Natural Treatment for Depression Found

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. Continue reading...

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Major Depression In The Context Of Evolution

Fundamental to the understanding of any biological process, including mental illnesses, involves understanding their evolutionary context. There are few readily apparent evolutionary advantages for the development of a high prevalence of major depressive illnesses among Homo sapiens. Major depression frequently destroys peoples lives and has a chronic recurring course. Major depression is defined by DSM-IV diagnostic criteria (American Psychiatric Association, 1994) by the loss of the ability to function in family or job life for at least 2 wk, as a a result of disturbances in mood, sleep, concentration, self-esteem, appetite, physical energy, and sexual energy or function. This disease not only directly reduces the likelihood of procreation but also causes significant disruption in social and family interactions. Prior to 1910, the prevalence of major depression may have been nearly 100-fold less than current rates (Klerman et al., 1985). The increased rates of prevalence of...

Major Depression And Tissue Composition Studies

Since the publication our of initial hypothesis (Hibbeln and Salem, 1995), a series of clinical studies have reported that depressed patients have low tissue concentrations of EPA and or DHA, and several supplementation trials have reported improvements in depressive or symptoms in the affective spectrum. Although initial reports described elevated plasma concentrations of DHA among subjects with some mixture of depressive symptoms (Ellis et al., 1977 Fehily et al., 1981), unfortunately these studies lacked diagnostic specificity, did not control for alcoholism or smoking, and did not specify the use of psychotrophic medications. Following those initial reports, eight studies have reported that lower concentrations of n-3 fatty acids in plasma or red blood cells (RBCs) predicted depressive symptoms (Adams et al., 1996 Maes et al., 1996 Peet et al., 1998 Edwards et al., 1998a Edwards et al., 1998b Peet et al., 1999 Maes et al., 1999 Hibbeln et al., 2000). Adams et al. (1996) were the...

Major Depression Treatment

Only one treatment study of omega-3 fatty acids in major depression has been completed and none have been published (Marengell et al., 2000). In contrast to the predictions of the tissue compositional and epidemiological studies, this 6-wk trial of 2 g d of DHA alone did not document any differences in depressive symptoms among subjects with mild to moderate major depression. This study of medication-free patients with a Hamilton depression rating scale of greater than 17 and no significant comorbid psychiatric diagnoses was well designed and carefully conducted. However, several questions remain before the efficacy of DHA in major depression can be ruled out. First, the trial length may not have been adequate. Second, although the dose of DHA (2 g d) appeared adequate to change most tissue compositions, this dose may have been excessive if there is a nonlinear or inverted U -shaped pattern of response. In other words, response may be seen at low doses, but secondary antagonistic...

Crossnational Epidemiology And Major Depression

The analyses of cross-national epidemiological data, collected using high-quality modern diagnostic and epidemiological sampling methods, does provide one method of testing the hypothesis that a lower omega-3 fatty acid status is related to higher prevalence rates of affective disorders, psychotic disorders, or aggressive behaviors. Economic data describing seafood consumption has been useful in these cross-national studies. Although economic data on the production and consumption of seafood cannot accurately be used to quantify dietary intake for an individual, these data can be used to describe trends for the populations of entire countries and thus provide a basis for comparing consumption across countries (World Health Organization, 1996). The financial incentive to produce accurate data also adds some confidence to the accuracy of consumption estimates derived from economic data. When compared cross-nationally, greater amounts of seafood consumption were robustly correlated (r...


SSRIs are widely used to treat depressive mood and anxiety in OSA patients. Moreover, SSRIs may be at least partially (and theoretically) effective in OSA by virtue of their REM sleep suppression (as OSA tends to worsen during REM sleep when muscle tone is lowest and the upper airway is most prone to obstruct) and or augmentation of upper airway dilator muscle activity. While SSRIs are relatively tolerable in OSA, antidepressants with side-effects of sedation or weight gain (such as antidepressants with H1 receptor blockade property) may exacerbate OSA.

Primary Nursing Diagnosis

Patients with bulimia generally do not need hospitalization unless they experience severe electrolyte imbalance, dehydration, or rectal bleeding. The bulimia is usually managed with individual behavioral and group therapy, family education and therapy, medication, and nutritional counseling. Work with the interdisciplinary team to coordinate efforts and refer the patient to the physician to evaluate the need for antidepressants and anti-anxiety medication.

Interindividual Variability and Polymorphism

Allelic variants, which arise by point mutations in the wild-type gene, are the source of interindividual variation in the CYP activity. Amino acid substitutions can result in an increase or more commonly a decrease in CYP activity. Environmental factors known to affect CYP levels include medications (e.g., barbiturates, anticonvulsants, rifampin, tro-glitazone, isoniazide), foods (e.g., cruciferous vegetables, charcoal broiled beef), social habits (e.g., alcohol consumption, cigarette smoking), and disease status (diabetes, inflammation, viral and bacterial infection, hyperthyroidism, and hypothyroidism.5 Due to recessive inheritance of gene mutation, some CYP enzymes can be absent or poorly expressed in a certain percentage of the population leading to increased pharmacological response or toxic effects of drugs.26-28 The two major polymorphically expressed enzymes are CYP2C19 and CYP2D6. The poor metabolizer phenotype of CYP2C19 is found in 2-3 of Caucasians and African-Americans...

Depression And Schoolage Children

Are often seen as normal mood swings typical of a particular developmental stage. Professionals are also often reluctant to prematurely label a young person with the diagnosis of depression, but early diagnosis and treatment are crucial to healthy emotional, social, and behavioral development. A longitudinal study published in 1999 found that early onset of depression often persists, recurs, and continues into adulthood and indicates that depression in youths may predict more severe illness in their adult life.

Treatment Of Children And Adolescents

Children and adolescents with dysthymic disorder are at risk for developing major depression. Prompt identification and treatment can reduce the duration, severity, and associated impairment of depression. Several screening tools, including the Children's Depression Inventory (CDI) for children and adolescents ages 7 to 17 years, the Beck Depression Inventory (BDI), and the Center for Epidemiologic Studies Depression (CESD) Scale, are useful for diagnosing possible depression with this group. When children and adolescents screen positive on any of these instruments, a comprehensive diagnostic evaluation by a mental health professional, which includes the youth, their parents, and other sources of information such as teachers and friends, is warranted. in children and adolescents. CBT is based on the premise that people with depression have cognitive distortions in their views of themselves, the world, and the future. A study supported by the National Institutes of Mental Health (NIMH)...

Suicide And Depression

Suicide attempts, especially with adolescent boys with conduct disorders and alcohol or other substance abuse problems. In 1997, suicide was the third leading cause of deaths in persons 10 to 24 years old. Adolescents with a major depressive disorder are seven times as likely to commit suicide as young adults in their twenties. Early diagnosis and treatment, accurate evaluation of suicidal thinking by trained professionals, and limiting young people's access to lethal agents, including firearms and medication, may hold the greatest prevention value.

Gender Differences in Psychopathology

Eysenck (1995) suggested that the dispositional trait underlying schizophrenia is an important ingredient of creativity and noted that the incidence of schizophrenia is higher in men than women. The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) (American Psychiatric Association, 1994) stated, however, that although men tend to be institutionalized at a greater rate, community-based studies have suggested an equal gender ratio between the men and women who have schizophrenia. As I mention in the chapter on neurotransmitters (chapter 8), enhanced creativity appears to be associated with affective disorders. According to the dSm-IV, bipolar disorders are also equally distributed between men and women. Major depressive disorders, however, are reported more frequently with women. Although the higher incidence of depression in women might be related to an ascertainment-reporting bias (e.g., men are less likely to go for professional help), the incidence of mood...

