Treatment and Management of Mood Disorders

What is a Mood Disorder?

Moods are emotions that affect our everyday lives. We can be happy and sometimes sad on the same day. Some people, however, experience extreme mood changes which greatly affect their lives (Stangor & Walinga, 2019). These extreme mood changes may be caused by a set of mental illnesses known as mood disorders.

Mood disorders are a set of mental illnesses that influence people’s feelings and thoughts about themselves, other people, and life in general. Mood disorders also interfere with normal body functions (Thatcher, 2001). They are among the most common mental illnesses in the overall population. Studies show that mood disorders convey the greatest burden to the population as a result of the associated functional impairment and disability that substantially affect people’s life at home, work, school, and general social life (Cordner et al., 2020). Understanding and effectively managing symptoms of mood disorders is therefore paramount.

Types of Mood Disorders

Major depressive disorder

Major depression is characterized by episodes of sadness, feeling worthless, emptiness or guilt, and increased irritability and tiredness. Individuals with major depression experience loss of interest in typical activities, appetite alterations, troubled sleep, anxiety, and isolation from family and friends (Mental, 2002). It also leads to a lack of concentration which impairs effective functioning.

Bipolar disorder

Bipolar disorder is characterized by mixed episodes of mania and depression. It involves feelings of happiness or increased irritability and anger. People with bipolar disorder may feel powerful and have contesting thoughts with little sleep. According to Thatcher (2001), the impact of bipolar disorder depends on the length of the mania and depressive episodes, the severity of the condition, and the length of the normal mood of an individual.

Dysthymic disorder

Dysthymic disorder is comparable to depression. However, the symptoms of depression, in this case, are slighter but last for a longer period. Individuals with dysthymic disorder experience feelings of sadness, depression, and irritability.

Who is Affected by Mood Disorders?

Mood disorders are common and affect people of all ages. The symptoms typically appear during teenage years or young adulthood. Approximately 3.5% of children and 5% of teens in the United States are diagnosed with mood disorders (Thatcher, 2001). According to Thatcher (2001), one in every seven people is likely to experience a mood disorder in their life. Studies also indicate that more women than men experience major depression on an average ratio of 2:1 and dysthymia on a ratio of 3:1 (Mental, 2002). The difference can be attributed to sex and social differences.

For instance, men become irritable, angry, and low when depressed whereas women express feelings of worthlessness, powerlessness, and persistent sadness. Women have also been known to seek help from health professionals more than men. In the case of bipolar disorder, the diagnosis rate in both men and women is equal.

Therefore, the most vulnerable group of people affected by mood disorders are women and young people. Other predisposing factors include familial/genetic factors, substance use complications, and long-term mental or general health problems. Close relatives of people with mood disorders have a high risk of developing one. Furthermore, some substances cause, trigger, or worsen mood disorders. People living with health problems such as cancer, HIV/AIDS, cardiac diseases, dementia, anxiety, or eating disorder are also more likely to experience depression.

Risk Factors and Causes of Mood Disorders

Mood disorders do not have a single cause. They are caused by several factors. The risk factors and causes of mood disorders include biological, psychological, socioeconomic, and cultural factors (Mental, 2002 & Shukla et al., 2020). Biological factors include genetics, brain biochemical imbalance, and altered circadian rhythm. Psychological factors include negative parental influence, early life traumas, and personality style. Socioeconomic factors include poverty, distressing social relationship, domestic violence, and poor diet. Cultural factors include religious and caste beliefs, attitudes, and interpretations. Chronic mental and physical illnesses, previous episodes of depression, and side effects of some substances and medication may also be causal factors.

In addition, current studies about the pathogenesis of mood disorders have mostly focused on monoamine neurotransmitter disorders, reduced production levels of monoamine, and secondary messenger system dysfunction (Fathinezhad et al., 2019).

