Affective disorders

Affective disorders

 * DSM V: separation of bipolar and unipolar

Classification of affective disorders

 * According to..
 * ..Polarity
 * bipolar, unipolar
 * ..Cause
 * primary, secondary (e.g. hypothyroidism)
 * ..Intensity
 * mild, moderate or severe
 * ..Quality
 * psychotic, non-psychotic
 * ..Length
 * short-term fluctuations in mood
 * long-term decline in mood (dysthymia)

Depressive episode according to DSM-5 (F32, F33)

 * Have to meet 5 or more criteria for more than 2 weeks, while one of those have to be either depressed mood or anhedonia
 * They are classically called the "SIG E CAPS" criteria
 * Sleep disturbances, loss of Interest, Guilt, Loss of energy, Concentration problems, Appetite loss/gain, Psychomotor retardation/agitation, Suicidal ideation

Etiopathogenesis

 * various biological (monoamine hypothesis) and psychosocial factors
 * External factors: e.g. economic crisis in spain, corona-virus, cancer diagnosis

Epidemiology

 * w>m
 * incidence is increasing over the past years, as well as the consumption of antidepressants
 * relapse rate in 1 year: 30%, 5 years: 60% ... → in reality less (study was inpatient)


 * other data: 50% remission

subgroups at risk: family history, old age and loneliness, female gender, adverse life-events, certain life styles, serious physical condition (e.g. stroke)


 * Factors influencing the course of depression
 * age of onset
 * gender
 * sleep..

Phases of depression

 * 3 phases: acute (6-12 weeks), continuation (4-9 months), maintenance (> 1 year)

Treatment

 * Psychotherapy: mild-moderate symptoms
 * Antidepressants
 * in general: reuptake blockade (e.g. SSRIs, TCA(serotonin,Na)..), influence on receptors (newer drugs, serotonin, melatonin receptors...e.g. TCA on Ach)
 * Biological treatment
 * e.g. in acute treatment of patients with depression
 * ECT
 * Chronobiologic treatment
 * rTMS: comparable effectiveness with ECT

Complications

 * Serotonin syndrome
 * Failure of treatment
 * compliance? right diagnosis? right dose? time? (4-6 weeks!) → change, combination, dose, potentiation of antidepressant action
 * Side-effects related to medication
 * Suicide
 * majority of depressed patients think about suicide
 * 10% of depressed commit real suicide
 * drug-interactions: cave
 * https://reference.medscape.com/drug-interactionchecker

Prognosis

 * 50-70% of antidepressants...?
 * residual symptoms (e.g. fatigue) are a negative prognostic factor

When to initiate maintenance treatment?


 * first depressive episode: no indication
 * two in past 5 years: any risk factors? (e.g. onset, genetic risk)
 * three+