EVERYONE OCCASIONALLY FEELS sad, low, and tired, with the desire to stay in bed and shut out the world. These episodes often are accompanied by anergia (lack of energy), exhaustion, agitation, noise intolerance, and slowed thinking processes, all of which make decisions difficult.
Work, family, and social responsibilities drive most people to proceed with their daily routines, even when nothing seems to go right and their irritable mood is obvious to all. Such “low periods” pass in a few days, and energy returns. Fluctuations in mood are so common to the human condi-tion that we think nothing of hearing someone say, “I’m depressed because I have too much to do.” Everyday use of the word depressed doesn’t actu-ally mean that the person is clinically depressed but, rather, that the person is just having a bad day. Sadness in mood also can be a response to misfor-tune: death of a friend or relative, financial problems, or loss of a job may cause a person to grieve .
At the other end of the mood spectrum are episodes of exaggeratedly energetic behavior. The person has the sure sense that he or she can take on any task or relationship. In an elated mood, stamina for work, family, and social events is untiring. This feeling of being “on top of the world” also recedes in a few days to a euthymic mood (average affect and activity).
Happy events stimulate joy and enthusiasm. These mood alterations are normal and do not interfere meaningfully with the person’s life.
Mood disorders, also called affective disorders, are per-vasive alterations in emotions that are manifested by depression, mania, or both. They interfere with a person’s life, plaguing him or her with drastic and long-term sad-ness, agitation, or elation. Accompanying self-doubt, guilt, and anger alter life activities, especially those that involve self-esteem, occupation, and relationships.
From early history, people have suffered from mood disturbances. Archeologists have found holes drilled into ancient skulls to relieve the “evil humors” of those suffer-ing from sad feelings and strange behaviors. Babylonians and ancient Hebrews believed that overwhelming sadness and extreme behavior were sent to people through the will of God or other divine beings. Biblical notables King Saul, King Nebuchadnezzar, and Moses suffered overwhelming grief of heart, unclean spirits, and bitterness of soul, all of which are symptoms of depression. Abraham Lincoln and Queen Victoria had recurrent episodes of depression. Other famous people with mood disorders were writers Virginia Woolf, Sylvia Plath, and Eugene O’Neill; com-poser George Frideric Handel; musician Jerry Garcia; artist Vincent Van Gogh; philosopher Frederic Nietzsche; televi-sion commentator and host of 60 Minutes Mike Wallace; and actress Patty Duke.
Until the mid-1950s, no treatment was available to help people with serious depression or mania. These people suffered through their altered moods, thinking they were hopelessly weak to succumb to these devastating symp-toms. Family and mental health professionals tended to agree, seeing sufferers as egocentric or viewing life nega-tively. Although there are still no cures for mood disorders, effective treatments for both depression and mania are now available.
Mood disorders are the most common psychiatric diag-noses associated with suicide; depression is one of the most important risk factors for it (Sudak, 2005). For that reason, this section focuses on major depression, bipolar disorder, and suicide. It is important to note that clients with schizophrenia, substance use disorders, antisocial and borderline personality disorders, and panic disorders also are at increased risk for suicide and suicide attempts.