Key Factors Involved in Mood Disorders

Diagnosis and Treatment of Mood Disorders

Mood disorders are manageable. According to Thatcher, about 80% of mood disorder patients no longer experience symptoms after undertaking the right treatment (2001). However, a considerable number of people with mood disorders do not seek professional help or remain undiagnosed for long which delays treatment. The failure to seek professional help can be linked to factors such as stigma, inadequate human resources, lack of knowledge, and inaccessibility of resources.

There are various treatment options for mood disorders. The most common include medication, counseling, electroconvulsive therapy, and light therapy. Self-management activities such as regular exercise, a good diet, enough sleep, and maintaining healthy social relationships are also used. These treatment options can be used solely or combined with other management strategies to achieve desired results.

The goal of treating mood disorders is to facilitate recovery and stabilize the mood of patients with depression and mania symptoms. According to Butler et al. (2018), it is after this mood stabilization that patients undertake maintenance treatment to attain euthymia, diminish symptoms, and halt or delay episodic relapse into mania and depression.

Treatment of Major Depressive Disorder

The treatment options available for people with major depressive disorder include the use of antidepressants, biological treatment, and psychosocial interventions.

Antidepressants

Antidepressants focus on neurotransmitters associated with depression. Antidepressant medications used for major depressive disorder include Monoamine Oxidase Inhibitors (MAOIs), Tricyclics, Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).

1. Monoamine Oxidase Inhibitors (MAOIs) are the oldest class of antidepressants used in depression treatment. According to Laban and Saadabadi (2022), the four most prescribed MAOIs for depression are selegiline (Emsam), isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). MAOIs obstruct the enzyme monoamine oxidase which deactivates dopamine, norepinephrine, and serotonin. They are effective in the treatment of depression. However, MAOIs display side effects such as xerostomia, nausea, diarrhea, stultification, lethargy, insomnia, and dizziness (Laban & Saadabadi, 2022). Therefore, they should only be used when all other treatment options have failed. Patients taking MAOIs should also avoid drugs such as antihistamines and foods that contain tyramine which may facilitate adverse side effects.
2. Tricyclics hinder the reabsorption of norepinephrine, serotonin, or dopamine at synapses. The approved Tricyclics for the treatment of major depressive disorder include amitriptyline, amoxapine, doxepin, desipramine, nortriptyline, protriptyline, imipramine, and trimipramine (Moraczewski & Aedma, 2022). Tricyclics effectively treat the bodily symptoms of depression, but they present side effects just like MAOIs. According to Moraczewski and Aedma (2022), Tricyclics may lead to distorted vision, constipation, xerostomia, misperception, urinary retention, and tachycardia. Due to the associated side effects, Tricyclics’ initial dosing is usually low. It is then increased gradually depending on the efficacy level. Tricyclics have proved more effective at higher dosages.
3. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most frequently used antidepressants for both adults and children. They are the first-line medications for depression in the United States due to their effectiveness, safety, and admissibility (Chu & Wadhwa, 2022). SSRIs inhibit the reabsorption of serotonin and norepinephrine. According to Gershon and Thompson (2018), the SSRIs used for major depressive disorder include Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram, and Vilazodone.
4. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are also used to impede serotonin and norepinephrine reuptake (Sansone et al., 2014). Often used SNRIs include venlafaxine, duloxetine, desvenlafaxine, milnacipran, and levomilnacipran. SNRIs and SSRIs have fewer side effects compared to MAOIs and Tricyclics. Nevertheless, according to Gershon and Thompson (2018), they may lead to orgasm difficulties, gastric issues, and insomnia.

Biological treatments

Biological treatments are the other alternative ways of treating major depressive disorder in case the response from antidepressant medication is inadequate. Several biological treatments have been pragmatically used in the management of major depressive disorder. The treatments focus on neurostimulation. Some of the promising biological treatments available include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), deep brain stimulation, and vagus nerve stimulation (Gershon & Thompson, 2018; Cordner et al., 2020). Biological treatments are practical for patients who show extreme symptoms and resistance to antidepressants. Besides, Cordner et al. (2020) clarify that studies are progressively encouraging the use of biological treatments in the early stages of treatment due to their effectiveness, safety, and limited side effects.

