Depression-related disorders

Anxiety disorders and insomnia represent relatively common medical problems within the general population. These problems typically recur over a person s lifetime (3,4). Epidemiological studies in the United States indicate that the lifetime prevalence for significant anxiety disorders is about 15%. Anxiety disorders are serious medical problems affecting not only quaUty of life, but additionally may indirecdy result in considerable morbidity owing to association with depression, cardiovascular disease, suicidal behavior, and substance-related disorders. 

Titus GAL3 antagonists may represent an alternate class of therapeutic agents for the treatment of depression, anxiety, and stress-related disorders. 

See Chap. 68, Substance-Related Disorders Overview and Depressants, Stimulants, and Hallucinogens, authored by Paul L. Doering and Lisa Boothby, and Chap. 69, Substance-Related Disorders Alcohol, Nicotine, and Caffeine, authored by Paul L. Doering, W. Klugh Kennedy, and Lisa A. Boothby, for a more detailed discussion of the topic. 

Other Uses in Geriatric Patient Depression refractory to other measures, anxiety symptoms and related disorders... 

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. 

Whereas such data exist for MDD and the various anxiety-related disorders, such data do not exist for the proposed mixed anxiety and depression category. 

Personality disorders can complicate management (e.g., borderline disorder with a superimposed MDD). Dual depression occurs in patients who have chronic dysthymic disorder and then experience a superimposed MDD. Substance abuse and dependence are frequently co-morbid with mood disorders and substantially increase depression-related morbidity and mortality rates (see Drug-Induced Syndromes ). 

Schizophrenia-related disorders, such as schizophreniform disorder, can closely mimic an acute exacerbation of mania. Attention to premorbid personal and family history may help differentiate them from mood disorders. A definitive diagnosis may not be possible, however, until the course of the illness is followed for a period of time. Clinical clues include the propensity of bipolar manics (in contrast to schizophrenics) to demonstrate pressured speech, flight of ideas, grandiosity, and overinclusive thinking. Hallucinations are less common than delusions in both mania and depression, with delusions normally taking on the qualities of expansivity, hyperreligiosity, or grandiosity. Delusions are also relatively less fixed than in schizophrenia. 

Sawabini, K.A., Watts, R.L. (2004) Treatment of depression in Parkinson s disease. Parkinsonism Relat Disord 10, S37-41. 

First, atypical antipsychotics undoubtedly cause far fewer EPS than do conventional antipsychotics and often cause essentially no EPS (i.e., they really do perform in this respect, as predicted pharmacologically and as advertised). Second, atypical antipsychotics reduce negative symptoms of schizophrenia better than do conventional antipsychotics, but this may be because they do not make things worse as much as because they really reduce negative symptoms. The magnitude of this effect is not as robust as the effects on EPS, and further innovations will be necessary to solve the negative symptom problem in schizophrenia—nevertheless, this is a good start. Third, atypical antipsychotics reduce affective symptoms in schizophrenia and related disorders such as treatment-resistant depression and in bipolar disorder, where treatment effects appear to be quite robust. Fourth, atypical antipsychotics may... 

Doering, P. L. Substance-Related Disorders Overview and Depressants, Simulants and Hallucinogen. Pharmacotherapy A Pathophysiologic Approach. 4th ed. Stamford, Conn. Appleton and Lange, 1999. 

Based on a new substantial body of pharmacological and clinical evidence, it is anticipated that the modulation of the effects of corticotropin releasing hormone or factor (CRH or CRF) may eventually play a role in the treatment of depression or anxiety-related disorders. This interest in CRH as a new important target for drug discovery is clearly evident. Recently Gilligan et al. [74] have observed that the Suzuki reaction can be used to synthesize a variety of aryl-substituted heterocyclic antagonists of the CRH receptor (Eq. (43)). 

Drags that act on the CNS include those used for the treatment of psychosis, affective (mood) disorders, such as depression and mania, anxieties and related disorders, seizure disorders (epilepsies), Parkinson s disease, Alzheimer s disease, pain (opioid analgesics) and brain tumors. Furthermore, the AIDS virus has a special affinity for the brain, where it attacks neurons and their structural supports (glial cells) causing memory loss, palsy, dementia and, finally, paralysis. 

Yevich, J. P., Mayol, R. F., Li, J., and Yocca, F. 2003b. S-6-Hydroxy-buspirone for treatment of anxiety, depression and related disorders. United States Patent Appl. Publ., 7 pp. CODEN USXXCO US 2003022899 A1 20030130 CAN 138 131151 AN 2003 77553 CAPLUS. 

Although DSM-IV includes twelve types of anxiety disorders, the list of disorders in this chapter is somewhat more brief. Patients suffering from post-traumatic stress disorder (PTSD) and a related disorder, acute stress disorder often do present with a host of anxiety symptoms however, anxiety is but one aspect of PTSD. This syndrome also often includes symptoms of depression, transient psychosis, and dissociation. Thus, we have chosen not to address it here, but in a separate chapter (see chapter 10). Additionally, although obsessive-compulsive disorder (OCD) is considered to be an anxiety disorder, its pathophysiology and treatment varies enough from the anxiety disorders to warrant a separate chapter (see chapter 8). 

For example, the CB1 gene has been associated with Huntington s age of onset [238], depression in Parkinson s [239], and at least some aspects of multiple sclerosis progression [240, 241]. With respect to schizophrenia, a psychosis that may be elicited by components of cannabis [242, 243], in some [244-248] but not all studies [249-252], implicates the CB1 in certain endo-phenotypes. Similarly, a complex pattern of associations of the CB1 gene with unipolar and bipolar depression, and related disorders, is emerging [253-256] that may involve other genes. 

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