Dream content analysis

The main goal of dream content analysis is the quantification of specific aspects of the dream (e.g. number of dream persons, types of interactions, settings) in order to perform statistical analyses (cf. 7 ). The following fictive example illustrates the procedure. A clinical psychologist formulates the hypothesis that depressed patients dream more often about rejection than healthy persons. The researcher develops a scale measuring rejection (occurrence vs. not present in the dream content). Dream reports are collected from the two groups and ordered randomly so that external judges applying the content scale do not know whether the dream is a patient's dream or a control dream. After the rating procedure, the dream reports are reassigned to the two groups and the difference in percentage of dreams including at least one rejection of the dream can be tested statistically.

Dreams and psychopathology

The literature reviews showed that the majority of empirical studies support the continuity hypothesis 61-63 . On the one hand, it was found that hallucinations of schizophrenic patients are not dreams experienced during the waking state (e.g. 64 ) and that the concept of dreaming as a mental disorder is not very helpful (cf. 65 ). On the other hand, dreams of schizophrenic patients are typical for this disorder, i.e. the dreams are more bizarre 65 and are characterized by aggression and negative emotions 61 . For depressive patients, Beck and Hurvich 66 and Beck and Ward 67 have found an increased amount of masochistic themes in their dreams. Subsequent studies (overview 68 ) confirmed that dreams of depressive patients are more negatively toned and include unpleasant experiences more often (definitions of masochistic dream content according to Beck & Hurvich 66 ) than healthy controls. Schredl and Engelhardt 65 were able to demonstrate that severity of depressive symptomatology was...

Epigenetics and Complex Disease

The scientific value of the epigenetic model of complex disease lies in the possibility of integrating a variety of apparently unrelated data into a new theoretical framework, which provides the basis for new hypothesis and experimental approaches. The below overview is primarily based on the epigenetic re-analysis ofvarious non-Mendelian irregularities in three major psychiatric diseases bipolar disorder, schizophrenia and major depression.

Psychiatric disorders in the antenatal period

Most psychotropic medication is relatively safe in pregnancy, with few overt congenital abnormalities described in association. The exceptions include lithium, which appears to be associated with an increased incidence of Ebstein's anomaly. This is a serious consideration for those patients with bipolar disorders, where a balanced judgement must be made reflecting psychiatric stability versus a 5 risk of a potentially surgically correctable anomaly. For many women suffering from anxiety disorders and mild depression, psychotherapy and counselling may be a better option than medication. Tricyclic antidepressants such as imipramine or amytryptaline appear to be safe in pregnancy, but there are arguments for reducing the dose or stopping treatment completely prior to delivery in view of the potential for anti-cholinergic side effects in the neonate. Benzodiazepines may carry some teratogenic risk and are best avoided. It is reasonable for many women on antidepressant medication at...

Affective and Mood Disorders

Of antidepressants (including tricyclic antidepressants and SSRIs) and anxiolytics (psychotropic medications used to manage anxiety disorders) is greater than the information available about their safety and efficacy for children and adolescents. Nevertheless, encouraging recent studies support the safety and efficacy of the SSRIs in managing affective and mood disorders in pediatric populations (Brown & Sammons, 2002).

Possible mechanisms underlying the association between depression and OSA

As with cognitive impairment, sleep fragmentation and hypoxemia during sleep are suspected to be responsible for depressive symptoms in OSA. Sleep fragmentation certainly contributes to the excessive daytime sleepiness (EDS) in OSA patients. Several studies have supported positive correlation between EDS as measured by the Epworth sleepiness scale and depressive symptoms 23,98 .

Clinical efects of ovulation disturbances

The focus on ovulation disturbances in this paper has so far only discussed their prevalence and incidence. It is likely however, that any SLP or persistent ovulation disturbances present in phases A and B when cycles are still regular causes dysfunctional bleeding and menorrhagia in women experiencing high oestradiol levels. It is also likely that premenstrual symptoms are increased in cycles with ovulation disturbances in addition to high oestradiol levels (Wang et al 1996). Severe mood swings, increased stretchy mucus and breast tenderness prior to and during flow commonly coexist with disturbed perimenopausal ovulation. Ballinger described heavy flow in such cycles (Ballinger et al 1987). In addition, the cycles with ovulation disturbances may be at increased risk for VMS based on data suggesting increased VMS prior to

Treatment effects on depression in OSA

Studies of CPAP's treatment effect on depressive mood are not consistent. Table 7.1 summarizes studies reporting the impact of CPAP treatment (for over 1 month of treatment) on depression and anxiety. Many studies reported that depressive symptoms were ameliorated by CPAP treatment. It is gratifying to see that this field is attracting careful study. At the risk of merely counting positive versus negative studies, it appears that more studies (i.e. 14 studies) report positive effects of CPAP on mood as compared to non-significant effects on mood (i.e. 6 studies). Differences in experimental design such as sample size, the nature of depressive symptoms, CPAP compliance, and co-morbid medical conditions need further exploration. In some negative studies, baseline depressive symptoms were not particularly high, and one could speculate that the lack of a treatment effect on depression was due to a floor effect 22 . Millman and colleagues found that OSA patients with more severe depressive...

Clinical implication depression in OSA

Clinicians should suspect OSA particularly in depressed patients who present with symptoms such as snoring and excessive daytime fatigue 119 . Moreover, undiagnosed OSA should be considered when depressed patients do not respond to antidepressant treatment. In this sense, depression refractory to treatment may be akin to hypertension refractory to treatment, with both instances possibly denoting occult OSA 120 .

Bipolar Affective Disorder

One of the most important contributions to the field of omega-3 fatty acids in psychiatric disorders has been the double-blind, placebo-controlled treatment study conducted by Stoll et al. (1999a) among subjects with bipolar affective disorder. Bipolar affective disorder is also commonly known as manic-depressive disorder, which more vividly describes the debilitating clinical course of this illness. Thirty subjects were treated with 14 capsules per day containing either 9.6 g d of ethyl ester EPA plus DHA or an olive oil placebo. Subjects were studied as outpatients for 4 mo and received the capsules in addition to their regular pharmacological therapies. After 4 mo, there was a significantly reduced relapse to a severe episode of mania or depression in the omega-3-treated group compared to the placebo treated group. Among subjects taking no other medications, four subjects in the EPA plus DHA group remained symptom-free for the length of the study, whereas the four subjects in the...

Postpartum Depression

Postpartum depression may provide an extremely useful model for testing the hypothesis that a deficiency of omega-3 fatty acids in adulthood, and in particular DHA, increases the predisposition to suffering depressive disorders (Hibbeln and Salem, 1995). Throughout pregnancy, the placenta actively transfers DHA from the mother to the developing fetus (Cambell et al., 1998). Without adequate dietary replenishment, DHA stores in mothers can become depleted (Holman et al., 1991 Al et al., 1995) and may not be replenished for 26 wk (Otto et al., 1997). Given these basic findings, we predicted that the prevalence rates of postpartum depression would be higher in countries with lower rates of seafood consumption. This study evaluated published data on the prevalence of

Neurotransmitter Alterations In Infancy

Other investigators have established that neurotransmission in the frontal cortex can also be affected by dietary essential fatty acids during infancy. De la Presa Owens and Innis (1999) fed piglets one of four infant formulas for 18 d. The formulas were either adequate or deficient in 18 2n6 and 18 3n3 or contained supplemental AA (0.2 ) and DHA (0.16 ). Frontal cortex concentrations of serotonin, tryptophan, dopamine, homovanillic acid, and norepinephrine were nearly doubled in the formulas supplemented with long-chain polyunsaturated fatty acids. It is remarkable that only 18 d of dietary intervention altered concentrations of these fundamental neurotransmitters. Austead et al. (2000) also reported changes in concentrations of both serotonin and CSF 5-HIAA in frontal cortex among piglets given control and DHA AA-supplemented formulas. They reported that frontal cortex concentrations of serotonin increased while the concentration of the metabolite, CSF 5-HIAA, decreased. One...

