Chapter 6: Mood Disorders and Suicide

The chapter distinguishes between unipolar disorders, where individuals experience depression without manic episodes, and bipolar disorders, involving cyclical shifts between depressive and elevated mood states. Major Depressive Disorder is defined by at least two weeks of depressed mood accompanied by anhedonia, concentration problems, sleep disturbances, fatigue, and feelings of worthlessness. Persistent Depressive Disorder represents a chronic condition lasting two or more years with less severe but pervasive depressive symptoms. Bipolar I Disorder involves episodes of full mania alternating with major depression, while Bipolar II Disorder features hypomanic episodes of lesser intensity combined with depressive phases. Cyclothymic Disorder constitutes a milder chronic pattern of mood fluctuation. The chapter explains etiological factors across multiple domains: genetic predisposition and neurobiological dysfunction in monoamine systems including serotonin, norepinephrine, and dopamine, as well as dysregulation of the hypothalamic-pituitary-adrenal stress response system. Psychological mechanisms include negative cognitive schemas, attributional patterns reflecting learned helplessness, maladaptive coping strategies, and responses to significant life stressors. Social and environmental factors such as insufficient social support, gender disparities in prevalence, and cultural norms surrounding emotional expression contribute to disorder development and maintenance. Treatment modalities discussed include cognitive-behavioral interventions targeting dysfunctional thought patterns and behavioral activation strategies, interpersonal therapy addressing relational difficulties, pharmacological agents particularly selective serotonin reuptake inhibitors for depression and lithium or anticonvulsant mood stabilizers for bipolar conditions, and somatic interventions including electroconvulsive therapy and transcranial magnetic stimulation for treatment-resistant cases. The chapter addresses the critical relationship between mood disorders and suicide risk, identifying warning indicators and protective factors while emphasizing crisis intervention, therapeutic support, and means restriction as essential prevention strategies.