Mood Disorders Practical Issues in Diagnosis and Management 1st edition by Ather Muneer ISBN 1351370774 9781351370776

1 Major Depressive Disorder and Bipolar Disorder

Introduction

Signs and Symptoms

Major Depressive Episode

Manic Episode

Mixed States

Diagnosis of Mood Disorders

Major Depressive Disorder

Major Depressive Disorder with Psychotic Features

Melancholic Depression

Bipolar Disorder

Rapid Cycling

Somatic and Neuropsychiatric Comorbidities

Seasonal Affective Disorder

Conclusion

Summary Points

References

2 Major Mood Disorders: Differentiating Features

Introduction

Allostatic Load Model of Mood Disorders

Mood Disorders as Systemic Ailments

Differentiating Features of Unipolar and Bipolar Depression

Disease Onset

Unipolar Versus Bipolar Depression

Illness Characteristics

Affective Ailments as Spectrum Disorders

The Continuum of Mood Disturbances

Epidemiological Considerations

Mood Disorders in Low Income Countries

Diagnostic Implications

Illness Trajectory

Suicide in Mood Disorders

Psychometric Scales

Differentiating Between Unipolar and Bipolar Depression

Catatonic Symptoms in Mood Disorders

Conclusion

Summary Points

References

3 Comorbidity in Mood Disorders

Introduction

The Relation Between Mood Disorders and Inflammatory Comorbidities

Autoimmunity

Hypersensitivity

Chronic, Low-Grade Inflammation and the Metabolic Syndrome

Immune-Inflammatory Imbalance and General Medical Comorbidities

Genetic Variations

Psychological Stress

Substance Use

The Gut–Brain Axis

Affective Episodes as Allostatic States

Role of Adipose Tissue

Therapeutic Considerations

Medication-Induced Metabolic Dysfunction

Treating Mood Disorders and Comorbidities Together

Using Anti-Inflammatory Agents in the Treatment of Mood Disorders

The Role of Regular Physical Exercise

Restoring Gut Microbiota Imbalance

Conclusion

Summary Points

References

4 The Role of Epigenetics

Introduction

The Relationship Between Mood Disorders and Inflammation

Inflammatory Markers and Mood Episodes

Inflammatory Abnormalities in Adolescent Depression

The Biological Mechanisms Linking Mood Disorders and Inflammation

Cytokines and the Brain

Microglia Dysfunction

The Role of Psychotropic Medications

Neuronal Plasticity

Brain-Derived Neurotrophic Factor

Brain-Derived Neurotrophic Factor and Mood Disorders

Brain-Derived Neurotrophic Factor and Psychotropic Medications

Brain-Derived Neurotrophic Factor and Neurogenesis

Childhood Abuse and Mood Disorders

Childhood Maltreatment

The Relationship Between Early Life Trauma and Mood Disorders

The Link Between Childhood Trauma and Inflammation

Human Studies

Hypothetical Framework

Rodent Experiments

Childhood Trauma and Neuronal Plasticity

Early Life Maltreatment and Brain-Derived Neurotrophic Factor

Rodent Models

Brain-Derived Neurotrophic Factor Transcription and Translation

Brain-Derived Neurotrophic Factor Dysregulation and Reduced Neurogenesis

Hypothalamic–Pituitary–Adrenal Axis Dysfunction

The Epigenetic Link

Epigenetic Regulation of the Genome

Animal Studies

Human Studies

Epigenetic Modification of Neuroplasticity

The Epigenetic Basis of Mood Disorders

Future Directions

The Significance of Epigenetic Regulation

Inflammation as a Likely Epigenetic Mechanism

Epigenetics and Neuroplasticity

Epigenetic Modification of HPA Axis Functioning

Conclusion

Summary Points

References

5 Neurobiology of Mood Disorders: The Circadian Connection

Introduction

Mood Disorders and the Circadian System

The Master Circadian Oscillator

The Core Molecular Clock

Human and Animal Genetic Studies

The Neurobiology of the Circadian System

Monoamine Signaling in Mood Disorders

The CLOCK Proteins and the Immune-Inflammatory System

Regulation of the Hypothalamic–Pituitary–Adrenal Axis

The Circadian Control of Metabolism

Oxidative Stress and the Circadian System

The Circadian Rhythm and Neurogenesis

Conclusion

Summary Points

References

