Natural Treatment for Depression

Destroy Depression

Destroy Depression is written by James Gordon, a former sufferer of depression from the United Kingdom who was unhappy with the treatment he was being given by medical personnell to fight his illness. Apparently, he stopped All of his medication one day and began to search for answers on how to cure himself of depression in a 100% natural way. He spent every waking hour researching all he could on the subject, making notes and changing things along the way until he had totally cured his depression. Three years later, he put all of his findings into an eBook and the Destroy Depression System was born. The Destroy Depression System is a comprehensive system that will guide you to overcome your depression and to prevent it from injuring you mentally and physically. Read more here...

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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this book are precise.

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Pharmacological Treatment of Major Depressive Disorders

For depressive disorders, controversy remains regarding whether medication or psychosocial interventions are more effective in bringing symptom relief (Craighead, Milkowitz, Vajk, & Frank, 1998a Friedman et al., 2004 Nemeroff & Schatzberg, 1998). Nevertheless, there is little question that those treated with antidepressants will have a more favorable course than those who do not take these medications (Angst, 1998). The treatments of choice for the relief of major depressive disorders are the drugs known as selective serotonin reuptake inhibitors, such as Prozac (Nemeroff & Schatzberg, 1998). This class of drugs is named for the nature of the effect they have on the neu-rotransmitter serotonin. Next, most commonly used are the tricyclic antidepressants such as Tofranil (imipramine), which are named for their chemical structure of three molecular circles. A third group of drugs, monoamine oxidase (MAO) inhibitors, although effective, is rarely used. Typically, it takes at least 3 to 6...

Does Antidepressant Medication Improve the Course and Outcome of Major Depression

Can antidepressant medication be used to improve the long-term course and outcome of major depression The use of antidepressants appears to have a positive effect on relapse rates. In the first year, those not receiving antidepressants had a 45 chance of relapse, while those who did receive these medications had a relapse rate of 20 . Among the groups without antidepressants, at the 14-month follow-up, 50 had relapsed. Among those being treated with antidepressants, the 50 relapse rate was not reached until 48 months. More previous episodes were associated with higher relapse. However, more previous episodes did not predict responsiveness to treatment. Although these findings highlight the efficacy of antidepressants, they also point out, once again, that, like the other severe mental illnesses, major depression relapses are a matter of time, even when medication is taken (Viguera et al., 1998).

Major Depressive Disorder

If the distinction between dementia and depression remains unclear, a trial of antidepressants is warranted because the prognosis for depression is much better than that of dementia. If the depression is superimposed on the dementia, treatment of the depression will improve the functional level of the patient.

Relationship between Depressive State and Reduced Dopaminergic and Serotonergic Transmission

To clarify the involvement of the reduction in serotonergic and dopaminergic transmission in the PFC in the chronic stress-induced depressive state, the beneficial effects of the serotonergic antidepressant, trazodone and those of SKF 81297 were examined. As shown in Figure 7, the chronic stress-induced impairment of rotarod performance was ameliorated by trazodone in a dose-dependent manner. Since the traction performance and locomotor activity were not affected by trazodone, the ameliorative effect of trazodone does not appear to be caused by an effect on muscle strength or motor function. Considering that trazodone has a 5-HT reuptake inhibitory action (Clements-Jewery et al., 1980), it is postulated that chronic stress induces a depressive state caused by a reduction in serotonergic transmission in the PFC (Fig. 6). Since trazodone also has a 5-HT2 receptor antagonistic action, dysfunction of 5-HT2 receptors may be attributed to the depressive state. Indeed, chronic forced swim...

Combined Treatment Medication and Psychosocial of Major Depression

Depression can often be a chronic disorder with a high risk of relapse that requires active treatment, often with a combination of medication and psychotherapy. Identifying which individuals would particularly benefit from psychosocial as compared to pharmacological approaches and developing an understanding of the mechanisms of action of these therapies remain major challenges (Scott & Watkins, 2004). In the treatment of major depression, behavioral therapy, cognitive-behavioral therapy, marital therapy, and interpersonal therapy have all been found to reduce depressive symptoms (Craighead et al., 1998a). A complete discussion of these treatments is outside the scope of this book. Depressive disorders that are treated definitely have a better course than depressions that remain untreated (Angst, 1998). Interventions using behavior therapy, cognitive-behavioral therapy, and interpersonal therapy have all brought about significant reductions in depressive symptoms. In 12 out of 15...

Clinical Depression

Clinical depression is an emotional disorder characterized by extreme sadness or a loss of ability to experience pleasure. Its clinical features also include symptoms that are cognitive (for example, low self-worth), behavioral (for example, decreased activity level), and physical (for example, fatigue). Depression is a frequently diagnosed disorder in both inpatient and outpatient mental health settings. Clinical depression is a severe emotional disorder that is characterized by four classes of symptoms emotional, cognitive, behavioral, and physical. The major emotional symptoms, at least one of which is necessary for the diagnosis of depression, are dysphoria (extreme sadness or depressed mood) and anhedonia (lack of capacity to experience pleasure). Depressed individuals also experience cognitive symptoms. They may have feelings of worth-lessness or excessive or inappropriate guilt. Some may have recurrent thoughts of death or suicidal ideation others actually attempt suicide or...


SSRIs and tricyclic antidepressants are widely used to treat anxiety disorders. SSRIs appear to have similar efficacy to venlafaxine and should also be considered as first line therapy. Their onset of action is much slower than that of the benzodiazepines, but they have no addictive potential and may be more effective. An antidepressant is the agent of choice when depression is present in addition to anxiety. b. Antidepressants are especially useful in patients with mixed symptoms of anxiety and depression.

Depressive State

The rotarod is an established test for evaluating pharmacological actions of psychotropic agents such as skeletal muscle relaxants, anticonvulsants, and antidepressants in the central or peripheral nervous system (Dunhan and Miya, 1957). Morimoto and Kito (1994) have shown that this test is useful to evaluate the antidepressive effects of serotonergic and adrenergic antidepressants. As shown in Figure 5, chronic stress impaired the rotarod performance, concomitant with unchanged traction performance and locomotor activity, suggesting that the impaired rotarod performance is not due to muscle relaxation or motor dysfunction. As antidepressants increase the riding time on the rotating rod in normal rats (Morimoto and Kito, 1994), the impaired rotarod performance suggests a depressive behavioral state.

DSMIV diagnostic criteria

Schizoaffective disorder is an illness which meets the criteria for schizophrenia and concurrently meets the criteria for a major depressive episode, manic episode, or mixed episode. C. If manic or mixed symptoms occur, they must be present for one week and major depressive symptoms must be present for two weeks. A. Bipolar Type. Diagnosed when a manic or mixed episode occurs. Major depression may also occur. B. Depressive Type. Diagnosed if only major depressive episodes occur. C. Delusional Disorder. Depressive symptoms can occur in delusional disorders, but psychotic symptoms of a delusional disorder are non-bizarre compared to schizoaffective disorder. B. The depressed phase of schizoaffective disorder is treated with antidepressant medications (see Antidepressant Therapy, page 109).

Dsmivtr Criteria for Bipolar I Disorder

Only one Manic Episode and no past Major Depressive Episodes Manic Episode not better accounted for by Schizoaffective Disorder and not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified Specify mixed if symptoms meet criteria for Mixed Episode Specify for current or most recent episode Severity Psychotic Remission Specifiers with Catatonic Features with Postpartum Onset Specify Longitudinal Course Specifiers (with and Without Interepisode Recovery) with Seasonal Pattern (applies only to pattern of Major Depressive Episodes) with Rapid Cycling The initial episode of bipolar disorder is typically one of mania or elation, although in some people a depressive episode may signal the beginning of the disorder. Episodes of bipolar disorder can recur rapidly within hours or days or may have a much slower recurrence rate, even of years. The duration of each episode, whether it is depression or mania, varies widely among...

Treatment Approaches

There are several major approaches to the treatment of clinical depression, each focusing on one of the four classes of symptoms of depression. Psychoanalytic therapists believe that the cause of depression is emotional underlying anger that stems from some childhood loss and that has been turned inward. Psychoanalysts therefore treat depression by helping the patient to identify the cause of the underlying anger and to cope with it in an effective manner. ture, and that they interpret their experiences in a distorted fashion so as to support these pessimistic views. A related cognitive model of depression is that of Martin E. P. Seligman. He argues that depression results from the perception that one is helpless or has little or no control over the events in one's life. Seligman has shown that laboratory-induced helplessness produces many of the symptoms of depression. Cognitive therapy for depression, which Beck described in 1979, aims at helping depressed patients identify and then...

