Mood Disorders, Research Paper Example

Mood Disorders

Historically, humanity always had to face an inevitable enemy – illnesses and various health conditions that affected one’s psychological and psychological performance. Although the contemporary medicine managed to overcome some severe illnesses of the past, it has numerous challenges related to the psychological aspect of one’s health and life performance. One group of such illnesses refers to mood disorders including depression and bipolar disorder. The aim of this paper is to outline existing biological and psychological theories explaining the causes of these illnesses, the existing approaches to their treatment and consequent efficiency. Moreover, the process of making differential diagnosis and decision-making regarding the choice of treatment are also discussed within this paper.

Theories

Mood disorder is a group of psychological/ mental imbalance of mood which can be characterised by extreme elevation or lowering down of an individual’s mood. The most common disorders within this category include major depression, dysthymia (recurring or long-term depression in mild but enduring form) and bipolar disorder. Although these disorders are far from being new to the science and the contemporary public, the causes and exact answers to their development remain quite vague. Thus, there are various theories explain the causes of these disorders.

From the biological perspective, depression and bipolar disorder were traditionally related to the dysfunction of brain activity, particularly in terms of neurotransmitters that are aimed at transferring signals in the brain. In this regard, various theories were developed on the basis of which transmitter and its imbalance were considered to be the primary cause of depression. According to the biogenic amine theory, the cause of depression was the low level of monoamine in one’s brain, primarily noradrenaline and serotonin (Barlow, 2014). However, clinical studied demonstrated that the increase of monoamine level does not correspond to the expected improvement level.

On the other hand, the receptor sensitivity theory suggests that depression is due to the pathological changes in the receptive function of receptor elements due to the insufficient stimulation of monoamines (Florio et al., 2014). There is also a theory that the primary cause of depression is the insufficiency of serotonin level. However, it does not explain the role of other monoamines and the delayed effect of treatment. The most recent biological theory is the permissive theory, which states that the stability of one’s mood depends on the balance of both noradrenaline and serotonin. The support of this theory was found in the analysis of different phases of bipolar disorders. In this regard, both on manic and depressive stages of bipolar disorder the processes related to serotonin function were characterised as very low and supressed (Barlow, 2014).

Based on the recent research, the theory argues that the primary function of serotonin is to act as a certain mediator and uniting element for the performance of other neurotransmitters. Consequently, the disorders occur when the normal and healthy amount of serotonin is altered or when it cannot interact with some of the neurotransmitters. The findings demonstrated that the drop in the level of serotonin triggered the drop in the level of noradrenaline which further resulted in the abnormality and development of depression (Florio et al., 2014).

Another biological theory of mood disorders particularly relevant in the case of bipolar disorder is a genetic theory. Currently, scientists are trying to find a gene that is responsible for the development of bipolar disorder and depression. The main rationale for this theory is that various studies demonstrated that both depression and bipolar disorder can be found through various generations, suggesting that genetic predisposition is present. Another feature of biological theories is that they consider that women suffer from these disorders more than men due to the hormonal factor of disorders development, particularly in the case of post-natal depression (Barlow, 2014).

From a psychological perspective, there are two primary theoretical approaches to explaining the causes of mood disorders. According to behaviourist theory, the cause of depression is human behaviour and interaction with the external social environment. In this regard, depression is a learned condition due to the empathy to one’s suffering or self-pity, etc. The primary treatment is considered to be through the pro-active life and learning of positive behaviour (Florio et al., 2014).

According to the cognitive theory, the cause of depression is one’s mind and consciousness, self-perception in the present, and future world approached from a negative perspective. In this regard, an individual gets depressed and develops bipolar disorder due to the negative and pessimistic thinking of one’s life and social interactions. The suggested treatment within this theory is cognitive behavioural theory aimed at improving positive image and self-assessment (Quilty et al., 2014).

