Major Mood Disorders

Major mood disorders (MMD) are define by the presence of depressive and/or manic or hypomanic episodes.15-17 Patients with recurrent depressive episodes without a history of mania or hypomania are said to have major depressive disorder (MDD). Patients who have experienced at least one manic or hypomanic episode, with or without an additional history of depressive episodes, are said to have bipolar disorder (BD).

The etiology of MDD and BD are not well understood at a molecular level and no reliable biomarkers have been identified. The disorders likely reflect complex disturbances in neural circuit activity rather than a simple chemical imbalance. However, the monoamine hypothesis, based largely on the mechanisms of action of known antidepressants, proposes that decreased serotonin and/or norepinephrine levels cause MMD.7,9,15-17

MDD is characterized by fatigue or loss of energy, anxiety or psychomotor agitation, loss of ability to concentrate, markedly diminished interest in activities, pessimism (intense sadness and despair), low self-esteem, insomnia, increased or decreased appetite, and recurrent thoughts of death or suicidal ideation.15-17 MDD can cause marked, clinically significant impairment in self-care and social and occupational functioning.

BD is characterized by a period of depression followed by a distinct period of abnormally elevated or euphoric mood. Symptoms include inflated self-esteem or grandiosity; decreased need for sleep; increased, rapid, and loud speech; distractibility; increased goal-directed activity; disorganized and racing thoughts; and inability to concentrate. BD can cause marked, clinically significant impairment of social and occupational functioning.15-17

Commonly used therapeutic agents for the medical management of MDD include the administration of SSRI, serotonin receptor agonists, SNRI, norepinephrine reuptake inhibitors, tricyclic antidepressants, and atypical antidepressant (Table 4).2,7,9,15-17 The treatment of BD includes mood stabilizers such as lithium (Table 4), atypical antipsychotic agents (Table 3), and certain anticonvulsants (Table 5).2,7-915-17

When providing oral healthcare to patients with MDD or BD, the goals are to develop and implement timely preventive and therapeutic strategies. Symptoms can cause clinically significant distress or impairment in the patient’s ability to perform optimal oral self-care, to participate in oral healthcare-related decision-making, to cooperate in his/her treatment, and may perceive the dental setting as threatening.