Bipolar depression

T/T variants showed better responses to treatment. Major depression, bipolar depression Caucasian... 

Agid O, Shapira B, Zislin J, Ritsner M, Hanin B, Murad H et al. Environment and vulnerability to major psychiatric illness a case control study of early parental loss in major depression, bipolar... 

Mood disorders, such as depression, Bipolar Disorder, and suicidal behaviors... 

Another way that professionals assess for psychiatric disorders is to use an inventory that assesses for personality characteristics. The most famous of these inventories is the Minnesota Multiphasic Personality Inventory (MMPI), which is now in its second edition as an instrument. Although the MMPI is actually a personality inventory, as it names suggests, many professionals will use it to spot suspected psychiatric disorders, such as depression, Bipolar Disorder, Schizophrenia, and Anxiety Disorder. The MMPI has several scales to assess common personality traits, such as depression, mania, psychopathic deviance, and even alcohol and drug use (Weed, Butcher, McKenna, Ben-Porath, 1992). 

The distinction between major depression and bipolar depression is an important one. Treating a depressed bipolar patient with antidepressant monotherapy (i.e., withont a concomitant mood stabilizer) can propel such a patient into a manic or hypomanic episode. Although it may not be prudent to initiate a mood stabilizer when the evidence for bipolar illness is equivocal, the clinician should be particularly vigilant for the emergence of manic or hypomanic symptoms when starting antidepressant treatment for the first time in a depressed patient. 

The next step in the management of the depressed bipolar patient is to evaluate thyroid function. This is especially important for patients treated with lithium in order to rule out lithium-induced hypothyroidism. When this occurs, the addition of thyroid hormone replacement may relieve the depressive symptoms without any additional changes to the bipolar treatment regimen. 

Mania. Mania and hypomania can also occur in children and adolescents on SSRIs, and, again, it is not known if there is an added developmental risk (Ven-kataraman et al., 1992). In a fluoxetine treatment study for depression, 3 (of 48) patients developed manic symptoms, even after excluding patients with psychotic depression, bipolar symptoms, or a family history of bipolar disorder (Emslie et al., 1997). In a paroxetine treatment study for depression, 5 adolescents (of 93) were removed for emotional lability and 1 for eupho-ria/expansive mood (Keller et al., 2001). 

Controlled studies involving lipid manipulation in children date back to the 1920s, when the ketogenic diet was pioneered to control treatment-resistant seizures in select pediatric populations (Freeman et al., 1998). However, no controlled evidence is available in children with depression, bipolar disorder, behavioral problems, or ADHD. In the absence of definite empirical data about effectiveness, treatment with EFA supplements should be considered unproven and patients ought to be advised accordingly. 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

A potential limitation of most of the controlled studies discussed above relates to the numerous exclusion criteria used for patient selection. For example, in order to find homogenous samples, major depression, bipolar disorder, Tourette s disorder, psychosis (clomipramine, fluvoxamine and fluoxetine trials), primary psychiatric disorder other than OCD (clomipramine and sertraline trials), and attention deficit/hyperactivity disorder (ADHD), autism, or other developmental disorders (clomipramine and fluoxetine trials) were excluded. Thus it remains unknown how well these controlled studies will generalize to more naturalistic clinical populations that are highly comorbid and where exclusion criteria are not applied. 

It is indicated in acute hypomania, mania, recurrent mania, depression - cyclic and recurring, unipolar depression, bipolar depression, schizoaffective psychosis, mental depression, cluster headache, chemotherapy induced leukopenia and agranulocytosis. 

Grunze H, Erfurth A, Amann B, et al. Intravenous valproate loading in acutely manic and depressed bipolar I patients. J Clin Psychopharmacol 1999 19 303-309. 

Antidepressants modify the long-term course of bipolar disorder as well. When given with lithium or other mood stabilizers, they may reduce depressive episodes. Interestingly, however, antidepressants can flip a depressed bipolar patient into mania, into mixed mania with depression, or into chaotic rapid cycling every few days or hours, especially in the absence of mood stabilizers. Thus, many patients with bipolar disorders require clever mixing of mood stabilizers and antidepressants, or even avoidance of antidepressants, in order to attain the best outcome. 

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... 

Affective disorders comprise the group of mental conditions that includes depression, bipolar syndrome (manic-depression), and several others that are characterized by a marked disturbance in a patient s mood.41 Patients with an affective disorder typically present with an inappropriate disposition, feeling unreasonably sad and discouraged (major depressive disorder) or fluctuating between periods of depression and excessive excitation and elation (bipolar disorder). 

Glueck et al. assessed hypocholesterolemia in 203 patients hospitalized with affective disorders (depression, bipolar disorder, and schizoaffective disorder), 1595 self-referred subjects in an urban supermarket screening, and 11,864 subjects in the National Health and Nutrition Examination Survey II (a national probability sample) [34], Low plasma cholesterol concentration (<160 mg/dL) was much more common in patients with affective disorders than in those found in urban supermarket screening subjects or in the National Health and Nutrition Examination Survey II subjects. When paired with supermarket screening subjects by age and sex, patients with affective disorders had much lower TC, LDL, HDL, and higher TG concentrations. However, there was no evidence that low plasma cholesterol could cause or worsen affective disorders [34]. 

The Idea of Special Drugs for Manic Depression (Bipolar Disorder) ... 

The claim that lithium is a disease-specific therapy for mania or manic-depressive (bipolar) disorder has no basis in fact it is a braindisabling agent. Its efficacy has been exaggerated, and its adverse effects on the brain and mind, as well as the body as a whole, have been too frequently minimized. 

As with mania and unipolar depression, ECT is a very effective treatment for the depressive phase of bipolar disorder, especially in cases with psychotic symptoms. It is at least as effective as antidepressant medications and probably more effective. Curiously, in spite of its proven antimanic properties, when ECT is administered to depressive bipolars, it may precipitate a switch into mania in some cases. Several other treatments have been tried for bipolar depression, especially in... 

Major Depression, Bipolar Syndi omes, and Schizophrenia... 

When bipolar patients present in a depressive episode, initial treatment with a mood stabilizer is recommended (Post, 2000). If a depressed bipolar does not respond to treatment with a mood stabilizer, an antidepressant is prescribed. Most patients with bipolar disorder end up on multiple medications. Elech o-convulsive therapy is an effective treatment for bipolar disorder in both the manic and depressed phases of the illness. 

Major depression, bipolar syndromes and schizophrenia are common and often severe mental illnesses. All three of these tend to have an onset in late adolescence or young adulthood. Major depression is characterized by persistent low mood and decreased interest and pleasure, as well as physical and psychological symptoms, including sleep disturbance. 

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