Mood Disorders: Depression & Bipolar – Causes, Types, Symptoms & Treatment

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Core Concepts: Definitions & Key Terms

1. What Are Mood Disorders?

Mood disorders are mental health conditions characterized by persistent or episodic disturbances in mood (emotional state) that impair daily functioning. They are not normal fluctuations in mood but disabling patterns affecting thoughts, behavior, and physical health.

2. Types of Mood Disorders

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Symptoms: Recognizing Mood Disorders

Depressive Symptoms (DSM-5)

Real-World Example: Seasonal Affective Disorder (SAD) in Nepal

• Cause: Reduced sunlight during monsoon/winter (Kathmandu: ~6 hours daylight in Dec).
• Symptoms: Low energy, oversleeping, carbohydrate cravings, social withdrawal.
• Prevalence: ~5% of Nepalis experience SAD-like symptoms during monsoon (June–Sept).
• Treatment: Light therapy (10,000 lux lamps), vitamin D supplements, CBT.

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Biological & Psychological Causes

1. Biological Factors

2. Psychological & Social Factors

• Cognitive: Negative triad (Beck’s theory: self, world, future are negative).
• Behavioral: Learned helplessness (Seligman’s dog experiment → humans).
• Social: Loss of a loved one, isolation, trauma (e.g., earthquake survivors in 2015 Nepal).
• Environmental: Poverty, unemployment, discrimination (e.g., LGBTQ+ individuals in Nepal).

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Diagnostic Criteria: DSM-5 vs. ICD-11

Worked Example: Diagnosing Bipolar I in a Nepali Student

• Case: A 20-year-old TU student stays awake for 3 days straight, spends all savings on impulsive purchases, and claims they can "cure cancer." Later, they experience a depressive episode with suicidal thoughts.
• Diagnosis:
  1. Manic episode (✓ elevated mood, grandiosity, risky behavior, reduced sleep).
  2. Depressive episode (✓ sadness, fatigue, suicidal ideation).
  3. No substance use (rules out drug-induced mood swings). → Bipolar I Disorder (most severe type).

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Treatment Approaches

1. Pharmacotherapy

2. Psychotherapy

• Cognitive Behavioral Therapy (CBT):

  • Goal: Challenge negative automatic thoughts (e.g., "I failed my exam → I’m worthless").
  • Technique: Behavioral activation (e.g., scheduling pleasurable activities).
  • Example: A depressed Daraz delivery worker avoids socializing. CBT helps them set small goals (e.g., chatting with 1 coworker daily).

• Interpersonal Therapy (IPT):

  • Focuses on grief, role disputes, transitions (e.g., unemployment after earthquake).
  • Example: A Ncell employee loses their job and spirals into depression. IPT helps them navigate the "role transition" to job hunting.

• Electroconvulsive Therapy (ECT):

  • Use: Severe depression with suicidal ideation or treatment-resistant cases.
  • Process: Controlled electrical stimulation to the brain (induces seizures).
  • Effectiveness: ~60–80% response rate for severe MDD.

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In the Real World

1. eSewa & Mental Health:
   • Idea Used: Digital mental health tools (e.g., eSewa’s partnership with mental health apps like Manas).
   • How: During COVID-19 lockdowns, eSewa promoted teletherapy and CBT-based chatbots to reduce depression/anxiety in users struggling with financial stress.

2. Nepal’s Monsoon & Seasonal Affective Disorder (SAD):

   • Idea Used: Circadian rhythm disruption (less sunlight → melatonin overproduction).
   • How: In Kathmandu, light therapy lamps (sold by local pharmacies) are used by students and office workers to combat winter depression. A 2022 study found 30% reduction in symptoms after 4 weeks of 30-minute daily light exposure.

3. Pathao Riders & Bipolar Disorder:

   • Idea Used: Hypomanic episodes (risk-taking, reduced sleep).
   • How: Some Pathao riders report working 24-hour shifts during hypomania, leading to accidents. Mental health awareness campaigns now train riders to recognize early signs (e.g., "If you’re not sleeping for 3 days, take a break").

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Comparative Analysis: Depression vs. Bipolar Disorder

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Exam Tip

1. Diagnostic Criteria:

   • Memorize the 9 DSM-5 symptoms of depression (SIG E CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal thoughts).
   • Distinguish between mania and hypomania (mania requires hospitalization; hypomania does not).

2. Real-World Applications:

   • Link theories to Nepal: Use seasonal patterns (monsoon depression), trauma (earthquake PTSD → depression), or cultural stigma (why bipolar is underdiagnosed in rural areas).
   • Treatment questions: Always mention pharmacotherapy + psychotherapy (e.g., "Lithium for bipolar + CBT for coping skills").

3. Common Pitfalls:

   • Don’t confuse grief with depression: Grief has guilt about the loss, while depression has guilt about self.
   • Bipolar II ≠ Bipolar I: Bipolar II has no full mania (only hypomania).

4. Past Exam Patterns:

   • Descriptive questions: Expect causes + symptoms + examples (e.g., "Describe the prevalence and symptoms of depressive disorder" → include Nepal’s monsoon SAD data).
   • Comparative questions: Be ready to contrast MDD vs. bipolar, anxiety vs. depression, or substance-induced mood disorders vs. primary mood disorders.

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Key Takeaways

• Mood disorders are biopsychosocial (genes + brain chemistry + environment).
• Depression = persistent sadness; bipolar = mood swings (mania/depression).
• Diagnosis requires DSM-5/ICD-11 criteria (symptom duration, severity, impairment).
• Treatment: Medication (SSRIs/lithium) + therapy (CBT/IPT).
• Nepal-specific: Monsoon SAD, earthquake trauma, and stigma affect help-seeking.

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Final Visual Summary: