appears
to work just as well as medications in the
Is a chronic, different mood disturbance
where a person reports a low mood almost
daily over a span of at least two years.
The symptoms are not as severe as those
for major depression, although people with
dysthymia are vulnerable to secondary
episodes of major depression (sometimes
referred to as double depression).
Is a chronic and often devastating illness that may go
diagnosed because of its complex and diverse
By the year 2020, bipolar disorder will be the sixth leading
cause of disability worldwide among all medical illnesses.
Clinicians can provide psychological treatments, in
conjunction with pharmacotherapy, that can reduce the
frequency, severity, and duration of maniac and
Persons with the disorder vary between the extremes of
mania (a highly energized, elated, or irritable state) and
depression (a deflated, withdrawn, morose, and often
Bipolar I is distinguished by the presence or history of one or
more manic episodes or mixed episodes with or without
major depressive episodes.
Bipolar II consisting of recurrent intermittent hypomanic and
Cyclothymia is a form of bipolar disorder, consisting of
recurrent hypomanic and dysthymic episodes, but no full
manic episodes or full major depressive episodes.
Bipolar Disorder Not Otherwise Specified (BD-NOS)
sometimes called "sub-threshold" bipolar, indicates that the
patient suffers from some symptoms in the bipolar spectrum
(e.g. manic and depressive symptoms).
The family environment is an important context for understanding
the development and maintenance of severe psychopathology
and mood disorders in particular.
Current thinking about the relapse–remission course of bipolar
disorder emphasizes a biopsychosocial model that incorporates
the interactive roles of genetic vulnerability, biological
predispositions, family or life events stress, and psychological
The illness is clearly heritable, and there is substantial evidence for
dysfunction of the neurotransmitter systems (notably dopamine
and serotonin) and of the limbic–cortical system.
Specifically, elevated activity in the amygdala and diminished
activity of the frontal-cortical regions may interfere with the
capacity to regulate emotion.
Key Features of Family-Focused Treatment
Commences shortly after an acute episode of mania, depression, or
Involves the patient and one or more relatives (spouse, parents, siblings)
Consists of three consecutive modules:
Psychoeducation: didactic information and interactive discussion about the
symptoms of bipolar disorder, early warning signs, relapse prevention
plans, roles of risk and protective factors, and the importance of medication
Communication enhancement training: behavioural rehearsal of effective
speaking, listening, and negotiating skills, with homework practice.
Problem-solving skills training: identify and define specific family
problems, brainstorm solutions, evaluate the advantages and disadvantages
of each solution, choose one or a combination of solutions, develop
implementation plans; homework between sessions .
Andrews, P. W., & Thomson, J. A., Jr. (2009). The bright side of being blue: depression as an adaptation
for analyzing complex problems. Psychological Review, 116(3), 620-654.
Beynon, S., Soares-Weiser, K., Woolacott, N., Duffy, S., & Geddes, J. R. (2008). Psychosocial
interventions for the prevention of relapse in bipolar disorder: systematic review of controlled
trials. The British Journal of Psychiatry: The Journal of Mental Science, 192(1), 5-11.
Cuijpers, P., van Straten, A., van Schaik, A., & Andersson, G. (2009). Psychological treatment of
depression in primary care: a meta-analysis. The British Journal of General Practice: The Journal of
the Royal College of General Practitioners, 59(559), e51-60.
Dumit, J. (2003). Is It Me or My Brain? Depression and Neuroscientific Facts. Journal of Medical
Humanities, 24(1/2), 35-47.
Hyde, J. S., Mezulis, A. H., & Abramson, L. Y. (2008). The ABCs of depression: integrating affective,
biological, and cognitive models to explain the emergence of the gender difference in depression.
Psychological Review, 115(2), 291-313.
Johnson, S. L., Cuellar, A. K., Cueller, A. K., Ruggero, C., Winett-Perlman, C., Goodnick, P., White, R., et
al. (2008). Life events as predictors of mania and depression in bipolar I disorder. Journal of
Abnormal Psychology, 117(2), 268-277.
Leahy, R. L. (2007). Bipolar disorder: Causes, contexts, and treatments. Journal of Clinical Psychology,
Miklowitz, D. J. (2007). The Role of the Family in the Course and Treatment of Bipolar Disorder.
Current directions in psychological science, 16(4), 192-196.