№ 13Clinical Disorders11 min read
Treatment of Affective Disorders
1. Overview & Epidemiology
- Affective (mood) disorders = unipolar depression (MDD, dysthymia) and bipolar disorder. Treatment splits along this axis: antidepressants drive unipolar therapy; mood stabilizers anchor bipolar therapy.
- MDD: lifetime prevalence ~10–15%; women > men ~2:1. ~60–70% respond to an adequate first antidepressant trial.
- Bipolar I: ~1% lifetime, sexes roughly equal. Requires a mood stabilizer ± antipsychotic — never antidepressant monotherapy (switch risk).
- Suicide is the central treatment-relevant complication. Gajdos: depressed patients are at increased risk as they begin to improve and regain energy to act (paradoxical suicide). It is clinically unwise to discharge a depressed patient with a large prescription of antidepressants, especially TCAs (lethal in overdose).
- Treatment-resistant depression (TRD): failure of ≥2 adequate antidepressant trials (adequate dose × ≥4–6 weeks).
- Drugs/treatments that themselves cause depressed mood (5.16): interferon-alpha, oral contraceptives, high-dose corticosteroids, deep brain stimulation in Parkinson's disease — also reserpine, beta-blockers, isotretinoin. Always screen for an iatrogenic cause before escalating.
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