Depression and mood disorders

McEwen BS Glucocorticoids, depression, and mood disorders Structural remodeling in the brain. Metabolism 2005 54(5 Suppl 1) 20. 

Depression and mood disorders Decreased Beneficial (Zanarini and Frankenburg, 2003 McNamara et al., 2006 Freeman, 2006 Leonard and Myint, 2006)... 

Tetrahydropyran, (I), and tetrahydrofuran derivatives, (II), prepared by the author (1) and Williams (2), respectively, were effective as NK receptor antagonists and used in treating depression and mood disorders. 

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

Schizoaffective and mood disorder exclusion Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. 

Both genetic and nongenetic factors play roles in the transmission of mood disorders. The familial nature of mood disorders is well established. Studies over the past 20 years have consistently documented higher rates of mood disorder in the relatives of individuals with major depression and bipolar disorder than in relatives of healthy controls [6,7], The familial aggregation of mood disorders is the outcome of both genetic and environmental factors. 

The mood disorders were once called affective disorders and are grouped into two main categories unipolar and bipolar. The unipolar depressive disorders include major depressive disorder and dysthymic disorder the bipolar disorders include bipolar 1, bipolar II, bipolar not otherwise specified, and cyclothymic disorder. Other mood disorders are substance-induced mood disorders and mood disorders due to a general medical condition. In addition, mood disturbance commonly occurs as a symptom in other psychiatric disorders including dementia, post-traumatic stress disorder, substance abuse disorders, and schizophrenia. 

The unipolar mood disorders consist solely of episodes of depression. On the other hand, the bipolar mood disorders consist of episodes of both depressed and elevated mood. The periods of elevated mood are characterized by either euphoria or irritability and are called mania or hypomania depending on the level of severity. A schematic of the mood disorders is shown in Figure 3.1. Substance-induced mood disorders and mood disorders due to general medical conditions usually manifest depressed mood however, manic episodes are occasionally seen as well. 

Adverse reactions occurring in at least 3% of patients include paresthesia, nausea, vomiting, diarrhea, depressive or mood disorders, taste disorder, and rash. 

Approximately three-quarters of children with OCD have comorbid diagnoses. These include tic disorders (24%-30%) and mood disorders, especially major depression (26%-29%). Riddle and colleagues (1990) found that 38% of children with OCD have other anxiety disorders, while Swedo (1989) more specifically identified increased rates of simple phobias (17%), overanxious disorder (16%), and separation anxiety disorder (7%). Other reported comorbidities include specific developmental disabilities, adjustment disorder with depressed mood, oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), conduct disorder, and enuresis/encopresis (Swedo et ah, 1989b Riddle et ah, 1990). 

There is no empirical evidence available for clinical use in children and adolescents. Yet, Hypericum seems to be used for the treatment of mild to moderate depression in the young (Walter et ah, 2000). St. John s wort should be avoided in young patients with severe depression and bipolar disorder (given the lack of adult data about effectiveness and risk of manic induction, respectively) and in those who have significant suicide risk. Treatments of proven efficacy (e.g., SSRIs, mood stabilisers) should be preferred in these cases. However, St. John s wort may be considered in cases of unipolar depression where conventional treatments have failed and prior to the use of combinations of drugs that have an increased risk of side effects and whose efficacy has not been demonstrated. 

A typical example of diagnostic splintering provides the group of mood disorders. One reads about major depression, minor depression, double depression, dysthymia, unipolar and bipolar depression, depressive personality, depression not otherwise specified, brief recurrent depression, subsyndromal symptomatic depression, mixed anxiety depression disorder, seasonal depression, and adjustment disorder with depressive mood. 

Adverse Effects. The most serious problem associated with chloroquine is the possibility of toxicity to the retina and subsequent visual disturbances. This issue is usually insignificant, however, when this drug is used for short periods in relatively low doses (see Chapter 16). Other relatively mild side effects may occur, including gastrointestinal distress (nausea, vomiting, stomach cramps, diarrhea), behavior and mood changes (irritability, confusion, nervousness, depression), and skin disorders (rashes, itching, discoloration). 

The potential association between the immune system and mood disorders has become a major topic of interest in biological psychiatry in the past decade. In general, three immune measures have been examined, namely white blood cell counts, functional measures of cellular immunity such as natural killer cell activity and immune cell markers as exemplified by human lymphoctye antigen (HLA). The cumulative data from these studies suggests that depressed patients have a decreased number of lymphocytes, reduced mitogen-induced lymphocyte proliferation and a reduction in the number of natural killer cells. However, this does not apply to all depressed patients. Furthermore, not all aspects of immune function... 

Mitani H, Shirayama Y, Yamada T, Maeda K, Ashby CR, Kawa-hara R. Correlation between plasma levels of glutamate, alanine, and serine with severity of depression. Progr. Neuro-Psycho-pharmacol. Biol. Psychiatry 2006 30 1155-1158. Martinez-Turrillas R, Erechilla D, Del Rio J. Chronic antidepressant treatment increases the membrane expression of AMPA receptors in rat hippocampus. Neuropharmacology 2002 43 1230-1237. Petty E. GABA and mood disorders a brief review and hypothesis. J. Affec. Disorders 1995 34 275-281. 

The major or most severe psychiatric disorders include depressive disorders, bipolar disorder (manic-depressive illness), and schizophrenia. Depression and bipolar disorder are classified as mood disorders, because the predominant feature of these conditions is an inappropriate or abnormal emotional state. Schizophrenia, on the other hand, is classified as a thought disorder, because the predominant symptoms involve disturbances in perception and thinking. 

For the diagnosis of major depressive disorder, a person must have either symptom 1 or 2, plus five out of nine symptoms, and these symptoms must occur most of the day, nearly every day, for at least two weeks. Major depressive disorder is differentiated from other depressive disorders, including minor depression (dysthymia), recurrent brief depression, and adjustment disorder with depressed mood. 

Depression— A mood disorder where the predominant symptoms are apathy, hopelessness, sleeping too little or too much, loss of pleasure, self-blame, and possibly suicidal thoughts. 

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