Newsletter

Mood and its Disorders2023-07-31

Mood is a way for organisms to adapt to the environment. Its underlying biology is activity, driven by energy metabolism, and regulated by circadian clock genes. When the environment is favorable, warm, sunlight, the organism is more active, to take advantage of the opportunities. When the environment is less favorable, cold, dark, the organism is less active, to conserve resources and stay out of harm’s way.

Mood disorders occur when there is excessive duration, intensity, or lack of fit to the environment of changes in levels of activity. Non- clinical low mood is a normal response when things are bad. Clinical depression is excessive duration or intensity of the low mood, or lack of congruence with the environment, i.e. the environment is actually favorable. The first two instances are called reactive depression, and the last is called endogenous depression. Non-clinical mood swings (cyclothymia) are normal in rapidly changing environments. Clinical mood swings, i.e. bipolar disorders, are excessive duration or intensity of the mood swings, or lack of congruence with the environment, i.e. the environment is actually favorable yet somebody swings to a depressed phase, or the environment is unfavorable yet someone swings to a manic phase. The first two instances should be considered reactive bipolar disorder, and the last is should be considered endogenous bipolar disorder.

Bio-socio-psychological measures can be used to treat clinical depression, and prevention of future episodes requires a lighter touch, perhaps dispensing with the need for medications. SSRIs are primarily anti-stress medications, and may help short-term with reactive depression, although their efficacy may be small and temporary, and their side effects may outweigh benefits. Antidepressants that stimulate energy levels work better for the treatment of endogenous depression. For bipolar disorder, after bio-socio-psychological treatment, prevention requires a more proactive approach with a mood stabilizer medication such as lithium or valproate. Diagnostically, making the distinction between bipolar disorder and unipolar depression is crucial, as antidepressants can make mood swings worse. It is likely that most cases of depression that fail multiple antidepressants and get labeled as treatment-resistant are in fact unrecognized bipolar disorders, and those patients respond better to treatment with a mood stabilizer. The use of blood biomarker tests such as the ones my groups have developed can help with diagnostic formulations and treatment choices made by clinicians.

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