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New Treatments for Depression and Mood 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 anxiety and a loss of interest in usual activities.

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 keep them up all night.

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.

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 major depressive illness.

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.

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.

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.

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.

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.

Panic disorder is when you have panic attacks out of nowhere. Now we’ve all experienced panic or panic attacks. Agoraphobia accompanies this.

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.

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 telephone and call." It’s that sort of person.

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.