Affective disorders are very common mood disorders in which the emotional states are abnormally elevated (or manic) and/or depressed (or depressed).
Affective disorders in the form of depression usually occur (in about two thirds of cases). In the remaining cases, manic and depressive phases alternate – manias alone occur only occasionally. Accordingly, affective disorders can be distinguished into different forms:
Affective disorders with only one depression or mania show a so-called unipolar course.
If mania and depression alternate, it is a so-called bipolar affective disorder (also called manic-depressive disorder).
Affective disorders are very common: about 16 to 20 percent of people develop depression in the course of their lives, with women being affected about twice as often as men. The risk of a bipolar affective disorder is 1 percent, regardless of sex. Most affective disorders do not develop until adulthood.
The causes of affective disorders are manifold: hereditary and psychological factors as well as biological changes in signal transmission in the brain play a role in the development of an affective disorder. The symptoms differ depending on the type of mood disorder:
The manic and/or depressive states develop with varying degrees of severity and usually occur in phases. In addition to mood, affective disorders also influence physical and mental performance. For example, attention and memory can be impaired by depression and mania.
Depression is characterized by the following symptoms:
- depressed mood
- lack of interest and joy
- lack of drive and strong fatigue
A mania, on the other hand, manifests itself in the form of
- inappropriately elevated or irritable mood
- drive increase
- Accelerated thinking and self-overestimation
Affective disorders typically proceed as depressive phases that last several months and then change into symptom-free or manic phases. In the case of unipolar depression, about four phases of the disease can be expected in life. The decisive factor for the course of affective disorders is the early detection and treatment of the disease.
Medication and psychotherapy are the primary remedies against affective disorders; in some cases, light therapy or sleep deprivation as well as occupational therapy are also used.
Affective disorders are mood disorders that by definition include states of depressed and elevated emotional state – depressions and manias. Depending on whether affective disorders are only associated with depression or mania or with both emotional states, they are subdivided as follows:
If the affective disorder is characterized only by a manic or depressive emotional state, it is a so-called unipolar disorder.
If manic and depressive phases alternate, there is a bipolar affective disorder (formerly: manic-depressive illness).
Depression
Depression is an emotional state characterized by great sadness and self-doubt. Affective disorders are usually associated with depression, which is why depression is the better known form of affective disorder.
Affective disorders differ in the extent of mood change, the signs that occur and the course of the disorder: a depressive episode is divided into three degrees of severity (mild, moderate, severe), which differ in the number and severity of symptoms of depression. If several depressive episodes occur in the course of time, a so-called recurrent depressive disorder is present. In addition, the following form can be distinguished:
Dysthymia is a chronic depressive disorder of mild degree. This affective disorder usually begins in early adulthood.
The mania is a state of intense but unfounded elevated mood. This manifests itself in excessive (often senseless) activity, the urge to speak, erratic thinking, distractibility and unrealistic plans. Affective disorders seldom manifest themselves in mania; manic and depressive phases usually alternate.
A manic episode is divided into three subtypes (hypomania, mania and mania with psychotic symptoms) according to the severity and duration of the symptoms and above all according to how severely those affected are socially impaired by the affective disorder.
Frequency
Affective disorders are most common (in about two thirds of all cases) in the form of depression. Since manias rarely occur alone and manic and depressive phases usually alternate, the bipolar form accounts for about the remaining third of affective disorders. The bipolar affective disorder usually begins at the age of 30 to 35, while depression often occurs later, between the ages of 40 and 45.
Overall, affective disorders are very common: The risk of developing depression is around 16 to 20 percent, with women being affected twice as often as men. The risk of a bipolar affective disorder is 1 percent, regardless of sex.
Hypomania
Hypomania is a slightly pronounced mania (Greek hypo = under). The lifestyle of those affected is hardly affected by the hypomanic symptoms.
Cyclothymia
Cyclothymia is a mild bipolar affective disorder that lasts for at least two years. It usually begins in early adulthood and is chronic. The mood is almost constantly unstable – there are numerous periods of mild depression and a slightly elevated emotional state. The mood swings in cyclothymia are usually not related to life events.
Causes
Affective disorders can be caused not only by hereditary vulnerability but also by many other external factors. Whether a life event triggers an affective disorder thus depends on how susceptible the individual affected is to such disorders.
Affective disorders are usually associated with depression. In the run-up to depression, traumatic events occur more frequently (such as the loss of a loved one or ongoing conflicts). However, these factors do not seem to be the underlying causes of depression, but rather lead to an unspecific stress reaction, which can manifest itself in depression.
Hereditary factors
Hereditary factors play an important role as causes of affective disorders. An indication of this is the fact that affective disorders occur more frequently among first-degree relatives. For example, if one parent has an affective disorder, there is a 10 to 20 percent probability that the child will develop the same disorder. If both parents are affected, the child’s risk of developing the disorder is 50 to 60 percent. If one affective disorder is present in a monozygotic twin, the other twin is also affected with a 65% probability.
Biological factors
Biological factors are also possible causes of affective disorders. In people with affective disorders, changes in certain chemical messengers in the brain (so-called neurotransmitters) can be detected, which are involved in the transmission of nerve stimuli:
In depression, the neurotransmitters norepinephrine and serotonin are present in too small amounts. Drugs that increase the concentration of these messengers help against depression.
In a mania, on the other hand, the messenger substances dopamine and noradrenaline are present in elevated concentrations.
It is now assumed that it is not individual changes in the messenger substances that cause affective disorders, but a disturbed balance between the messenger substances. In addition, the sensitivity and density of the stimulant cells (receptors), on which the messenger substances act, is altered in depressives.
A further indication of biological factors as causes of affective disorders results from the fact that the activation of different areas of the brain has special characteristics in some affected persons: In depressives, the brain structures associated with the development of targets are less active, while areas involved in the development of negative emotions are excessively excited.