Mood disorders. Frequent disorders, potentially lethal (up to 15% of suicide) High comorbidity with somatic diseases (cardiovascular ++) Individual, familial, social impact Social cost* Can be treated
*WHO ranked depression as one of the top four medical conditions with the greatestdisease burden worldwide, measured in disability-adjusted life years, which express year of life lost to premature death and years lived with a disability of specific severity and duration. In 2020 depression will be the second largest contributor of disease burden worldwide
Mood Disorder Due to a
general medical condition
Unipolar Depressive Disorders
Adjustment disorder with depressive Mood
Chronic and recurrent course
Kessler et al The Epidemiology of Major Depressive Disorder Results From the National Comorbidity Survey Replication (NCS-R) JAMA. 2003;289:3095-3105.
TWO WEEKS DURATION
TWO WEEKS DURATION
*Age cohort effect
Present to a significant degree during the mood disturbance
Bipolar type II
Edgar Allen Poe
Buzz Aldrin ?
Ludwig Van Beethoven
Marilyn Monroe ?
Francis Scott Key Fitzgerald
Ernest Miller Hemingway
Jimi Hendrix ?
Patrick Joseph Kennedy
Robert Louis Stevenson
Jean-Claude Van DammeFamous bipolar Kay Redfield Jamison's Touched With Fire, National Alliance Mental Illness
Recurrence preventionSchematic time course of a depressive episode treatment
- If taking lithium, the dose should be increased to 0.8 mEq / L; - if taking another antimanic, it should be continued, with lamotrigine added.
- If not receiving an antimanic and having a history of recent or severe mania: lamotrigine or another antimanic;
- if no such history is present and the patient is not taking a current antimanic, lamotrigine should be initiated.
- lithium, lamotrigine, quetiapine,
- combined olanzapine and fluoxetine.
- all of the stage 3 drugs are available as well as valproate;
- a combination of carbamazepine and SSRI, buproprion, or venlafaxine;
- electroconvulsive therapy.