Depressive disorders goals

State the goals of pharmacotherapy in major depressive disorder. 

I and depressive symptoms. Hypomanic symptoms include inflated self-esteem or grandiosity (non-delusional), decreased need for sleep, pressure of speech, flight of ideas, distractibility, and increased involvement in goal-directed activities, not causing severe impairment in social or occupational functioning or requiring hospitalization. Psychotic features are not found in cyclothymic disorder.1... 

The main objectives of treatment are to reduce the severity and frequency of panic attacks, reduce anticipatory anxiety and agoraphobic behavior, and minimize symptoms of depression or other comorbid disorders.48 The long-term goal is to achieve and sustain remission. 

Chronic use has been associated with an "amotivational syndrome" characterized by loss of interest in social activities, school, work, or other goal-directed activities. Cannabis use is cited as the cause of this phenomenon, but there is no evidence to support any causal relationship. There is evidence, however, that the symptoms of the "amotivational syndrome" are secondary to depression (Musty and Kraback 1995). In contrast to ethanol, there is no evidence to support that cannabis causes an increase in violent behavior (Murray 1986). However, cannabis use may be contraindicated in those with preexisting psychiatric disturbances such as bipolar disorder or schizophrenia. 

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. 

The goal of treatment of depression and anxiety disorders is complete remission of current symptoms as well as prevention of future relapses... 

The treatment of bipolar disorder is complex, and depends on the particular phase of illness. The mood stabilizers form the foundation of treatment. These include lithium and the anticonvulsant drugs, valproate, and carbamazepine (Bowden, 1998 McElroy and Keck, 2000 Post, 2000). Recently, lamoh igine has been found effective in some patients (Post, 2000). The goal of treatment with mood stabilizers is reduction of frequency and severity of episodes of depression and mania. 

The desired outcome for bipolar disorder is to alleviate or shorten the duration of an acute manic, hypomanic, or depressive episode, to maintain good functioning, and to prevent further cycles of mania or depression. The general principles and goals for the management of bipolar disorder are found in Table 68-5. 

The long-term goal of therapy for GAD, panic disorder, and SAD is remission of core anxiety symptoms with no impairment in functionality, minimal anxiety, and no depressive symptoms. Clinicians can use the pharmacological armamentarium effectively to achieve this goal for patients. 

PTSD compares with depression in the level of disability it imposes on patients with the disorder. Individuals fail to realize their potentials for career development, marriage, and education. Decreased productivity leads to a financial loss of more than 3 billion per year. This figure does not include economic loss associated with the failure of patients with PTSD to achieve their educational or career goals. Women in a health care maintenance organization with high scores on the Posttraumatic Stress Disorder Checklist had more than twice the adjusted total annual median cost ( 1,283) of care (i.e., outpatient, specialty care, primary care, pharmacy and mental health care costs) than those with a low score ( 609). Treatment with effective pharmacotherapy can improve the QOL of these patients. Sertraline and fluoxetine improved measures of social and occupational functioning as well as the perception of improved QOL in patients with PTSD. - ... 

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