Major depression subtypes

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... 

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. 

Haslam, N., Beck, A. T. (1994). Subtyping major depression A taxometric analysis. Journal of Abnormal Psychology, 103, 686-692. 

Mood Disorder with Psychotic Features. One subtype of major depression and many episodes of mania are associated with psychotic symptoms. Like schizophrenia, the most prominent psychotic symptoms of psychotic depression or mania are delusions and auditory hallucinations. Unless a longitudinal history is available, it is often difficult to distinguish schizophrenia from a psychotic mood disorder. 

Strober, M., Lampert, C., Schmidt, S., and Mottell, W. (1993) The course of major depressive disorder in adolescents I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes. J Am Acad Child Adolesc Psychiatry 32 34 2. 

I. F. Small et al. 1986), and in our experience the same may hold true for some young patients with schizophrenia. However, confounding variables such as age and gender have not been addressed in these studies. In patients with major depressive disorder, we found no relation between seizure threshold and unipolar versus bipolar or psychotic versus nonpsychotic subtypes. Similarly, Coffey et al. (1995a) found no correlation between initial seizure threshold and severity of depressive illness or the unipolar-bipolar distinction. Finally, we found that history of ECT did not predict seizure threshold (Krueger et al. 1993). 

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. 

Given the generally favorable response of PMD to ECT, an important question is whether PMD responds to ECT preferentially over nonpsychotic subtypes of major depression. M. Greenblatt et al. (1964) found that psychotic depression did not show a significantly different response rate to ECT from bipolar depression or even psychoneurotic depression. In contrast, more recent studies (R. P. Brown et al. 1982 C. L. Rich et al. 1984) have found that patients with psychotic depression did not respond preferentially to ECT over other subtypes of depression. However, Charney and Nelson (1981) found that the presence of delusions predicted a more favorable response to ECT in 49 inpatients with depression. The question of whether PMD responds preferentially to ECT over other subtypes remains unanswered. 

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 ... 

Meanwhile, benzodiazepines became second-line treatments or augmentation treatments for these anxiety disorder subtypes in the 1990s. While buspirone continues to be recognized as a first-line general anxiolytic, it has not developed a convincing efficacy profile for anxiety disorder subtypes or for the treatment of major depressive disorder. 

Seasonal subtype of major depressive disorder characterized by an annual pattern of symptoms (e.g. depression occurring in the autumn or spring). 

Several subtypes of depression require specific treatment strategies that go beyond a simple course of conventional antidepressant therapy (these subtypes include bipolar depression, major depression with psychotic features, seasonal depression, atypical depression, comorbid anxiety disorder, comorbid substance abuse, double depression [major depression... 

Sariacora G, Gueorguieva R, Epperson CN, Wu YT, Appel M, Rodi-mari DL, Ki ystal JH, Mason GF (2004a) Subtype-specific altera-doris of gamma-aminobutyric acid and glutamate in paderits widi major depression. Ar ch Gen Psychiatr y 61 705—713. 

In addition to these subtypes, it is important to keep in mind that many, if not most, borderline personalities have comorbid Axis I disorders—especially common are major depression and substance abuse. These coexisting disorders always complicate the picture and must be dealt with in any approach to treatment. In particular, longitudinal studies following the course and outcome of borderline personality disorders over the life span suggest very clearly that those patients who continue to do poorly are those who continue to abuse alcohol and other substances. Thus treatment of chemical dependency problems must be addressed. 

Endogenous opioid receptors have been identified, cloned, and sequenced. They are members of the trimeric G-protein-binding superfamily, which are coupled to signal transduction via adenyl cyclase, and to Ca and ion-channel transport. Three major receptor subtypes are known (mu, kappa, and delta). Mu (p) receptor activation results in sedation, euphoria (via dopamine release), analgesia, respiratory depression, and GI dysmoflity. Kappa (k) receptors mediate spinal analgesia, miosis (via acetylcholine... 

ECT is a safe and effective treatment for certain severe mental illnesses, including all subtypes of major depressive disorder as well as other selected psychiatric illnesses. 

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