Depression unipolar

Studies of health economics in the UK and the USA in unipolar depressive illness show... 

Ikemi, Y. and S. Nakagawa, A Psychosomatic Study of Contagious Dermatitis , Kyoshu Journal of Medical Science 13 (1962) 335-50 Imel, Zac E., Melanie B. Malterer, Kevin M. McKay and Bruce E. Wampold, A Meta-Analysis of Psychotherapy and Medication in Unipolar Depression and Dysthymia , Journal of Affective Disorders no (2008) 197-206... 

These data show that for three psychotic disorders (schizophrenia, bipolar disorder and unipolar depression) the genetic contribution is over 50% but for reactive depression (in response to a traumatic life event ) and tuberculosis, an infectious disease caused by a species of Mycobacterium, environmental factors account for over 90% of the variance. 

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

Mood stabilisers are used to regulate the cyclical change in mood characteristic of bipolar disorder, since they can attenuate both manic and depressive phases. Their main use is as a prophylactic for manic depression and unipolar mania. However, they can also be administered concomitantly with antidepressants for refractory (non-responsive) unipolar depression. 

Bauer M et al. (2002). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. Part 1 Acute and continuation treatment of major depressive disorder. World Journal of Biological Psychiatry, 3, 5-43. 

Antidepressant A drug used principally to treat major depressive disorder (unipolar depression). 

McGuffin, R, Katz, R., Watkins, S. and Rutherford, J. A hospital-based twin register of the heritability of DSM-IV unipolar depression. Arch Gen. Psych. 53 129-136,1996. 

Fava, M., Vuolo, R. D., Wright, E. C. et al. Fenfluramine challenge in unipolar depression with and without anger attacks. Psych. Res. 94 9-18, 2000. 

Delusions, hallucinations, and suicide attempts are more common in bipolar depression than in unipolar depression. 

Hypothyroidism can precipitate a depression and be a risk factor for rapid cycling thyroid supplementation can be used for refractory rapid cycling and augmentation of antidepressants in unipolar depression. 

Schumann, G., Benedetti, E., Voderholzer, U., et al. (2001) Antidepressive response to sleep deprivation in unipolar depression is not associated with dopamine receptor genotype. Neuropsychobiology. 43, 127-130. 

Baghai, T.C., Binder, E.B., Schule, C., et al. (2006) Polymorphisms in the angiotensinconverting enzyme gene are associated with unipolar depression, ACE activity and hypercortisoUsm. Mol. Psychiatry, 11, 1003-1015. 

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. 

An episode of bipolar depression is virtually indistinguishable from that of unipolar depression. The key is to gather a careful history of the patient s premorbid functioning, earlier episodes of illness, and family psychiatric illness. This information should be gathered from the patient, as well as family members and friends. Previous episodes of full-blown mania seldom go unreported however, prior hypo-manic episodes are often unrecognized not only by the patient but by friends and family as well. One should inquire about periods of decreased need for sleep (as... 

Antidepressants. The use of antidepressants in the treatment of major depressive episodes has already been thoroughly discussed in Section 3.2. Therefore, we will not repeat that discussion here. Antidepressants that are useful for treating unipolar depression are most likely effective for bipolar depression as well, but several issues warrant discussion. 

In addition to epilepsy, reduced GABA has been recorded in patients with unipolar depression, following alcohol withdrawal and in hepatic encephalopathy. The finding that the concentration of GABA is reduced in depression is unexpected as there is no evidence that the disorder is associated with an increased cortical excitability. One possibility is that the reduction in GABA is a reflection of a decreased availability in its excitatory amino acid precursor glutamate. 

The diagnosis of mania is made on the basis of clinical history plus a mental state examination. Key features of mania include elevated, expansive or irritable mood accompanied by hyperactivity, pressure of speech, flight of ideas, grandiosity, hyposomnia and distractibility. Such episodes may alternate with severe depression, hence the term "bipolar illness", which is clinically similar to that seen in patients with "unipolar depression". In such cases, the mood can range from sadness to profound melancholia with feelings of guilt, anxiety, apprehension and suicidal ideation accompanied by anhedonia (lack of interest in work, food, sex, etc.). 

Manic-depressive illness connotes a psychotic disorder of affect that occurs episodically without external cause. In endogenous depression (melancholia), mood is persistently low. Mania refers to the opposite condition (p. 234). Patients may oscillate between these two extremes with interludes of normal mood. Depending on the type of disorder, mood swings may alternate between the two directions (bipolar depression, cyclothymia) or occur in only one direction (unipolar depression). 

The most common mood disorders are major depression (unipolar depression) and manic-depressive illness (bipolar disorder). Major depression is a common disorder that continues to result in considerable morbidity and mortality despite major advances in treatment. Approximately 1 in 10 Americans will be depressed during their lifetime. Of the 40,000 suicides occurring in the United States each year, 70% can be accounted for by depression. Antidepressants are now the mainstay of treatment for this potentially lethal disorder, with patients showing some response to treatment 65 to 80% of the time. 

Kudoh A., H. Isihara, and A. Matsuki (1998). Effects of carbamazepine on pain scores of unipolar depressed patients with chronic pain A trial of off-on-off-on design. Clinical Journal of Pain 14 61-65. 

There is an emerging literature in MRS in adults with BD, with reports of decreases in dorsolateral prefrontal cortex of neuronal marker NAA (Winsberg et al., 2000) and abnormalities in phopholipid metabolism (Kato et ah, 1995, 1998 Hamakawa et ah, 1999). There is preliminary work to suggest that cortical GABA levels and glutamate turnover are decreased in unipolar depression in adults, but these abnormalities may not be present in bipolar depression (Sanacora et al., 1999, Mason et al., 2000). 

Shah, P.J., Ebmeier, K.P., Glabus, M.F., and Goodwin GM (1998) Cortical grey matter reductions associated with treatment-resistant chronic unipolar depression. Controlled magnetic resonance imaging study. Br J Psychiatry 172 527-532. 

---