Serotinergic Metabolism And Impulsivity

Abnormalities in serotinergic neurotransmission caused by low-omega-3 status could potentially increase the risk for impulsive behaviors such as suicide and homicide and may be an important mechanism leading to an increased predisposition toward developing a depressive disorder (Hibbeln et al., 1998a). Abnormalities in serotinergic function are thought to be important in impulsive, suicidal, and depressive behaviors. Most of the commonly used antidepressant medications act to increase serotinergic neurotransmission (Meltzer and Lowey, 1987). One of the best-replicated findings in biological psychiatry is that low concentrations of CSF 5-HIAA are associated with suicide and depression (Roy et al., 1991). Low CSF 5-HIAA concentrations predict impulsive, hostile, and aggressive behaviors (Mann, 1995 Virkkunen et al., 1994 Linnoila et al., 1983) and reflect serotonin turnover in the frontal cortex (Stanley et al., 1985).

Considerations Of Central And Peripheral Mechanisms

One paradoxical observation that appears to be emerging from the clinical intervention trials is that EPA appears to be more clinically effective than DHA. In fact, no clinical study has yet demonstrated a clinical effect of DHA (Voigt et al., 1998 Peet et al., 2000 Marengell et al., 2000). Whereas DHA is selectively concentrated in neuronal membranes, EPA is virtually absent from neuronal tissues. Few peripheral mechanisms by which EPA could have central nervous systems effects have been described. For example, it is possible that EPA and or DHA might increase vascular blood flow through the brain. However, a more plausible and well-substantiated immune-neuro-endocrine mechanism has been proposed by Smith (1991) and examined by Maes et al. (1993). This model has been described extensively in other publications (Smith, 1991 Maes et al 1993 Hibbeln, 1999) and will only be briefly presented here. Hyperactivity of the hypothalamic pituitary axis has repeatedly been described among...

Comments For The Design Of Future Studies Tissue Concentration Studies

Comparisons of tissue concentrations between controls and patients groups may be useful for exploratory analyses, but the groups should be controlled for confounding influences on fatty acid metabolism and catabolism and care should be take in the interpretation of the results. Comparison studies are of little value without careful diagnostic assessment and patient characterization. Consideration should also be given to the observation that improvement of depressive symptoms among subjects with other diagnoses may confound other outcome measures such as improvements in psychosis or cognition. Typically, comparison studies of the tissue composition of the fatty acids only determine if there is a difference between the groups at single point in time. Thus, it may be difficult to make interpretations concerning differences in basal metabolism or causal relationships. A series of critical questions must be addressed. Does this measure reflect differences in dietary intake Does the measure...

Psychological distress associated with genetic counselling for breastovarian cancer

Some research has used standard measures, which give an indication of the proportion of women who can be classified as clinical cases in terms of their levels of anxiety, depression and general psychological distress, and has found fairly high proportions of individuals to be under stress. In a recent study it was found that 41 of the women had a possible anxiety disorder, as measured by the Hospital Anxiety and Depression Scale, and 11 had a possible depression disorder, prior to attending for genetic counselling (Bish et al., 2002). These proportions are comparable to those found in other studies of women undergoing genetic counselling for breast ovarian cancer risk (e.g. Dudokdewit et al., 1998 Lodder et al., 1999 Kent et al., 2000). Other studies (e.g. Cull et al., 1999 Watson et al., 1999) have found approximately 30 of their sample of women undergoing genetic counselling to be classifiable as 'cases' on a psychiatric measure (General Health Questionnaire).

Specific treatments for CPP evidence from randomized trials

Limited randomized controlled trial (RCT) evidence is available to guide treatment decisions in CPP. It is important to be clear as to whether treatment is directed towards an underlying condition such as adhesions or whether pain itself is the main focus. While hormonal therapy aims to achieve benefit in a non-specific manner by inhibiting ovarian activity, based on the observation that many patients with CPP experience resolution at the time of the menopause, psychological approaches aim to enhance coping skills and reduce pain-associated distress. Many proven treatments for chronic neuropathic pain such as low-dose tricyclic antidepressants and gabapentin are equally relevant in CPP where there are neuropathic

Family Factors And Youth Wellbeing

The findings thus far suggest that economic destitution is a significant contributor to the difficulties demonstrated by children raised in single-parent homes. Murry and colleagues (2001) and Kleist (1999) analyzed the extant research that has attempted to disentangle the relationship between poverty and child developmental outcomes in single-mother households. Taken as a whole, these findings suggest that financial strain influenced children's adaptive development indirectly through its pernicious grip on maternal psychological functioning and parenting quality. Specifically, the results reveal that a single mother's educational attainment is associated positively with better economic conditions (i.e., higher income level and less financial strain), which, in turn, foster parental involvement (e.g., spending time with children and effective supervision) and supportive, cognitively stimulating (e.g., reading books) parenting practices. Such positive parenting practices were...

Survey of Drugs and Medicines That Have Detrimental Impacts on Drivers Performance

The study also reviewed the effect of medication on driving, relying on experimental and pharmaco-epidemiological studies. The most important groups are the benzodiazepines, which are used by 10-20 of the population in some countries, such as Belgium and France. Pharmaco-epidemiological studies have clearly shown that users of benzodiazepines face a two- to fivefold higher risk of being involved in an accident. This risk is even higher (8- to 10-fold) for people in the first 2 wk of treatment. Some studies have shown that the increase in crash risk is even more pronounced in young males taking long-acting benzodiazepines. Other drugs that were reviewed were antidepressants, antihistamines, neuroleptics, and opiods.

Survey of Stateofthe Art Roadside Testing Devices Available for Urine Sweat and Saliva Matrices

For urine testing, there are three kinds of test designs a dip test (test strip or test card the device is partially immersed in the urine for a few seconds), a pipet test (test cassette a few drops of urine are deposited in the device with a dropper), and a cup test (the testing device is built into the side or top of a cup). Several manufacturers supplied single-parameter and multiple-parameter tests for the dip- and pipet-type devices. Most of the tests were available for the detection of amphetamines, methamphetamine, cannabinoids, cocaine, opiates, and phencyclidine. Eighty percent of the urine devices also included benzodiazepines and barbiturates in their panels. Fifty percent included methadone, and only 30 offered a test for tricyclic antidepressants.

When the Response is Binary

Binary endpoints are very popular in clinical trials. Frequently, success and failure are used to describe the outcome of a treatment. Even if the endpoint is continuous, there is an increasing tendency to define criteria and classify subjects as a responder or a nonresponder . For example, patients in antidepressants trials are frequently referred to as a responder if they experience a 50 reduction in the HAM-D score from their baseline values. The American College of Rheumatology (ACR) proposed to use ACR20 as the basis to determine if the treatment is a success or not for an individual. ACR20 is defined as There are situations when binary response makes sense. Examples include alive or dead for patients in salvage trials with end stage cancer. In anti-infective trials, it is natural to consider if an individual is cured of the underlying infection, both clinically and microbiologically. There are many situations where dichotomizing subject's response in a manner that makes clinical...

