ChronoRecord Background

Mood disorders are mental illnesses in which a person experiences emotions outside the normal boundaries of sadness and elation.¹ The most frequently occurring mood disorder is major depressive disorder, which features one or more episodes of depression.² Other depressive disorders include dysthymia (persistent low-grade depression) and premenstrual dysphoric disorder. Bipolar I disorder features one or more episodes of mania or episodes of both mania and depression. Bipolar II disorder features one or more episodes of both hypomania and depression. Other bipolar related disorders include cyclothymia (mild moodswings).

Mood disorders are common and recurrent illnesses. In the US, the lifetime prevalence rate for major depressive disorder is 17%, with 1.6% for bipolar disorder.³ Following an initial episode the probability of recurrence in major depressive disorder is 50-85%.⁴ For bipolar disorder, the probability of recurrence within 5 years is 90%.⁵ Dysthymia is associated with a marked increase in risk of developing major depressive episodes.⁶ Patients with mood disorders also have an increased risk of suicide.⁷

Despite current treatments, many patients do not obtain full recovery between episodes. About 25% of those with major depressive disorder⁸ and half of those with bipolar disorder do not recover from the acute episode in one year.⁹ Many patients with depressive disorder or bipolar disorder experience residual depressive symptoms when not in episodes^10,11,12 and these may impose considerable morbidity.^13,14 As a consequence, many patients will develop a chronic and disabling course.^15,16 Both major depressive disorder and bipolar disorder are among the top ten causes of worldwide disability.¹⁷

The treatment of mood disorders is complex and usually requires a patient to take multiple medications several times a day. Maintenance therapy to prevent a recurrence of major depressive disorder may last several years or more¹⁸ while maintenance therapy for bipolar disorder is usually for the patient's lifetime.¹⁹

Most medications that are used to treat psychiatric disorders have uncomfortable side effects such as weight gain, tremors, hair loss and cognitive dulling.²⁰ Although the combinations of drugs needed to treat mood disorders may improve response, they also increase side effects and patient costs. Polypharmacy schedules can be difficult to adhere to. Thus, an understanding of the disorder and long-term commitment to the treatment is needed from the patient. Patient non-adherence with medication recommendations is a serious problem that contributes to patient relapse. Studies show that between 24-53% of patients with major depressive disorder or bipolar disorder are non- adherent with maintenance therapy.^21,22,23,24

Patient Self-Reporting

Daily patient self-reporting of mood and sleep is a well-established clinical tool that has many benefits for both the patient and clinician.^25,26 Mood disorders are characterized by rapid changes in mood that make treatment decisions difficult. The prospective fluctuations of patients' mood and sleep allows for detailed assessment of frequency and pattern of illness.²⁷ Simultaneous comparison of daily mood fluctuations and medications may help to optimize complex pharmacological therapy and to better detect nuances of partial response.²⁸ Another benefit of daily self-reporting of mood is increased patient involvement in their care.

References

¹ Whybrow, PC. A Mood Apart. New York: HarperCollins Publishers, Inc. 1997.

² American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, 2013.

³ Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.

⁴ Mueller TI, Leon AC, Keller MB, Solomon DA, Endicott J, Coryell W, Warshaw M, Maser JD. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry 1999;156:1000-6.

⁵ Tohen M, Waternaux CS, Tsuang MT. Outcome in Mania: A 4-year prospective followup of 75 patients utilizing survival analysis. Arch Gen Psychiatry 1990;47:1106-11.

⁶ Keller MB, Shapiro RW. "Double depression": superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry 1982;139:438-42.

⁷ Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord 2002;68:167-81.

⁸ Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Hirshfield RM, Shea T. Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry 1992;49:809-16.

⁹ Keck PE Jr, McElroy SL, Strakowski SM, West SA, Sax KW, Hawkins JM, Bourne ML, Haggard P. 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Am J Psychiatry. 1998;155:646-52.

¹⁰ Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA, Keller MB. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998 55:694-700.

¹¹ Paykel ES, Abbott R, Morriss R, Hayhurst H, Scott J. Sub- syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. Br. J. Psychiatry 2006;189,118-23.

¹² Bauer M, Glenn T,Grof P, Pfennig A, Rasgon NL, Marsh W, Munoz RA, Sagduyu K, Alda M, Quiroz D, Sasse J, Whybrow PC. Self-reported data from patients with bipolar disorder: frequency of brief depression. J Affect Disord 2007;101:227-33.

¹³ Judd LL, Paulus MP, Wells KB, Rapaport MH. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry 1996;153:1411-7.

¹⁴ Bauer M, Glenn T, Grof P, Rasgon NL, Marsh W, Sagduyu K, Alda M, Lewitzka U, Sasse J, Kozuch-Krolik E, Whybrow PC. Frequency of subsyndromal symptoms and employment status in patients with bipolar disorder. Soc Psychiatry Psychiatr Epidemiol 2008 Nov 13. (in press).

¹⁵ Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder. Am J Psychiatry 1995;152:1635-40.

¹⁶ Thase ME, Sullivan LR. Relapse and recurrence of depression: A practical approach for prevention. CNS Drugs 1995;4,261-77.

¹⁷ Murray CJ, Lopez AD. Evidence-based health policy-- lessons from the Global Burden of Disease Study. Science 1996;274:1593-4.

¹⁸ Bauer M, Whybrow PC, Angst J, Versiani M, Möller HJ. World Federation of Societies of Biological Psychiatry. Guidelines for biological treatment of unipolar depressive disorders. Part 2. World J Biol Psychiatr 2002;3:67-84.

¹⁹ Müller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7.

²⁰ Bauer M, Whybrow PC, Angst J, Versiani M, Möller HJ. World Federation of Societies of Biological Psychiatry. Guidelines for biological treatment of unipolar depressive disorders. Part 1. World J Biol Psychiatr 2002;3:5-43.

²¹ Schumann C, Lenz G, Berghhöfer A, Müller-Oerlinghausen B. Non-adherence with long-term prophylaxis: A 6-year naturalistic follow-up study of affectively ill patients. Psychiatry Res 1999;89:247-57.

²² Simon SE, VonKorff M, Wagner EH, Barlow W. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry 1993;15:399-408.

²³ Aagaard J, Vestergaard P, Maargjerg K. Adherence to lithium prophylaxis: I. Clinical predictors and patient's reasons for nonadherence. Pharmacopsychiatry 1988;21:121-5.

²⁴ Berghöfer A, Kossmann B, Müller-Oerlinghausen B. Course of illness and pattern of recurrences in patients with affective disorders during long-term lithium prophylaxis: a retrospective analysis over 15 years. Acta Psychiatr Scand 1996;93:349-54.

²⁵ Bauer MS, Crits-Christoph P, Ball WA, Dewees E, McAllister T, Alahi P, Cacciola J, Whybrow PC. Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania. Arch Gen Psychiatry 1991;48:807-12.

²⁶ Leverich GS, Post RM. Life charting the course of bipolar disorder. Curr Rev Mood Anxiety Disord 1996;1:48-61.

²⁷ Denicoff KD, Smith-Jackson EE, Disney ER, Suddath RL, Leverich GS, Post RM. Preliminary evidence of the reliability and validity of the prospective life-chart methodology (LCM-p). J Psychiatr Res 1997;31:593-603.

²⁸ Post RM, Leverich GS, Denicoff KD, Frye MA, Kimbrell TA, Dunn R. Alternative approaches to refractory depression in bipolar illness. Depress Anxiety 1997;5:175-89.