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The shadows behind the smile:

Unraveling Mood Disorders

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Learning Objectives:

  1. What is the difference between clinical depression and a low mood?

  2. Are there different kinds of depression?

  3. Are we more likely to experience depression as we get older? 

  4. Why do some people become depressed after stressful life events while others do not?

  5. Is psychological treatment as effective as medication in treating depression?

The difference between Clinical Depression and a Low Mood

A low mood is a temporary emotional state that can be caused by stress, fatigue, or difficult life circumstances. It usually improves with time or positive changes in one's environment.

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Clinical depression, on the other hand, is a persistent and severe mental health condition that affects daily functioning and requires medical or psychological intervention. (Cole, 2023)

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Different kinds of Depression

Major Depressive Disorder (MDD): 
Persistent and severe depressive episodes

  • Major Depressive Disorder (MDD) requires at least one major depressive episode with no history of manic episodes.

  • DSM-5 Criteria for Major Depressive Episode:

  1. Some individuals experience a single, isolated episode followed by full recovery.

  2. However, most cases follow an intermittent course, meaning repeated episodes occur over time.

Persistent Depressive Disorder (Dysthymia):
Chronic, long-term depression that lasts for years.

  • Persistent Depressive Disorder (PDD) differs from major depression in terms of severity (milder) and duration (chronic).

  • Represents a long-term depressive condition that lasts for many years.​

  • Persistent Depressive Disorder (PDD) is a chronic, mild form of depression lasting at least two years.

  • Symptoms include changes in appetite or sleep, low energy, poor concentration, low self-esteem, and hopelessness.

  • Symptoms cannot be absent for more than two months during the two years.

  • If a major depressive episode occurs during the first two years, the diagnosis changes to major depression.

  • Any manic episode rules out a PDD diagnosis.

  • DSM-5 criteria require:

  1. Depressed mood for most of the day, on more days than not, for at least two years.

  2. Presence of two or more additional symptoms to meet diagnostic requirements

Bipolar Depression: 
Occurs in individuals with bipolar disorder, alternating with manic episodes.

All three types of bipolar disorders involve manic or hypomanic episodes.

 

The mood disturbance must be severe enough to interfere with occupational or social functioning.

Mass General Brigham, 2022)

Bipolar I Disorder is diagnosed when a person has experienced at least one manic episode.

 

Most individuals with this disorder also experience episodes of major depression along with manic episodes.

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Bipolar II disorder is diagnosed when a person has had at least one major depressive episode and one hypomanic episode.

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Unlike Bipolar I, no full-blown manic episodes occur in Bipolar II Disorder.

  • Manic vs. Hypomanic Episodes: Differ in duration and severity.

  • Hypomanic episodes last at least four days, while manic episodes last a week or more.

  • Hypomania: Mood changes are noticeable but do not severely impair daily functioning or require hospitalization.

  • Mania: Symptoms are more intense, often leading to significant disruptions and possible hospitalization.

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Cyclothymia (a.k.a. Bipolar III)

 

Cyclothymia is a chronic but less severe form of bipolar disorder, comparable to persistent depressive disorder in its milder, long-term nature.

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To meet DSM-5 criteria, a person must experience:

 

  1. Multiple periods of hypomanic symptoms and frequent depressive episodes over two years.

  2. No major depressive episodes during this time.

  3. No manic episodes within the first two years of the disorder

Seasonal Affective Disorder (SAD): 
Depression is linked to seasonal changes, often occurring in winter.

  • Seasonal depression typically occurs in winter, likely due to reduced sunlight exposure.

  • Common symptoms include overeating, carbohydrate cravings, weight gain, fatigue, and excessive sleep.

Postpartum Depression: Depression following childbirth

Symptoms of Postpartum Depression

 

  1. Emotional symptoms: Persistent sadness, severe mood swings, feelings of worthlessness, guilt, or hopelessness.

  2. Social impact: Difficulty bonding with the baby, withdrawal from family and friends

  3. Physical symptoms: Loss of appetite or overeating, sleep disturbances (insomnia or excessive sleeping), overwhelming fatigue or loss of energy.

  4. Behavioral changes: Intense irritability and anger, severe anxiety or panic attacks.

  5. Serious concerns: Thoughts of self-harm or harming the baby.

Are we more likely to experience depression as we get older?

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Contrary to popular views, older people are less likely to be depressed than are younger people. Some subgroups of elderly people, however, are at high risk for depression.

 

Mood disorders (major depression, persistent depressive disorder, and bipolar disorder) are more common in young and middle-aged adults than in older adults, according to NCS-R research.

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Possible explanations:

  1. Memory impairments in older adults may make it harder to recall past depression episodes.

  2. Higher mortality rates among those with severe mood disorders could reduce the number of older adults with these conditions.

Despite these factors, multiple studies support the conclusion that clinical depression is genuinely less prevalent in older adults than in younger ones.

Why do some people become depressed after stressful life events while others do not?

  • Stressful life events are closely linked to the development of depressive disorders.

  • Research confirms that people who become clinically depressed often experience a higher number of stressful events.

  • This correlation has been repeatedly demonstrated in studies (Hammen, 2005; Monroe & Reid, 2009).

