Understand the key topics in your own ways. HYT 008: Mood Disorders

The most important 2 symptoms of depression are

1. Depressed mood
2. Loss of interest or pleasure

Not included for the diagnosis of depression are the following:

1. Due to a general medical condition. E.g. Stroke
2. Due to Mood-incongruent delusions or hallucinations. E.g a delusion of persecution
3. Accounted for by bereavement. E.g. death of a loved one
4. Direct physiologic effects of a substance intake. E.g. Cannabis use

Supportive symptoms for a diagnosis of major depression are:

• Significant weight loss
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
• Recurrent thoughts of death

Lithium carbonate, sodium valproate and olanzapine are equally effective in acute mania. Lamotrigine is effective in the depressed phase of Bipolar Disorder.

The response rate to lithium carbonate is 70–80% in acute mania. Lithium also has a prophylactic effect in prevention of recurrent mania and, to a lesser extent, in the prevention of recurrent depression.  

The only absolute contraindication is the presence of increased intracranial pressure, as may occur with a neoplasm or intracranial hematoma. ECT should also be used cautiously in the presence of uncontrolled systemic hypertension or with a known sensitivity to the anesthetic agents that are used as premedication, particularly malignant hyperthermia. Epilepsy is a caution but not a contraindication.