Mental health awareness has been on the rise, with more people educating themselves on different mental health conditions, sharing their experiences with living with mental illness on social media, along with an increase in the development of new public health programs to improve access to valuable resources.
Mental health is a critical part of every single person’s overall wellness. The mind is the control center of the body, and when there are imbalances or abnormalities, our minds can present a variety of symptoms that are often distressing. Mood disorders are a category of mental health conditions in which individuals have an “abnormal range of moods and lose some control over them.” We all have changes in our internal emotional state occasionally, but when these moods interfere with daily life, it’s time to seek help. These disorders are split into two categories: Depressive Disorders and Bipolar/Related Disorders, according to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM).
About one in five adults in the US live with a mental illness, making it vital that all health professionals have the knowledge to recognize them in their patients, as well as the tools to provide effective patient-centered care.
Keep reading to understand various mood disorders better, how to diagnose them in your patients properly, and the different treatment modalities available.

Demystifying Depressive Disorders
A spectrum of disorders falls under the broad umbrella of depressive disorders. Though their symptoms may differ, there are shared diagnostic criteria. First, symptoms should not be due to another medical condition, medication, or drug; the symptoms should cause occupational or social impairment.
Let’s begin with Major Depressive Disorder (MDD), commonly referred to as depression. Some patients may use sadness and depression interchangeably when describing their current emotional state, but it’s important to help patients understand the difference between them.
Feeling sad is a normal reaction to life’s ebbs and flows. While sadness is a part of Major Depressive Disorder, it also includes additional symptoms that interfere with daily life.
When evaluating a patient for Major Depressive Disorder, it’s crucial to ask if they’ve been experiencing any of the following symptoms for at least two weeks:
- Persistent feelings of sadness or emptiness
- Changes in sleep, such as insomnia or hypersomnia
- Reduced concentration
- Feelings of excess guilt or worthlessness
- Changes in appetite (increased/decreased)
- Loss of energy or fatigue
- Loss of interest in pleasurable activities (anhedonia)
- Thoughts of death or suicide
- Slowing down of physical or mental activities or restlessness that leads to repetitive movements (Decreased/increased psychomotor activity)
Remember, to be diagnosed with Major Depressive Disorder, a patient must have five or more of the nine symptoms persisting for at least two weeks.
Next up, Persistent Depressive Disorder, previously known as Dysthymic Disorder or Dysthymia. This disorder shares similar symptoms with Major Depressive Disorder. However, these symptoms have a prolonged course. Patients must have a depressed mood for at least two years, accompanied by at least two of the following symptoms:
- Changes in appetite (increased or decreased)
- Changes in sleep (hypersomnia or insomnia)
- Diminished concentration or difficulty with decision-making
- Feelings of hopelessness
- Low energy or fatigue
- Low self-esteem
Also, throughout this two-year period, the patient must not have been symptom-free for more than two months. If you’re having trouble remembering the difference between MDD and Persistent Depressive Disorder, try associating the latter with the number two: two years of depressed mood, accompanied by two of the symptoms listed above, with symptom relief for no more than two months.
Next, let’s discuss Premenstrual Dysphoric Disorder (PMDD). The way premenstrual disorders are recognized has changed a lot, from “menses moodiness” to now being classified as a type of depressive disorder in the latest DSM. When it comes to the presentation of symptoms, at least one of the following must be present:
- Marked irritability, more interpersonal conflicts
- Affective lability (mood swings)
- Feelings of hopelessness or depressed mood
- Anxiety/tension
One of these symptoms should also be present:
- Loss of interest in pleasurable activities (anhedonia)
- Difficulty concentrating
- Low energy/fatigue
- Changes in appetite (food cravings or overeating)
- Changes in sleep (hypersomnia/insomnia)
- Feeling overwhelmed
- Physical symptoms such as breast tenderness/swelling, joint/muscle pain, bloating, and weight gain
Overall, a total of five or more symptoms should be seen in a patient’s presentation. Mood changes should occur one week or less prior to the onset of menses and must occur during the majority of menstrual cycles of the past year. Premenstrual Dysphoric Disorder causes significant distress and issues with relationships and social activities.

Disruptive Mood Dysregulation Disorder
Did you know that one in six individuals under the age of eighteen in the US experience a mental health disorder each year? One of them is Disruptive Mood Dysregulation Disorder, which is seen during childhood and adolescence.
The diagnostic criteria are as follows:
- Severe and recurrent physical and/or verbal outbursts that are out of proportion to the situation
- Temper outbursts that are inconsistent with current developmental level
- Three or more outbursts per week
- Irritable or angry mood in between outbursts for the majority of the day
- Presence of the above criteria for twelve or more months and no more than three months without symptoms
- Symptoms in a minimum of two different settings
- Onset of symptoms before age ten
- Diagnosis made between ages six to eighteen years old
- No period meets the symptoms of a hypomanic or manic episode
Remember, Disruptive Mood Dysregulation Disorder is not diagnosed before age six due to the normalcy of temper tantrums at this age.