Another relevant theory is the psychodynamic theory that has originated from Freud’s psychoanalysis and has various contemporary interpretations. In this regard, various aspects of human self-perception conditioned by the early experiences and further interactions with other people can result in the development of depression and bipolar disorder. According to Coyne’s interpersonal theory of depression, negative interpersonal experiences cause mood disorder and it is suggested that the best treatment is interpersonal therapy (Barlow, 2014).

Treatment of mood disorders

As it is seen from the aforementioned discussion of theories of what causes mood disorders, it becomes clear that depending which theory is adopted a different approach to treatment can be expected. However, in the contemporary medical practice the primary treatment is pharmacological particularly in the case of bipolar disorder. In terms of depression, the primary category of the used medications is anti-depressants that are aimed at the restoration of the normal functioning of neurotransmitters. In this regard, the primary targets of anti-depressants are serotonin, dopamine and norepinephrine. Among the most common antidepressants are Prozac (the active substance of fluoxetine), Zoloft (sertraline), Paxil (paroxetine) and Celexa (citalopram) (Barlow, 2014).

The principle of work of antidepressants can be explained on the example of fluoxetine. The substance acts as selective serotonin reuptake inhibitor (SSRI). In this regard, fluoxetine is a transporter that brings required amount of serotonin to the neurons. Moreover, secondary function is that transporters decrease the time serotonin requires to send a signal thus increasing its efficiency (Florio et al., 2014).

Regarding the bipolar disorder the primary medications are aimed at mood-stabilisation. They include lithium, oxcarbazepine, lamotrigine and carbamazepine. The main purpose of mood-stabilisers is to prevent various episodes of mania, depression and aggressive behaviour from reoccurring. The principle of their action is the same as in the case of anti-depressants, and they target the normal level of neurotransmitters (Cappleman et al., 2014).  Although it may seem that the prescription of the anti-depressants and mood-stabilisers can successfully treat mood disorder, the problem is far more complex and requires a systematic and multi-faceted treatment.

The recent studied demonstrated that aforementioned pharmacological treatment is incredibly case-sensitive. In some cases medication demonstrated to eliminate the symptoms of the mood disorders and stabilise patient’s condition, while in other cases it was resulting in substance abuse, addiction or complete incompatibility between patients psychology and prescribed drugs (Quilty et al., 2014).  Another factor to influence the efficiency of drugs is the presence of other psychological conditions, illnesses and genetic predispositions. In this regard, practitioners are testing the combination of treatments on the case-to-case basis.

In terms of the psychological perspective of treating mood disorders, there are various practices and approaches applied on various stages of the development of disorders. Although it may seem that psychological treatment should be an alternative to the pharmacological one, in fact, they become more and more perceived as mutually supportive aspects of systematic treatment of mood disorder, since they have different effects on various stages of the treatment and recovery.  Moreover, it is argued:

“Pharmacotherapy is the first line of treatment but often fails to bring patients to sustained remission. The limited efficacy of pharmacotherapy alone has motivated the study of adjunctive psychosocial interventions. Randomized controlled trials support the efficacy of psychosocial treatment modalities, such as family-focused treatment, family psychoeducation, cognitive behavioural therapy and group psychoeducation, in improving medication adherence, preventing mood episode recurrences, reducing residual mood symptoms, and improving psychosocial functioning” (Deckersbach, at al., 2014, p. 179).

Thus, the essence of psychosocial treatment of mood disorders is aimed facilitation of an individual into the social environment in the most effective manner and stimulation of normalisation of inter-personal relations. In terms of the treatment of disorder, psychosocial therapies are aimed at strengthening one’s self–perception and normalisation of social interactions which are aimed at reduction of potential conflict situations and the consequent mood swings related to mood disorder (Quilty et al., 2014).   Thus, the efficacy of this treatment depends highly on the individual cases. In this regard of tremendous importance are such factors as stability and support of the family and close relatives, the type of work the patient conducts and individual triggers and destabilising factors od mood changes (Florio et al., 2014).

