Depression subtypes

Tricyclic antidepressants (TCAs) are effective for all depressive subtypes, but their use has diminished because of the availability of equally effective therapies that are safer on overdose and better tolerated. In addition to inhibiting the reuptake of NE and 5-HT, they also block adrenergic, cholinergic, and histaminergic receptors. 

Depression Subtypes Taxonic 4 Fair to strong None... 

Major depression represents a syndrome of different etiologies. Thus, various depressive subtypes may respond differently to different treatments. Unfortunately, to date, no litmus test for matching the depressive subtype to the appropriate treatment has been identified. Therefore, what we now call stage I TRD may often be more accurately construed as treatment mismatching. 

Anton RF Jr, Burch EA Jr Response of psychotic depression subtypes to pharmacotherapy. J Affect Disord 28 125-131, 1993 Anton SF, Robinson DS, Roberts DL, et al Long-term treatment of depression with nefazadone. Psychopharmacol Bull 30 165-169, 1994 Aoba A, Kakita Y, Yamaguchi N, et al Absence of age effect on plasma halopeiidol neuroleptic levels in psychiatric patients. J Gerontol 40 303-308, 1985 Appel SC Treatment of Alzheimer disease, in Chnical Imphcations of Neurotrophic Factors. Edited by Appel SC. Philadelphia, PA, Dppincot-Raven, 1997, pp 156-175... 

Kupfer DJ, Reynolds CF 111, Ehlers CL Comparison of EEG sleep measures among depressive subtypes and controls in older individuals. Psychiatry Res 27 13-21, 1989b... 

Schizoaffective (SA) disorder is characterized by both psychotic and mood symptoms, with patients meeting the inclusion diagnostic criteria for acute schizophrenia and a major mood disorder. They should also have had a period during the episode of at least 2 weeks when psychotic symptoms predominate in the relative absence of mood symptoms. In addition, mood symptoms should be present for a substantial portion of an episode. This disorder can be further divided into SA-bipolar or SA-depressed subtypes. Although this disorder is not well understood, it has been considered as ... 

Aronson TA, Shukla S, Hoff A, et al. Proposed delusional depression subtypes preliminary evidence from a retrospective study of phenomenology and treatment course. J Affect Disord 1988 14 69-74. 

Depressive subtype, particularly psychotic or melancholic as defined in Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV)... 

McElroy and her coworkers (109) surveyed the response of 85 consecutive patients, including 14 bipolar patients with psychotic features, who received clozapine for 6 weeks. The response rates of the schizoaffective patients (both bipolar and depressed subtypes), as well as those with bipolar disorders with psychotic features, were excellent (i.e., almost 90%) and substantially better than the response rate for the pure schizophrenic group (i.e., 46%). 

Janicak et al. (113, 283) recently reported the results of a double-blind, randomized trial of risperidone monotherapy versus haloperidol monotherapy for controlling both psychotic and mood symptoms in 62 patients with schizoaffective disorder (bipolar or depressed subtype). These authors observed that, in comparison with haloperidol, risperidone was as follows ... 

The other end of the psychiatric spectrum (Fig. 12-19) is depression. A catecholamine hypothesis that evolved here during the mid-1960s essentially stated that most of depression is associated with a relative or absolute catecholamine deficiency, especially NE at functionally important adrenergic receptor sites in the brain (Schildkraut, 1965). It is presumed that the opposite situation, which is excess catecholamines, may produce mania. Even though overly simplistic, the hypothesis served as a useful initiation into the developing complexity that followed. The NE deficiency, of course, can arise in any of several ways (1) decreased synthesis, (2) impairment of receptor binding, (3) storage impairment, (4) increased intracellular release, (5) increased oxidative metabolism rate, and (6) decreased receptor sensitivity. It is possible that different depression subtypes relate to dif-... 

Future Outlook for Antidepressants. Third-generation antidepressants are expected to combine superior efficacy and improved safety, but are unlikely to reduce the onset of therapeutic action in depressed patients (179). Many dmgs in clinical development as antidepressive agents focus on estabhshed properties such as inhibition of serotonin, dopamine, and/or noradrenaline reuptake, agonistic or antagonistic action at various serotonin receptor subtypes, presynaptic tt2-adrenoceptor antagonism, or specific monoamine—oxidase type A inhibition. Examples include buspirone (3) (only... 

The existence of further alternative transcripts of MOP was postulated by the observation that in knockout mice with disrupted exon 1, heroin but not morphine was still analgesically active. Based on earlier observations that the antagonist naloxazone blocked morphine-induced antinociception but not morphine-induced respiratory depression, a subdivision of the MOP in pi and p2 was proposed. However, no discrete mRNA for each of these MOP subtypes has been found. It is, however, possible that subtypes of MOPs result from heterodimerization with other opioid receptors or by interaction with other proteins. 

Bipolar disorder can be conceptualized as a continuum or spectrum of mood disorders and is not comprised solely of bipolar I disorder.9 They include four subtypes bipolar I (periods of major depressive, manic, and/or mixed episodes) bipolar II (periods of major depression and hypomania) cyclothymic disorder (periods of hypomanic episodes and depressive episodes that do not meet all criteria for diagnosis of a major depressive episode) and bipolar disorder, NOS. The defining feature of bipolar disorders is one or more manic or hypomanic episodes in addition to depressive episodes that are not caused by any medical condition, substance abuse, or other psychiatric disorder.1... 

A 36-year-old male heroin addict is seen in the ED because he cannot be aroused from sleep On examination, he has shallow breathing and pinpoint pupils. Naloxone is administered, and the patient wakes up. Which of the opiate receptor subtypes that binds naloxone is responsible for reversing the respiratory depression and miosis ... 

The answer is c. (Hardman, pp 528-537.) Morphine is a pure agonist opioid drug with agonist activity toward all the opioid subtype receptor sites. In high doses, deaths associated with morphine are related to the depression of the respiratory center in the medulla. Morphine has a high addiction potential related to the activity of heroin or dihydromorphine. Codeine has a significantly lower addiction potential. 

Disturbances of sleep are typical of mood disorders, and belong to the core symptoms of major depression. More than 90% of depressed patients complain of impaired sleep quality [60], Typically, patients suffer from difficulties in falling asleep, frequent nocturnal awakenings, and early morning awakening. Not only is insomnia a typical symptom of depression but, studies suggest, conversely, insomnia may be an independent risk factor for depression. In bipolar disorders sleep loss may also be a risk factor for the development of mania. Hypersomnia is less typical for depression [61] and, in contrast to insomnia, may be related to certain subtypes of depression, such as seasonal affective disorder (SAD). 

Other taxometrics research has evaluated the validity of theoretical psychopathological subtypes. For example, Haslam and Beck (1994) used CCK procedures to test whether five proposed subtypes of major depression (e.g., endogenous, sociotropic, autonomous) reflect underlying categories. Again, because these theoretical subtypes of depression are not necessarily represented in the DSM, they do not speak directly to psychiatric nosology. 

Support for a depression taxon comes primarily from subtyping studies. First, Haslam and Beck (1994) tested the taxonicity of several theoretical... 

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