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New Treatments for Depression, Bipolar Disorder, Mania and Anxiety Disorders

Symptoms of major depressive disorder include problems of sleep, interest, guilt, energy, concentration, appetite, psychomotor symptoms, and suicidal thoughts. Five symptoms of the criteria are needed to make a diagnosis. Commonly in depressive illness you see a lot of depression, bipolar disorder, mania, anxiety, anziety, manic

Another important point is what happens to REM sleep during a major depressive episode. REM increases; REM density increases. You are in REM quicker and you are in REM longer when you are depressed. Most antidepressants will decrease REM sleep. An old trick back before there were good antidepressants, a thing you could do for refractory patients was

When people get depressed, or manic, they can get psychotic. A thirty-five-year-old housewife comes in says the devil is punishing me. She’s not interested in doing anything anymore. She is sleeping two hours a night. She says she can’t get to sleep. She has a lot of psychomotor retardation, what’s going on? She doesn’t have schizophrenia. She has major depressive illness. When people get too high or too low they can get psychotic. But not everybody who is

It’s not schizoaffective. In a nutshell, what is schizoaffective? We’ll go through the five schizos before we are done. Unfortunately, psychiatrists thought it was a good idea to name five similar disorders starting with schiz and there’s no real easy way to sort that out. So we’ve got to go through them one by one. Basically, here’s schizoaffective. Let’s say you are a schizophrenic and you are like a street person and you hear voices, and you believe that the moon is made out of cheese or whatever, and you get depressed. You are not a schizophrenic with

Dysthymic disorder is basically a low-level depression. This is like people who are chronically depressed. Major depressive illness is, people are going along fine and then boom! They are down there and then you put them on Prozac and they come back up to their baseline. People with dysthymia, they are like down here. They are not way down at the bottom but they are not

Bipolar disorder, formerly manic depression. Mania means episodes of irritable moods, severe enough to cause problems with function. Classically people feel great but judgment is impaired. The symptoms include for bipolar disorder: they are grandiose, diminished need for sleep, pressured speech. What’s pressured speech? It’s like they have this pressure to keep talking. Flight of ideas. It’s just one idea after another, and "I’m going to write a book, I’m going to paint my house …" and just a whole bunch of ideas at once. Very

In bipolar type II disorder, the person is hypomanic. Hypomanic is they have problems with depression and they don’t have problems with mania, they have problems with hypomania which is sort of a low level mania. When people are manic they are bad. They are out of control, they are dangerous, and they are just not sleeping, they’ve got to be in the hospital basically. Hypomanic people sometimes can do well. They are just really really up and really really enthusiastic. Sometimes it can help their career. 

Cyclothymic disorders. Cyclothymic disorder is hypomania alternating with depressive symptoms. So you don’t have full-blown mania and full-blown depression. You kind of have hypomania and sort of depressive symptoms. You just give these people enough time and they go to full-blown depression and now they are not cyclothymic anymore, now they are bipolar type II. Because they have that hypomania and a full-blown depression. Substance abuse, for

Seasonal affective disorder. If you live in places like Buffalo New York or anywhere where it’s overcast. Anywhere were you don’t see the sun people get depressed. But you know isn’t just us. Classically it hits young women, youth and female gender is a risk factor for that. Now

Panic disorder is when you have panic attacks out of nowhere. Now we’ve all experienced panic or panic attacks. Agoraphobia accompanies this because what happens is, when people have had panic attacks out of nowhere they lose trust in their body, and they say, "I never know when the panic is going to come on" and they become very very attuned to the signals their

Specific phobia. This used to be called simple phobia. It’s a fear of things such as animals, objects, situations, blood, elevators, storms, insects. About 10% of the population will have fears strong enough to cause impairment and warrant diagnosis, which kind of relates to the point of when is it a disorder? Everybody has got this. A lot of us say, "I don’t like bugs, I don’t like blood" I don't like something, you know, bats, rats. If you read Orwell’s 1984 rat phobia

Social phobia is just afraid of social situations. It can be generalized where you are like, "Oh, I’m afraid of every person. I’ve never been on a date in my life. I can’t stand to talk to the neighbors. I would rather drive to the store to see what the hours are rather than pick up a

Obsessive-compulsive disorder (OCD. OCD is sort of the hand-washing, the checking, the counting. How many of you have some OCD traits? You don’t have to raise your hand because I know the answer. Probably all of us do. Probably 80-90% of college and professional athletes have some OCD stuff going on. The basketball player who has to bounce the ball three times before he makes a free-throw. 

The etiology of OCD. There’s a few things going on. One, there may be some evolutionary components. You know, chimpanzees groom each other. It might be grooming rituals gone nuts.

It’s one of the few things in psychiatry that is very similar in kids as it is in adults. You see a lot of kids with OCD and they think it may be related to strep infections now. Occasionally, one of the things about OCD by definition, is there has to be some un-comfort with it. People have to say, "I know this is stupid." That’s what differentiates this from psychosis. The schizophrenic, why does he check all the food in the refrigerator before he eats it? Because he thinks the CIA is