Discharge And Home Healthcare Guidelines

Instruct the patient to avoid sugar, tobacco, alcohol, and spicy, salty, and highly acidic foods. Recommend high-calorie, protein-rich liquid supplements to patients with painful mouth lesions. Teach the patient how to instill eye drops, ointments, or sustained-release capsules. Advise the patient to avoid over-the-counter medications that include saliva-decreasing compounds, such as antihistamines, antidepressants, anticholinergics, and atropine derivatives.

Treatment of narcolepsy

While modafinil and traditional stimulants can ameliorate EDS, these agents impart no beneficial impact on cataplexy. However, drugs other than sodium oxybate can be used effectively to treat cata-plexy. While not rigorously studied in controlled trials, agents which exhibit affinity for CNS norepinephrine receptors have been in common use for decades as anticataplectic agents. Specifically, tricyclic anti-depressants, mixed serotonin-norepinephrine re-uptake inhibitors, and more selective serotonin reuptake inhibitors with parent compound or active metabolite affinity for noradrenergic receptors (e.g. fluoxetine) can be effective in the treatment of cata-plexy. Frequently patients with narcolepsy experience EDS many months in advance of the development of cataplexy. At this early stage of disease development the patient may present to a physician with a complaint of tiredness coupled with diminished motivation and reduced energy and therefore be misdiagnosed with an atypical form of...

Alternatives to HRT [3637 For Symptoms

There is little scientific evidence that complementary and alternative therapies can help menopausal symptoms or provide the same benefits as conventional therapies. Yet many women use them, believing them to be safer and 'more natural' especially following the current controversies regarding HRT. The choice of treatments is confusing and unlike conventional medicines, little is known about their active ingredients, safety or side effects or how they may interact with other therapies. They can interfere with warfarin, antidepressants and anti-epileptics with potentially fatal consequences. Some herbal preparations may contain oestrogenic compounds and this is of concern for women with hormone dependent disease such as breast cancer. There is also concern about contaminants such as mercury, arsenic, lead and pesticides. Legislation is soon to be introduced which will make it mandatory for herbal preparations to at least be registered with the MHRA. This will at least allow some control...

Posttraumatic Stress Disorder

Significantly, studies examining patient outcomes demonstrate that PTSD is among the most predictive variables of functional outcome following injury. In a retrospective study examining persons with moderate traumatic injury, PTSD was found to contribute more to perceived general health than injury severity or the degree of physical functioning (7). A prospective study examining posttraumatic stress, problem drinking, and functional outcome after injury also found that, one year after injury, PTSD was the strongest predictor of an adverse outcome (9). Another prospective study demonstrated that the most predictive variable for health, work satisfaction, and general functional outcomes was mental health as measured by the SF-36 mental health sub-scale. While this subscale is inclusive of PTSD, it also suggests that other psychological symptoms and conditions may explain variation in patient outcomes. Michaels et al. (8) identified major depression as one of those conditions.

Psychiatric disorders

While it is true that tiredness, fatigue, and or lack of energy are reported by a majority of patients with major depression, evaluation of EDS with subjective rating scales and objective measures suggests that frank sleepiness or a high sleep propensity may be less common than the complaint of fatigue or lack of energy 79 . Only a few studies have evaluated objective measures of sleepiness, such as the MSLT, in depression. These produce somewhat conflicting results, but overall suggest that most patients with depression maintain a normal level of daytime alertness and sleep propensity on MSLT 80 . Decreased sleep latency, shortened REM latency, and increased REM percentages are reported on overnight polysom-nography in both sleep-deprived, non-depressed patients and suicidal patients 81,82 . Other studies suggest that insomnia, but not sleepiness or fatigue, correlates with thoughts of suicide, plans for suicide, or attempted suicide 83-85 .

Medications and sleepiness

Side-effects from some psychiatric medications and non-prescription substances must be considered in the evaluation of a patient complaining of EDS. Special consideration should be given to sedating antidepressants, antipsychotics, antiepileptics, hypnotics, or sleep aids. Many psychotropic medications involve antidopaminergic, antiadrenergic, anticholin-ergic, or antihistaminic activity, all of which can contribute to sleepiness or fatigue. While side-effects are typically worse at drug initiation or during dose escalations, patients on stable dosing may continue to have sedation or fatigue related to their medication regimen. Many of the medications used in psychiatry have half-lives which lead to drug accumulation, and it is thus not surprising that even medications used at bedtime can produce EDS, as daytime serum levels of sedating medications can be many times higher than the maximum serum concentration immediately after drug initiation. For shorter-acting agents, one potential...

Patents on Oral Drug Delivery

Although Paxil's patent expires in 2006, a number of generic companies have already filed ANDAs to market generic versions of the drug (paroxetine hydrochlor-ide). Paxil's patent holder, GlaxoSmithKline, has been fending off patent challenges by filing patent-infringement suits against these generic companies. At the same time, GlaxoSmithKline had extended the Paxil product line by launching a new controlled-release formulation and by gaining approval for new indications. Paxil has been approved in 28 countries for treating posttraumatic stress disorder. Paxil CR is a controlled-release formulation of paroxetine which was launched in the United States in April 2002. It is intended for the treatment of major depressive disorder and panic disorder. Paxil CR combines the efficacy of paroxetine with an advanced technology that controls dissolution and absorption of the drug in the body. In addition to demonstrating efficacy, clinical studies of Paxil CR indicated a favorable tolerability...

Urinary frequency and urgency

Cystitis Symptoms Women

Dimethylsulphone (DMSO) has been instilled into the bladder with some success 275 . Many clinicians believe that this gives good symptomatic relief even if only in the short term although there are concerns that it may be carcinogenic. Other treatments which have been tried include local anaesthetics, calcium channel blockers and tricyclic antidepressants which should probably be used as an adjunct to treatment to help to relive pain 268 .

Mood and impact on quality of life

It is important to identify coexisting mood disturbance. While it is unlikely that depression is the cause of CPP, the presence of disturbed mood makes it difficult for patients to engage fully with pain management initiatives and tackle associated lifestyle factors. The absence of laparo-scopically visible pathology was not associated with a higher probability of depression 7,8 . In these studies no differences in mood-related symptoms were identified in women with CPP with and without endometriosis. Antidepressant therapy may be indicated to alleviate depression, but sertraline was not effective for relief of pelvic pain in a small but well-conducted randomized trial 9 .

Schizophrenia and Bipolar Disorder

One of the first bipolar disorder molecular genetic studies implicated chromosone 11, but this finding was not replicated in several other studies. A similar failure to replicate occurred with the initial reports of linkage on the chromosome X. Regions on chromosome four are reported to show strong evidence of linkage to some bipolar families. Major efforts in the last few years have been focused on chromosome seven and eighteen. Some of the studies have suggested a parent-of-origin effect, with maternal transmission more common than paternal. Both linkage and association studies have implicated chromosomes 4p, 6p, 12q, 13q, 16p, 18p, 18q, 21q, and 22q in bipolar disorder. Major depressive disorder has also been studied, but the underlying genetic factors have not been identified.

The Acute Phase Response and Alzheimer Disease

Enhanced levels of cortisol have been found in major depression as well as in AD. However, after low-dose adrenocorticotropin stimulation, increased cortisol release was found to be characteristic of major depression but not AD. By contrast, an enhanced release of androgens after low-dose adrenocorti-cotropin stimulation has been found in patients with mild to moderate AD, but not in persons with depression (313).

Clinical Uses Of Electrical Stimulation

This is a relatively painless procedure that is effective in treating major depression. A short, controlled set of electrical pulses is given for about a minute through scalp electrodes to produce generalized seizures. Biological changes that result from the seizure are believed to result in a change in brain chemistry which is believed to be the key to restoring normal function. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current.

