Depressive disorders minor

Bertolino, A., Crippa, D., di Dio, S., Fichte, K., Musmeci, G., Porro, V., Rapisarda, V., Sastre-y-Hernandez, M., and Schratzer, M. (1988) Rolipram versus imipramine in patients with major, minor, or atypical depressive disorder a double-blind study, double-dummy study aimed at testing a novel therapeutic approach. Int Clin Psychopharmacol 3 245-253. 

A typical example of diagnostic splintering provides the group of mood disorders. One reads about major depression, minor depression, double depression, dysthymia, unipolar and bipolar depression, depressive personality, depression not otherwise specified, brief recurrent depression, subsyndromal symptomatic depression, mixed anxiety depression disorder, seasonal depression, and adjustment disorder with depressive mood. 

Antidepressants for minor and major depressive disorders and mood stabilisers (anfimanic drugs) for mania. 

For the diagnosis of major depressive disorder, a person must have either symptom 1 or 2, plus five out of nine symptoms, and these symptoms must occur most of the day, nearly every day, for at least two weeks. Major depressive disorder is differentiated from other depressive disorders, including minor depression (dysthymia), recurrent brief depression, and adjustment disorder with depressed mood. 

The depressive disorders described below are sometimes referred to as minor depressions because they do not reach the depths or intensity seen in major depression. However, the term minor may be a misnomer. Although these disorders are low-grade, they tend to be very long-term, often having their onset in late childhood or early adolescence, and potentially lasting a lifetime. The cumulative toll such disorders exact on the quality of life and productivity over a lifetime are not minor at... 

The lifetime prevalence of major depressive disorder is 10—25 percent for women and 5—iz percent for men, as compared to 6 percent for minor depressive (dysthymic) disorder. 

Working under constant scrutiny, always striving for perfection, facing second-guessing and doubt, being paid less or promoted less often, all may present special challenges to female and minority engineers they may become more vulnerable to depression. For instance, 3 percent of total shortterm disability days are due to depressive disorders, and in 76 percent of those cases the employee was female. ... 

The usually accepted prevalences for generalized anxiety disorder (GAD) are around 1.6% for current, 3.1% for 1 year and 5.1% lifetime (Roy-Byrne, 1996). The condition is twice as common in women as in men (Pigott, 1999). A small minority (10%) have GAD alone, and about the same proportion suffer from mixed anxiety and depression. Morbidity is high. About a half of those with uncomplicated GAD seek professional help, but two-thirds of those with comorbid GAD do so. Up to a half take medication at some point. The condition may coexist with other anxiety disorders such as phobias, with affective disorders, or with medical conditions such as unexplained chest pain and irritable bowel syndrome. 

Generalized Sociai Anxiety Disorder, Treatment Resistance. A significant minority of patients will not experience a satisfactory treatment response to antidepressant therapy, even after a trial of adequate duration at full strength doses. For those with comorbid depression who are experiencing no benefit from SSRI treatment for either the anxiety or depression, then switching treatment is advisable. The options include switching to another SSRI, a SNRI (venlafaxine or perhaps dulox-etine), or, when other alternatives fail, phenelzine. 

Lithium is used in the prophylaxis and treatment of mania and in the prophylaxis of bipolar disorders and recurrent depression. Lithium should be stopped 24 hours before major surgery but the normal dose can be continued for minor surgery, with careful monitoring of fluids and electrolytes. After major surgery, renal function is reduced and this may compromise clearance of lithium. Lithium is a drug with a narrow therapeutic index and it should be avoided if possible in patients with renal impairment. Renal function should be tested before initiating treatment. If lithium is given to patients with renal impairment, a reduced dose should be used and serum lithium concentrations should be monitored closely. 

Ethanol (ethyl alcohol) has central nervous system depressant properties and is widely used to relieve anxiety and produce sedation. Although some medical practitioners occasionally prescribe an alcoholic beverage for relieving minor anxiety and inducing sleep, individuals frequently self-medicate with ethanol. Many individuals who abuse alcohol may have started using it to relieve symptoms of central nervous system disorders, such as anxiety and depression. 

Flistrionic personality disorder is similar to the syndrome that Liebowitz and Klein ( 259) have termed hysteroid dysphoria or atypical depression. MAOIs have proven to be very helpful in this condition and these data are reviewed in Chapter 7. As noted earlier, Rifkin et al. (242) also investigated the effects of antidepressants in patients with emotionally unstable personalities, a syndrome characterized by excitability and ineffectiveness when confronted with minor stress. This syndrome is primarily found in female adolescents whose moods consist of the following ... 

Other indications for the use of antipsychotics include Tourette s syndrome, disturbed behavior in patients with Alzheimer s disease, and, with antidepressants, psychotic depression. Antipsychotics are not indicated for the treatment of various withdrawal syndromes, eg, opioid withdrawal. In small doses, antipsychotic drugs have been promoted (wrongly) for the relief of anxiety associated with minor emotional disorders. The antianxiety sedatives (see Chapter 22) are preferred in terms of both safety and acceptability to patients. 

Affective illness is a recurrent illness characterized by episodes of depression -and in some cases, mania - that recur and remit repeatedly during the course of a patient s life. A group of minor conditions characterized by chronic intermittent symptomatology such as dysthymia or cyclothymia also exists. Sleep research over the past decades has primarily focused on major affective disorders such as unipolar or bipolar disorders, and minor affective conditions have been neglected in the research literature. Accordingly, the present chapter will largely rely on publication in that field. 

The occurrence of psychiatric disorders has been prospectively investigated in 63 patients who received a 6-month course of interferon alfa (9 MU/week) for hepatitis C (379). All were assessed at baseline with the Structured Clinical Interview for DSM-III-R (SCID) and monitored monthly with the Hopkins Symptoms Checklist (SCL-90). Most had a history of alcohol or polysubstance dependence, and 12 had a lifetime diagnosis of major depression. There were no significant changes in the SCL-90 scores during the 6-month period of survey in the 49 patients who completed the study, even in those who had a lifetime history of major depression. At 6 months, there was probable minor depression in eight patients and major depression in one none had attempted suicide. 

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