Mood disturbances depression

The essential feature of major depressive disorder is a clinical course that is characterized by one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes. Dysthymic disorder is a chronic disturbance of mood involving depressed mood and at least two other symptoms, and it is generally less severe than major depressive disorder. This chapter focuses exclusively on the diagnosis and treatment of major depressive disorder. 

The mood disorders were once called affective disorders and are grouped into two main categories unipolar and bipolar. The unipolar depressive disorders include major depressive disorder and dysthymic disorder the bipolar disorders include bipolar 1, bipolar II, bipolar not otherwise specified, and cyclothymic disorder. Other mood disorders are substance-induced mood disorders and mood disorders due to a general medical condition. In addition, mood disturbance commonly occurs as a symptom in other psychiatric disorders including dementia, post-traumatic stress disorder, substance abuse disorders, and schizophrenia. 

Depression is an imprecisely used term both in public circles and in the mental health community. It may refer to brief feelings of sadness or to a mood disturbance manifesting profound despair that persists over time. In the latter sense, depression represents the key symptoms of a psychiatric mood disorder. 

Again, the character of the patient s prior episodes, premorbid functioning, and family history all are helpful. By definition, schizophrenia is marked by a 6-month decline in social and occupational functioning that is seldom seen in bipolar illness. In addition, the delusions and hallucinations of schizophrenia are present during periods of normal mood, whereas bipolar patients only experience psychotic symptoms in the context of severe mood disturbance (i.e., mania or depression). 

The schizoaffective diagnosis is warranted when the patient at times fulfills criteria for schizophrenia while no mood disturbance is evident but at other times also fulhlls criteria for a major depressive episode or a manic episode. 

Appropriate management of AN also requires the early detection and treatment of any comorbid psychiatric disorders. The most common comorbid conditions associated with AN are major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and substance use disorders. At the time of presentation, over 50% of AN patients also fulfill criteria for MDD however, accurate diagnosis of depression in these patients is complicated by the fact that prolonged starvation often produces a mood disturbance and neurovegetative symptoms identical to MDD. If MDD appears to be comorbid with AN at the time of presentation, there is debate as to whether it is more prudent to withhold treatment of the depression until weight restoration has been initiated. If the depression persists despite refeeding, then treatment of the depression is likely warranted. 

In addition to its acute actions, Li+ can reduce the frequency of manic or depressive episodes in the bipolar patient and therefore is considered a mood-stabilizing agent. Accordingly, patients with bipolar disorder are often maintained on low stabilizing doses of Li+ indefinitely as a prophylaxis to future mood disturbances. Antidepressant medications are required in addition to Li+ for the treatment of breakthrough depression. 

Treatment with steroids may initially evoke euphoria. This reaction can be a consequence of the salutary effects of the steroids on the inflammatory process or a direct effect on the psyche. The expression of the unpredictable and often profound effects exerted by steroids on mental processes generally reflects the personality of the individual. Psychiatric side effects induced by glucocorticoids may include mania, depression, or mood disturbances. Restlessness and early-morning insomnia may be forerunners of severe psychotic reactions. In such situations, cessation of treatment might be considered, especially in patients with a history of personality disorders. In addition, patients may become psychically dependent on steroids as a result of their euphoric effect, and withdrawal of the treatment may precipitate an emotional crisis, with suicide or psychosis as a consequence. Patients with Cushing s syndrome may also exhibit mood changes, which are reversed by effective treatment of the hypercortisolism. 

Mood disturbances, such as irritability and depression dry mouth aggressive behavior... 

It is indicated in all types of depression, nocturnal enuresis, intractable chronic pain, narcolepsy, chorea, cachexia, mood disturbances and sleep apnoea syndrome. 

Another complication which can be expected in a methadone detoxification, seemingly more even than in other methods, is that of mood disturbances. In a comparison of methadone and buprenorphine withdrawal courses, actually in addition to carbamazepine, Seifert et al. (2005) found more tiredness, sensitivity in mood and depression in the (randomly assigned) methadone patients, which situation can lead to either tranquillizers or antidepressants being considered. 

Clearly, a single neurotransmitter theory does not suffice to explain all known evidence. As a result, models that include two or more systems have been developed to encompass their modulatory interactions. One of the most cogent is the permissive hypothesis, which proposes that a decreased function in central serotonin transmission sets the stage for either a depressive or manic phase ( 60). This circumstance itself is not sufficient to produce the mood disturbance, however, with superimposed aberrations in NE function required to determine the phase of an affective episode (i.e., decreased 5-HT and decreased NE subserves depression decreased 5-HT and increased NE subserves mania). Data from animal studies to support this theory include the following ... 

Lyketsos and colleagues (485) have reported a dramatic, sustained increase in depressive symptoms as early as 18 months before the clinical diagnosis of AIDS. Mood disturbance, primarily depression, can range from mild adjustment phenomena to a major depressive episode with psychotic features. Depression in this group can be categorized as... 

There are several reasons to anticipate that antidepressants might be effective in the treatment of anorexia nervosa. Malnutrition has been shown to produce a syndrome that is virtually indistinguishable from depression, with anhedonia, weight loss, motor retardation, anergia, and decreased ability to think or concentrate. In addition, the high association of co-morbidity between anorexia nervosa and mood disturbances, as well as the preponderance of mood disorders in first-degree relatives of those with anorexia nervosa, have led some clinicians to consider and treat this condition as a depressive variant. 

One unexpected observation, which I will discuss in chapter 10, is that some SSRI drugs that potentiate the serotonin system in favor of enhanced mood in depression cause disturbingly long-lasting alterations in REM sleep physiology, and these alterations sometimes cross the border into the REM sleep behavior disorder. 

Depressed mood and emotional lability occur in up to 75 % of gonadorelin recipients, and there are rare reports of more severe mood disturbances (18). Defects of verbal memory have been described and may be reversed by add-back estrogen treatment (18) and sertraline (19). 

Chronic nitrous oxide abuse can remove a lot of vitamin B12 from the bloodstream. B12 (cobalamin) is necessary for the creation of blood cells and neurotransmitters, as well as the protective layers that cover nerves. This results in nerve damage and pain balancing, walking, and concentration difficulties mental impairment mood disturbances (such as depression) and other physical problems. Chronic nitrous oxide use may also interfere with the production in bone marrow of white blood cells and red blood cells. Treatment with intramuscular injections of B12 may reverse these symptoms. 

In a double-blind, placebo-controlled study, 175 manic or recently manic patients were stabilized over 8-16 weeks with lamotrigine 100-400 mg/day (n = 59), lithium in a dose sufficient to produce a serum concentration of 0.8-1.1 mmol/1 (n = 46), or placebo and were then randomized to continued treatment (94). Both lamotrigine and lithium were superior to placebo in prolonging the time to the next episode of any mood disturbance. Lamotrigine, but not lithium, was superior to placebo in prolonging the time to a depressive episode. Lithium, but not lamotrigine, was superior to placebo in prolonging the time to a manic, hypomanic, or mixed episode. 

In another study PET was used to investigate metabolic abnormalities in 20 recently abstinent metamfetamine abusers and 22 controls (13). The mood disturbances in these individuals were also compared with their cerebral metabolism. Metamfetamine abusers were tested after 4-7 days of abstinence. All gave self-ratings on depression, anxiety, and craving for metamfetamine. PET images were acquired... 

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