Mood symptoms, electroconvulsive

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

Finally, when depressive symptoms persist after treatment with both a mood stabilizer and an antidepressant has been maximized, other treatment alternatives remain. These include the use of electroconvulsive therapy (ECT) or the addition... 

When symptoms of major depression and psychosis coexist, medication treatment is always warranted. (Often hospitalization, ECT, or both may also be necessary.) Psychotically depressed patients do not respond to psychotherapy alone, and they represent a very high suicide risk when actively psychotic. It has been firmly documented that treatment with antidepressants alone is not very effective (only 25 percent). Likewise, treatment with antipsychotics alone produce disappointing results (35 percent effective). However, combined antidepressant-antipsychotic treatment is significantly more effective (60 to 70 percent). Electroconvulsive treatment is really the gold standard in the treatment of psychotic mood disorders (90 percent effective). (See chapters 14 and 17, on treatment with antidepressants and antipsychotics, respectively.)... 

To date, two types of major depression have been postulated. The first is often referred to as endogenous or melancholic depression. In this type of major depression, symptoms of depressed mood are related directly to internal biologic factors such as neurotransmitter dysfunction (Kaplan Sadock, 1990 Tierney et al., 1997). Electroconvulsive therapy (ECT), referred to historically as shock treatments, is often considered an endogenous treatment. Here, direct (biologic) stimulation of the neurotransmission process is the treatment strategy. Similar to ECT, antidepressant medications also are successful in lifting endogenous depression, with the major difference that they affect the neurochemical pathways chemically rather than electrically (Maxmen Ward, 1995). 

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