Affective disorders disorder Depression

Table 12.1. Symptoms of the affective disorders major depression and mania. 

For patients with bipolar affective disorder (manic-depressive illness) lithium, usually in the form of lithium carbonate, has been the main prophylactic agent for the last forty years. However, during the last ten years certain anticonvulsants (carbamazepine and sodium valproate) have also been found to be effective. 

FIGURE 5—5- Bipolar disorder is characterized by various types of episodes of affective disorder, including depression, full mania, lesser degrees of mania called hypomania, and even mixed episodes in which mania and depression seem to coincide. 

Depressive and anxious symptoms are frequently associated with schizophrenia, but this does not necessarily mean that they fulfill the diagnostic criteria for a comorbid anxiety or affective disorder. Nevertheless, depressed mood, anxious mood, guilt, tension, irritability, and worry frequently accompany schizophrenia. These various symptoms are also prominent features of major depressive disorder, psychotic depression, bipolar disorder, schizoaffective disorder, organic dementias, and childhood... 

Mendlewicz J, Sevy S, de Martelaer V (1989) REM sleep latency and morbidity risk of affective disorders in depressive illness. Neuropsychobiology 22 14-17... 

The past 20 years have witnessed a broad interest in the role of the hypothalamic-pituitary-adrenal axis in the psychobiology of affective disorders. In depressed patients, increases in serum cortisol are frequently reported in addition to disruptions of circadian patterns of cortisol secretion... 

The Affective Disorders Manic Depressive Psychoses Lithium in the Affective Disorders A. Side Effects Chemistry Isotopes of Lithium Inorganic Biochemistry Mechanisms of Action Lithium and the Phosphoinositide Signaling System Lithium and the Cell Membrane A. Sodium-Lithium Exchange Anion Exchange Leak... 

KOnig 1993 112 (28 m/84 f) affective disorder with depressed mood (not specified, Bf-S 220) Z-90017 2 x 250 mg, after week 3 2 x 500 mg in case of nonresponse 6 weeks A all randomized patients (Hyp 55, Pic 57) for safety and global assessments, 81 patients per protocol (Hyp 42, Pic 39) for rating scales B Bf-S decrease in mean total score from 34.7 to 21.2 (placebo 34.3 to 23.8), as. (U-test) DSI (modified version) decrease in total score from 44.2 to 33.3 (placebo 44.6 to 34.9), iLs. (U-test) Physician s and patient s global judgement no significant differences between treatment groups... 

The role of eiectroconvuisive therapy (ECT) in delusional disorder has not been studied. However, it has proven efficacy in psychotic depression, and is very efficacious in affective disorders (major depressive disorder, bipolar I). Thus, since delusional disorder has psychotic and possibly affective components,... 

C. Clinical Use Lithium carbonate is used in the treatment of bipolar affective disorder (manic-depressive disease). Maintenance therapy with lithium decreases manic behavior and reduces both the frequency and the magnitude of mood swings. Drug therapy with neuroleptics or benzodiazepines may also be required at the initiation of lithium treatment. Antidepressant drugs may be required adjunctively during maintenance. Alternative drugs of value in bipolar affective disorder include carbamazepine, clonazepam, gabapentin, and valproic acid. 

Melatonin [73-31-4] C 2H N202 (31) has marked effects on circadian rhythm (11). Novel ligands for melatonin receptors such as (32) (12), C2yH2gN202, have affinities in the range of 10 Af, and have potential use as therapeutic agents in the treatment of the sleep disorders associated with jet lag. Such agents may also be usehil in the treatment of seasonal affective disorder (SAD), the depression associated with the winter months. Histamine (see Histamine and histamine antagonists), adenosine (see Nucleic acids), and neuropeptides such as corticotropin-like intermediate lobe peptide (CLIP) and vasoactive intestinal polypeptide (VIP) have also been reported to have sedative—hypnotic activities (7). 

Affective (mood) disorders are characterized by changes in mood. The most common manifestation is depression, arranging from mild to severe forms. Psychotic depression is accompanied by hallucinations and illusions. Mania is less common than depression. In bipolar affective disorder, depression alternates with mania. 

VMATs are irreversibly inhibited by the potent antihypertensive drug reserpine. The depressive effects of reserpine helped to formulate the original monoamine hypothesis of affective disorders. Reseipine also appears to interact with the transporters near the site of substrate recognition. Tetrabenazine, which is used in treatment of movement disorders, inhibits VMAT2 much more potently than VMAT1, consistent with the less hypotensive action of this agent. 

Dean AJ, Bell J, Mascord DJ, et al A randomized, controlled trial of fluoxetine in methadone maintenance patients with depressive symptoms. J Affect Disord 72 ... 

The anxiety disorders are a case in point. They comprise a range of conditions contiguous with the affective disorders and the stress responses (Table 4.1). Much overlap and comorbidity exist. Furthermore, definitions and diagnostic criteria have changed substantially over the years. For example, generalized anxiety disorder is a rare condition in its pure form, but a common condition if comorbid phobic and depressive disorders are accepted. 

The usually accepted prevalences for generalized anxiety disorder (GAD) are around 1.6% for current, 3.1% for 1 year and 5.1% lifetime (Roy-Byrne, 1996). The condition is twice as common in women as in men (Pigott, 1999). A small minority (10%) have GAD alone, and about the same proportion suffer from mixed anxiety and depression. Morbidity is high. About a half of those with uncomplicated GAD seek professional help, but two-thirds of those with comorbid GAD do so. Up to a half take medication at some point. The condition may coexist with other anxiety disorders such as phobias, with affective disorders, or with medical conditions such as unexplained chest pain and irritable bowel syndrome. 

Depression and mania are both affective disorders but their symptoms and treatments are quite distinct. Mania is expressed as heightened mood, exaggerated sense of self-worth, irritability, aggression, delusions and hallucinations. In stark contrast, the most obvious disturbance in depression is melancholia that often co-exists with behavioural and somatic changes (Table 20.1). Some individuals experience dramatic mood swings between depression and mania. This is known as "bipolar disorder which, like mania itself, is treated with lithium salts or neuroleptics. 

QUESTION Does anything suggest that people who have taken these drugs or MDMA for a period of time are subject to episodes of depressive disorders or affective disorders ... 

Furukawa, T. A., Kitamura, T. Takahashi, K. (2000). Treatment received by depressed patients in Japan and its determinants naturalistic observation from multi-center collaborative follow-up study. /. Affect. Disord., 60(3), 173-9. 

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