Mood and Personality Disorders

Understanding Mood and Personality Disorders

Mood and personality disorders are two groups of mental health conditions that affect how a person feels, thinks and relates to others. Mood disorders involve marked disruptions in emotion, such as severe lows (depression) or highs (mania or hypomania), and are mainly classed as depressive disorders and bipolar disorders.^[1] Personality disorders are long-lasting patterns of thinking, emotion and behavior, grouped into clusters A, B and C.^[2]

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

Depression involves low mood, loss of interest or pleasure, changes in sleep, energy, appetite and concentration, feelings of guilt, and sometimes thoughts of suicide.^[1] Bipolar disorder adds episodes of mania or hypomania, with elevated or irritable mood, less need for sleep, racing thoughts and reckless behavior.^{[1, 3]}

Personality disorders vary by type. Borderline personality disorder, for example, involves rapidly shifting emotions, unstable relationships and self-image, fear of abandonment, impulsive behavior and sometimes self-harm.^[2]

Causes and risk factors

Causes are not fully understood, and no single cause explains these disorders. Mood and personality disorders arise from a mix of inherited, biological, psychological and life factors, and other mental health or medical conditions often occur alongside them.^{[2, 3]}

How it is diagnosed and treated conventionally

A physician or mental health professional makes the diagnosis, mainly through a clinical interview using standard criteria.^[1] Depression is usually treated with psychotherapy, antidepressants or both.^[4] Bipolar disorder is a lifelong condition with high relapse rates that needs long-term monitoring and management by a clinical team.^[3]

For borderline personality disorder, psychological therapy such as dialectical behavior therapy is the main treatment. A Cochrane review of 75 trials found psychotherapy reduced symptom severity compared with usual care, with moderate-quality evidence.^[5] Another Cochrane review found no medicine effective for borderline personality disorder pathology itself, mostly on very low-certainty evidence.^[6]

Why Mood and Personality Disorders calls for a whole-person approach

These conditions affect more than mood. Sleep, stress, other health problems and relationships are linked to them, so a plan that attends to all of them alongside psychiatric treatment is reasonable.

Emotional regulation and stress

Difficulty regulating intense emotions is central to borderline personality disorder.^[2] Psychological therapy is the main treatment for it, which is why stress and coping are part of care.^[5]

Sleep

Insomnia is one of the core symptoms of depression, and a reduced need for sleep is a feature of mania.^[1] Sleep changes can be an early sign of a mood episode, so they are worth reporting to your treating team.

Coexisting conditions

Bipolar disorder is often complicated by anxiety, substance use and cardiovascular disease.^[3] Borderline personality disorder is often complicated by mood, anxiety, eating and substance use disorders and post-traumatic stress disorder.^[2]

Daily function

Both conditions can impair work and relationships.^{[2, 3]} Supportive care may address stress, sleep and tension, but it is not a treatment for the disorder.

Acupuncture as supportive care in Mood and Personality Disorders

What the research shows

Most acupuncture research is on depression, and the evidence is weak. A Cochrane review of 64 studies found low-quality evidence that acupuncture may moderately reduce depression severity compared with no treatment, and a small reduction compared with sham acupuncture. It found the evidence on acupuncture alongside medication very low quality, and called for better trials.^[7]

Newer trials add some support as an add-on. In a multicenter trial of 120 people with moderate to severe depression taking SSRIs, 10 sessions of intradermal acupuncture reduced depression scores more than sham or SSRIs alone over 6 weeks, without serious adverse events.^[8] A pragmatic trial of 477 patients found acupuncture plus SSRIs improved some symptom scores (such as anxiety and sleep) and quality-of-life measures more than SSRIs alone, but it had no sham control, so placebo effects could not be excluded.^[9]

For bipolar disorder, one study found favorable but not statistically significant effects of acupuncture on mania and depression outcomes, and a review judged the evidence inconsistent.^{[10, 11]} For personality disorders, we found no trials of acupuncture for the disorder itself. One uncontrolled study of ear acupuncture in an inpatient program for substance use found it linked to completing the program in people with borderline personality disorder, but it cannot show acupuncture caused that.^[12]

How acupuncture may work

No reliable explanation specific to these disorders has been established. Imaging in the intradermal acupuncture trial found changes in brain connectivity, which is a proposed mechanism and not a proven one.^[8]

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, usually left in place for about 20 to 40 minutes. A course of several visits is typical; the intradermal trial gave 10 sessions over 6 weeks.^[8] We reassess after a short course to see whether stress, sleep and tension are changing.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Mood and Personality Disorders

The Ayurvedic view

Ayurveda describes mental and emotional disturbance as an imbalance of the mind-related qualities (sattva, rajas, tamas) together with the doshas, and classical texts describe many mind-related conditions without matching modern diagnoses. These are traditional categories used to choose supportive measures, not biomedical diagnoses.