Evaluation of the patient with EDS

Evaluation of EDS with MSLT is pursued. Practicing clinicians should also be aware that commonly prescribed antidepressants can have profound effects on the MSLT by suppressing potential SOREMPs. Therefore, the decision regarding whether such medications should be tapered prior to MSLT should be made cooperatively with the patient, and include the risks of potentially worsening the psychiatric illness versus a confounded MSLT.

Puerperal psychological disorders

Mild pyschological and transient depression is extremely common in the few days post-partum. This transient state of tearfulness, anxiety, irritation and restlessness has been variously described as 'the blues' and it may occur in up to 70 of women. It is usually resolved by day 10 post-natally and is probably associated with disruptive sleep patterns and the adaptation and anxiety of having a newborn baby. The changes in steroid hormone levels that occur immediately following delivery are not correlated with this transient depressive state and because it is transient no therapy is needed. Post-partum depression occurs in approximately 8-15 of women and this disorder may vary in severity from mild to suicidal depression 15 . The signs and symptoms of post-natal depression are not different from those of depression in non-pregnant women and there are a number of antenatal factors that increase the risk of major post-partum depression. These are outlined in Table 10.5. There is a high...

Idiopathic hypersomnia

Which may be prolonged but usually are unrefreshing, in contrast to classically refreshing naps in narcolepsy. No amount of sleep ameliorates the EDS. Micro-sleeps, with or without automatic behavior, may occur throughout the day. This diagnosis is distinctly different from that of major depression, as patients with idiopathic hypersomnia lack the generalized anhedonia associated with a major depressive episode and are much sleepier on objective testing than the patient with an atypical depression (see Section VI Sleep disturbance in psychiatric illness).

Insomnia history of the chief complaint

The longitudinal pattern of insomnia is also an important component of the history. Symptoms of insomnia typically change over time, as a complaint of initial insomnia, for example, can progress into one of a difficulty in sleep maintenance. In one study, the nature of symptoms changed in over half of insomniacs over the course of 4 months 7 . The temporal relationship between insomnia and co-morbid illnesses can also indicate what factors may have caused insomnia, and provide a basis for treatment. It should be borne in mind, however, that this relationship can be complex, especially in the case of psychiatric illness. For example, the presence and persistence of insomnia predicts the future onset of new psychiatric disorders, especially depression 8 . Insomnia can temporally precede, follow, or occur in concurrence with, the onset of a major depressive episode 9 . Insomnia can, therefore, be a harbinger of affective disease, and a residual symptom following treatment. Precipitants...

Neurochemistry of Depression

Agents that deplete monoamines such as reser-pine (see Chapter 16) tend to induce depressive illness whilst agents that have the opposite effect, most importantly the MAO inhibitors (MAOIs) such as clorgyline and deprenyline, are antide-pressants. The important tricyclic antidepressants (e.g. imipramine and amitryptiline) act by blocking reuptake of monoamines from the synaptic cleft. Acetylcholine, on the other hand, tends to act in an opposite sense to the central monoamines. Most antidepressants seem to have an anticholinergic action vice versa, reserpine potentiates central cholinergic activity. This could further enhance the depression. The suggestion is, therefore, that depression may result from an imbalance between central mono-aminergic and cholinergic systems (Figure 21.6). It may also be supposed that the cycling of manic-depressive illness is due to first one and then the other system gaining the upper hand. Figure 21.6 Neurotransmitter balance and depression. In...

Discordance of Monozygotic Twins Environmental Impact Stochasticity

Common phenotypic differences (discordance) in identical twins have been one of the hallmarks of complex non-Mendelian disease. For example, pro-band-wise, MZ concordance for major depression is 31 for male and 48 for female MZ twins (Kendler and Prescott 1999), 62 -79 in bipolar disorder (Bertelsen et al. 1977), and 41 -65 in schizophrenia (Cardno and Gottes-man 2000) for concordance rates in other diseases, in both MZ and dizygotic (DZ) twins, see Fig. 1 . The phenomenon of differential susceptibility to disease in genetically identical twins was identified decades ago however, the

Warning Signs And Risk Factors

Psychopathology is another important risk factor commonly found in youths who have engaged in suicidal behavior or have committed suicide. Psychological autopsies have reported that more than 90 of youths who died by suicide had at least one psychiatric disorder, such as depression, anxiety, substance abuse, conduct disorder, and borderline personality disorder. In fact, most adolescents who have committed suicide had multiple psychiatric disorders occurring simultaneously (comorbidity). The most common psy-chopathology linked to suicidal behavior is depression, with approximately 50 to 66 of those who committed suicide experiencing some type of depressive disorder. The psychopathology profile of an adolescent who attempts suicide looks very similar to those who die by suicide, with depression being the most common psychiatric disorder. Also, hopelessness, which is not a separate diagnosis, plays an important role regarding suicidal behavior in adolescents.

Subconscious Incubation

EEG studies of autistic patients also suggest that some of these people might be in chronically high states of physiological arousal (Hutt, Hutt, Lee, & Ounsted, 1965). In contrast, studies of physiological arousal in depression, as determined by EEG power analysis, have revealed that depressed patients have reduced arousal that is altered with treatment (Knott, Mahoney, & Evans, 2000 Nieber & Schlegel, 1992). If, as I suggested previously, lower levels of physiological arousal allow people to increase the extent of their concept representations and increase their cognitive flexibility, then it would follow that people with depression might have a propensity to be creative and patients with autistic spectrum disorder would tend to have limited creativity. Functional imaging studies of patients with depression can provide some insight into the mechanisms by which depression might provide the basis for creative inspiration. Many such studies have shown that depression is associated with...

Psychological Disorders Following Trauma

Presently, few studies have specifically evaluated the psychological impact of pelvic fractures in an adult population. However, studies have indicated that psychological distress following pelvic fracture is a significant issue in the pediatric population (4,5). Subasi et al. (4) examined 58 children who experienced unstable pelvic fractures and assessed urologic outcomes as well as psychiatric data. To assess psychiatric status, both the parents and children were interviewed by a psychiatric specialist. Fifty-six percent (31) of the children were found to have a psychiatric disorder, five of whom had two diagnoses and three of whom had three diagnoses. The diagnoses included dys-thymic disorder, social phobia, post-traumatic stress disorder (PTSD), major depression, and specific phobia. The prevalence of psychiatric disorders was significantly higher than the normal population. Similar results were found in 49 children who sustained a posterior urethral rupture secondary to pelvic...

Epidemiology and Diagnosis

In the history it is important, as well as asking about LUTS, to exclude any other co-morbidities that could be contributing to the presentation. It is important to exclude neurological disorders, including cerebrovas-cular events, multiple sclerosis (MS), spinal cord injury (SCI), pelvic or perineal trauma, Parkinson's disease, multisystem atrophy (MSA), and motor neuron disease (MND), and consider if they are taking any drugs that could contribute to dysfunctional voiding (anticholin-ergics, antidepressants, anesthetic agents, analgesics). Also, it is important to assess the patient's general medical state to ensure that they are not going to come to any harm as a result of any therapy instigated.

Risk Taking and Substance Abuse

On the basis of the information I reviewed earlier, we can see that people, even in the absence of known brain lesions, who have a propensity to take risks, including extremely creative people, might have a OMPC-ventral striatal system that is different from people who are not risk takers. I previously mentioned the relationship between creativity and substance abuse, and I mentioned that people with a propensity for substance abuse might have aberrant functioning of their ventral striatum, including the nucleus accumbens. I also mentioned that creative people also have a propensity to be depressed. Functional imaging studies of depressed people have revealed abnormalities in portions of the orbital-medial prefrontal-ventral striatal circuit (Drevets et al., 1992). Drevets and coworkers also showed that a portion of the ventral medial prefrontal cortex is 40 smaller in depressed patients than in controls.

