Unipolar depression, major

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. 

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). 

Oruc, L., Verheyen, G. R., Furac, I. et al. Positive association between the GABRA5 gene and unipolar recurrent major depression. Neuropsychobiol. 36 62-64,1997. 

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. 

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. 

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. 

The treatment of the major depressive disorders such as unipolar and bipolar depressions was initially considered to be uniform, ffowever, with psychopharmacological advances, it has been demonstrated that the patients with bipolar depression may be partially responsive, at least prophylactically responsive, to lithium therapy, whereas the patients with unipolar depression are not as responsive (Abou-Saleh 1992). In addition, the treatment of depression may contribute through serendipity to the confirmation of a subgroup of patients with a bipolar disorder referred to as bipolar II. These patients, following treatment with antidepressants, will switch over to a hypomanic or fully manic phase resulting from pharmacological mechanisms. Thus, another subgroup of the bipolar disorder may be identified in the future. 

A number of epidemiological studies [including several reviewed in May and Lichterman 1993] have shown that panic disorder and unipolar depression occur more commonly together than could be explained by chance. Some 50%-70% of patients with panic disorder also have major depression [J. Johnson et al. 1990 Volrath and Angst 1989]. The association also holds true for seasonal depression [Halle and Dilsaver 1993] and to some extent for bipolar disorders [Savino et al. 1993]. 

Advances in this area have perhaps been the most profound over the past 5 to 10 years, occurring as a result of imaging studies followed by focused postmortem studies of the brains of patients with both bipolar and unipolar depression. Neuroimaging studies of patients with familial pure major depression have identified neurophysiological abnormalities in multiple areas of the orbital and medial prefrontal cortex (PFC), the amygdala, and related parts of the striatum and thalamus. Some of these abnormalities appear to be state dependent (i.e., present only when the patient is clinically depressed), whereas other abnormalities appear to be trait dependent (i.e., present whether the patient is depressed or not) ( 27). 

The form of depression discussed previously is often referred to as major depressive disorder or unipolar depression, in contrast to bipolar or manic-depressive disorder. As these terms imply, bipolar syndrome is... 

Major unipolar depressions reactive, biological, reactive-biological, atypical... 

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. ... 

Almost ten years later, the subjects, now adults in their twenties, were questioned about depressive symptoms and rate of drug use. Of these subjects, 8.3 percent were given unipolar depression diagnoses. Furthermore, 5.2 percent were alcohol dependent, and 6.1 percent used illicit drugs. Heavy alcohol, marijuana, and other illicit drug use were all correlated to major mood disorders. Over 80 percent of the depressed subjects had histories of marijuana use during adolescence and 66 percent reported illicit drugs use. 

The first major groups of antidepressant medications are the tricyclics, also known as the TCAs. Discovered in the late 1950s, these drugs are considered the oldest in the treatment of depression and have historically been used as the first line of medication intervention for the treatment of unipolar depression (Austrian, 1995). The side-effect profile that accompanies this group of medications, however, has recently caused them to fall into disfavor. For years, these medications were often considered the first choice for the client who suffers from depressed mood. Today, however, the antidepressant medications known as the selective serotonin inhibitors (SSRIs), and the selective serotonin norepinephrine inhibitors (SSNRIs) are often considered as the first-line medications. 

The natural history of major depression (either as unipolar depression or depressive phases of bipolar disorder) is that individual episodes tend to remit spontaneously over 6—12 months however, there is a high risk of relapse of depression for at least several months after discontinuation of antidepressant treatment. This risk is estimated at 50% within 6 months and 65—70% at 1 year, rising to 85% by 3 years. To minimize this risk, it is best to continue antidepressant medication for at least 6 months following apparent clinical recovery. Continued use of initially therapeutic doses is recommended, although tolerability and acceptance by patients may require flexibility. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

Major depression (also called unipolar depression) is the most serious type of depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once-pleasurable activities and may reoccur several times during a lifetime (5). Many people with major depression cannot continue to function normally. Major depression seems to run in families, suggesting that depressive illnesses can be inherited. Early signs (prodromal symptoms) of major depression include changes in brain function in those individuals having low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress. The treatments for major depression are medication, psychotherapy, and in extreme cases, electroconvulsive therapy. 

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