The Experience of Hospitalization

After being discharged from the hospital, what is the likelihood of rehospitalization One of the most illustrative articles on this topic was published by Anthony, Cohen, and Vitalo (1978). By comparing the reported recidivism (rehospitalization) rates from the studies available at the time (see Table 3.1), the authors demonstrated that the probability of relapse in the short term (1 to 5 years) is very high. An examination of Table 3.1 reveals that as the follow-up period increases from 3 months to 5 and 10 years, the corresponding cumulative rate of recidivism also increases from 10 to 15 to as high as about 75 . Clearly, if you have been hospitalized because of a serious mental illness, the chance you will need rehospitalization at some point in time is very high. This high risk of relapse is true of schizophrenia, schizoaffective disorder, major depression, and bipolar disorder.

Sources for Further Study

Shaw, and G. Emery. Cognitive Therapy of Depression. 1979. Reprint. New York Guilford Press, 1987. Summarizes the cognitive theory of depression and describes how this model can be applied in the treatment of depressed patients. Beutler, Larry E., John F. Clarkin, and Bruce Bongar. Guidelines for the System Seligman, Martin E. P. Helplessness On Depression, Development, and Death. 1975. Reprint. San Francisco W. H. Freeman, 1992. Seligman explains the learned helplessness theory of depression, describing his early research and comparing the symptoms of laboratory-induced helplessness to those of clinical depression.

Mental Disorders and Public Health

The World Development Report and associated publications 7-9 have provided the first estimates that have allowed comparison between depression, other mental disorders and physical illness leading to death. The report estimated that neuropsychiatric disorders led to 8 of the Global Burden of Disease (GBD). For adults aged 15 to 44, mental disorders are estimated to account for 12 of the GBD. Mental disorders are projected to increase to 15 of the GBD and major depression is expected to become second only to ischaemic heart disease in terms of disease burden by the year 2020 8 .

Therapeutic Techniques

Finally, cognitive therapy has been applied to a variety of psychological disorders with striking success. For example, studies from seven independent centers have compared the efficacy of cognitive therapy to antidepressant medication, a treatment of established efficacy. Comparisons of cognitive therapy to drugs have found cognitive therapy to be superior or equal to antidepressant medication. Further, follow-up studies indicate that cognitive therapy has greater long-term effects than drug therapy. Of special significance is the evidence of greater sustained improvement over time with cognitive therapy.

Depression and Cognitive Therapy

Cognitive theory and cognitive therapy originated in Beck's observation and treatment of depressed patients. Originally trained in psychoanalysis, Beck observed that his patients experienced specific types of thoughts, of which they were only dimly aware, that they did not report during their free associations. Beck noticed that these thoughts were frequently followed by an unpleasant effect. Further, he noted that as the patients examined and modified their thoughts, their mood began to improve.

Clinical Features of Dysthymic Disorder

Symptoms of dysthymic disorder are similar to those of major depression. The most common symptoms are loss of pleasure in usually pleasurable activities, feelings of inadequacy, social withdrawal, guilt, irritability, and decreased productivity. B. Changes in sleep, appetite or psychomotor behavior are less common than they are in major depressive disorder. D. Episodes of major depression may occur after the first two years of the disorder. The combination of dysthymia and major depression is known as double depression.

Gender Differences in Prevalence of Common Mental Disorders

The OPCS National Survey of Psychiatric Morbidity has noted that the relationship with gender appeared to vary according to age. In older subjects the prevalence of common mental disorders was no higher in women than men in the UK 62 . In the Chile survey, older men were more likely to show depressive symptoms than women. These may have been chance findings, though the consistency of finding argues against this. This result

Understanding Course Treatment and Outcome What the Staff and Consumers Dont Know Can Hurt Them

And recurrent major depression (Keck & McElroy, 1998 Nemeroff & Schatzberg, 1998). Still, the need to take medication on a long-term basis presents a major challenge for consumers, their loved ones, PsyR staff, and psychiatrists. Because it may take weeks or months for the effects of the medication to weaken and leave the body completely, the connection between discontinuing medication and a relapse is sometimes difficult for both the individual and the family to recognize. Conveying the knowledge of the importance of continuing medication is imperative. These truths highlight the necessity for collaborative psychopharmacology, illness management and recovery training (discussed earlier) and family psychoeducation (see Chapter 13).

Treatmentof Dysthymic Disorder

Many patients respond well to antidepressants. SSRIs are most often used. If these or other antidepressants such as venlafaxine, nefazodone or bupropion have failed, then a tricyclic antidepressant such as desipramine, 150 to 200 mg per day is often effective. (For a complete discussion of antidepressant therapy, page 109) C. Psychotherapy Cognitive psychotherapy may help patients deal with incorrect negative attitudes about themselves. Insight oriented psychotherapy may help patients resolve early childhood conflicts that have precipitated depressive symptoms. Combined psychotherapy and pharmacotherapy produces the best outcome.

Intendedness of Pregnancy and Preterm Delivery

It is estimated that approximately 60 percent of all pregnancies are unintended, and of these, about half end in a live birth (IOM, 1995). Women with unintended pregnancies are less likely to seek early prenatal care (Bitto et al., 1997 IOM, 1995 Kost et al., 1998 Pagnini and Reichman, 2000) and are more likely to use alcohol or tobacco (IOM, 1995). They also appear to be more likely to experience high levels of exposure to psychosocial stress and depressive symptoms (Orr and Miller, 1997). Although unintended pregnancies occur among women across the sociodemographic spectrum, they are disproportionately likely among mothers who are adolescent, unmarried, or over age 40 (Bitto et al., 1997 IOM, 1995). The child of an unwanted pregnancy (as opposed to the child of a wanted or a mistimed pregnancy) is at greater risk of low birth weight, death in the first year of life, abuse, and receiving insufficient resources for optimal early child development (IOM, 1995). Additional consequences...

Endocrinological Aspects

Decreased growth hormone (GH) response to pharmacological stimulation has been found in children and adolescents during an episode of major depressive disorder and after recovery. GH secretion is similarly altered in children and adolescents who had never experienced depression but were at high risk of developing depression 53 . These results suggest that the decreased GH response found in high-risk subjects may represent a trait marker for depression in children and adolescents. It is interesting to note that one of the candidate psychogenes identified by our work using convergent functional genomics 5 described below is insulin-like growth factor 1 (IGF1), a downstream effector in the GH pathway.

Delusional disorder and other psychotic symptoms

Related to an organic brain syndrome or peripheral degenerative changes that may cause some cutaneous dysaesthesias. A delusional disorder may coexist with a major depressive episode where the patient experiences delusions that are congruent with his or her depressed mood, and typically represent a more severe form of depressive disease. BDD is often associated with delusions of disfigurement. If the delusion or hallucination becomes more bizarre and if they are clearly implausible and not derived from normal life experience (e.g. a complaint that aliens are putting electricity through the body and causing the patient to feel a stinging sensation in the skin) the diagnosis of schizophrenia should be considered.

Druginduced effects on gastric emptying

Drugs contained within the formulations may also alter gastric motility. For example adrenergic agonists, particularly E2-agonists such as salbutamol, delay gastric emptying. In asthmatic subjects an variable quantity of the inhaled drug may be swallowed, and hence even though the drug is not taken by the oral route, it may still have an effect on the gastric emptying of other drugs. Tricyclic antidepressants and some anti-Parkinsonian drugs depress gastrointestinal motility. Dopaminergic antagonists e.g. domperidone, and cholinergic agonists e.g. bethanechol, enhance gastric motor activity.

Associated Medical Problems

Low levels of potassium and sodium and other imbalances in the body's electrolytes can lead to cardiac arrest, kidney failure, weakness, confusion, poor memory, disordered thinking, and mood swings. The death rate for anorexics is high About 5 percent will die within eight years of being diagnosed and 20 percent within twenty years.

