Antidepressants and mood stabilisers

Turning to the pharmacotherapy for mania, for decades lithium was the only effective drug treatment. More recently, a number of antiepileptic drugs including carba maze pine, lamotrigine and valproate have been shown to also act as mood stabilisers and are becoming established for the treatment and prophylaxis of both unipolar mania and bipolar manic depressive disorders. 

Until one has experienced a debilitating severe depression it is hard to understand the feelings of those who have it. Severe depression borders on being beyond description it is not just feeling much lower than usual. It is a quite different state, a state that bears only a tangential resemblance to normal emotion. It deserves some new and special word of its own, a word that would somehow encapsulate both the pain and the conviction that no remedy will ever come. We could certainly do with a better word for this illness than one with the mere common connotation of being down . 

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

The classic symptoms of depression are listed in Table 12.1, which is based on DSM-IV criteria. For a diagnosis of major depressive disorder, most of these symptoms must be present, including the first two (APA, 2000). These symptoms should be of sufficient intensity and chronic duration (at least 2 weeks) to cause clinically significant distress and impairment in social or economic functioning. However, they should not be a result of another psychiatric or somatic illness, nor of drug misuse or bereavement. For a diagnosis of mania, the symptoms are a mirror image of those for depression (Table 

Insomnia Disturbed sleep, characterised by difficulty in falling asleep and early 

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