Affective Disorder

Affective disorders are a group of mental health conditions characterized by significant disruptions in mood, ranging from severe depression to extreme elation, that can profoundly impact a person’s ability to function in daily life.

mood disorder, affective disorder

Table of contents

• What Is an Affective Disorder?
• Main Types of Affective Disorders
• Symptoms of Affective Disorders
• Causes and Risk Factors
• How Affective Disorders Are Diagnosed
• Treatment Options

What Is an Affective Disorder?

An affective disorder, also called a mood disorder, is a mental health condition that primarily affects a person’s emotional state. The term “affective disorder” comes from the word “affect,” which refers to the outward expression of emotions that others can observe, while “mood” describes the internal emotional state that lasts over time^[1][3].

These disorders involve marked disruptions in emotions, causing severe lows called depression or highs called hypomania or mania. A person with an affective disorder experiences long periods of extreme happiness, extreme sadness, or both, along with other persistent emotions such as anger and irritability^[4][5].

It’s normal for your mood to change depending on what’s happening in your life. However, for a diagnosis of an affective disorder, symptoms must be present for several weeks or longer and must interfere with your ability to perform routine activities, such as work or school^[4].

Main Types of Affective Disorders

Affective disorders are broadly divided into two major groups: depressive disorders and bipolar disorders^[5][7]. Each group includes several different types with varying levels of severity.

Depression and Depressive Disorders

Depression is a medical term that describes ongoing feelings of extreme sadness and hopelessness lasting for more than just a day or two. If you have depression, you may experience episodes that last for several days or even weeks. It’s estimated that more than 264 million people worldwide live with depression^[1].

The most common types of depression include^[1][4]:

• Major depressive disorder (MDD), also called clinical depression or unipolar depression, which involves long-term and persistent episodes of low mood, hopelessness, fatigue, and other symptoms. For a diagnosis, symptoms must last for at least two weeks.
• Persistent depressive disorder, also called dysthymia, which is a chronic form of depression with less severe symptoms occurring for at least two years.
• Seasonal affective disorder (SAD), which occurs during certain seasons of the year, typically starting in late fall or early winter and lasting until spring or summer when there’s less daylight.
• Postpartum depression, which occurs during pregnancy or after the end of pregnancy in women, caused by hormonal, physical, emotional, financial, and social changes.
• Depression with psychosis, which is a severe form of depression combined with psychotic episodes such as hallucinations or delusions.

Bipolar Disorder

Bipolar disorder is a lifelong mood disorder that causes intense shifts in mood, energy levels, thinking patterns, and behavior. It was formerly known as manic depression. People with bipolar disorder experience significant mood fluctuations referred to as manic or hypomanic episodes and depressive episodes^[4][8].

The main types of bipolar disorder include^[4][5]:

• Bipolar I disorder, where people have experienced one or more episodes of mania lasting for at least one week or requiring hospitalization. Most people with bipolar I will have episodes of both mania and depression.
• Bipolar II disorder, which involves current or past major depressive episodes interspersed with hypomanic periods lasting at least four days. Hypomania is a less severe form of mania that doesn’t last as long and doesn’t interfere with daily functioning as much.
• Cyclothymia or cyclothymic disorder, which involves a chronically unstable mood with cycles of low-level depression and hypomania. In adults, these episodes must occur for at least two years without ever meeting full criteria for mania, hypomania, or major depression.

Other Affective Disorders

Additional mood disorders recognized by mental health professionals include^[2][4]:

• Premenstrual dysphoric disorder (PMDD)
• Disruptive mood dysregulation disorder
• Mood disorders related to another medical condition
• Substance or medication-induced mood disorders

Symptoms of Affective Disorders

Symptoms of Depression

The symptoms of major depression and other depressive disorders include^[1][2][7]:

• Feelings of sadness, emptiness, or hopelessness
• Loss of interest in normally pleasurable activities, a condition called anhedonia
• Changes in appetite, often with cravings for carbohydrates
• Changes in sleep patterns, usually sleeping too much
• Loss of energy and extreme fatigue
• Problems with concentration and decision-making
• Feelings of worthlessness or guilt
• Physical symptoms such as pain and tiredness
• Thoughts of death or suicide

Symptoms of Mania and Hypomania

During a manic episode, which occurs in bipolar I disorder, a person experiences an abnormally elevated or irritable mood lasting at least one week. Symptoms include^[2][5][8]:

• Elevated, expansive, or extremely irritable mood
• Inflated sense of self-esteem or self-importance (grandiosity)
• Decreased need for sleep
• Racing thoughts and distractibility
• Increased or pressured speech, talking more than usual
• Increased goal-directed activity and physical restlessness
• Reckless or impulsive behaviors, such as suddenly spending or gambling extreme amounts of money
• In severe cases, psychotic symptoms such as hallucinations and delusions

Episodes of hypomania are typically shorter and less severe than mania. They last at least four days and don’t cause as much interference with daily life^[5].

Causes and Risk Factors

Researchers don’t know the exact causes of affective disorders, but several factors are believed to contribute^[4][5].

