- Describe major depressive disorder, related disorders, and their risk factors
- Describe bipolar disorder and its risk factors
- Describe genetic, biological, and psychological explanations of major depressive disorder
- Discuss the relationship between mood disorders and suicidal ideation, as well as factors associated with suicide
Depression and Related Disorders
Arjun cries most of the day and feels hopeless; he can’t get out of bed. Ava stays up all night, talks rapidly, and spends $3,000 on furniture she can’t afford. Maria recently had a baby and feels overwhelmed, tearful, anxious, and panicked, and believes she is a terrible mother. Each example shows symptoms that could point to a mood disorder—conditions that involve a clinically significant shift in mood that affects daily functioning.
mood disorders
Mood disorders are marked by severe disruptions in mood and emotion—most commonly depression, but also mania (periods of unusually elevated or irritable mood and increased energy). Everyone has ups and downs, often tied to life events. Mood disorders go further: the changes are more intense, last longer, and interfere with relationships, school, work, health, or safety.
The DSM-5 groups mood disorders into two broad categories:
Depressive disorders
Depressive disorders share a core feature: persistent low mood and/or loss of interest or pleasure, along with other symptoms (sleep, appetite, energy, concentration, guilt/worthlessness, etc.) that disrupt functioning. The best-known example is major depressive disorder.
Bipolar and related disorders
Bipolar and related disorders share a defining feature: mania or hypomania (a less severe form of mania). During manic states, mood and energy shift in ways that can include unusually high confidence, decreased need for sleep, racing thoughts, rapid speech, risk-taking, and impaired judgment. The most recognized condition in this category is bipolar I disorder (which includes manic episodes).
What is Major Depressive Disorder?
major depressive disorder
Major depressive disorder involves episodes of depressed mood and/or loss of interest or pleasure that last most of the day, nearly every day, and are accompanied by additional symptoms that cause significant distress or impairment.
A diagnosis requires five or more symptoms during the same 2-week period, and at least one symptom must be:
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depressed mood, or
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loss of interest/pleasure
Other possible symptoms include:
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significant weight or appetite change
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insomnia or hypersomnia
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psychomotor agitation or slowing
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fatigue or loss of energy
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feelings of worthlessness or excessive guilt
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difficulty thinking, concentrating, or making decisions
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recurrent thoughts of death or suicidal ideation (including plans or attempts)
Major depressive disorder is often episodic—symptoms can be intense for a period of time and then lessen. Many people recover, but recurrence is common, and some people experience lingering or returning symptoms over time.
in 2021, an estimated 21.0 million U.S. adults experienced at least one major depressive episode in the past year (8.3% of adults). Rates were higher among women (10.3%) than men (6.2%), and highest among ages 18–25 (18.6%) (NSDUH).
Major depressive disorder is often referred to as the common cold of psychiatric disorders. Around 6.6% of the U.S. population experiences major depressive disorder each year; 16.9% will experience the disorder during their lifetime (Kessler & Wang, 2009). Based on a survey in 2019, the percentage of adults aged 18 and over with regular feelings of depression was about 4.7%.[1] It is more common among women than among men, affecting approximately 20% of women and 13% of men at some point in their life (National Comorbidity Survey, 2007). The greater risk among women is not accounted for by a tendency to report symptoms or to seek help more readily, suggesting that gender differences in the rates of major depressive disorder may reflect biological and gender-related environmental experiences (Kessler, 2003).
Lifetime rates of major depressive disorder tend to be highest in North and South America, Europe, and Australia; they are considerably lower in Asian countries (Hasin, Fenton, & Weissman, 2011). The rates of major depressive disorder are higher among younger age cohorts than among older cohorts, perhaps because people in younger age cohorts are more willing to admit depression (Kessler & Wang, 2009).
Results of Major Depressive Disorder
Major depression can affect nearly every area of life—energy, attention, motivation, relationships, work/school participation, and physical health. It can also increase risk for other problems (like substance use) and may require intensive treatment or hospitalization in severe cases.
A number of risk factors are associated with major depressive disorder: unemployment (including homemakers); earning less than $20,000 per year; living in urban areas; or being separated, divorced, or widowed (Hasin et al., 2011). Comorbid disorders include anxiety disorders and substance abuse disorders (Kessler & Wang, 2009).
Subtypes of Depression
The DSM-5 lists several different subtypes of depression. These subtypes—what the DSM-5 refer to as specifiers—are not specific disorders; rather, they are labels used to indicate specific patterns of symptoms or to specify certain periods of time in which the symptoms may be present.
- One subtype, seasonal pattern, applies to situations in which a person experiences the symptoms of major depressive disorder only during a particular time of year (e.g., fall or winter). In everyday language, people often refer to this subtype as the winter blues.
- Another subtype, peripartum onset (commonly referred to as postpartum depression), applies to women who experience major depression during pregnancy or in the days–even months–following the birth of their child (APA, 2013). These women often feel very anxious and may even have panic attacks. They may feel guilty, agitated, or sad. They may not want to hold or care for their newborn, even in cases in which the pregnancy was desired and intended.
- In extreme cases, the mother may have feelings of wanting to harm her child or herself. In a horrific illustration, a woman named Andrea Yates, who suffered from extreme peripartum-onset depression (as well as other mental illnesses), drowned her five children in a bathtub (Roche, 2002). Most women with peripartum-onset depression do not physically harm their children, but most do have difficulty being adequate caregivers (Fields, 2010).
- A high number of women experience symptoms of peripartum-onset depression. A study of 10,000 women who had recently given birth found that 14% screened positive for peripartum-onset depression, and that nearly 20% reported having thoughts of wanting to harm themselves (Wisner et al., 2013).
- People with persistent depressive disorder (previously known as dysthymia) experience depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depressive disorder. People with persistent depressive disorder are chronically sad and melancholy but do not meet all the criteria for major depression. However, episodes of full-blown major depressive disorder can occur during persistent depressive disorder (APA, 2013).
- Clarke, T. C., Schiller, J. S., & Boersma, P. (2019). Early release of selected estimates based on the data from the 2019 National Health Interview Survey. National Center for Health Statistics. https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease202009-508.pdf ↵