Chapter 5: Depression and Mania

Raskin examines depression and mania, two of the most common and debilitating mood problems. Through case examples, the chapter highlights the defining features of depressive episodes—persistent sadness, anhedonia, fatigue, sleep and appetite disturbances, impaired concentration, and suicidal thoughts—as well as manic episodes marked by elevated or irritable mood, inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, risky behavior, and psychomotor agitation. Diagnostic systems DSM-5-TR and ICD-11 describe categories such as major depressive disorder, persistent depressive disorder (dysthymia), disruptive mood dysregulation disorder, bipolar I and II disorder, and cyclothymic disorder. Their distinctions between types of mood episodes and their criteria for duration, severity, and impairment are reviewed in detail, along with debates about validity and reliability. Alternative frameworks such as the Psychodynamic Diagnostic Manual (PDM), HiTOP, and the Power Threat Meaning Framework (PTMF) provide dimensional and psychosocial understandings of mood problems. Historically, the chapter traces perspectives on melancholia from Hippocrates’ humoral theory, through Christian notions of acedia, Renaissance ideas of black bile, and nineteenth-century neurasthenia, to modern biomedical conceptions. Biological perspectives are explained extensively, including the monoamine hypothesis of depression, serotonin and norepinephrine deficits, dopamine dysregulation in mania, and the role of glutamate. Treatment options covered include SSRIs, SNRIs, tricyclics, MAOIs, lithium, anticonvulsants, atypical antipsychotics, ECT, transcranial magnetic stimulation, vagus nerve stimulation, herbal remedies like St. John’s wort, and emerging ketamine and esketamine therapies. Genetic studies reveal heritability for both depression and bipolar disorder, while evolutionary accounts suggest depression may function as an adaptive response to loss or social defeat, and mania may be linked to circadian rhythm disruptions. Psychological perspectives include Freud’s theory of anger turned inward, attachment perspectives, short-term dynamic and interpersonal therapies, Beck’s cognitive theory of negative schemas and the cognitive triad, Seligman’s learned helplessness model, and CBT strategies such as behavioral activation and thought restructuring. Humanistic approaches emphasize authentic emotional processing, person-centered empathy, and Emotion-Focused Therapy (EFT) for restructuring maladaptive emotions. Sociocultural perspectives explore the impact of poverty, inequality, gender, race, stigma, and cultural variations in symptom expression, while service user narratives reveal the lived experience of depression, the challenge of mania, and struggles with psychiatric labeling. Systems perspectives highlight the role of family relationships, expressed emotion, marital conflict, and systemic therapies. Closing reflections emphasize that depression and mania are not simply brain diseases or personal flaws but complex, multifactorial conditions shaped by biological, psychological, cultural, and relational forces, requiring integrative treatment approaches.