Mood disorders are mental illnesses where the underlying problem primarily affects the person’s emotional state or mood. Mood disorders include bipolar disorders and depressive disorders, both of which are discussed in this section.

Bipolar Disorders

Bipolar disorders (formerly called manic depression) are mental illnesses that cause unusual shifts in a person’s mood and accompanying energy and activity levels. Moods range from extremely “up,” elated or energized periods (known as manic episodes) to very “down,” sad or hopeless periods (known as depressive episodes). These shifts can cause difficulty in carrying out day-to-day tasks.

Bipolar I disorder is defined by manic episodes that last for at least 7 days or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”

Bipolar II disorder involves a pattern of depressive episodes and hypomanic episodes, which are less severe than the manic episodes in bipolar I disorder. During a hypomanic episode, a person may feel very good and be able to get things done, and they may not feel that anything is wrong. Family or friends, however, may recognize changes in mood or activity levels as possible symptoms of a disorder.

Sometimes people having severe manic or depressive episodes also have symptoms of psychosis, which may include hallucinations or delusions that tend to match the person’s extreme mood. For example, someone having psychotic symptoms during a depressive episode may falsely believe they are financially ruined, while someone having psychotic symptoms during a manic episode may falsely believe they are famous or have special powers.

Bipolar disorder is a lifelong diagnosis that can be treated with medications and therapy. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Mood stabilizing medications, such as lithium, can help prevent mood episodes or reduce their severity. Although bipolar depression is often treated with antidepressant medication, a mood stabilizer must be taken as well—taking an antidepressant without a mood stabilizer can trigger a manic episode or rapid mood changes in a person with bipolar disorder.

Watch the short video in figure 2.11 in which a person diagnosed with bipolar disorder shares their perspective on diagnosis and treatment.

https://www.youtube.com/watch?v=zj4s532wTxE

Depressive Disorders

Depression is a mood disorder with symptoms that include feelings of sadness, hopelessness, and loss of interest in activities. Depression can also cause physical symptoms such as aches, pains, and digestive problems. Because depression tends to make people think more negatively about themselves and the world, some people experiencing depression may have thoughts of suicide or self-harm. Depression is also very common; an estimated 21 million adults (more than 8% of all adults) in the United States had a major depressive episode in 2021 (NIMH, n.d.-a).

A diagnosis of major depressive disorder, which is considered a serious mental illness, requires the presence of depression symptoms for at least 2 weeks. Symptoms can vary, and depression can have different triggers, which can lead to more specific diagnoses. When a major depressive episode occurs in the context of pregnancy, for example, that is called perinatal depression. This condition is familiar to many under the name of postpartum depression, but the DSM now uses terminology recognizing that depression symptoms often begin during, not after, pregnancy. Perinatal depression is thought to impact one in every seven women (American Psychiatric Association, 2023). A severe depressive episode that includes symptoms of psychosis, such as delusions or hallucinations, is called depression with psychotic features (Smith, 2021).

Although people of all genders can feel depressed, how they express and cope with their symptoms may differ. For example, because men may be less likely to recognize, talk about, and seek help for their feelings or emotional problems, they are at greater risk than women for depression symptoms being undiagnosed or undertreated (Beharry & Ogrodniczuk, 2017). The incidence of depression varies based on gender as well. Data shows higher rates of depression, as well as anxiety, among members of the LGBTQIA+ community, which includes people who are lesbian, gay, bisexual, transgender, queer, intersex, and asexual. (Marlay et al., 2022). Transgender youth in particular are reported to have a much greater risk of experiencing depression compared to non-transgender peers. Mental health symptoms within this group can relate to the general stigma and discrimination that they experience, as well as the daily barriers they may face, such as bathroom access (Human Rights Campaign Foundation, n.d.).

Watch the short video in figure 2.12 to hear one man’s account of his severe depressive disorder.

https://www.youtube.com/watch?v=1clEHAj-eRE

Depression, even in the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Depression is usually treated with medication, psychotherapy, or a combination of the two. If treatments like medication and psychotherapy do not reduce depressive symptoms or if the need for rapid relief from symptoms is urgent, brain stimulation therapy may be an option. Brain stimulation therapies, including electroconvulsive therapy (ECT), activate or inhibit the brain with electricity. Modern ECT is very different from the barbaric-seeming predecessor practices described in Chapter 1 of this text, but it remains in the category of last-resort treatments, in part due to its stigmatizing history. If you are interested in learning more about brain stimulation therapies, particularly modern ECT from a first-person perspective, watch the optional five-minute video linked in figure 2.13.

https://www.youtube.com/watch?v=qk_FjhitKDI

Anosognosia in Mood and Psychotic Disorders

Sometimes, a person who has one of the mental disorders discussed in this section will experience a lack of insight into, or awareness of, their mental illness. This lack of insight, which may involve rejection of the diagnosis or treatment, can appear to be willful resistance. However, it may be a challenging aspect of the underlying disorder called anosognosia. Anosognosia is quite common in both psychotic and mood disorders, and it is a common reason that people with these disorders discontinue treatment (Treatment Advocacy Center, 2018).

Anosognosia can, in some cases, lead to criminal justice system involvement. Someone with anosognosia may be inconsistent with their medication regimen, believing it unnecessary, and engage in conduct that places them at risk of problems such as homelessness or contact with police (NAMI, 2024b).

Watch the video in figure 2.14 if you are interested in hearing more about anosognosia from a self-advocate who has experienced this condition.

https://www.youtube.com/watch?v=R3d_kybSfOc

Licenses and Attributions for Mood Disorders

Open Content, Original

“Anosognosia in Mood and Psychotic Disorders” by Anne Nichol is licensed CC BY 4.0.

Open Content, Shared Previously

“Mood Disorders” is adapted from:

• Bipolar Disorder by National Institute of Mental Health, which is in the Public Domain.
• “Depression” by the National Institute of Mental Health, which is in the Public Domain.

Modifications by Anne Nichol, licensed CC BY 4.0, include revising, condensing, and expanding the content.

All Rights Reserved Content

Figure 2.11. Profile: Phil Y., Living with Bipolar Disorderby SAMHSA is licensed under the Standard YouTube License.

Figure 2.12. Profile: Dan L., Living with Major Depressionby SAMHSA is licensed under the Standard YouTube License.

Figure 2.13. ECT: Disrupting the Stigma Around An Essential Treatment Option by Michigan Medicine is licensed under the Standard YouTube License.

Figure 2.14. What is Anosognosia?by Living Well with Schizophrenia is licensed under the Standard YouTube License.