Attention to Quality of Life

The physician in charge of the continuity in care of the thyroid cancer patient (likely the endocri-nologist) is instrumental in promoting compliance with the long-term follow-up and the required repeat investigations. Compliance can be enhanced by giving attention to many details which - although not determining the main outcome of the disease - may severely affect the patient's life. The cost of care should not be forgotten, as patients may have no or insufficient insurance 44 . The incidence of chronic xerostomia as a result of 131I-induced sialadenitis may decrease considerably with amifostine pretreat-ment 45 . During thyroid hormone withdrawal, hypothyroid symptoms are common such as fatigue, weight gain, peripheral edema, muscle cramps, skin dryness, anxiety, constipation, cold, depression, and impairment of memory and concentration these complaints are more pronounced in the elderly than in younger patients 45 . It is thus not surprising that quality-of-life questionnaires...

Advances and Insights from Pharmacological Studies

The interplay between sleep disturbances and mood disorder is underlined, for example, by the use of stimulants to augment antidepressant treatment in patients who have had only a partial response to first-line therapy. Modafinil is a novel psychostimulant that has shown efficacy in, and is marketed for, treating excessive daytime sleepiness associated with narcolepsy. The mechanism of action of modafinil is unknown, but, unlike other stimulants, the drug is highly selective for the CNS, has little effect on dopaminergic activity in the striatum, and appears to have a lower abuse potential. In a retrospective case series of seven patients with DSM-IV depression (four with major depression and three with bipolar depression) in whom modafinil was used to augment a partial or non-response to an antidepressant, all patients achieved full or partial remission within 1-2 weeks 89 . These preliminary results suggest that modafinil may be of use as an augmenter of antidepressants, especially...

Treatmentof Post Traumatic Stress Disorder

Older antidepressants (imipramine, amitriptyline, and MAO inhibitors) are moderately effective, especially for symptoms of increased arousal, intrusive thoughts, and coexisting depression. Sertraline (Zoloft) has demonstrated efficacy for all the symptom clusters of PTSD. Other SSRIs are also likely to be effective. Treatment at higher doses than are used for depression may be required. B. Propranolol, lithium, anticonvulsants, and buspirone may be effective and should be considered if there is no response to antidepressants. Benzodiazepines have not been effective for PTSD, except during the early, acute phase of the illness.

Stress And Prefrontal Cortical Dysfunction In The

Abstract Although the mechanism responsible for cognitive deficits or a depressive state in stress-related neuropsychiatry disorders has not been fully elucidated, dopaminergic or serotonergic dysfunction in the prefrontal cortex (PFC) is thought to be involved. In rats, the mesoprefrontal dopaminergic system, in particular, is activated in response to acute stress, whereas chronic stress reduces dopaminergic transmission in the PFC, causing working memory impairment through a Di receptor mechanism. However, chronic stress does not affect reference memory, which is attributed to hyperactivity of hippocampal cholinergic transmission. In addition, chronic stress induces a depressive behavioral state, caused by a reduction in dopaminergic and serotonergic transmission in the PFC. These findings provide important information for the understanding of the mechanisms underlying PFC dysfunction in stress-related neuropsychiatry disorders. In this chapter, I mainly discuss the mechanisms of...

Prospective Memory in Affective Disorders

Overview There is nearly a complete lack of studies investigating prospective memory in affective disorders such as major depression or bipolar disorder, although some studies have addressed this issue in nonclinical samples (see Kliegel, J ger, et al., 2005 see Kliegel & J ger, 2006, for a review). As impairments in retrospective memory (Austin, Mitchell, & Goodwin, 2001 Burt, Zembar & Niederehe, 1995 Rogers et al., 2004) and executive functions (Channon, 1996 Elliott et al., 1997 Robertson & Taylor, 1985) have been found in major depression and bipolar disorder (Quraishi & Frangou, 2002), one can expect prospective memory deficits in patients suffering from affective disorders. Relevant Findings So far, only one study has addressed prospective remembering in major depression (Rude, Hertel, Jarrold, Covich, & Hedlund, 1999). In this study, patients demonstrated substantial deficits in their ability to carry out a time-based prospective memory task relative to normal controls. This is...

Sex Differences in Metabolic Pathways

The CYP2D6 isoenzyme is polymorphic and metabolizes more than 40 drugs commonly in use, including antidepressants, antiarrhythmics, analgesics, and beta-blockers. Poor metabolizers comprise 5-10 of the Caucasian population but only about 2 of African-American or Asian populations. Heterozygous extensive metabolizers (or intermediate metabolizers) are common in African-American and Asian populations but many studies do not report genotypes or ethnicity. Although rat studies suggest a sex difference in metabolic activity of CYP2D6 (male greater than female), this finding has not been replicated in primates (44, 45). The limited in vivo human data exhibit conflicting results. Studies using clomipramine and ondansetron as CYP2D6 substrates showed small but significant differences in enzyme activity, with men having greater activity than women (46, 47), but neither omeprazole nor clomipramine are validated probe drugs for CYP2D6. Other studies using the validated probe dextromethorphan...

Hypothalamicpituitarygonad Axis

The response to administration of exogenous GnRH in depressed patients has also been investigated. Normal LH and FSH responses to a high dose of GnRH (250 g) have been reported in male depressed and female depressed (pre- and postmenopausal) patients 104 , whereas a decreased LH response to a lower dose of GnRH (150 g) has been reported in pre- and postmenopausal depressed patients 102 . Unden et al. 105 observed no change in basal or TRH luteinizing hormone-releasing hormone (LHRH)-stimulated LH concentrations in a depressed cohort including both sexes, though depressed males with an abnormal DST response showed a significantly higher increase in FSH compared to the controls.

Studies Conducted in Areas Where Refugees Have Settled

Diagnostic Interview for Children and Adolescents (DICA) 10 and the Schedule for Affective Disorders and Schizophrenia for School Age Children (KSADS) 11 , it was found that, whereas among the youths the point prevalence was 18.2 for PTSD and 11 for depressive disorders, the parents showed a much higher point prevalence 53.2 PTSD and 22.2 depression in mothers and 29.4 PTSD and 23.4 depression in fathers. Comorbidity was also higher among the parents than in their children. In Thailand, Allden et al. 12 studied 104 Burmese political prisoners and found that 38 had elevated scores for depression and 23 for PTSD. Drozdek 13 found PTSD in 44 of the Bosnian refugees surveyed by him. In a prospective study over a 2-year period, Beiser and Hyman 14 found the prevalence of depression to decrease from 6.4 to 3.1 , in 1348 South East Asian refugees settled in Vancouver. The prevalence of mental disorders among a group of Central American refugees in the USA was also found to be very high PTSD...

Historical Context

Clifford Beers was an articulate and intelligent Yale graduate who suffered from bipolar disorder, then called manic-depressive illness. Shortly after his graduation from college in the early 1900s, he suffered a mental collapse that resulted in his being hospitalized in several of what were then called mental asylums. Though much of the neglect and mistreatment of patients common in Dix's time had been eliminated, Beers soon discovered that confining patients in strait-jackets and choking them into unconsciousness were still very much a part of mental health care in American psychiatric hospitals. Beer's mistreatment and his recovery in spite of it became the basis of his 1908 bestseller, A Mind that Found Itself. Two of Beers' staunchest and most influential admirers turned out to be James and famed psychiatrist Adolph Meyer. Meyer coined a new name for what was then commonly called madness mental hygiene. That same year, the Society for Mental Hygiene was founded, soon followed by...

Autonomic Nervous System

Data are sparse that conclusively establish that altered drug effects result from impaired ANS function, perhaps due to the difficulty in ascribing a particular drug effect to a particular ANS function. However, increased orthostatic hypotension seen at baseline, in addition to drugs that cause sympathetic blockade, such as typical neuroleptics and tricyclic antidepressants, is likely to be a contributing factor to the increased incidence of hip fracture noted in patients receiving these drugs (41). Similarly the

Somatic theory of insanity

ECT developed after the 1935 discovery that schizophrenia could be treated by convulsions induced through camphor injection. Soon, convulsion production was accomplished by passage of electric current through the brain, as described in 1938 by Italian physicians Ugo Cerletti and Lucio Bini. ECT was most successful in alleviating depression and is still used for that purpose. In contrast, classic psychosurgery by bilateral prefrontal leu-cotomy (lobotomy) is no longer performed because of its deleterious effects on the physical and mental health of many subjects. These effects included epilepsy and unwanted personality changes such as apathy, passivity, and low emotional responses. It should be remembered, however, that psycho-surgery was first planned to quiet chronically tense, delusional, agitated, or violent psychotic patients.