Psychological Factors​

  1. Severe life events can contribute to depression, but they do not fully explain why some people develop it.

  2. Many individuals experience severe events without becoming depressed, suggesting differences in vulnerability.

  3. Psychological factors influence a person's susceptibility to stress and its impact on mental health.

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Biological Factors​

 

Twin studies indicate that genetic factors play an important role in the etiology of both depressive and bipolar disorders. They also indicate that genetic factors may play a stronger role in the development of bipolar disorder than depressive disorders.

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Genes may contribute to the development of depression directly through an effect on the central nervous system and indirectly by influencing the person’s sensitivity to environmental events, such as severe stress.

 

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Neurochemical messengers in the brain also play a role in the regulation of mood and the development of mood disorders.

 

Current thinking is focused on serotonin, norepinephrine, and dopamine, although many other neurotransmitter substances may also be involved in depression.

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Brain imaging tools like PET and fMRI help researchers understand mood disorders, showing how severe depression is linked to both abnormal brain activity and structural changes.

 

Key brain regions involved in depression:

 

  1. Dorsolateral Prefrontal Cortex (PFC) – Reduced activity here impacts planning and emotional anticipation.

  2. Orbital & Ventromedial PFC – Increased activity influences emotional responses to rewards and punishments.

  3. Anterior Cingulate Cortex (ACC) – Plays a role in connecting attention and emotion; lower activity here can result in prolonged negative emotions.

  4. Amygdala – Central to emotional processing and also affected by depression.

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Cognitive vulnerability to depression refers to persistent negative thinking patterns that influence emotional well-being.

 

According to cognitive theories, individuals prone to depression often view themselves, the world, and their experiences through a pessimistic lens.

 

After negative life events, they engage in cognitive distortions, such as blaming themselves for setbacks, overgeneralizing failures, and making unwarranted negative assumptions.

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These thought patterns not only contribute to the onset of depression but also help sustain it over time.

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Depression vulnerability often stems from childhood experiences like neglect or harsh criticism, fostering negative thought patterns and weak interpersonal skills.

 

Over time, these issues can lead to unhealthy relationships and difficulty handling conflict or seeking support. Stressful life events, particularly those involving close relationships, often trigger depression.

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The way individuals interpret these events significantly impacts their emotional response—negative perceptions can lower self-worth and prolong depressive episodes.

 

Persistent cognitive and social difficulties can further reinforce and deepen depression over time.

Is psychological treatment as effective as medication in treating depression?

Both psychotherapy and medication can be effective, but their effectiveness depends on the severity of depression.

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There are several effective treatments for depression, depending on its severity and individual needs. Here are the main types:

 

Psychotherapy (Talk Therapy)

  • Cognitive Behavioral Therapy (CBT) – Helps individuals recognize and change negative thought patterns

  • Interpersonal Therapy (IPT) – Focuses on improving relationships and communication.

  • Psychodynamic Therapy – Explores past experiences and unconscious thoughts that may contribute to depression.

  • Mindfulness-Based Cognitive Therapy (MBCT) – Combines mindfulness techniques with cognitive therapy.

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Lifestyle & Alternative Treatments

 

  • Exercise – Regular physical activity can improve mood and reduce symptoms.

  • Diet & Nutrition – A balanced diet supports brain health.

  • Light Therapy – Used for Seasonal Affective Disorder (SAD).

  • Meditation & Relaxation Techniques – Helps manage stress and anxiety.

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Medical & Advanced Treatments

 

  • Electroconvulsive Therapy (ECT) – Used for severe, treatment-resistant depression.

  • Transcranial Magnetic Stimulation (TMS) – A non-invasive procedure that stimulates brain activity.

  • Ketamine Therapy – A newer treatment for severe depression.

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In conclusion, understanding mood disorders can help foster empathy and support among peers. By recognizing the signs and providing resources, we can contribute to creating a more understanding and supportive environment.

Mental Health Resources

If you or someone you know is struggling with their mental health, there are resources available to help.

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  • In an emergency, call 911.

  • Mental Health Helpline. Call 1-800-534-6463 (MIND) Monday to Friday, 9 am to 5 pm, to talk to the Mental Health Helpline.

  • The Alex Panton Foundation. The non-profit’s primary objective is to raise “awareness of mental illnesses affecting children and young adults in the Cayman Islands with a particular focus on anxiety and depression”.

  • Department of Children and Family Services. For non-critical services provided by DCFS, email DCFS@gov.ky or call 949-0290 in Grand Cayman and 948-2331 in Cayman Brac, Monday to Friday, 8:30am to 5pm.

  • The Cayman Islands Crisis Centre. Provides support to all victims of domestic violence through “services and programs focusing on domestic and sexual abuse”. Among its services, it provides shelter, counselling, a 24/7 crisis helpline on 943-2422, and a kids’ helpline on 649-5437.

  • There are also several private health care providers, offering counselling and support, such as Infinite Mind Care and the Wellness Centre.

References

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  • Cole, L. (2023, November 3). Low Mood vs. Depression: What’s the Difference? Lynne Cole Therapy.

  • Mass General Brigham. (2022, May 25). Bipolar Disorder Explained: Signs, symptoms, different types, and more | Mass General Brigham [Video].

  • Mayo Clinic. (2022, October 6). Understanding Depression: Symptoms, causes, and treatments [Video].

  • Abnormal Psychology (8th ed.). Pearson. Oltmanns, T. F., & Emery, R. E. (2015).

  • Types of depression and how to recognize them. (2024, July 11). WebMD

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