Breaking Down Bipolar/Related Disorders
It’s not uncommon to hear moodiness equated to Bipolar Disorder in popular movies, TV shows, and social media, where it’s inaccurately presented as a rapid cycling through emotions. Let’s take a moment to understand this common disorder and the symptomatology associated with each type.
Before learning about the two types of Bipolar Disorder, it’s helpful to understand the difference between hypomania and mania, as they occur in the context of Bipolar Disorder or separately as episodes. They both have periods of abnormally elevated, irritable mood with increased goal-directed activity and energy and also share the same symptoms (which can be remembered by the DIGFAST mnemonic).
DIGFAST stands for:
- Distractibility
- Impulsivity
- Grandiosity
- Flight of ideas
- Activity increase
- Sleep deficit
- Talkativeness
The difference between the two conditions lies in the length of time with the symptoms. A hypomanic episode must last four consecutive days, while a manic episode must last at least one week. Also, during a hypomanic episode, these symptoms are not severe enough to cause impairment in social and occupational functioning. In contrast, in a manic episode, the symptoms are severe, and an individual or caretaker should consider hospitalization.
Bipolar I Disorder is the occurrence of one manic episode. A hypomanic or depressive episode may also occur, but it isn’t necessary to establish a diagnosis. In contrast, Bipolar II Disorder, previously known as Manic Depressive Disorder, is the occurrence of one or more major depressive episodes and at least one hypomanic episode.
Interestingly, individuals with a first-degree relative with Bipolar Disorder are ten times more likely to develop the disorder, making it imperative to ask your patients about not only medical illnesses when gathering a patient’s family history but also their family’s mental health history.
Cyclothymic Disorder, also called Cyclothymia, has alternating periods between hypomanic and depressive symptoms, but these patients don’t meet the criteria for a hypomanic or major depressive episode. Patients must not be symptom-free for more than two months within two years and shouldn’t have any history of a depressive, hypomanic, or manic episode. Statistically speaking, fifteen to fifty percent of these individuals eventually develop Bipolar I or Bipolar II Disorder.

Comprehending the Causes of Mood Disorders
Several characteristics are a part of the etiology of mood disorders, including biological, psychological, hormonal, and genetic factors. For example, different mood disorders are linked to an imbalance of neurotransmitters. Patients with Bipolar Disorder tend to have an increased level of dopamine, while patients with Major Depressive Disorder have decreased levels of serotonin. Medical conditions, drugs, and medications can cause symptoms seen in mood disorders as well (e.g., corticosteroids, anticonvulsants, opioids, hormonal contraceptives, stimulants, and proton pump inhibitors or PPIs).
In terms of risk factors for the development of mood disorders, psychological factors such as stress, childhood abuse, and trauma are all important factors to consider.
Research is ongoing about the genetic factors and the development of mood disorders, but those with a strong family history of mood disorders have a higher chance of developing them.

Tackling Treatment Options
Now we’ve established the diagnostic criteria and etiology of the various mood disorders, let’s look at the different treatment options available.
Patients are commonly offered a combination of psychotherapy and pharmacological treatments. The type of treatment provided will vary based on the patient’s needs. Cognitive Behavioral Therapy (CBT) is often the first type of treatment offered to patients with mood disorders. It’s a collaborative process between the patient and the therapist to identify thinking and behavioral patterns that aren’t helpful to the patient while helping them better understand the root causes of their disorder, along with problem-solving skills to cope with their symptoms.
Interpersonal therapy is another excellent tool for treatment. It focuses on communication and bettering current interpersonal relationships. This type of therapy focuses on areas such as grief, life changes, and relationship difficulties. Other helpful options for psychotherapy include family therapy, supportive psychotherapy, and group therapy.
Electroconvulsive Therapy (ECT) is typically for patients with Major Depressive Disorder or Bipolar Disorder whose conditions haven’t responded to other treatment interventions, as well as a way to treat manic episodes. ECT involves placing the patient under anesthesia and inducing a seizure and is very effective in improving patients’ condition. However, it doesn’t prevent the return of the illness in the future.
In terms of pharmacological treatments, MDD and Persistent Depressive Disorder are managed with antidepressants. Antipsychotics are necessary when a patient presents with psychotic characteristics or if they have refractory MDD. Doctors may prescribe stimulants when necessary. Antipsychotics and mood stabilizers may be prescribed to manage Bipolar I, II, and Cyclothymic Disorder.
Unfortunately, there is self-stigma, public stigma, and institutional stigma toward mental illness, leading to a reluctance to seek help for mental health conditions or accept treatment once a clinician diagnoses it. It’s important to remember that mental health is health, and normalizing caring for the mind and body is essential for everyone. And the stigma of mental illness is only one of the many barriers to care patients deal with. As we learn how common mental health conditions are in the overall population, it’s vital to support efforts to reduce the stigma surrounding them.
Whether you’re a new health professional or a seasoned clinician in your field, it’s necessary to examine and check our biases about mental health and illness. Take some time to learn the symptoms of different mental health conditions so you can work closely with mental health specialists to give your patients well-rounded and inclusive care.

Resources
- Ganti, Latha; Kaufman, Matthew S.; and Blitzstein, Sean M. First Aid for the Psychiatry Clerkship, Fifth Edition. New York: McGraw-Hill Education, 2018
- https://www.nimh.nih.gov/health/statistics/mental-illness
- https://www.camh.ca/
- https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t6/
- https://www.ncbi.nlm.nih.gov/books/NBK532307/
- https://www.ncbi.nlm.nih.gov/books/NBK279045/table/premenstrual-syndrom.table1diag/
- https://www.nami.org/mhstats
- https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Disruptive-Mood-Dysregulation-Disorder-_DMDD_-110.aspx
- https://childmind.org/guide/disruptive-mood-dysregulation-disorder-a-quick-guide/
- https://www.psychologytoday.com/us/conditions/cyclothymic-disorder
- https://www.ncbi.nlm.nih.gov/books/NBK558911/
- https://my.clevelandclinic.org/health/diseases/17843-mood-disorders
- https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
- https://camh.ca/en/health-info/mental-illness-and-addiction-index/interpersonal-psychotherapy
- https://www.psychiatry.org/patients-families/ect
- https://www.psychiatry.org/patients-families/stigma-and-discrimination
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