Clinical Symptoms and History

Premenstrual syndrome is characterized by mood swings, depressed mood, irritability and or anxiety, which may be accompanied by physical symptoms. These symptoms occur exclusively during the luteal phase of the menstrual cycle. Common physical symptoms observed in PMS are breast tenderness, abdominal bloating, headache, and joint and muscle aches. The diagnosis of PMDD requires marked mood disturbance (depression, irritability, mood swings) as well as the presence of other emotional and or physical symptoms. Additionally, a significant

Dimensions of the problem

Of the ten leading causes of disease burden in young adults (in the 15A4 year age group) four were neuropsychiatric conditions. In 1998, alcohol dependence, unipolar major depression, bipolar disorder and schizophrenia were among the leading causes of disease burden in adults aged 15A44 years.

Studies of Prescribing Outcomes

Ray et al. identified 1021 patients with hip fractures and matched case-controls. They concluded that the risk of hip fracture was approximately doubled for patients taking CNS agents with half-lives over 24 h (odds ratio (OR) 1.8). For tricyclic antidepressants, OR 1.9 for antipsychotics, OR 2.0. The risk was dose related. These data show that the sedative effects of psychotropic drugs increase the risk of falling and fractures in elderly persons. 51 (See Chapter 2.)

Lifestyle Interventions

Patients with mild to moderate premenstrual symptoms have reported that reducing caffeine, refined sugars, or sodium intake can be helpful. Although increased exercise has been found to reduce symptoms of major depressive disorder, there is no definitive evidence that it results in improvement of PMDD symptoms. There are no recent controlled studies to support the anecdotal reports of the benefits of a healthy diet and exercise for premenstrual syndrome. Nonetheless, these interventions are recommended because of their other benefits and safety.

Treatment of Premenstrual Dysphoric Disorder

SSRIs such as fluoxetine (marketed as Sarafem for PMDD) is effective in reducing symptoms of PMDD. The dosage of fluoxetine (Sarafem) is 20 mg per day throughout the month. The dosage may be increased up to 60 mg per day if necessary. Sertraline (Zoloft) is also effective in treating PMDD. Sertraline should be started at 50 mg per day and increased up to 150 mg if necessary. These agents are often effective when given only during the luteal-phase.

Examples of Medications Use Indicators

Apparently inappropriate length of therapy (LT). LT is the duration from the earliest time of dispensing to the most recent, within a defined therapeutic class, where therapy was continuous. (Therapy was continuous if there was no interval longer than 2 weeks between theoretical refill dates and the next actual refill date.) An example is short length of therapy for selective serotonin reuptake inhibitor (SSRI) antidepressants. SSRIs may require many weeks to show therapeutic effect, and some patients may become discouraged and stop taking their medicine before it has time to work. Another example is long length of therapy for appetite suppressants, or cyclobenzaprine. These drugs lose their effectiveness after a certain period. Their behavioral side effects, possibly including habituation and dependency, would no longer be justified by their therapeutic effects.

Prevalence Of Mental Disorders Among Homeless People

In most studies of homeless populations, the lifetime prevalence of mental disorders is 28-37 3.3-5 for severe cognitive disorders (dementia), 7.813 for schizophrenia, 8.2-17.5 for severe depressive disorders, and 5 for bipolar disorder. In addition, a pooled lifetime prevalence estimate from diverse studies indicates that 56 of homeless people in their lifetime will meet criteria for a substance-related disorder 30 .

The Use Of Health Care Services By The Homeless Mentally

In order to clarify which factors predict care for mental disorders, two series of logistic regression were computed, using any contact with the health system for psychiatric symptoms and hospitalization as dependent variables. Men were less frequently in contact with the health system than women, especially in the case of depressive disorder. Young homeless subjects under 25 years old appeared to be undertreated they had six times less contact with the health care system in the case of schizophrenia and alcohol- or drug-related disorders, and four times less in the case of depressive disorder. Concomitant alcohol- and drug-related problems increased levels of contact in the case of depressive disorders. Being born in France increased contact with the health system for alcohol-related disorders, and having had a job increased the likelihood of contact for drug-related disorders, irrespective of age. Negative life events before the age of 12 increased the chance of hospitalization for...

Heatstroke and Hypothermia

Gradual acclimatization before travel, if possible, facilitates this adjustment. Adequate hydration and appropriate clothing are essential in both hot and cold climates. In hot climates, anticholinergic agents as well as beta blockers, calcium antagonists, diuretics, antihistamines, and tricyclic antidepressants may impair thermoregulation, worsen dehydration, or precipitate heatstroke.

Lamotrigine Lamictal

Clinical experience suggests that it may be effective in the treatment of manic and depressive episodes. It also appears to be more effective in the treatment of depression compared to other mood stabilizers, prompting some clinicians to use it in treatment resistant unipolar depression. C. Lamotrigine has been successful as monotherapy and as adjunctive treatment to other mood stabilizers and or antidepressants. It appears to be effective for mixed episodes and rapid cycling.

Becks continuity hypothesis

Explanation Beck's continuity hypothesis has systematic as well as practical consequences. In terms of his system of thought, the continuity hypothesis provides a bridge between schemas and cognitions on the one hand and what Beck calls automatic thoughts on the other. Beck's concept of automatic thoughts, which he defines as brief signals at the periphery of consciousness, grew out of his early work with depressed patients. One patient undergoing treatment in 1959, when Beck was still practicing traditional psychoanalysis, reported a secondary succession of thoughts that occurred while he was free-associating and angrily criticizing Beck. The thoughts concerned feelings of guilt for verbally attacking the therapist. Beck was intrigued by the patient's account of his internal monologue and began asking other patients if they had thoughts during therapy sessions that they had not mentioned. On the basis of their replies, he elaborated his notion of automatic thoughts.

Substance Abuse and Dependence

Posttraumatic Stress Disorder patients with comorbid Substance Abuse or Dependence Disorders have been found to have higher levels of pathology in both disorders, more stressors, higher rates of health care utilization, less effective coping skills, and poorer responses to treatment than either disorder alone (Meichenbaum, 2003). Additionally, comorbid disorders of Panic Disorder, Major Depressive Disorder, Personality Disorders, Antisocial Behavior, and violence exist at higher rates. A quick summary of the DSM-IV-TR criteria for Substance Abuse are characterized by at least one of the following

Course Treatment and Outcome of Severe and Persistent Mental Illnesses

Depressive Disorders 86 Does Antidepressant Medication Improve the Course and Outcome of Major Depression 87 Disorder 95 Combined Treatment (Medication and Psychosocial) of Major Depression 95 Some Ineffective Treatments 95 Maria's Story 96 Understanding Course, Treatment, and Outcome What the Staff and Consumers Don't Know Can Hurt Them 97

Psychological Model of Adjustment to Cancer

Inauthor Stirling Moorey

Psychological adjustment, based on an individual's appraisal of cancer, is associated with emotional response. Greer and Watson 10 have described five distinct styles of adjustment fighting spirit avoidance or denial fatalism helplessness and hopelessness and anxious preoccupation. Fighting spirit is characterized by a perception that cancer is a threat to be actively challenged. It is associated with less risk of developing anxiety and depression. The helpless and hopeless adjustment style, characterized by a perception of major loss and a lack of active coping behaviors, is associated with clinical depression. An anxiously preoccupied adjustment style characterized by excessive worrying and compulsively seeking reassurance is associated with clinical anxiety 9 .

Clinical Forms of Anxiety

Among the forms of pathological anxiety, the DSM-IV-TR 1 distinguishes, in addition to generalized anxiety, phobias, panic attacks, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). There are some theories that since OCD involves structural and functional organic deficits, it is questionable whether it can be classified as an anxiety or depressive disorder 2 . The ICD-10 3 in fact classifies this disorder separately from the other manifestations often associated with it.

The Stress VulnerabilityCoping Competence Model

The stress vulnerability coping competence model was proposed by two individuals who are well known in the field of psychiatric rehabilitation, William A. Anthony and Robert Paul Liberman (1986). An elaboration of the diathesis stress model described earlier, the stress vulnerability coping competence model provides both a theory about the cause of severe mental illness and an explanatory framework for the impact that psychiatric rehabilitation and treatment interventions can have on the symptoms and functional level of people who have psychiatric disabilities. The model proposes the following Individuals inherit or otherwise acquire a vulnerability (sometimes referred to as diathesis) to major mental illnesses such as schizophrenia, major depression, or bipolar disorder. This vulnerability results in abnormal development of brain structures and processes or an unusual type of stress reaction.

