Mood Disorders Outline

See also: http://www.vakkur.com/psy/mood_faq.htm

Mood Disorders FAQ

Depression FAQ

Antidepressant FAQ

Mark Vakkur, MD, PC

www.vakkur.com

What is a Mood Disorder?

What is major depression and how is it different from sadness? Don't we all get depressed?

Question: what percentage of the American population gets major depression?

What is the natural course of depression?

Question: is depression treatable?

Question: Does depression reflect a weakness of character?

Can depressed patients become psychotic?

Question: What is bipolar disorder?

Question: how common is bipolar disorder?

QUESTION: What is the treatment for bipolar disorder?

Mood stabilizing medications (also called thymoleptics) are the rule. There are 3 medications with FDA approval for the treatment of mania: lithium; Depakote; and Zyprexa. Other medications may be helpful, such as Tegretol, but they do not have the specific FDA indication. Antidepressants also may help, once the mood has been stabilized, but they may also increase the risk of mania and convert someone into rapid-cycling.

No, it's thought to be a mood disorder; schizophrenia is thought to be a thought disorder. Having a family history of schizophrenia (assuming the diagnosis has been well-made) means you are LESS likely to have bipolar disorder (and vice versa). The two can be roughly distinguished as follows:

Note that many people with bipolar disorder can be very charismatic and engaging. This is in contrast to many who suffer from schizophrenia, who often are withdrawn and "autistic."

Besides the consequences of behavior while manic (increased spending, reckless sexual behavior, substance abuse), suicide is a major concern. The suicide rate for clients suffering from bipolar disorder is higher than for any other major psychiatric illness. This is why close observation and/or hospitalization is often necessary, especially following the first episode.

Absolutely. Perhaps the most common is substance abuse, especially of a stimulating substance like cocaine or amphetamines. The grandiosity, irritability, increase in goal-oriented activities, hypersexuality, and pressured, rapid, loud speech seen in these clients is sometimes indistinguishable clinically from mania. Other illnesses include schizoaffective disorder, schizophrenia, and a variety of organic disorders (head injury, stroke, medication side effect).

Yes, this is the rule. Most people suffering from mania do not recognize that they are ill and will view the idea of treatment as ridiculous. They may feel euphoric and grandiose, and completely incapable of grasping why you do not share their worldview. They may spend a great deal of money, engage in high risk behaviors such as taking on multiple sexual partners, or travel impulsively to other cities. Their judgment is as a rule impaired; they may disregard ethical concerns. Often as the mania progresses, the person may be common irritable and even violent. Suicidal risk is highest immediately following the manic episode. Bipolar disorder has one of the highest suicide rates of any mental illness.

Yes. Unfortunately, antidepressant medications, such as Prozac or Zoloft or Paxil, can trigger a manic episode in those who are predisposed. Also, sleep deprivation, abuse of stimulant medication, and extreme stress can trigger a manic episode. Studies at Heathrow airport in England demonstrate that travelers who lose sleep (travel East) have much higher subsequent rates of hospitalization for mania than travelers who travel west.

Rapid cycling bipolar disorder is characterized by at least four episodes per year. 10 - 15% of bipolar patients have rapid cycling. Females are more likely than males to have this.

Yes. The critical difference is that bipolar disorder should first be treated with a mood stabilizing medication. Since antidepressants can trigger a manic episode, they should generally be avoided until a mood stabilizer has been started. Only 3 mood stabilizers are currently approved by the food and drug administration for the treatment of mania: lithium; valproic acid (Depakote); and olanzapine (Zyprexa). Other medications that have been shown in clinical trials to be effective in the treatment of mania include carbamazepine (Tegretol) and adjunctive antipsychotic medication. Trials are ongoing with several other agents that show promise in treating this disorder. Benzodiazepines in the short-term may help normalize sleep and reduce agitation.

Absolutely. As a general rule, people who suffer from mood disorders tend to have more or less complete remission between episodes. With successful treatment, future episodes can be prevented or greatly ameliorated. However, it is absolutely critical that treatment be continued between episodes. Often when a person feels better, they discontinue their medication. Long term clinical trials indicate that the time to relapse disorder, the number of relapses is greater, the severity of the relapse is greater, and the response to treatment is less when medication is frequently started and stopped.

 [1] "In September 1809, after much difficulty in trying to mediate between the Natives and commercial interests, Lewis fled St. Louis for Washington to plead his case before the new administration. He caught a riverboat to Memphis, during which his feelings of melancholy were enhanced by his continued drinking, and he twice attempted to take his own life. Later, while staying in a roadhouse along the Natchez Trace, Lewis took his own life by shooting himself first in the forehead then in the breast. He was buried next to the tavern, and today the site is marked by a monument that was erected in his honor in 1846." - pbs.org (http://www.pbs.org/lewisandclark/inside/idx_corp.html).