Psychosocial interventions

Psychosocial treatments involve emotional and behavioral interventions aimed at advancing an individual’s mental development and interaction with the social environment. The available psychosocial treatments for major depressive disorder include cognitive behavioral therapy and interpersonal therapy.

1. Cognitive behavioral therapy (CBT) is the most used in major depressive disorders. It analyzes and clarifies a person’s cycle of thoughts, moods, and behaviors underlying depression (Renn & Areán, 2017). Subsequently, CBT provides knowledge and skills on how to cope with depressive symptoms and mood fluctuations, recognizes patterns and triggers, and develops a strategy to avoid relapse.
2. Interpersonal therapy for major depressive disorder aims at cultivating social relationships by addressing potential risks (Gershon & Thompson, 2018). The risks addressed include but are not limited to unresolved anguish, social disputes, role shifts, and interpersonal shortfalls.

Treatment of Bipolar Disorder

Bipolar disorder is an enduring condition that requires psychiatric management. Psychiatric management aims at establishing and sustaining a curative association between psychiatrists and bipolar patients. According to Hirschfeld et al. (2003), the psychiatrist should diagnose, evaluate, and assess the patient’s level of well-being and performance to decide on the best treatment option. Management of bipolar disorder also involves interactive psychiatric monitoring, provision of relevant educational resources, treatment compliance enrichment, curtailing functional impairments, and encouraging healthy behavior among the patients

The current treatments for bipolar disorder aim at managing the symptoms depending on the severity and individual needs. According to Hirschfeld et al. (2003), the treatment options for bipolar disorder include pharmacotherapy and psychotherapy.

Pharmacotherapy

Pharmacotherapy is the initial treatment for patients with bipolar disorder. It involves the use of lithium, antipsychotic, and anticonvulsant medications. In severe cases of bipolar, a medical practitioner may recommend supplementing the lithium treatment with an antipsychotic or a combination of anticonvulsant and antipsychotic medication.

1. Lithium is used to reduce excitative neurotransmission and intensify repressive neurotransmission. Lithium treatment is effective. However, it can be tough for some patients due to the associated side effects. According to Gershon and Thompson (2018), its side effects include mental impairment, nausea, obesity, lethargy, and body tremor. Nevertheless, these side effects diminish with time as treatment continues.
2. Antipsychotic medications regulate psychotic symptoms of bipolar disorder such as hallucinations, delusions, mania, insomnia, anxiety, or agitation. According to Kishi et al. (2021), combining lithium with an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) can immensely benefit patients experiencing extreme symptoms.
3. Anticonvulsant medications, on the other hand, act as mood stabilizers. According to Bhandari (2021), anticonvulsants used in the treatment of bipolar disorder include carbamazepine (Tegretol) divalproex sodium, valproic acid, or valproate sodium (Depakote, Depakene) lamotrigine (Lamictal).

Psychotherapy

Psychotherapy is used as an assistive treatment option for patients with bipolar disorder. Gershon and Thompson designate Interpersonal and Social Rhythm Therapy (IPSRT) as one of the most effective psychotherapy treatments for bipolar disorder (2018). IPSRT is a psychosocial intervention that promotes steadiness in rhythmic patterns of an individual’s life and addresses factors that lead to relapse. For optimum results, therapists and patients must work together to ensure a steady balance in activity and stimulation to avoid triggering or recurrence of episodes (Gershon & Thompson, 2018). Bipolar disorder patients are vulnerable to relapses. There are also issues with long-term medication adherence among patients. Psychotherapeutic interventions aim at reducing stress, ensuring medication adherence, and improving the general functioning of the patients especially in between episodes.