HPT Axis Dysfunction in Patients with Primary Psychiatric Disorders

Excluding patients with primary endocrine disorders, a considerable amount of data has revealed an elevated rate of HPT axis dysfunction, predominantly hypothyroidism, in patients with major depression. More than 25 years ago, research groups led by Prange and Kastin demonstrated that approximately 25 of patients with major depression exhibit a blunted TSH response to TRH 8, 9 . Presumably this is due to hypersecretion of TRH from the median eminence, which leads to TRH receptor down-regulation in the anterior pituitary resulting in reduced sensitivity of the pituitary to exogenous TRH. This hypothesis seems plausible in the light of evidence showing elevated TRH concentrations in the CSF of drug-free depressed patients 10 . Depressed patients have also been shown to have an increased occurrence of symptomless autoimmune thyroiditis (SAT), defined by the abnormal presence of antithyroglobulin and or antimicro-somal thyroid antibodies consistent with grade 4 hypothyroidism 11 ....

GFP in Miniaturized Microfluidicbased Assays

Another mutant of GFP, the enhanced GFP (EGFP), has been employed for the high-throughput screening of calmodulin antagonists in a microtiter plate and a CD microfluidic platform 70, 75 . A class-selective homogeneous assay for the detection of phenothiazine-type antidepressants has been developed. Phenothiazine drugs are known to bind the Ca +-binding protein calmodulin effectively, inhibiting the interaction of calmodulin with other peptides or proteins in various biological pathways. A fusion protein of calmodulin (CaM) and EGFP was first genetically constructed. The conformational change of calmodulin, upon binding to the phenothiazine class of drugs, alters the fluorescence properties of the fused EGFP, and these changes can be correlated to the concentration of the drug present in the sample. The comparison of the assay performance using the two different measurement platforms, the microtiter plate, and the CD micro-fluidic platform is presented in Table 10.2.

Some Ineffective Treatments

Insight-oriented, psychodynamic therapies can be defined as those that use interpretation of unconscious material and focus on therapeutic transference. In the treatment of serious mental illnesses of all types, this form of psychotherapy has been found to be generally ineffective. Actually, some studies have found psychodynamic treatments to be harmful. The consensus is that these therapies should no longer be used to treat schizophrenia (Lehman & Steinwachs, 1998), bipolar disorder (Keck & McElroy, 1998), or major depression (Craighead et al., 1998a). There is, however, a role for providing support through individual counseling identified in the research of Hogarty (1993). Effective individual counseling with people who have severe mental illness generally focuses on support, the person's present life situation (rather than past experiences), and problem solving.

Course of Mood Disorders

In one study, Kessing and his colleagues followed all individuals admitted for psychiatric care in Denmark diagnosed with an affective disorder over a period of 20 years. During this time, more than 20,000 first-admission patients had been discharged with a diagnosis of major depression or bipolar disorder. The results indicated that the rate of recurrence increases with the number of previous episodes for people with these disorders. The natural history of severe depression and bipolar disorder seems to be progressively worse, regardless of gender, age, and type of disorder. This suggests that for some, the course of these disorders is progressive, or worsening despite treatment. In short, an increasing number of relapses predicts an acceleration of relapses for the future (Kessing, 1998 Kessing et al., 1998).

Psychopharmacological Therapy for PTSD

Without being facetious, alcohol is probably the oldest form of medicinal treatment for PTSD. Heroin abuse and dependence was not uncommon in Vietnam and in those who returned home with addictions. In essence, any medicine, drug, or substance that could calm one's nerves might be sought out as a medicinal remedy to the distress of PTSD. Barbiturates, powerful central nervous system depressants, have been used in the past, but their strong addictive properties and drugging effects have resulted in their falling out of favor. As medicine and pharmacology progressed in both research and practice, newer, more efficacious drugs that could produce the desired effects without the unde-sired consequences of side effects and nontarget effects came into use. The pharmacological treatment of PTSD involves the use of the following classes of drugs anxiolytics, antidepressants, anticonvulsants, antiadrenergic drugs, antipsychotic agents, and various other, more atypical drugs. Antidepressants and...

The Severe Mental Illnesses

For society as a whole, schizophrenia, which strikes an estimated 1 of the population, is by far the most devastating and the most feared mental illness. In addition, several other mental illnesses also cause untold suffering and disability. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), of the American Psychiatric Association (2000) recognizes recurring depressive disorders, bi-polar and unipolar disorders (commonly known as manic depressive disorders), schizoaffective disorder, and organic brain syndromes among others as serious mental illnesses that can become long term, cause psychosis, and lead to psychiatric disability.

From Melancholy to Prozac

The identification of depression as a recognizable state has a very long history. Clinical depression was described as early as the eighth century b.c.e. In the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (rev. 4th ed., 2000), a common diagnostic tool, unipolar depression is divided into the categories Dysthymic Disorder, Major Depressive Disorder-Single Episode, and Major Depressive Disorder-Recurrent, while bipolar depression is divided into Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified (NOS). In most articles, the term depression refers to unipolar depression only. Because unipolar depression is much more common than bipolar depression, it is likely that it will continue to attract a larger share of research attention in the future.

Pharmacological Treatment of Bipolar Disorder and Mania

Lithium is a mood stabilizer that has been used as a treatment for bipolar disorder in the United States since 1970 and was being used in other countries even earlier. It is an effective medication for both the treatment of acute mania and the prevention of the recurrence of both manic and depressive symptoms in bipolar disorders (Keck & McElroy, 1998). Belmaker (2004) and Keck and McElroy (1998) reviewed numerous studies showing that lithium reduces the symptoms of acute mania. Like antipsychotic medications, mood stabilizers work by influencing neurotransmitter activity in the brain. also sometimes used to treat severe mania, particularly during the acute phase, to decrease potentially dangerous behavior (Belmaker, 2004). However, in general, their use should not be prolonged into the maintenance phase. Antidepressants have also been used for the relief of depressive episodes (Keck & McElroy, 1998). Unfortunately, persons who also suffer manic episodes, can have a manic state...

Paranoid and Depressive Anxieties

Gression, for instance, excessive aggression causing intolerable frustration, the child risks regressing to the paranoid-schizoid position, or may present manic-depressive symptoms, where denial of the destruction alternates with despair for the loss of the bond. Failures during development are fixation points from which the child can subsequently regress when faced with fresh hurdles. Once past the paranoid-schizoid and depressive phases, a person can find themselves later in a paranoid-schizoid or depressive position in any situation that revives memories of the past circumstances. This permits further work on mourning for one's own ideal identity and that of the idealized love objects, allowing re-affirmation of love of oneself and one's objects, though the gratification is always accompanied by the frustration of aspirations toward omnipotence.

Principles of Teratology

This concept developed from Brent's studies of the effects of radiation on the developing embryo and may or may not apply to fetal exposure to chemicals (106). After implantation, during the process of differentiation and embryogenesis, the embryo is very susceptible to teratogens. However, since terato-gens are capable of affecting many organ systems, the pattern of anomalies produced depends on which organ systems are differentiating at the time of ter-atogenic exposure. A difference of one or two days can result in a slightly different pattern of anomalies. After organogenesis, a teratogen can affect the growth of the embryo by producing growth retardation, or by changing the size or function of a specific organ. Of particular interest is the effect of psychoac-tive agents, such as cocaine, crack, or antidepressants, on the developing central nervous system during the second and third trimesters of pregnancy, as these drugs can potentially affect the function and behavior of the...

Specifiers for Mood Disorders

Specifiers allow for a more specific diagnosis, which assists in treatment and prognosis. A postpartum onset specifier can be applied to a diagnosis of major depressive disorder or bipolar I or II disorder if the onset is within four weeks after childbirth. Symptoms include fluctuations in mood and intense (sometimes delusional) preoccupation with infant well-being. Severe ruminations or delusional thoughts about the infant are correlated with increased risk of harm to the infant. The mother may be uninterested in the infant, afraid of being alone with the infant, or may even try to kill the child while experiencing auditory hallucinations instructing her to do so or delusions that the child is possessed. Postpartum mood episodes severely impair functioning, which differentiates them from the baby blues Seasonal pattern specifier can be applied to bipolar I or II disorder or major depressive disorder. Occurrence of major depressive episodes is correlated with seasonal changes. In the...

