that the individual is under the influence of a stimu-
lant drug, such as cocaine. Indeed, many of the
symptoms of bipolar disorder seem excessive and
uncontained.Types of Mood Disorders
The most prevalent depressive disorder, known as
major depressive disorder, corresponds loosely to the
popular concept of a clinical depression.At the very
minimum, major depressive disorder involves experi-
encing one episode of deep depression characterized
by a sad mood or loss of enjoyment in life. Other com-
mon symptoms include sleep problems, fatigue, feel-
ings of worthlessness, and suicidal thoughts. The
depressive episode will typically last for months, dur-
ing which the person experiences these problems most
of the time. The symptoms usually remit 6 to 12
months after the onset. There is, however, a significant
chance of future depressive episodes. A significant
number of people who have recovered from major
depressive disorder will have recurrent episodes
although these can occur years apart. Major depressive
disorder is usually first experienced in late adolescent
or early adulthood. Nearly 17% of the U.S. population
is likely to experience major depressive disorder, and
the rates are twice as high for women as for men.
Major depressive disorder can take many varied
forms. The variant with psychotic features involves an
unusually severe form of depression accompanied by
auditory hallucinations (such as hearing accusing or
insulting voices), delusional beliefs, and overwhelm-
ing feelings of guilt. The melancholic form, which is
more common in older adults, is characterized by
early morning waking, weight loss, and anhedonia.
The seasonal pattern describes a cyclical form of
depression that recurs every fall or winter and
involves weight gain and excessive sleep. The sea-
sonal mood disturbance typically lifts in the spring.
Dysthymic disorder is a mild but long-lasting
depressive disorder. Whereas the duration of major
depressive disorder is measured in months, dysthymic
disorder is evident over several years (the minimum is
2 years). Low self-esteem, loss of pleasure, social
avoidance, and poor concentration are typical symp-
toms. The onset of dysthymic disorder is gradual and
occurs at an early age.
The types of bipolar disorders are mostly distin-
guished on the basis of the manic symptoms. The
most well-known is Bipolar Disorder Type 1, whichwas formerly called manic depression.It involves
multiple recurrent episodes of depression and mania.
The manic episodes, which are shorter, usually either
precede or follow a severe depressive spell. Mood
may temporarily return to normal between episodes.
Bipolar Disorder Type 1 is less prevalent than major
depressive disorder, affecting fewer than 2% of the
population; the gender ratio is equal. Bipolar Disorder
Type 2 is similar with the exception that it does not
involve full-blown manic symptoms. The mild manic
episodes, or hypomania,evidence bursts of energy,
elevated or irritable mood, and poor judgment, but
without the extremes of a full-blown manic episode.
Cyclothymic disorder, the mildest bipolar disorder,
involves chronic and fluctuating mood changes. The
severity and duration of these mild mood changes are
less than those witnessed in major depressive disorder
or Bipolar Disorder Type 1, yet they are serious
enough to cause disruptions in important areas of life
and to cause significant unhappiness. To an outsider,
the person with cyclothymic disorder may come
across as abnormally moody.Suicide
Suicide is the conscious and deliberate taking of one’s
own life. Worldwide, it is one of the top 10 leading
causes of death. More than 31,000 individuals die by
suicide in the United States annually, and an addi-
tional 600,000 people attempt suicide each year. The
fatality figures are probably underestimates because
some suicidal deaths are mistaken for accidents and
surviving family members are often reluctant to label
the deaths as intentional because of stigma or guilt.
The rates of suicide vary significantly according to
age, gender, occupation, life situation, and health.
Many young adults, as many as 1 in 10, have seriously
contemplated suicide. However, the highest rates of
completed suicides occur in older adults above the age
of 65. Women are more likely than men to attempt sui-
cide, but men are more likely to die of suicide because
they tend to use more lethal methods. Whereas suici-
dal women often rely on overdosing or cutting their
wrists, men tend to use firearms or hanging. People in
the midst of relationship problems, such as separation
or divorce, have higher suicide rates, as do people
with terminal illnesses. As many as 15% of persons
with mood disorders will commit suicide, and the risk
is particularly high during or following an episode of
severe depression.Mood Disorders——— 513M-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 513