Treatment of Dysthymic Disorder

The commonly used treatment approaches for dysthymic disorder are pharmacotherapy and psychotherapy. According to Sansone et al. (2009), pharmacotherapy and psychotherapy management and treatment options used for major depressive disorder are effective in the case of dysthymic disorder. However, differences may surface as a result of individualized plans of treatment based on the severity of symptoms and chronicity (Patel & Rose, 2021).

Pharmacotherapy

Pharmacotherapy treatment for dysthymic disorder involves the use of antidepressants. The use of Selective Serotonin Reuptake Inhibitors (SSRIs) has proven efficacy as the first-line treatment for dysthymia (Patel & Rose, 2021). The other classes of antidepressants such as Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) and atypical antidepressants (Bupropion, Mirtazapine, Nefazodone, Trazodone, Vilazodone, and Vortioxetine) are also used in the treatment in case the indicated SSRIs do not respond effectively.

Psychotherapy

Psychotherapy is also helpful in the management of dysthymic disorder. Although Sansone et al. (2009) term the process as challenging, several psychotherapy treatments have been encouraged. These treatments include cognitive behavioral analysis systems of psychotherapy (CBASP), interpersonal therapy, cognitive behavioral therapy, manualized group therapy, and problem-solving therapy.

Cognitive behavioral therapy and interpersonal therapy are the most frequently used in the treatment of dysthymia. The recently developed treatment model, the CBASP, is specifically designed to enhance effectiveness in the management of chronic depression (Patel & Rose, 2021). CBASP employs a socially organized problem-solving procedure in dealing with interpersonal problems, a practice that promotes patient learning regarding their cognitive and behavioral patterns and how they affect them socially (Melrose, 2019). The model also provides a remedy for maladaptive patterns among dysthymic patients. According to Melrose (2019), several studies have consistently conveyed the prominence of combining pharmacotherapy and psychotherapy in the treatment of dysthymic disorder.

Alternative Remedies for Mood Disorders

Various lifestyle adaptations and natural remedies for mood disorders are also available. These include self-management, natural plant-based remedies, and over-the-counter supplements.

Self-management

The connection between diet, physical health, and mental health

Self-management helps individuals to feel better and achieve mood stability. Self-management involves regular and healthy sleep patterns, reduced screen time, limiting alcohol intake, avoiding stress, effectively managing stressful situations, and spending time with family and friends (Railton, 2018). Generally moderating addictive behaviors through self-awareness and seeking help in case of problems is also an effective self-management strategy that helps stabilize mood disorders. Similarly, regular exercise and physical activity are beneficial to patients. According to Firth et al. (2020), adopting a healthy diet and eating patterns is also important to both physical and mental health. Poor nutrition may lead to negative interference with mood.

Natural Plant-based and herbal remedies for mood disorders

Various natural plant-based and herbal products are used in the management and treatment of mood disorders. Some plant or herbal products directly influence neurotransmission and immunological processes (Fathinezhad et al., 2019). They are used to neutralize stressors, regulate levels of monoamine and neurotransmitters, and induce therapeutic effects in people with mood disorders. Fathinezhad et al. (2019), note that some herbal products treat symptoms of depression with 100% success. Plants used in the treatment of mood disorders include St. John’s Wort, Melissa leaf, Valerian Root, Lavender, Rose root, Ginseng, Chamomile, Borage, and Saffron.

1. St. John’s wort is commonly used in the treatment of depression. Its active compounds include Polycyclic phenols, hypericin, and pseudo-hypericin (DeSousa & Patel, 2014). Hypericum extracted from St. John’s Wort flowers exerts its effects by inhibiting monoamine reuptake (Fathinezhad et al., 2019). It is tolerant and exhibits immunomodulation, pharmacokinetic, and pharmacodynamic interactions.
2. Lavender enhances the modulation of Gamma-Aminobutyric Acid (GABA). It also acts as an N-methyl-D-aspartate (NMDA) receptor antagonist and inhibits the reuptake of monoamines (DeSousa & Patel, 2014). Lavender is more effective in the management of mood disorders when combined with Imipramine. It is however associated with side effects such as nausea, anxiety, and changes in appetite.
3. Chamomile is also a strong Monoamine oxidase A (MOA)-inhibitor. It is widely known for its tranquilizing and sleep-inducing effects. Chamomile extracts improve brain neurotransmitter activities and thus impact positively on mood and anxiety.
4. Rose root normalizes serotonergic transmission. It causes inhibition of MOA, cortisol, nitric oxides, and stress-induced protein kinases (DeSousa & Patel, 2014). It also has antistress and anti-fatigue effects. These properties make Rose root an effective remedy in the treatment of mood disorders.
5. Melissa (Lemon balm) leaf primarily causes MAO inhibition. It has been found to elevate calmness (DeSousa & Patel, 2014). A combination of Melissa leaf and Valerian root extracts is an effective remedy for primary symptoms of mood disorders, especially among children under 12 years.
6. The Valerian root of both Valerian officinalis and Valerian edulis species have been traditionally used in America and Europe in the treatment of nervous and mood disorders. Valerian modulates and increases GABA binding. It has demonstrated agonism of GABA-A receptor and 5-HT5a agonism. It also has a calming effect.
7. Borage flowers and leaves are used for depressive symptoms of mood disorders. Borage extracts inhibit 5-HT reuptake and enhance immunomodulation (Fathinezhad et al., 2019). However, its long-term use should be avoided especially by people with liver disease or pregnant and breastfeeding women.
8. Ginseng improves brain function, including mood, memory, and behavior. It increases dopamine levels and suppresses stress which is a major cause of mood disorders. Ginseng’s active compounds such as ginsenosides and K-compounds also prevent brain damage by free radicals.
9. Saffron is a mood-elevating and calming herb. Traditionally, it has been used as a tranquilizing, antidepressant, and anti-inflammatory medicine. This is due to its ability to modulate stress response and increase levels of mood-enriching neurotransmitters like dopamine and serotonin in the brain. It also enhances appetite and helps in digestion. The effect of Saffron on mood can be experienced in one week, and its benefits remain for several months.

Over-the-counter natural supplements

Over-the-counter natural supplements such as Omega-3 Fatty Acids, 5-hydroxytryptophan (5-HTP), and S-adenosyl methionine (SAMe) are also used to treat depression and stabilize mood. According to Melrose (2019), people using herbal products and natural supplements should exercise caution. Potential interactions with “blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications, and some antidepressants” exist that may be detrimental to the user. Generally, consulting with professional health care providers is recommended before consuming herbal/plant extracts.

Takeaway Message

Mood disorders affect thoughts and feelings processes in relation to self and others. As the most common mental illness that causes substantial functional impairment and disability, mood disorders have a great socioeconomic burden on the population. The set of mental illnesses affects people of all ages. Underlining mood disorders are biological, psychological, socioeconomic, and cultural factors.

Mood disorders are manageable. The management and treatment options for mood disorders include pharmacotherapy, biological treatment, psychotherapy, and other self-management strategies. Natural supplements, plant-based remedies, and diet modification also play an important role in the management and treatment of mood disorders. Their effects on monoamine transmitters, and neurotrophic, serotonergic, and dopaminergic activities make natural supplements and plant-based extracts effective for mood disorders.

The main goal of the treatments is to facilitate recovery, stabilize the mood, and stop or delay mania and depressive episodes. Combining the recommended treatment option with the various self-management, plant/herbal medicines, and natural supplements that manage symptoms can be both effective and sustainable. Severe and acute cases of depression and bipolar disorder almost always require pharma-psychotherapeutic approaches. Opting for herbal remedies should be done in consultation with the patient’s primary care provider.

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