Recurrent mood disorders

Thus, it is possible that recurrent mood disorders, as in the case of bipolar disorder, may lower the threshold for cell death and/or atrophy in response to a variety of other physiological (e.g. normal aging) and pathological (e.g. ischemic) events, and thereby contribute to a variety of deleterious health-related effects. 

Chronic dysthymia followed by major depressive disorder ( double depression ) Prompt relapse following prior treatment discontinuation Strong positive family history of recurrent mood disorders Coexisting medical problems or complication of aging that would make a future episode hazardous... 

The Time Course of Recurrent Mood Disorders Periodic, Noisy and Chaotic Disease Patterns... 

Approximately 1% to 3% of the adult population has either bipolar I or II disorder, but broader definitions suggest prevalence rates up to 5% if the full spectrum of recurrent mood disorders are included. A national comorbidity survey reported that the lifetime prevalence rate of a manic episode is 1.6% 0.3% for men and 1.7% 0.3% for women in the United States (approximately 4 million people). The... 

Smeraldi, E., Benedetti, F. Zanardi, R. (2002). Serotonin transporter promoter genotype and illness recurrence in mood disorders. Eur. Neuropsychopharmacol. 12, 73-5. 

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. 

Sprouse JS, Wilkinson LO Innovative therapeutic actions by targeting serotonin lA receptors selectively. International Review of Psychiatry 7 5-15, 1995 Squillace K, Post R, Savard R, et al Life charting of the longitudinal course of recurrent affective illness, in Neurobiology of Mood Disorders, Vol 1. Edited by Post RM, Ballenger JC. Baltimore, MD, Williams Wilkins, 1984, pp 38-59 Squires RF, Braestrup C Benzodiazepine receptors in rat brain. Nature 266 732-734, 1977... 

NIMH/NIH Consensus Development Conference Statement Mood disorders pharmacologic prevention of recurrences. Consensus Development Panel. Am J Psychiatry 142 469 76, 1985 Physicians Desk Reference, 59th Edition. Montvale, NJ, Medical Economics, 2005... 

Lithium has been proven effective for acute and prophylactic treatment of both manic and depressive episodes in patients with bipolar illness (American Psychiatric Association 2002). However, patients with rapid-cycling bipolar disorder (i.e., patients who experience four or more mood disorder episodes per year) have been reported to respond less well to lithium treatment (Dunner and Fieve 1974 Prien et al. 1984 Wehr et al. 1988). Lithium is also effective in preventing future depressive episodes in patients with recurrent unipolar depressive disorder (American Psychiatric Association 2002) and as an adjunct to antidepressant therapy in depressed patients whose illness is partially refractory to treatment with antidepressants alone (discussed in Chapter 2). Furthermore, hthium may be useful in maintaining remission of depressive disorders after electroconvulsive therapy (Coppen et al. 1981 Sackeim et al. 2001). Lithium also has been used effectively in some cases of aggression and behavioral dyscontrol. 

Davis JM, Janicak PG, Hogan DM. Mood stabilizers in the prevention of recurrent affective disorders a meta-analysis. Acta Psychiatr Scand 1999 100 406-417. 

Lithium is an alkaline earth element that is used medicinally in the form of salts such as lithium chloride and lithium carbonate. Its main use is in the prevention or attenuation of recurrent episodes of mania and depression in individuals with bipolar mood disorder (manic depression). Lithium also has clearly established antima-nic activity, although its relatively slow onset of action often necessitates the use of ancillary drugs, such as antipsychotic drugs and/or benzodiazepines, at the start of therapy. If lithium alone is ineffective for recurrent bipolar mood disorder, combining it or replacing it with car-bamazepine or valproate may be of value reports with lamotrigine and olanzapine are also encouraging. 

In contrast to this study, a 31-year-old woman with major depressive disorder, which responded to paroxetine and trazodone, had progressive recurrence of mood disorders after the introduction of interferon alfa for essential thrombocythemia (389). 

The authors suggested that the recurrence of the manic symptoms could have been due to premedication with prednisolone. Exacerbation of manic symptoms after the use of glucocorticoids has been documented before, but never in a case of short-term premedication before contrast-enhanced radiographic examination. This report shows that even a short-term course of glucocorticoids can have significant adverse effects in patients with a history of mood disorders. 

Lithium is the major drug used to treat the mood disorders of mania and manic-depressive illness. Lithium is the only psychotherapeutic drug that is an effective prophylaxis against disease recurrence. 

Bipolar disorder is a cyclic mental illness with recurrent mood episodes that occur over a person s lifetime. The symptoms, course, severity, and response to treatment differ among individuals. 

Bipolar disorder (manic-depressive illness) is one of the most common of the severe chronic psychiatric disorders. The cyclic mood disorder is characterized by recurrent fluctuations in mood, energy, and behavior encompassing the extremes of human experiences.Bipolar disorder differs from recurrent major depression (or unipolar depression) in that a manic, hypomanic, or mixed episode occurs during the course of the illness. Bipolar disorder is a lifelong illness with a variable course and requires both nonpharmacologic and pharmacologic treatments for mood stabilization. ... 

Lithium provides effective prophylaxis against mood swings in severe and recurrent bipolar disorder in a proportion of patients. In initial randomised controlled trials, around 80% of patients were reported to benefit. More recent trials, however, suggest poorer results with 70% of patients relapsing and only 30% having good occupational outcome. 

Lithium carbonate is used specifically for the prophylaxis or prevention of recurrent mood changes in patients suffering from manic depressive psychoses, the recurrent affective disorders. It is of limited use for other psychiatric states, with the possible exception of pathological aggression, where it does seem to have a role to play. Despite many scares, lithium is a very safe drug in experienced hands. The ability of lithium to reduce or abolish recurrent mood swings has undoubtedly improved immensely the quality of life of many patients and their families and saved the lives of many who would otherwise have been led to suicide. ... 

Sudden lithium withdrawal also causes mood disorders to recur. A retrospective review of 310 charts yielded 53 cases of withdrawal [80 ]. Recurrence of a mood episode after lithium withdrawal was highest at 86% within 3 months. Withdrawal of antipsychotic drugs (64%) and antidepressants (58%) were associated with lower rates of recurrence. More than half of these episodes required hospitalization. 

The mood stabilizers were so called because they prevent recurrences of mood swings in people with bipolar disorder. The evidence for this is best with lithium, but is based on smdies carried out more than 20 years ago. However, recent naturalistic surveys tend to find that lithium is far less useful in general clinical practice than in research settings. Many patients discontinue lithium... 

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