Effectors And Second Messengers

Block one of the steps in this resynthesis pathway the step from inositol monophosphate to inositol. Whether the well-known effects of lithium in controlling the mood swings of bipolar depression (in particular suppressing the manic phase) can be connected to its action in this biochemical pathway is an interesting speculation - but as yet no more than a speculation.

Bipolar Disorder Childhood Onset

Bipolar disorder (BD), or what historically was called manic-depressive disorder, has long been identified as an adult disorder. BD is characterized by extreme shifts in mood, energy, and behavior that significantly impair an individual's functioning. In adults, it is characterized by cycles of depression alternating with either mania (i.e., feelings of elation, inflated self-esteem, excessive talking, flight of ideas, increased goal-directed and risk-taking behavior, and agitation) or hypomania (manic-like symptoms but less severe and shorter in duration) each component of the cycle lasts at least 4 days. With children, it has been suggested that the components of the cycle can be very short (i.e., rapid or ultrarapid cycling) (Papolos & Papolos, 1999). Furthermore, in children, the depression may manifest as irritability, low motivation, poor concentration, and loss of interest. Not only do some of the behaviors associated with BD occur in the course of normal development, but...

Cytokine and metabolicrelated hormone studies

There is a growing literature suggesting that the links between depressive symptoms and OSA may be associated with obesity and the metabolic syndrome. Although both OSA and depression have independently been shown to be associated with metabolic syndrome and cardiovascular disease 105,106 , it is still poorly understood how these risk factors interact with each other. t Daytime Sleepiness t Depressive Symptoms t Fatigue I Quality of Life

Clinical presentation of urinary incontinence

Some drugs affect urinary tract function, especially diuretics, which increase urine output. In older people they may cause urinary incontinence where only urgency existed previously. Other drugs which affect detrusor function include tricyclic antidepressants, major tranquillizers and a adrenergic blockers.

The Genetic Epidemiology of ADHD

Family studies have provided evidence for the genetic heterogeneity of ADHD. Studies that systematically assess other psychiatric disorders suggest that ADHD and major depression often occur together in families that ADHD children with conduct and or bipolar disorders might be a distinct familial subtype of ADHD and that ADHD is familially independent from anxiety disorders and learning disabilities. It may therefore be appropriate to divide ADH children into those with and those without conduct and bipolar disorders, thus forming more familially homogeneous subgroups. In contrast, major depression may be a nonspecific manifestation of different ADHD subforms.

Pharmacologic Highlights

Encourage the patient to follow the medication regimen and reassure him or her while waiting for it to take effect. To determine the response to treatment and to prevent thyroid storm, assess the cardiovascular status, fluid and diet intake and output, daily weights, bowel elimination, and the ability of the patient to perform activities of daily living without excessive fatigue. Reassure the patient's family that the patient's mood swings, nervousness, or anxiety will diminish as treatment continues. If the patient or family requires additional support, ask a clinical nurse specialist or mental health counselor to see the patient or family. Note that extreme anxiety

Testosterone Treatment

Intramuscular T esters (cypionate, or enanthate) are initiated at doses of 200 mg im every 14 d or 100 mg every wk. Thereafter the dose and or frequency of injections can be adjusted so that the total T value immediately preceding the next injection falls within the low- to midnormal range. This is the most inexpensive form of effective T replacement therapy. One potential disadvantage of this regimen, however, is that blood T frequently rises to values above 1000 ng dL during the first few days following injection and then falls over time until the next dose. The resulting cyclic fluctuations in serum T that occur following repeated doses have been associated with concurrent mood swings in some individuals. Furthermore, the supraphysiologic T values attained early after each injection have been linked to a greater frequency of polycythemia than observed with other ART regimens (see Side Effects section below).

Selected Issues in Clinical Development

Variation in response to drugs among individuals has long been recognized. One of the mechanisms for such variation is genomic variation in the population (Fig. 8.39) At the most readily observed level, this variation results in responders and nonresponders in clinical trials and clinical practice and also in the occurrence of drug toxicity in some treated individuals but not in others (called pharmacogenomics). More recently, individual variations in drug metabolism, particularly with respect to cytochrome P450 (CYP450) mediated liver metabolism, began to be systematically explored in an effort to understand the bases for individual differences in drug efficacy and toxicity. Numerous well-studied examples (e.g., dextromethorphan, tri-cyclic antidepressants, beta-blockers, narcotic analgesics) exist of interindividual variation in the expression of a CYP450 drug-metabolizing enzyme (phenotypic expression) resulting in varying systemic drug exposure and consequent clinical sequelae 36 .

Sleepwalking and sleep terrors overview and clinical description

Of particular interest to psychiatrists are cases of parasomnias related to the use of psychotropic drugs. SW ST, occasionally of severe and injurious intensity, have been reportedly associated with the use of neuroleptics including olanzapine 45 and quetiapine 46 antidepressants including paroxetine 47,48 , reboxetine 49 , and bupropion 50 lithium 51,52 sedative-hypnotics (zolpidem) 53 anti-epileptics including topiramate 54 , valproic acid combined with Zolpidem 55 stimulants minor tranquilizers and antihistamines, often in various combinations 20,21,56-62 . Other associated medications are metoprolol 63 and fluoroquinolone 64 .

Affective disorders in RLS

Self-reported decrease of mental health 88 and self-reported depressed mood and social isolation in RLS patients 86 . Up to now, two studies used a structured diagnostic interview to evaluate the prevalence of co-morbid depression in RLS. Winkelmann and coworkers found a 12-month prevalence of depressive episodes according to DSM-IV criteria in 17.7 (lifetime prevalence 36.9 ) and dysthymia in 5.3 (lifetime prevalence 5.3 ) in RLS 97 . In this study, the majority of interviewed RLS patients (82 ) received pharmacological treatment for RLS. Another study that examined data from the Baltimore epidemiologic catchment area (ECA) study found that the risk of MDD was roughly five times higher amongst those with RLS than those without 98 . An earlier study that examined data from the Wisconsin Sleep Cohort study demonstrated a positive association between RLS symptom frequency and self-reported depression, with individuals with daily RLS symptoms substantially more likely to have depression...

Antirhinoviral Strategies

Release of chemokines and attenuate symptoms. The acid sphingomyelinase (ASM), which was shown to be crucial for generation of ceramide-enriched platforms, a suben-tity of lipid domains, might be an additional target to prevent HRV infections. Fibroblasts isolated from NPDA patients (Niemann-Pick disease type 1) lacking functional ASM were shown to be resistant to HRV infections. The ASM can be inactivated pharmaceutically by tricyclic antidepressants such as amitryptiline and imipramine. Studies in which the ASM was inhibited by these substances showed a dramatic decrease of viral reproduction, suggesting that the ASM is critically involved in the propagation of rhinoviruses in human cells. Drugs derived from the structure of tricyclic anti-depressants might therefore be effective against rhinovi-rus infections.

Culture Context and Individual Differences

Rates of depression and substance abuse disorders are low among Mexican Americans born in Mexico (Vega et al., 1998), and immigrant Mexican American women have a lifetime rate of depression of 8 , similar to the rates of nonimmigrant Mexicans (Vega et al., 1998). However, after 13 years in the United States, rates of depression for those women who immigrated to the U.S. rise precipitously. U.S.-born women of Mexican heritage experience lifetime rates of depression similar to those of the White population in the United States, nearly twice the rate of immigrants. These findings are mirrored in other indicators of health Despite high rates of poverty, Mexican American immigrant women have low rates of physical and mental health problems (Vega et al., 1998), Chinese American immigrant women have a lifetime rate of major depression near 7 , approximately half that of White women (Takeuchi et al., 1998). These results suggest that some aspects of culture may protect against culture pp....

