Depression clinical aspects

Bertilsson, L., "Pharmacogenetics of Anti-depressants Clinical Aspects," Acta. Psychiat. Scand. Suppl., 391,14-21 (1997). 

Beck, A.T. (1967) Depression Clinical, Experimental and Theoretical Aspects. New York Harper Row. 

Lewy AJ, Numberger JI, Wehr TA Supersensitivity to light possible trait marker for manic-depressive illness. Am J Psychiatry 142 725-727, 1985 Lewy AJ, Hughes RJ, Bauer VK, et al Melatonin modulation of brain and behavior clinical aspects, in Hormonal Modulation of Brain and Behavior. Edited by Halbreich U. Washington, DC, American Psychiatric Press (in press ... 

Fig. 2 Clinical aspect and brain pathology. Upper picture shows a female mule deer, 3 years of age, with clinical signs of late chronic wasting disease, which include hypersalivation, emaciation and depression. Lower pictures depict amyloid plaques in the thalamus of a WTD with CWD. Left shows formalin-fixed, paraffin-embedded tissue stained with HE. Plaques are delineated with arrows. Right picture shows an immunohistochemical (IHC) staining of such amyloid plaques. Pictures kindly provided by the abatement of the late Beth Williams, University of Wyoming...

Tetrahydrobiopterin, BH.f a hydrogen transfer cofactor of a number of aromatic amino add hydroxylases, including phenylalanine, tyrosine and tr tophan hydroxylases. These are necessary for synthesis of the neurotransmitters, dopa, 5-hydroxytryptophan, dopamine, adrenalin, noradrenalin and serotonin thus BH4 is necessary for neurological function. Brain tissues from adults with Down s syndrome, senile dementia of the Alzheimer type and severe endogenous depression have a very low synthetic capadty for BH<. [J. A. Blair etal. in Biochemical and Clinical Aspects of die Pteridines vol. 3 (de Gruyter, Berhn, 1984))... 

J.P. Scott and E.C. Saray, in Separation and Depression Clinical and Research Aspects, (AAAS, 94, Washington, 1973). 

Physical exercise as a treatment for clinical depression has not been studied as extensively as dmgs or psychotherapy, but there are a number of clinical trials evaluating its effectiveness.41 In some of these studies, exercise was compared to no treatment at all. In others, it was compared to psychotherapy, medication or attention-control procedures intended to control for the nonspecific placebo aspects of the exercise programme. Some of the trials also looked at the combination of physical exercise with... 

Both clinical and experimental studies have shown that a number of transmitter receptors and amine transport processes show circadian changes. It is well established that depression is associated with a disruption of the circadian rhythm as shown by changes in a number of behavioural, autonomic and neuroendocrine aspects. One of the main consequences of effective treatment is a return of the circadian rhythm to normality. For example, it has been shown that the 5-HT uptake into the platelets of depressed patients is largely unchanged between 0600 and 1200 hours, whereas the 5-HT transport in control subjects shows a significant decrease over this period. The normal rhythm in 5-HT transport is only reestablished when the depressed patient responds to treatment. Thus it may be hypothesized that the mode of action of antidepressants is to normalize disrupted circadian rhythms. Only when the circadian rhythm has returned to normal can full clinical recovery be established. 

Stress is frequently a trigger factor for depression in vulnerable patients. There is clinical evidence to show that CRT is elevated in the cerebrospinal fluid of untreated depressed patients, which presumably leads to the hypercortisolaemia that usually accompanies the condition. One of the consequences of elevated plasma glucocorticoids is a suppression of some aspects of cellular immunity. It is now established that many cellular (for example, natural killer cell activity, T-cell replication) and non-cellular (for example, raised acute phase proteins) aspects are abnormal in the untreated depressed patient. Such observations could help to explain the susceptibility of depressed patients to physical ill health. 

As with the dopamine theory of schizophrenia, the monoamine hypotheses of depression emphasize one or more aspects of the actions of clinically effective... 

A summary of the plasma concentration-efficacy data with these four TCAs supports the use of TDM, at least once, as a routine aspect of therapy for major depressive disorder. The data are consistent across three of these agents that optimal plasma levels are associated with a greater likelihood of full remission after 4 weeks. Translated into clinical terms. Perry et al. (326) find a 1.7- to 3-fold increase in clinical response to TCAs if the depressed patient obtains an optimal TCA plasma level. 

Preliminary results from case reports, case series, and open and increasingly better controlled trials have found TMS to be effective in the treatment of depression. TMS, antidepressants, and ECS appear to induce similar effects in animal behavioral models of depression and changes in brain neurochemical activity. These include changes in the forced swim test, increase in seizure threshold, and effects on b-noradrenergic receptor downregulation. Whereas seizures appear unnecessary to achieve clinical benefit with TMS, it is still unclear what aspects are beneficial. As noted earlier, although this modality is associated with some complications (e.g., headaches and, rarely, inadvertent seizure) relative to ECT and perhaps even pharmacotherapy under certain situations, it appears to be quite safe. Future studies of major depression should explore TMS-related issues such as the following ... 

Clinical descriptions and criteria for diagnosis of disorders of mood will only be mentioned in passing. The reader should consult standard reference sources for this material. Here we will discuss how discoveries of various antidepressants have impacted the diagnostic criteria for depression and how they may have modified the natural history and course of this illness. The goal of this chapter is to acquaint the reader with current ideas about the clinical and biological aspects of mood disorders in order to be prepared to understand how the various antidepressants and mood stabilizers work. 

Laura is being treated for the medical aspects of anorexia by a pediatrician who has expertise in this particular eating disorder. Previously, Laura had seen at least five different therapists of various disciplines and specialties, none of whom had been able to treat her anorexia effectively. Two reasons prompted Laura to contact Dr. P. First, her dance teacher (Eren), whom she idolizes, told her she should (Dr. P had helped Eren when she was clinically depressed). Second, Eren thinks that anorexia is... 

Education of patients about antidepressants has several facets. First, education about the biological aspects of depression is helpful, especially so that they do not view taking medication as a sign of moral weakness. Next, it is important to describe what to expect from the antidepressants what typical side effects are, that the medication is not habit forming, that a clinical response typically takes two to three weeks to be achieved, that side effects diminish over time, and that other medications can be tried if the first one does not work. For people taking MAOls, education about foods and medications to avoid is crucial. 

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