Another aspect to consider in terms of treatment is that mood disorders often develop on the basis other illnesses.  For instance, one of the most recent studied explored the effect of comorbid anxiety disorders on the efficiency of psychotherapy for bipolar disorder (Deckersbach, at al., 2014). The study was based on the clinical observation that almost half of patients with bipolar disorder also suffer from a lifetime anxiety disorder. In their cases, the illness is more severe and long-lasting than in the case bipolar disorder alone. The following findings were demonstrated:

“Patients with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat = 3.22, medium to large effect), whereas patients with multiple anxiety disorder exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat = 12.5, small effect)” (Deckersbach, at al., 2014, p. 181).

Differential diagnoses and decision of the potential treatment

In the process of seeing patients with one of the mentioned above disorders one of the primary tasks is to create a friendly and supportive environment for the patient to feel comfortable to talk about his/her problems. This is particularly essential since the behaviour of people with bipolar disorder is difficult to predict especially without knowing the potential triggers that result in one mood swing or another (Cappleman et al., 2014). The importance of a patient feeling comfortable and secure in practitioner’s presence is also crucial for the differential diagnosis. In this regard, a patient could be more open to practitioner’s inquiries and would be more eager to discuss both physiological and psychological concerns which would give an opportunity to make a more precise diagnosis.

The main reason why good and open relationship is essential is because there are various illnesses that share the same symptoms as a mood disorder, and the more open patient is, the more accurate the diagnosis would be. From the perspective of medical disorders, the most commonly confused with depression are the diseases of the central nervous system such as various forms of dementia, Parkinson disease and multiple sclerosis (Barlow, 2014). The problem also might be related to the endocrine system such as hyperthyroidism or hypothyroidism disorder. In other cases, symptoms can be related to infectious diseases, sleeping disorders or effects of substances abuse. In this regard, the best way to rule out the medical differential diagnosis is to ask the patient to explain the medical conditions he had before, life-style patterns and timeframes of when certain symptoms occurred. In the case when medical history of the patient is available certain medical differential diagnosis can be ruled out.

On the other hand, the primary challenge in differential diagnosis is related to psychiatric disorders. For instance, it is often quite challenging to distinguish major depressive disorder from dysthymia. Dysthymia is characterised by the lower severity of symptoms than major depression, and it is characterised by a low mood for at least 2 years in a row (Quilty et al., 2014). Another category is anxiety disorders. Patients with this type of disorders are very likely to develop various depressive conditions, known as comorbid depression. In this case, it is essential to identify anxiety disorder as a source and the root of a depressive condition, since then the treatment would have to target anxiety disorder as the source of depressive conditions. Among such disorders include post-traumatic stress disorder, phobias, obsessive-compulsive disorder (Quilty et al., 2014). While most of these conditions can be ruled out by asking precise questions regarding symptoms and their time of occurrence, the greatest challenge for the practitioner is to deal with personality disorders since patients’ credibility as source of accurate information becomes is compromised.

Another problem is in differentiating depression from the bipolar disorder. In this regard, the primary danger for the practitioner is to miss out the symptom of hypomania and thus to concentrate only on the monopolar part, meaning depressive episodes. The potential consequences of mistreatment could be in the increase of hypomanic and manic episodes (Florio et al., 2014). In terms of distinguishing bipolar disorder from any other condition, of a particular relevance are a systematic patient’s history with precise exploration of symptoms phenomenology and related contextual features such as family history, interpersonal relations, longitudinal course of illness, and response to the preliminary treatment (Cappleman et al., 2014). Thus, for the practitioner to be successful with diagnosis, each case should be treated individually and systematically.