6 Pathogenesis of Mood Disorders: The Neuroinflammatory Hypothesis

Introduction

Cytokines and Neuroinflammation

Immune-To-Brain Signaling

Activation of Microglia

TNF-α Mediated Neurotoxicity

IL-6 Trans-Signaling

The Notion of Sterile Inflammation

Inflammatory Molecular Patterns

Sterile Inflammation and the Inflammasome

Neuroinflammation and Mood Disorders

Inflammation, Kynurenines and Mood Disorders

The Immune Basis of Mood Disorders

Inflammation and the Kynurenine Pathway

Kynurenines and the Development Of Mood Disorders

Neuroactive Properties of the Kynurenine Pathway Metabolites

Promising Strategies for Treating Mood Disorders

Purported Model of Depression

Oxidative Stress

Physiological Role of Free Radicals

Pathophysiological Mechanisms

Redox Balance in the Brain

Measurement of Oxidative Stress

NADPH Oxidase Enzymes as a Potential Therapeutic Target

Conclusion

Summary Points

References

7 Staging and Neuroprogression of Mood Disorders

Introduction

Developmental Trajectory and Clinical Heterogeneity of Mood Disorders

Classical, Recurrent Bipolar Disorder

Bipolar Spectrum Disorders

Youth Precursors of Bipolar Disorder

Prospective Studies of Offspring of Parents with Bipolar Disorder

Major Depressive Disorder

Neuroprogression as the Basis for Staging Mood Disorders

Allostatic Load and Neuroprogression

Biomarkers of Mood Disorders

Potential Neuroimaging Markers

Brain-Derived Neurotrophic Factor

Oxidative Stress

Inflammatory Factors

Staging Models for Bipolar Disorder

Model Proposed by Berk et al

Staging Model of Kapczinski et al.49

Duffy’s Model50

Staging Models for Major Depressive Disorder

Therapeutic Implications of Staging

Limitations of the Staging Models

Conclusion

Summary Points

References

8 The Management of Treatment-Resistant Depression: Monoamines and Beyond

Introduction

Switching or Combining First-Line Antidepressants

Switching

Antidepressants in Combination

Combining Atypical Antipsychotics With Standard Antidepressants

Brexpiprazole

Aripiprazole

Quetiapine

Olanzapine/Fluoxetine

Vortioxetine in Treatment-Resistant Depression

Targeting other Pathways in Treatment-Resistant Depression

The Inflammatory Pathway

Oxidative and Nitrosative Stress

Targeting Glutamate

One-Carbon Metabolism

Mitochondrial Bioenergetics

The Hypothalamic–Pituitary–Adrenal Axis

The Neurotrophin Signaling Cascade in Mood Disorders

The Brain-Metabolic Axis

Conclusion

Summary Points

References

9 Depressive Phase of Bipolar Disorder: Treatment Recommendations

Introduction

Lithium and Anticonvulsants

Pharmacodynamic Considerations

Lithium Salts

Carbamazepine/Oxcarbazepine/Eslicarbazepine

Divalproex Sodium

Lamotrigine

Topiramate

Gabapentin/Pregabalin/Gabapentin Enacarbil

Levetiracetam

Atypical Antipsychotics

Pharmacodynamic Considerations

Risperidone

Olanzapine

Quetiapine

Ziprasidone

Lurasidone

Aripiprazole

Cariprazine

Conclusion

Summary Points

References

10 Manic Phase of Bipolar Disorder: Treatment Recommendations

Introduction

Diagnosis of Mania

Treatment of Mania

Current Treatment Guidelines for Bipolar Disorder

Pharmacotherapy of Acute Mania

Management Issues

Maintenance Treatment

General Considerations

Psychological Therapy

Pharmacotherapy

Conclusion

Summary Points

References

11 Non-Pharmacological Treatments for Mood Disorders

Psychological Treatments

Introduction

Psychoeducation

Cognitive Behavioral Therapy

Interpersonal and Social Rhythm Therapy

Dialectical Behavior Therapy

Mindfulness-Based Cognitive Therapy

Family Therapies

Future Directions in Research on Psychological Treatments

Conclusion

Electroconvulsive Therapy

Introduction

Depressive Episodes

Electroconvulsive Therapy for Manic/Mixed Episodes

Maintenance Electroconvulsive Therapy

Conclusion

Chronobiological Therapy for Mood Disorders

Introduction

Sleep Deprivation

Sleep Phase Advance Therapy

Light Therapy

Dark Therapy

Conclusion

Summary Points

References

Index