Depression an allostatic disorder with premature mortality

Human depression is a clear example of the allostatic link between chronic stress and reduced longevity. The importance of psychosocial stress for provocation of depressive episodes, for vulnerability to, and for risk of depression has been reviewed by Checkley (1996). Depression is an established outcome of stress, and the ongoing depressive episode itself constitutes a chronic stress. In large, prospective studies of adverse medical outcomes in depression, the customary psychiatric distinction between depressive symptoms and a depressive syndrome appears not to be important. Stress is a risk factor for both major depression (syndrome) and minor depression (symptoms). Minor depression is both a prodrome of major depression and an outcome of major depression and major depression is a major outcome of minor depression. Recent studies suggest a linear relationship between the number of depressive symptoms and premature mortality. Koenig et al (1999) found in a nine-year prospective...

Medical Management of Terrorist Related Injuries

Of patients with urgent and salvageable life-threatening injuries (undertriage) (Frykberg 2004 Kluger 2003 Stein and Hirshberg 1999). In these circumstances, prioritization of treatment regimens is mandatory and definitive therapy should be delayed until the patient is hemodynamically stabilized damage control principles should be applied. However, identifying those critically injured patients who are candidates for damage control maneuvers, which aims to achieve hemostasis and prevent uncontrolled spillage of bowel contents and urine, is undoubtedly a challenge. Throughout the management of the event, coordination between the primary on-scene teams responsible for the primary triage and evacuation is obligatory, followed by similar close interaction between the in-hospital teams conducting the triage, the initial treatment, the surgical interventions and the intensive care, as well as between neighboring hospitals, in order to optimize utilization of the hospitals' personnel and...

Psychiatric disease

Psychiatric disease also warrants good quality prepreg-nancy care and counselling. There are often concerns about transmission of mental illness to children, and risks of destabilizing mental illness. The estimate is that there is a 10-15 risk of schizophrenia or manic depressive illness in offspring. Risks of instability and potential plans for withdrawing medication must be discussed thoroughly with

The Risks of IVF

In some women, the drugs used to promote superovulation may cause side effects, including mood swings. Some investigators have suggested that procedures used in assisted reproductive technology may not be safe because of the potential for increased ovarian hyperstimulation syndrome and bone


Lithium salts have been used in the treatment of manic-depressive disorders since 1949, and treatment is frequently complicated by the development of polyuria and polydipsia 49 . When patients on lithium are dehydrated, they exhibit impaired concentrating ability which is not responsive to exogenous vasopressin. Moreover, ADH levels in these patients are elevated. Therefore, lithium induces nephrogenic diabetes insipidus. Although acute administration of lithium can impair renal concentrating ability to a moderate degree, chronic administration tends to make the defect more severe. Clearance studies have shown that lithium does not alter diluting capacity, and sections of medulla from rats with lithium-induced diabetes insipidus exhibit normal hypertonicity. These results localize the defect to the collecting duct 49 because medullary tonicity, everything else being equal, is dependent primarily on salt transport by the thick ascending limb. In isolated perfused rabbit cortical...

Cytochrome P450 2d6

The CYP2D6 gene is a very polymorphic gene with more than 70 alleles described today. 1,2 This diversity leads to a great variety of activity of the enzyme debrisoquine 4-hydroxylase, which is encoded by the CYP2D6 gene. Many popular drugs such as antidepressants, neuroleptics, or cardioactive drugs, e.g., amitriptyline, paroxetine, haloperidol, metoprolol, etc., 3 are substrates of CYP2D6. This may lead to adverse drug effects or therapy resistance. Subjects with normal enzymatic activity are called extensive metabolizers (EM). Subjects with increased activity are termed ultraextensive and ultrarapid metabolizers (UM), respectively, and have a prevalence of 1-10 in a Caucasian population.1-4-1 They often do not reach therapeutic drug concentrations and suffer from therapeutic failure. Individuals with low or absent activity run the risk of potentially increased drug concentrations and adverse drug reactions. They are named poor


In China, the rhizome is used as a deodorant, carminative, and stimulant. A decoction is used in various skin affections and in the bath to give fragrance to the body. In India, the rhizome is used to treat depression, hysteria, epilepsy, convulsions, headache, colic, and as a tonic and carminative.


It was found many years ago that MAO inhibitors (MAOIs) (e.g. iproniazid, nialamide, pargyline) lifted psychological states of depression. This observation led to what has been called the biogenic amine theory of depression. It was suggested that endogenous depression was caused by a deficiency in biogenic, especially catechol, amines. This idea received support from the finding that reserpine tends to cause sedation in experimental animals and depression in humans. Further support was provided by the finding that tricyclic compounds such as desipramine, imipramine and amitriptyline (Figure 16.23) which are known to block reuptake of noradrenaline and serotonin into presynaptic terminals are powerful antidepressants. The biogenic amine theory thus argues that Figure 16.24 The noradrenergic synapse. The pharmacology of the adren-ergic synapse is similar to the dopaminergic synapse. Only additional features will be described here. The synthetic step from dopamine (DA) to noradrenaline...

Special Studies

Phase 3b or 4 studies may examine the effect of a meal on absorption (if the drug is taken by mouth), including increases and decreases in blood levels, or its ability to reduce abdominal reactions like nausea (Fig. 5.13). Interactions between the new drug and other medications that would likely be used concomitantly are studied in phase 3b and phase 4, for example, warfarin drugs that alter the activity of cytochrome P450 (CYP) isoenzymes, if the drug is metabolized by these enzymes. Many drug categories have impact on the CYP family of degradative liver enzymes and increase or decrease blood levels of concurrent drugs, such as antidepressants, beta-blockers, calcium channel blockers, narcotic analgesics, antipsychotics, estrogens, and nonsteroidal anti-inflammatory drugs. The effects of age may influence sensitivity to side effects, alter metabolism, or change patients' responsiveness. Diseases, especially liver, kidney, and heart, may change the pharmacokinetics of the new product,...


Although children with enuresis are usually treated with behavioral methods, there is some interest in using medications for this disorder. Medications for managing enuresis include the tricyclic antidepressants (a classification of antidepressant medications that are hypothesized to potentiate the adrenergic synapses by blocking the reuptake of norepinephrine at the nerve endings) and the antidiuretic hormone desmopressin (a synthetic version of the naturally occurring hormone vasopressin, a hormone affecting renal functioning or water retention) (Phelps & colleagues, 2002). However, these drugs have high relapse rates, and potentially fatal cardiac effects have often been an adverse effect of the tricyclic antidepressant (Werry & Aman, 1998).


According to Eysenck (1995), Aristotle claimed, No great genius has ever been without some madness. According to Simonton (1999), Aristotle also wrote, Those who have become eminent in philosophy, politics, poetry and the arts all had tendencies toward melancholia. John Adams said, Genius is sorrow's child. In his book, Eysenck tried to make the argument that there is a strong relationship between creativity, psychosis, and schizophreniform thinking, but then quoted Eisenman's studies that demonstrate that schizophrenics are even less creative than normal hospital employees, who Eysenck noted are not particularly creative. Kraepelin in 1921 noted that manic-depressive psychosis was often associated with enhanced creativity (Weisberg, 1994). Post (1996) studied the biographies of a large group of world-famous creative people, such as composers, scientists, artists, and writers. To classify these people, Post used the diagnostic criteria found in the Diagnostic and Statistical Manual of...