Just as the differential diagnosis requires systematic, comprehensive and individual approach, so does the treatment for each case should vary according to the individual specifics of each case. Moreover, although pharmacological treatment is perceived to be the primary one, its efficiency also largely depends on various factors such as affective temperament. One of the recent researches of antidepressant treatment demonstrated that there is a relation between affective temperament the response to antidepressant treatment and recovery of patients with mood disorder conditions. The following findings were demonstrated:

“We observed a statistically significant relationship between depressive and anxious affective temperaments and no antidepressant response. In bipolar disorder patients, cyclothymic temperament (p<0.01) and hyperthymic temperament (p<0.05) were associated with antidepressant-associated mania. Hyperthymic temperament was associated with complete antidepressant responses in major depressive disorder patients” (Ferreira et al., 2014, p. 139).

From all mentioned above it can be concluded that in making decisions regarding prescribing a certain treatment individual characteristics, lifestyle and interpersonal context have to be taken into account. From the perspective of prescribing certain drugs, it is essential to finds out how the patient might respond to that treatment, whether there are any other medications that he might be taken and other medical or psychological conditions that could influence the efficiency of pharmaceutical treatment. Another rationale for not hurrying up with drugs prescription particularly in the case of depression is the significance of external factors and interpersonal relations that trigger the development of depression. Consequently, when the cause of depression is related to dysfunctional relations or psychological traumas, psychosocial treatment can be more effective and timely.

On the other hand in the case of severe conditions of depression and deterioration of bipolar disorder, prescription of drugs is inevitable. However, it should not be considered as the final cure of any of the conditions, since in any case the patient would require to return to the social environment and compensate to the events that were triggered by his/her illness. Consequently, depending on the social implications of the disorder episodes and interpersonal problems different therapies would be prescribed. In the case when internal family conflict took place and was projected into social environment, inter-family therapy would be the most rational start of patient’s recovery and return to social interactions (Cappleman et al., 2014). The absence of such psychosocial treatment might make the effect of drugs short-termed since factors triggering episodes would remain unchanged in patient’s life.

Conclusion

Overall, from all mentioned above, it can be concluded that the issue of mood disorders remains one of the complex issues of the contemporary medical practice. Irrespective of the development of new technologies and advancement of medical science, the causes of various diseases including mood disorders remain yet to be found. Numerous theories and approaches to identifying the causes and the best treatment of these class of disorders demonstrate that excluding biological or psychological perspective of the matter can be counter-productive and result in inefficiency of treatment.

In this regard, although the drug treatment demonstrated to be effective, there are various psycho-somatic characteristics that can alter its efficiency. Thus, the application of psychosocial treatment is essential in strengthening the effect of the drug treatment and also in patient’s recovery from the treatment and return to the social environment. In terms of differential diagnosis, the practitioner has to pay attention to and rule out all of the possible alternative diseases. While in the case of medical conditions ruling out of other diagnoses is easier, separate attention should be paid to psychological conditions and potential overlap of different psychological disorders. In any case, the practitioner requires treating each case individually and trying not to over-generalise patients with the same mood disorders.

References

Barlow, D. (2014). Clinical Handbook of Psychological disorders. New York, NY: Guilford Press.

Cappleman, R., Smith, I. and Lobban, F. (2014). Managing bipolar moods without medication: A qualitative investigation. Journal of Affective Disorders, 174, 241-249.

Deckersbach, T. et al. (2014). Do Comorbid Anxiety Disorders Moderate the Effects of Psychotherapy for Bipolar Disorder? Results from STEP-BD. The American Journal of Psychiatry, 171(2), 178-186.

Ferreira, A., Vasconcelos, A., Neves, F. and Correa, H. (2014). Affective temperament and antidepressant response in the clinical management of mood disorders. Journal of Affective Disorders, 155, 138-141.

Florio, A. et al. (2014). Mood disorders and parity – A clue to the aetiology of the postpartum trigger. Journal of Affective Disorders, 152-154, 334-339.

Quilty, L., Pelletier, M., DeYoung, C. and Bagby, M. (2014). Hierarchical personality traits and the distinction between unipolar and bipolar disorders. Journal of Affective Disorders, 147, 247-254.