Therapies that may be used

Supportive care is chosen for the individual and may include:

• Daily routine and diet, with regular meals, sleep and waking times
• Warm oil massage of the body or scalp
• Breathing practices, yoga and meditation
• Turmeric (curcumin), a spice in Ayurvedic cooking that has been studied in depression^[14]

Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty, during a depressive, manic or psychotic episode, or without your treating team's agreement.

What the research shows

We found no trials of whole Ayurvedic treatment for mood or personality disorders. The only related evidence is for single ingredients. A meta-analysis of 10 studies (531 participants) found curcumin added to standard care was linked to lower depression and anxiety scores, but the studies were small and the authors urged caution.^[14] A network meta-analysis of 192 trials of nutraceuticals for depression also ranked curcumin among the better-performing options, mostly alongside antidepressants.^[15] These findings concern depression, not bipolar or personality disorders.

Herbal medicine as supportive care in Mood and Personality Disorders

Herbs and formulas that have been studied

The herbs with the most research for depression are St John's wort, saffron and curcumin.^{[15, 16]} We found no herbal trials for personality disorders, and herbal research in bipolar disorder is sparse.^[10]

What the research shows

For mild to moderate depression, a meta-analysis of 27 trials (3,808 patients) found St John's wort gave response and remission rates comparable to SSRIs, but the studies lasted 4 to 12 weeks, and long-term benefit and use in severe depression are unclear.^[17] A review of 34 trials found saffron reduced self-reported depression and anxiety scores but not clinician-rated scores, so the authors called for better trials.^[18]

A guideline from two biological psychiatry societies supported some herbs for depression, but advised using them alongside standard care, especially for more severe illness. It also noted quality and standardization problems with herbal products.^[16]

Safety and herb-drug interactions

Herbs can interact with the medicines used for these conditions. St John's wort has been reported to lower the blood levels of other drugs and to cause serotonin syndrome when combined with SSRI antidepressants, and ginseng has induced mania alongside the antidepressant phenelzine.^[19] St John's wort and SAMe (a supplement) can also trigger mania, so people with bipolar disorder should not use them without their psychiatrist.^[11] Lithium and other mood stabilizers also need careful monitoring, so tell us all of your medicines.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes low mood and emotional instability through patterns such as liver qi stagnation, heart and spleen deficiency or phlegm disturbing the spirit. Researchers studying acupuncture for depression look at brain network connectivity and the way the nervous system responds to stress.^[8]

Ayurveda's sattva, rajas and tamas describe the clarity, restlessness and heaviness of the mind. No study has shown that these correspond to a specific biological process or to a psychiatric diagnosis.

How this care fits with your medical care

Mood and personality disorders need diagnosis and treatment by a physician or mental health professional. Our care is supportive and does not replace psychotherapy, psychiatric care or medicines. Do not stop or change antidepressants, mood stabilizers or other prescribed medicines without your prescriber, since stopping suddenly can cause relapse or withdrawal symptoms. We do not diagnose or manage these conditions.

Please bring your diagnosis, a list of your medicines and supplements, and the contact details of your treating clinician. We ask that your treating team knows you are receiving complementary care.

When to seek urgent medical care

Mood and personality disorders can involve a risk of suicide and self-harm.^{[1, 2]}

• Thoughts of suicide or self-harm; call or text 988 (Suicide and Crisis Lifeline)
• Thoughts of harming another person
• Mania with no sleep for days, risky behavior, or loss of touch with reality
• Seeing or hearing things that others do not, or severe confusion
• Sudden change in behavior, or being unable to care for yourself

If any of these are an emergency, call 911 or go to the nearest emergency department.