Preliminary data are beginning to emerge that suggest a relationship between low-omega-3 status and suicidal behavior, which often has a component of impulsivity. Across 31 countries, greater seafood consumption predicts a lower risk of death as a result of suicide among males in an age-adjusted logarithmic regression (r -0.42, p 0.02) (Hibbeln, unpublished data). This relationship is not as robust as the relationship of seafood consumption to prevalence rates of major depression, postpartum depression, or bipolar affective disorders. However, two epidemiological studies within countries are consistent with these cross-national findings. We examined 1767 subjects in northern Finland and reported that frequent fish consumption (twice per week or more) significantly reduced the risk of reporting depressive symptoms (odds ratio 0.63, p 0.03) and of reporting suicidal thinking (odds ratio 0.57, p 0.04) (Tanskanen et al., 2001). In a17-yr follow-up of256,118 Japanese subjects (Hirayama,...

Drug Targets

In Europe today, routinely tested DOA are shown in Table 1. In a typical screening assay, it is quite common to see combinations of these drugs being tested. At roadside screening, it has been reported that cannabis, opiates, cocaine, amphetamines (including methamphetamines), and benzodiazepines represent the most regularly tested DOA (6,7). Codeine, cotinine, salicylate, and tricyclic antidepressants may also be present in test panels. Phencyclidine (PCP), regularly included in the Substance Abuse and Mental Health Services Administration (SAMHSA)-5 panel of drugs in the United States, is rarely included in European DATs, especially on the POC format. Commonly abused in the United States, PCP is consumed at much lower levels in Europe.


Before embarking on this subject, however, we need to make some important distinctions. First we need to separate endogenous from exogenous or reactive depression. Both may involve the same neurochemical mechanisms but clearly the endogenous type is less dependent upon environmental triggering. Second, within each category of the forgoing classification, it is important to distinguish between 'monopolar' and 'bipolar' affective disorder. The first condition is commonly known simply as major depression or major depressive disorder (MDD) and the second as 'manic-depression'.

Monoamine Oxidases

In mammals, monoamine oxidases A and B (EC catalyze the oxidation of neurotransmitters such as serotonin and dopamine by O2 to form aldehydes and H2O2 (fig. 17-5A). These membrane-bound flavoproteins, known as MAO A and MAO B, are drug targets for the treatment of depression and Parkinson's disease, respectively (Silverman, 2004). MAO A in the brain selectively catalyzes oxidation of serotonin and norepinephrine, and inhibitors of brain MAO A are antidepressants. MAO B selectively catalyzes the oxidation of dopamine, and inhibitors can be employed in the treatment of Parkinson's disease. MAO A and B display about 70 amino acid sequence identities in their catalytic domains.

Sleep architecture

The majority of sleep EEG studies have focused on patients with major depressive disorders, and have found three main abnormalities 76 (1) reduced sleep continuity (2) SWS deficits and (3) REM sleep abnormalities. Reduced sleep continuity manifests in subjects with depression as longer sleep latency, increased waking periods after sleep onset, frequent early morning awakenings, decreased sleep efficiency, and less total sleep time compared to age-matched healthy controls. Depressed patients exhibit a reduction in total minutes of SWS 77 that is particularly evident during the first sleep cycle, when SWS activity in healthy subjects peaks. REM sleep abnormalities are present in patients with depression, who show reduced REM sleep latency, a longer first REM sleep episode, enhanced phasic REM activity, and increased total minutes of REM sleep 65,76 . Intriguingly, similar sleep architecture disturbances have been found in bipolar patients, during both manic and depressive episodes 78 ....

Chronic Constipation

FI can occur in patients affected by chronic constipation as a consequence of stool retention in the rectum, resulting in overflow incontinence. Chronic fecal retention determines a significantly decreased anorectal sensation. On the other hand, constipation can be caused by excessive consumption of drugs, including antidiarrheals, narcotics, calcium-channel blockers, antidepressants, and other psychotropic agents. Finally, particularly in the older subjects, dehydration and insufficient fiber and fluid intake cause chronic constipation. Overflow FI is particularly frequent in institutionalized patients. It can require manual disimpaction, stool softeners, laxatives, enemas, or suppositories 22 .

Depression in OSA

Depression is the most commonly encountered affective disorder associated with OSA 68 . The prevalence of depression in OSA has ranged from 7 to 63 69 . Early investigations by Guilleminault and colleagues reported that 24 of male patients with OSA had previously seen a psychiatrist for anxiety and depression 70 . A recent epidemiological study of 18 980 subjects representative of the general population in the UK, Germany, Italy, Portugal, and Spain found that 17.6 of subjects with a Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) breathing-related sleep disorder diagnosis (by history, without sleep study) have major depressive disorder (MDD) 71 . Thus, some co-morbidity between SRBD and depression has long been observed. The variations in the prevalence of depression are thought to be affected by sampling characteristics, mood assessment methods, and diagnostic difficulty due to an overlap of symptoms across depression and OSA. A number of studies, using varied...

Exogenous Depression

Exogenous depression again may be either monopolar (i.e. 'major depression') or bipolar (i.e. 'manic-depression'). It should not be thought, however, that the symptoms and symptom patterns are at all clear cut. They have, in fact, been long known to constitute 'an extraordinarily heterogeneous syndrome'. It is interesting to note, however, that major studies in the US have shown that whereas male and female Americans suffer bipolar depression in about equal numbers, twice as many females as males suffer monopolar depression.

Drug therapy

Antidepressants (C) Antidepressants in the treatment of patients with detrusor overactivity 213 although others report little effect 214 . In light of this evidence and the serious adverse effects associated with tricyclic antidepressants their role in detrusor overactivity remains of uncertain benefit although they are often useful in patients complaining of nocturia or bladder pain.

The Dsmiv Approach

The most common DSM-IV diagnoses for children include ADHD, conduct disorder, oppositional defiant disorder, separation anxiety disorder, generalized anxiety disorder, dysthymia, major depressive disorder, and adjustment disorder. The DSM-IV approach implies that there are categorical differences between mental health and each type of disorder. If a child meets criteria for a disorder and is judged to be impaired by the disorder, then the child is not mentally healthy.


Members of this class, such as fenfluramine and dexfenfluramine, which act by enhancing the release and blocking the reuptake of serotonin, were withdrawn from the market in the late 1990s because of valvular heart disease and pulmonary hypertension. Some antidepressants such as fluoxetine and sertraline inhibit serotonin reuptake but do not enhance serotonin release from nerve terminals, which may explain the absence of any valvular heart disease or pulmonary hypertension associated with their use. Although they are not approved for the treatment of obesity, off-label use has demonstrated the induction of weight loss in some obese patients. However, this effect may be transient, as significant weight regain has been reported after several months of treatment with fluoxetine (91).


Low activity of gamma aminobutyric acid (GABA) has been reported in patients with depression, PMDD and PMS. Oestrogen increases binding of GABA agonists and the upregulation of GABA receptors. In addition to the effect of SSRIs on the serotonergic system, they have been shown to enhance GABA function, hence improving depressive symptoms. Investigations of the metabolites of progesterone have shown that women with PMS had lower levels of allopregnanolone in the luteal phase

Natural Depression Cures

Natural Depression Cures

Are You Depressed? Heard the horror stories about anti-depressants and how they can just make things worse? Are you sick of being over medicated, glazed over and too fat from taking too many happy pills? Do you hate the dry mouth, the mania and mood swings and sleep disturbances that can come with taking a prescribed mood elevator?

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