Causes and mechanisms of development
The etiology of affective disorders is complex. The disruption of the balance of key neurotransmitters—norepinephrine and serotonin—is considered the most crucial neurochemical mechanism in the development of depressive states.
Genetic factors and constitutional predisposition play a significant role. It has been noted that affective psychoses develop somewhat more frequently in individuals prone to overweight (patients with the so-called pyknic body type).
Special attention should be paid to secondary depressions, which can be triggered by a wide range of external and internal factors:
- Somatic diseases: inflammatory conditions (e.g., inflammatory lung disease) and malignant neoplasms.
- Pharmacogenic factors: depression can result from taking certain medications, such as reserpine or propranolol.
- Addictions: the development of affective disorders is frequently accompanied by alcohol dependence.
Clinical presentation of affective disorders
Affective pathology is extremely diverse. The main clinical variants mentioned within this topic:
- Dysthymia: a chronic state of depressed mood with no pronounced fluctuations in the patient's well-being.
- Cyclothymia: a disorder characterized by alternating hypomanic episodes and periods of mild depression.
It is important to distinguish the typical manifestations of endogenous depression, which are characterized by worsening of symptoms in the morning hours, from atypical depression, the symptoms of which may include increased appetite and pronounced sleep disturbances.
A separate category is involutional depression, which develops in late adulthood. Nihilistic hypochondriacal delusions, known in psychiatry as Cotard's syndrome, are extremely specific to this condition.
Regarding the outcomes of classic manic-depressive psychosis (MDP), the lucid interval between phases is called an intermission. The disease has a favorable course regarding the preservation of intellect: the outcome shows no deterioration in memory, impaired comprehension, apathy, or abulia. Furthermore, an increase in social withdrawal, suspiciousness, or egocentrism is atypical for the outcome of MDP (unlike schizophrenic-spectrum disorders). A significant age or quantitative indicator of manifestation and phase course is often described in the range of 16 to 25.
Treatment and patient management
The choice of treatment method directly depends on the form and severity of the disorder.
In the treatment of reactive depression, psychotherapy aimed at working through the psychotraumatic situation traditionally demonstrates the highest efficacy.
For pharmacotherapy in outpatient practice, physicians choose medications with a favorable safety profile. The safest options for treating depression in such settings are considered to be SSRIs (selective serotonin reuptake inhibitors) and pirlindole, which is a reversible MAO-A inhibitor.
In cases of overcoming treatment resistance (in severe, drug-resistant forms of depression), ECT (electroconvulsive therapy) is successfully used.
Preventive therapy is necessary to prevent new episodes of bipolar disorder. During the interepisode period (intermission), patients are recommended to take mood stabilizers long-term, which include lithium salts or specialized anticonvulsants.
Briefly: answers to topical questions
What factors and somatic diseases can trigger the development of secondary depression?
- Somatic diseases include inflammatory lung disease and malignant tumors.
- Pharmacogenic factors include the intake of reserpine or propranolol.
- Addictions include alcohol dependence.
What pharmacological drugs can induce drug-induced depression?
- Reserpine is a medication whose intake can trigger secondary depression.
- Propranolol is a medication whose intake can also trigger secondary depression.
What clinical symptoms are included in the structure of atypical depression?
- Increased appetite is a symptom that may be included in the presentation of atypical depression.
- Sleep disturbance is a symptom that may also be included in the presentation of atypical depression.
Which psychopathological syndromes are specific to involutional depression?
- Nihilistic hypochondriacal delusions are a specific psychopathological syndrome for involutional depression, known as Cotard's syndrome.
Which groups of drugs belong to mood stabilizers and are used for the prevention of bipolar disorder?
- Lithium salts are a group of drugs recommended for the prevention of bipolar disorder during the interepisode period.
- Anticonvulsants are a group of drugs also recommended for the prevention of bipolar disorder during the interepisode period.
What are the indications for prescribing electroconvulsive therapy in depressive disorders?
- Treatment-resistant forms of depression — electroconvulsive therapy is used in treatment-resistant forms of depression to overcome therapeutic resistance.
DYsthmia — Long-term Downward shift in mood (even low mood). CYCLothymia — CYCLES of polarity shifts (from mild depression to hypomania).
Class and exam questions
Does manic-depressive psychosis lead to dementia?
No, the disease progresses without the development of pronounced personality or cognitive deficits. Memory impairment, apathy, and increasing egocentrism and suspiciousness are not observed as an outcome.
At what time of day do patients with endogenous depression feel worst?
A typical sign of classic endogenous depression is the worsening of the patient's condition in the morning hours.
Which medications are the safest for outpatient treatment of depression?
In outpatient practice, SSRIs and pirlindole (a reversible MAO-A inhibitor) are considered the safest medications.
What is characteristic of involutional depression?
The so-called Cotard's syndrome — nihilistic hypochondriacal delusions — is highly specific to involutional depression.
What else to study on this topic
- Pathogenesis of affective disorders: the role of serotonin and norepinephrine
- Specifics of atypical depression (changes in appetite and sleep)
- Cotard's syndrome in the structure of involutional depression
- Mechanism of action of mood stabilizers: lithium salts and anticonvulsants
- Indications and principles of electroconvulsive therapy (ECT)
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