Pituitarygrowth Hormone Axis

GH release response to a variety of stimuli, including l-DOPA, a dopamine precursor 118 , apomorphine, a centrally active dopamine agonist 110 , and the serotonin precursors l-tryptophan 119 and 5HTP 120 , has been demonstrated. Several findings indicate dysregulation of GH secretion in depression. Studies have demonstrated a blunted nocturnal GH surge in depression 121 , whereas daylight GH secretion seems to be exaggerated in both unipolar and bipolar depressed patients 122 . A number of studies have also demonstrated a blunted GH response to the a-adrenergic agonist clonidine in depressed patients 123, 124 . Siever et al. 125 demonstrated that the blunted GH response to clonidine was not related to age or sex, and this study provided evidence that the diminished GH response to clonidine may be secondary to decreased a2-adrenergic receptor sensitivity in depression. Using a GHRF stimulation test, our group later demonstrated a slight exaggeration of GH response to GHRH in depressed...

Differential Diagnosis of Dysthymic Disorder

Dysthymia leads to chronic less severe depressive symptoms compared to Major Depression which usually has one of more discrete episodes. B. Substance-Induced Mood Disorder. Alcohol, benzodiazepines and other sedative-hypnotics can mimic dysthymia symptoms, as can chronic use of amphetamines or cocaine. Anabolic steroids, oral contraceptives, methyldopa, beta adrenergic blockers and isotretinoin (Accutane) have also been linked to depressive symptoms. Rule out with careful history of drugs of abuse and medications. C. Mood Disorder Due to a General Medical Condition. Depressive symptoms consistent with dysthymia occur in a variety of medical conditions. These disorders include stroke, Parkinson's disease, multiple sclerosis, Huntington's disease, vitamin B12 deficiency, hypothyroidism, Cushing's disease, pancreatic carcinoma, HIV and others. Rule out with history, physical exam and labs as indicated. D. Psychotic Disorders. Depressive symptoms are common...

Medical Models of Abnormality

The medical model ushered in humane treatment for people who hitherto had been persecuted as agents of the devil. Some of the advances in treatment for psychological problems include antipsychotic medication, which can reduce hallucinations and help a person with schizophrenia avoid hospitalization lithium, which can moderate the debilitating mood extremes of bipolar disorder antidepressants, which can relieve the chronic pain of depression and antianxiety drugs, which can relieve the acute stress of anxiety disorders. These kinds of advances help the day-to-day lives of many people.

Alternative Medicine and Female Infertility

Other than its potential central role in affecting hypothalamic pituitary ovarian function and peripheral role in improving uterine blood flow and implantation function, acupuncture has been definitively shown to reduce stress and anxiety through its sympatho-inhibitory property. Undoubtedly, infertility is stress inducing and anxiety provoking. The use of acupuncture to reduce stress is a very viable option when couples undergo the stringent process of evaluation and treatment of infertility. Compared to the conventional administration of antidepressants and anxiolytic drugs, side effects of which are largely unknown on the outcome of infertility treatment, acupuncture presents a relatively benign and simple alternative.

Epidemiology of Cyclothymic Disorder

Patients with bipolar type II disorder exhibit hypomania and episodes of major depression. B. Depressive episodes must be treated cautiously because of the risk of precipitating manic symptoms with antidepressants (occurs in 50 of patients). Antidepressants can also increase the rate of cycling. Patients are often treated concurrently with anti-manics and antidepressants.

The Role of the SN in Symptom Control and Rehabilitation

Separate psychological from physical symptoms in order to best assess and re-refer the patient to the most appropriate MDT resources. This can be particularly challenging in a patient following DTC treatment as many common psychological symptoms of stress, low mood or clinical depression can also be found in thyroid hormonal imbalance or directly following surgery, as demonstrated in Tables 5.1 and 5.3.

Effects of Drugs and Natural Reinforcers

In contrast to the increased synaptic density in the Cg3 neurons exposed to stimulants, there was a decrease in dendritic length and spine density in the insular cortex. This result was completely unexpected and shows that different subregions of the rat PFC may respond dramatically differently to the same stimulation. Further studies showed a similar asymmetry in the medial orbital regions in response to morphine. In this case, there was a decrease in dendritic length and spine density in the anterior cingulate neurons but an increase in the insular neurons (Robinson et al., 2002). Thus, not only were the effects of stimulants and depressants on the prefrontal neurons qualitatively different, but in both cases there were qualitatively different effects of the drugs on different prefrontal subfields. The contrasting effects of the psychoactive drugs on the two subfields of the rat PFC are intriguing and are reminiscent of the differences seen in metabolic levels of the dorsolateral...

Cholinergic and Monoaminergic Gating Systems

The PFC of rats and primates plays a role in gating the inputs of the cholinergic and monoaminergic systems to the rest of the cerebral mantle (e.g. Ragozzino, 2000). Thus, although the entire neocortex receives inputs from cholinergic, noradrenergic, and serotinergic systems, only the PFC sends reciprocal connections to the basal forebrain, locus coeruleus, and the dorsal and median raphe (e.g. Uylings and Van Eden, 1990 Arnsten, 1997 Everitt and Robbins, 1997). This feedback system is presumed to modulate these inputs and thus drugs, such as antidepressants, that affect these systems likely have a significant impact upon frontal lobe functioning.

Role of the Clinical Psychologist in Thyroid Cancer

Psychological assessment and direct clinical interventions should be provided by the clinical psychologist for more complex psychological problems, for example clinical depression or anxiety, post-traumatic stress disorder, phobic avoidance of treatment. Enabling other clinical staff to recognize and detect such distress and make appropriate referrals is part of this role.

Disorders of the HPT Axis

Disorders of the HPT axis lead to numerous psychiatric manifestations, ranging from mild depression to overt psychosis. Numerous conditions can lead to hypothyroid states, also known as myxoedema, including CNS causes of decreased TSH or TRH secretion, severe iodine deficiency, thyroid surgery, drugs, or autoimmune disorders. The most common cause of hypothyroidism is Hashimoto's thyroiditis, which is due to autoimmune destruction of thyroid tissue. Regardless of the aetiology, hypothyroidism leads to a number of clinical manifestations, including slowed mentation, forgetfulness, decreased hearing, cold intolerance and ataxia. Decreased energy, weight gain, depression, cognitive impairment or overt psychosis ( myxoedema madness'') may also result. Due to the overlap of symptoms with clinical depression, thyroid hormone deficiency must be ruled out in the evaluation of patients with depression. The first prospective study that scrutinized psychiatric comorbidity in patients with...

Functional Magnetic Resonance Imaging

Fmri Hypothyroidism

To date little fMRI research has been done in psychiatric disorders besides schizophrenia. In order to examine the neuroanatomy of major depression, Beauregard et al. 49 performed an fMRI study using an emotion-activation paradigm. Subjects were exposed to an emotionally laden film aimed at inducing a transient state of sadness. Patients with unipolar depression as well as normal subjects had significant activation in the medial and inferior prefrontal cortices, the middle temporal cortex, the cerebellum and the caudate. The depressed patients exhibited significantly greater activation in the left medial prefrontal cortex and in the right cingulate gyrus compared with controls, indicating alterations in these regions in the pathophysiology of depressive states.

Impact Of Preterm Birth On Families

Have used prematurity and low birth weight as a continuous variable (Beckman and Pokorni, 1988). The assessment of outcomes has centered on the mother's psychological well-being in the postpartum period and suggests that the mothers of infants born preterm are at risk of experiencing depressive symptoms (Davis et al., 2003 Singer et al., 1999 Veddovi et al., 2001). Longitudinal studies of children born preterm and with low birth weights in the first 2 to 3 years of life suggest that the levels of maternal depression and psychological distress (Singer et al., 1999), as well as problems related to the child, decreased over time (Beckman and Pokorni, 1988) except among high-risk (defined as having bronchopulmonary dysplasia) infants (Singer et al., 1999). Furthermore, specific factors that may contribute to depressive symptoms include a higher medical risk for the infants, the less frequent use of informal networks to obtain information about their infants, increased use of...

Differential Diagnosis of Obsessive Compulsive Disorder

Major depression may be associated with severe obsessive ruminations (eg, obsessive rumination about finances or a relationship). These obsessive thoughts are usually not associated with compulsive behaviors and are accompanied by other symptoms of depression.