Biological Factors

Affective disorders appear to involve imbalances in brain chemicals called neurotransmitters, which send communications between nerve cells. These chemicals include serotonin, which contributes to feelings of happiness and emotional stability. When there’s less sunlight, as happens in fall and winter, your body’s production of serotonin can be affected^[4].

Changes in your biological clock, also called circadian rhythms, may also play a role. When there’s less sunlight, your internal clock that regulates mood, sleep, and hormones can shift, making it difficult to adjust to changes in daylight length^[4].

Affective disorders may also be linked to changes in levels of melatonin, a sleep-related hormone, and vitamin D deficiency, particularly in seasonal affective disorder^[4].

Other Contributing Factors

Additional factors that may increase the risk of developing affective disorders include^[2][7]:

• Family history of mood disorders
• Previous diagnosis of a mood disorder
• Trauma, stress, or major life changes
• Physical illness or use of certain medications
• Major diseases such as cancer, diabetes, Parkinson’s disease, or heart disease
• Substance use disorders

Who Is Most at Risk

Women are twice as likely as men to experience major depression, while bipolar disorder occurs equally in women and men. Although these disorders can begin at any age, many people experience their first episode between the ages of 25 and 44^[2].

For seasonal affective disorder specifically, about 5% of Americans are affected, with women being four times more likely to experience it. People who live in northern states tend to experience seasonal affective disorder more frequently^[8].

How Affective Disorders Are Diagnosed

A psychiatrist or other trained mental health professional can diagnose an affective disorder through a psychiatric evaluation^[1]. The diagnosis uses criteria laid down in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the World Health Organization’s International Classification of Diseases (ICD-11), which focus on key features of the condition^[3][8].

A thorough evaluation generally includes^[7][9]:

• Physical exam: Your healthcare provider may perform a physical exam and ask detailed questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests: Your provider may order blood tests, such as a complete blood count or thyroid function tests, to rule out other conditions that could be causing your symptoms.
• Psychological evaluation: Your healthcare provider or mental health professional will ask about your symptoms, thoughts, feelings, and behavior patterns. You may fill out a questionnaire to help answer these questions.
• Medical and family history: Your doctor will review your symptoms, medical and family histories, and history of alcohol or drug use.

For a diagnosis of seasonal affective disorder specifically, you must meet diagnostic criteria for depression and experience a pattern of symptoms that appears at certain times of the year, with a two-year period typically needed to establish the seasonal pattern^[8].

Treatment Options

Affective disorders are treatable conditions. For most people, mood disorders can be successfully managed with a combination of talk therapy, medications, or both^[4][9].

Talk Therapy (Psychotherapy)

Psychotherapy, also called talk therapy, is a general term for treating a mood disorder by talking about your condition and related issues with a mental health professional. It focuses on both psychological aspects (how your brain functions) and social aspects (how you interact with others)^[9].

Cognitive behavioral therapy (CBT) is a common and effective form of talk therapy based on the idea that the way we think and behave affects how we feel. During CBT, you work with a specially trained therapist over several weeks or months to change thought patterns and behaviors^[9].

Other helpful therapies include family-focused therapy, counseling, and psychodynamic psychotherapy^[9].

Medications

Several types of medications are used to treat affective disorders^[1][9]:

• Antidepressants are often prescribed to treat depression. Selective serotonin reuptake inhibitors (SSRIs) are the preferred type, as they increase serotonin levels in the brain to help lift mood. It can take four to six weeks for antidepressants to take full effect.
• Mood stabilizers such as lithium and anticonvulsants are first-line treatments for bipolar disorder.
• Antipsychotics may be used to treat severe depression or bipolar disorder.

Medications should typically be used along with talk therapy to improve results. It’s important to take medications as prescribed and continue until your doctor advises you to gradually stop^[9].

Light Therapy

For seasonal affective disorder, light therapy (also called phototherapy) is one of the first-line treatments. You sit a few feet from a special light box that produces very bright light, usually for around 30 minutes to an hour each morning. The light mimics natural outdoor sunlight and appears to cause a change in brain chemicals linked to mood. Light therapy generally starts working within a few days to a few weeks and causes very few side effects^[9][11].

Other Treatments

For some people with depression, other procedures called brain stimulation therapies may be suggested. These include transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT)^[9].

Self-Care Strategies

There are several self-help approaches that can complement professional treatment^[4][9]:

• Try to get as much natural sunlight as possible, even brief outdoor walks during daylight hours
• Make your work and home environments as light and airy as possible
• Take plenty of regular exercise, particularly outdoors and in daylight
• Eat a healthy, balanced diet with adequate protein and high-fiber foods
• Maintain good sleep habits
• Avoid stressful situations when possible and take steps to manage stress
• Stay connected with family and friends for support

It’s important that mood disorders be accurately diagnosed and treated, as they can take an enormous toll on people’s ability to work, their relationships, and family life. However, proper treatment can help improve symptoms and return people to a better quality of life^[2].