Mood Disorders: Diagnosis and Management

Dear Colleagues,

COVID-19 caused a global health crisis that lasted for far longer than expected. As such, the pandemic came to constitute a collective trauma, being a threat with no possibility of individual control and bringing drastic readjustment to environmental pressures. In relation to mental health, the consequences of spreading COVID-19 were generalized depression, anxiety, insomnia, mental fatigue, and post-traumatic stress symptoms. Women, children, adolescents, health workers and family members of people who died from the virus were among those most heavily affect. The frequency with which mood disorders occur in the general population is very high compared to other psychiatric diseases or disorders. Major depressive disorder is the best known and most prevalent mood disorder. According to data from the National Comorbidity Survey, the lifetime likelihood of developing a depressive disorder in the Western world is around 17%. In addition, depression is prominent in children and adolescents, with rates ranging from 18% to 22% in girls and 7% to 10% in boys by age 17. Numerous studies have shown increased hypothalamic–pituitary–adrenal (HPA) axis activity in individuals with mood disorders. This axis coordinates neuroendocrine response systems to stress, results in increased levels of cortisol—the stress hormone. In addition, an increase in TSH (thyrotrophic hormone) has been shown to be associated with depressed mood. Several studies have shown that abnormalities in different brain areas are also related to depressive disorders. For example, during the progression of depression there is an overactivation of the ventromedial prefrontal cortex involved in affect regulation mechanisms, as well as a hypoactivation of the dorsolateral prefrontal cortex mediating cognitive functions such as intention processing. The size of the orbitofrontal cortex and the activity of the anterior cingulate cortex are found to be reduced. This leads to reduced selective attention processes and abnormality in emotional self-regulation. Finally, abnormal activity of the ventral striatum contributes to the symptoms of anhedonia in depression, while increased activation of the amygdala explains the attentional bias toward emotions with negative connotation. 

The treatment of mood disorders involves both pharmacological and psychological intervention. Cognitive-behavioral psychotherapy is very effective, improving the dysfunctional cognitions and attitudes that generate depressed moods. Proven therapies also include mindfulness-based cognitive-behavioral psychotherapies, better known as third-generation approaches. Implementing evidence-based treatments of mood disorders is essential to manage their impact. This is not only true on a personal level, but also in terms of the entire social community. Evidence-based psychological interventions have been used to manage the mood disorders that emerged after the COVID-19 pandemic and reduce the experience of social isolation experienced, especially in the younger age group of the population, with good results. In order to be effective, evidence-based interventions must bring the individual to the centre of the diagnostic and therapeutic process. Engagement in the care of the subject needs to be developed to include them in the clinical pathway and make them aware of, informed about, and involved in their treatment. Patient psychological and emotional engagement, combined with the relationship that is established with the clinician, can make the difference in the management of the disorder as an ever-changing array of expectations and needs are expressed.

The attention paid to mood disorders by the scientific world is justified not only by their high prevalence, but also by the serious complications associated with them, such as the impairment of social functions, working capacity, and emotional life, alcohol or drug abuse, and finally suicide. Personalized interventions are constantly evolving, as is the search for targeted biological interventions. For this reason, it is my pleasure to personally invite you and your colleagues to contribute to this Special Issue in order to gather work, ideas and findings from experts in different fields in the diagnosis and management of mood disorders. We welcome both articles addressing psychological and biological aspects of mood disorders and those focusing on new diagnostic and therapeutic possibilities.

We look forward to potentially collaborating with you and hope to hear back soon.

Prof. Dr. Daniela Pia Rosaria Chieffo
Guest Editor

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• mood disorders
• depression
• suicide
• mental fatigue
• evidence-based treatments
• cognitive-behavioral psychotherapy
• personalized interventions
• engagement in care