HPA Axis Abnormalities in Depression

The occurrence of depression and other psychiatric symptoms in both Cushing's and Addison's disease served as an impetus for researchers to scrutinize HPA axis abnormalities in depression and other psychiatric disorders. Most investigators would agree that one of the most venerable findings in all of psychiatry is the hyperactivity of the HPA axis observed in a significant subset of patients with major depression. Based on the work of research groups led by Board, Bunney and Hamburg, as well as by Carroll, Sachar, Stokes and Besser, literally thousands of studies have been conducted in this area. The earliest studies in this field demonstrated elevated plasma cortisol concentrations in depressed patients 40,41 . Other markers of hypercortisolism that have been reliably demonstrated in depressed patients include elevated 24-hour urinary free cortisol concentrations and increased levels of cortisol metabolites in urine 42 . One commonly used test to measure HPA axis function is the...

Magnetic Resonance Imaging

Brain Has Structure Magnet

Comparisons of brain MRI data generally find more morphological deviations in schizophrenic patients than in those with affective disorders or alcohol abuse 32, 33 . The most consistent structural change in depressive patients is the observation of deep subcortical hyper-intensities in patients with severe and old-age depression 34, 35 . In some studies, expansion of the ventricular system and reduction of prefrontal lobe volumes have also been observed 36 . Although authors of the latter study found reduced volumes of the left hippocampus in depressed patients, such a change has been questioned by other authors 37 . In a structural brain MRI study of depressed children, Steingard et al. 38 found a significantly lower frontal lobe volume in the depressive patients with early onset. The incidence of cavum septum pellucidum, which has often been regarded as a neurodevelopmental anomaly, has been found to be higher in patients with schizophrenia. Shioiri et al. 39...

The Concept Of Quality Of Life

Katschnig and Angermeyer 46 have developed an action-oriented framework for assessing quality of life in depressed patients, which includes well-being and satisfaction as psychological dimensions, as well as functioning and contextual factors as sociological dimensions (Figure 7.1). This model can be easily applied to other diagnostic categories. They show that helping actions have to be differentiated, since some act on psychological well-being (e.g., antidepressants), some on role functioning

Principal Publications

Freud had posited in Mourning and Melancholia (1917) that depression results from anger turned inward against the self, emerging outwardly as the patient's need to suffer. Beck decided to set up a series of studies involving depressed patients, partly to collect data to convince psychologists of the soundness of Freud's hypothesis, and partly to design a brief form of psychotherapy that would target the core symptoms of depression. He received a research grant from Penn in 1959, and consulted two colleagues in the psychology department, Seymour Feshbach and Marvin Hurvich, for research methodology and statistical analysis. Beck then analyzed the dreams of 12 patients diagnosed with depression. The patients' dreams did in fact contain such themes as losing something of value, being prevented from achieving a goal, or appearing ugly, damaged, or diseased. When Beck gave the depressed patients verbal conditioning and card-sorting tests, however, they reacted positively to successful...

Predisaster Risk Factors

In the absence of baseline data in most studies, the literature on pre-disaster risk factors is rather limited. To date, the most reliable predictors of postdisaster psychopathology are female sex and especially being a mother of young children 16 . After the TMI disaster, women with young children showed significantly increased rates of anxiety and depressive disorders compared with non-exposed controls, as assessed with the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L) (risk ratio 3.4 for new cases 99 ). In a within-sample analysis of risk factors among a large population sample in Belarus exposed to the Chernobyl disaster, Havenaar et al. 16 found that being a mother was associated with a 4-5-fold risk of having a DSM-III-R anxiety disorder and an almost 3-fold risk of any psychiatric disorder. However, these variables are also risk factors for poor mental health in non-disaster studies 100-102 . Nevertheless, the consistency of the findings in disaster...

How Are Schizophrenia and Mood Disorders Different

Does Tara really have schizophrenia Does she have another type of psychosis Is she someone who has schizophrenia, but now is also experiencing a depressive episode Are these the signs of a catatonic episode, perhaps the most bizarre form of schizophrenia, in which movement stops altogether medications are not only unhelpful, they can be directly harmful because of side effects and the potential aggravation of other symptoms. For example, antidepressant medication can increase symptoms of psychosis and antipsychotic medication can bring on depressive symptoms. Issues about medications will be discussed further in Chapter 3.

Differential Diagnosis

Distinguishing the emotional symptoms observed in PMS from those present in other major mood or anxiety disorders (e.g., major depressive disorder, dys-thymia, panic disorder) is important because of the different treatment strategies. Women with PMS respond to unique therapeutic interventions, such as calcium carbonate, gonadotropin releasing hormone agonists and intermittent dosing with serotonin reuptake inhibitors (SRIs). If patients present with continuous mood or anxiety symptoms across the menstrual cycle, the diagnosis of PMS cannot be made. If patients exhibit mood and or anxiety symptoms across the menstrual cycle with an increase in severity during the luteal phase, the appropriate diagnosis is premenstrual exacerbation (PME) of the underlying condition, not PMS. Therefore, diagnostic verification of premenstrual syndrome is best accomplished through prospective daily symptom recording (or charting ). This prospective rating is required to make a diagnosis of PMDD.

Cytokines in depression and anxiety

There is mounting evidence that both depression and depressive symptoms can induce immune dysregulation by the production of proinflammatory cytokines including IL-6 (Maes et al., 1998). Similar responses in chronic anxiety with the production of IL-6 and reduced IL-2 receptor production (which is an essential cytokine to counter infection) was deemed a factor in increased URTI episodes (Ravindran, 1995). Persistent elevation of pro-inflammatory cytokines may lead to chronicity in disease, poor healing and increased disability (Leventhal et al., 1998). It seems, therefore, that negative emotions can directly affect the immune system to up or down regulate the response via inflammatory cytokines. This affects not only immediate reaction to the challenge of infection, but also the mechanisms of inflammatory disease.

Gabapentin Neurontin

Clinical experience suggests that it may be effective in the treatment of manic and depressive episodes. It also appears to be more effective in the treatment of depression compared to other mood stabilizers, prompting some clinicians to use it in treatment resistant unipolar depression. C. Gabapentin has been successful as monotherapy and as adjunctive treatment to other mood stabilizers and or antidepressants. It appears to be effective for mixed episodes and rapid cycling.

Why Do Some Develop PTSD and Some Do

An interesting question has been researched asking whether having a preexisting mental disorder increases one's risk for exposure to traumatic stressors or events. Research has shown that someone with a prior history of major depression and illicit drug use is at a higher risk for exposure to traumatic stressors. Finally, Dohrenwend (1998) and McNally (2003) report that being African American, having a family history of psychiatric illness, having a childhood history of conduct problems, having a history of prior traumatic event exposure, having a history of Major Depression, and having a history of drug or Alcohol Abuse puts someone at greater risk for exposure. This issue of race has been found to be significant with respect to combat exposure. Minority status has been shown to be a risk for combat and war exposure and thus higher risk for PTSD (Green, Grace, Lindy & Leonard, 1990 MacDonald, Chamberlain, & Long, 1997). People with a lifetime history of PTSD typically have at least...

Mental Health and Substance Abuse

It is more than the normal, everyday ups and downs or the blues, as some may refer to them. It also is not just situational, relating solely to the fact that the youth is incarcerated. The term clinical depression is used when this mood persists for more than a couple of weeks. Clinical depression is a serious health problem that can change behavior, physical health and appearance, academic performance, social activity, and the ability to handle everyday decisions and pressures (DSM-IV, 1994). These feelings may prevent youth from seeking preventive health care and complying with health regimens which can affect behavioral problems and eventual incarceration. Many factors may influence service utilization, such as family pressure, environmental stress, having a primary care doctor, health insurance, and experiences with past services. These factors may be seen as hindrances or can conversely aid in recovery. The RWJ report found a greater distance from traditional support...

Fashions In Disease Names And Patterns

What was wrong with this diagnosis Serology (and skin tests) remain positive for years after Brucella infection, whether or not the patient is symptomatic. Later studies were to show 26 that what distinguishes those with persisting symptoms from those without them is not the agglu-tinin titer but a depressive disorder which correlates with pre-illness personality and life circumstances. Chronic brucellosis is not a disease, but a pattern of illness behavior, triggered by an acute infection in a psychologically predisposed individual, an illness pattern reinforced by medical labeling that crystallizes distress by sanctioning it as a biological entity.

