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
  • [1]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+

Related articles

• Depression