Social and Cultural Contexts

Suicide risk increases in clinically depressed individuals. In depressed patients, suicide risk has been found to be associated with hopelessness As one's sense of hopelessness increases, one's risk for suicide increases. Since the 1970's, Beck's Hopelessness Scale has been used in efforts to predict risk for suicide among depressed patients. Although the suicide rate has been relatively stable in the United States since the early twentieth century, the suicide rate of young people has increased since the 1960's.

Serotonergic Transmission in the PFC

The dopaminergic and serotonergic systems in the PFC are thought to be involved in the depressive state. It has already been indicated that chronic stress reduces dopaminergic transmission in the PFC (Fig. 3). As shown in Figure 6, chronic stress also reduces serotonergic transmission in the PFC. These findings support the chronic stress-induced depressive state.

Seasonal affective disorder SAD

Although mood fluctuations are a normal part of life, individuals with bipolar affective disorder experience extreme mood changes. Bipolar affective disorder, or bipolar disorder (also called manic-depressive disorder), has been identified as a major psychiatric disorder characterized by dramatic mood and behavior changes. These changes, ranging from episodes of high euphoric moods to deep depressions, with accompanying behavioral and personality changes, are devastating to the victims of the disorder and perplexing to the loved ones of those affected. Prevalence rates have been estimated at about 1.6 (0.8 to 2.6) percent of the American population. The disorder is divided fairly equally between males and females. Clinical psychiatry has been effective in providing biochemical intervention in the form of lithium carbonate to stabilize or modulate the ups and downs of this illness. However, lithium treatment has only been effective for approximately 70 percent of those to whom it is...

Evaluation of Depressive Behavioral State

Although several methods, e.g. a forced swimming test (Porsolt et al., 1977) or a tail suspension test (Stern et al., 1985), are used to evaluate a depressive behavioral state of rats or mice, we selected the rotarod test, because it shows a higher sensitivity in evaluating the effects of serotonergic antidepressants such as trazodone, mianserin, and clomipramine than the forced swimming test (Morimoto and Kito, 1994). Furthermore, this test does not involve any habituation or adaptation to water, which could cause

Application Of Neuropsychological Methods To Research And Clinical Practice

Neuropsychological deficits are now recognized to be a common and significant feature of depressive disorder, resembling the profile of cognitive deficiencies seen in traumatic brain injury 16 . Attentional, executive and secondary memory functioning are the areas principally affected 17-21 . Two different patterns of attentional deficit have been described in depression distractor inhibition, and deficits in the processing of resources, that is, the central executive component of working memory 22 . Memory disorder in depression is principally due to a retrieval rather than encoding deficit 23 , but has not been consistently reported, perhaps because testing is often limited to verbal or visual stimuli, and there is some evidence to suggest the deficit may in some cases be related to dysfunction in a single hemisphere 17,24 . dysfunction of frontostriatal circuits, the mediotemporal lobe, hippocampus and cingulate as the principal underlying neuroanatomical correlates of cognitive...

Mood Disorders

More common than schizophrenia, mood disorders are estimated to affect from 5 to 20 of the general population. Compared to schizophrenia, mood disorders affect a smaller proportion (about 25 ) of persons served in psychiatric rehabilitation programs (Arns, 1998). This is probably because mood disorders cover a wide spectrum of symptoms and functional deficits. Some individuals experience relatively mild or moderate symptoms that do not have a significant negative effect on their day-to-day functioning and therefore do not require PsyR services. Others have occasional bouts of mood swings intermixed with long periods of good mental health. It is also common for people with other serious disorders to experience mood disorders as well. Depressive episodes are characterized by extreme sadness or emptiness lasting most of the day, everyday, for a period of 2 weeks or longer. Manic episodes are marked by an elevated mood, in which the person feels excessively up or high, and occasionally...


Individuals who are served in psychiatric rehabilitation programs have various psychiatric diagnoses including schizophrenia, schizoaffective disorder, bipolar disorder, and recurrent major depressive disorder. Generally speaking, within PsyR programs, the most common diagnoses are schizophrenic disorders, while in the general population, mood disorders are more common. Details of the criteria of these diagnoses are reported in the American Psychiatric Association's DSM-IV-TR manual (APA, 2000). These disorders are long term and characterized by episodes of acute illness followed by periods of residual symptoms and remission. In the acute phases of these disorders and occasionally at other times, the resulting symptoms have serious behavioral manifestations, and often come to preoccupy the sensory and cognitive experience of the individual.

Depression Research

Many research projects since the 1970's have examined the effectiveness of cognitive and behavioral treatments of depression. Beck and his colleagues have demonstrated that cognitive therapy for depression is superior to no treatment whatsoever and to placebos (inactive psychological or medical interventions which should have no real effect but which the patient believes have therapeutic value). In addition, this research has shown that cognitive therapy is about as effective as both antidepressant medications and behavior therapy. Similarly, Lewinsohn and others have shown the effectiveness of behavior therapy on depression by demonstrating that it is superior to no treatment and to placebo conditions. One of the most important studies of the treatment of depression is the Treatment of Depression Collaborative Research Program, begun by the National Institute of Mental Health (NIMH) in the mid-1980's. Members of a group of 250 clinically depressed patients were randomly assigned to...


Clinical depression is one of the most prevalent psychological disorders. Because depression is associated with an increased risk for suicide, it is also one of the more severe disorders. For these reasons, psychologists have devoted much effort to determining the causes of depression and developing effective treatments. Theories and treatments of depression can be classified into four groups emotional, cognitive, behavioral, and physical. In the first half of the twentieth century, the psychoanalytic theory of depression, which emphasizes the role of the emotion of anger, dominated clinical psychology's thinking about the causes and treatment of depression. Following the discovery of the first antidepressant medications in the 1950's, psychologists increased their attention to physical theories and treatments of depression. Since the early 1970's, Beck's and Seligman's cognitive approaches and Lewinsohn's behavioral theory have received increased amounts of attention. By the 1990's,...


The transplant psychiatrist evaluates for any psychiatric disorders that may interfere with the transplant. He or she should also screen for self-destructive behaviors, compliance with medical treatment and the transplant workup itself, and any personality traits or disorders that may prove to be maladaptive. Psychotic disorders may make the patient unacceptable for a transplant if he or she becomes paranoid and noncompliant. However, a diagnosis of schizophrenia alone should not be an absolute contraindication to transplantation if the patient has a history of compliance with medication and is stable both psychiatrically and socially. Recurrent depressive disorders with multiple suicide attempts or failure to take care of one's needs would also be considered a contraindication. Even severe conditions such as borderline personality disorder could interfere with the ability of a patient to comply with the transplant protocol. Rapid shifts in mood, inability to sustain a positive...

Atypical Agents

Nefazodone (Serzone) Nefazodone is a serotonergic antidepressant, but it is not considered a SSRI because of other receptor effects. It tends to be more sedating than the SSRIs and can have a calming or antianxiety effect in some patients. It is also useful in patients who experience sexual impairment with other antidepressants.

Postoperative Period

Patients in the postoperative period can develop psychiatric symptoms because of the stress of hospitalization, the disappointment of an outcome that is not what was expected, or a recurrence of an underlying psychiatric disorder. Patients who develop depressive or anxiety syndromes should be treated, if at all possible. However, patients may not require pharmacologic treatment simply for a brief period of distress. For example, a day or two of crying and distress may be perfectly normal and would not require an antidepressant. Decisions regarding the initiation of treatment should be made in conjunction with the psychiatric consultant. A major depressive disorder should not be diagnosed without the depressed mood being experienced most of the day, every day for 2 weeks. If the transplant patient requires psychotropic medication, caution should be exercised. Most psychotropic medications are metabolized in the liver, the exceptions being lithium and gabapentin. They are excreted by...

How to Stop Your Depression Now

How to Stop Your Depression Now

Finally, Retired Clinical Counsellor Reveals the Secrets Successful Psychiatrists and Psychologists Don't Want You to Know. How to Stop Your Depression Now Reclaim Yourself and Live Again Get the Depression Busting Tools You Need To Win the War Against Depression. Depression is an illness that many people often sweep under a rug. However if depression is left untreated... Your life can become a living nightmare. Depression is a growing epidemic in the US, but it never gets the urgent attention it deserves. You need help and you need it now.

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