Depression, the mood disease

218 Pages·2006·0.836 MB·English

by  Mondimore, Francis Mark

depression, the mood disease
A J O H N S H O P K I N S P R E S S H E A LT H B O O K
FRANCIS MARK MONDIMORE, M.D.
Depression, the
Mood Disease
Third Edition
THE JOHNS HOPKINS UNIVERSITY PRESS BALTIMORE
note to the reader: This book is not meant to substitute for medical care
of people with depression or other diseases, and treatment should not be
based solely on its contents. Instead, treatment must be developed in a dia-
logue between the individual and his or her physician. This book has been
written to help with that dialogue.
drug dosage: The author and publisher have made reasonable efforts to
determine that the selection and dosage of drugs discussed in this text con-
form to the practices of the general medical community. The medications
described do not necessarily have specifi c approval by the U.S. Food and
Drug Administration for use in the diseases and dosages for which they
are recommended. In view of ongoing research, changes in governmental
regulations, and the constant fl ow of information relating to drug therapy
and drug reactions, the reader is urged to check the package insert of each
drug for any change in indications and dosage and for warnings and pre-
cautions. This is particularly important when the recommended agent is a
new and/or infrequently used drug.
©1990,1993,2006 The Johns Hopkins University Press
All rights reserved. Published 2006
Printed in the United States of America on acid-free paper
9 8 7 6 5 4 3 2 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4363
www.press.jhu.edu
Library of Congress Cataloging-in-Publication Data
Mondimore, Francis Mark, 1953–
Depression, the mood disease / Francis Mark Mondimore. — 3rd ed.
p. cm.
Includes bibliographical references and index.
isbn 0-8018-8450-0 (hardcover : alk. paper) — isbn 0-8018-8451-9 (pbk. : alk. paper)
1. Depression, Mental—Popular works. I. Title.
rc537.m65 2006
616.85ʹ27—dc22 2006005264
A catalog record for this book is available from the British Library.
Illustrations by Jacqueline Schaffer
For JAY, of course
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Contents
Preface ix
Introduction xi
part i SYMPTOMS, DIAGNOSIS, AND TREATMENT
1. Mood 3
Mood: What Is It? 3
The Chemistry of Mood 6
An Early Breakthrough in Brain Science 7
Mood Disorders 8
What Is the Biology of Depression? 9
2. Depression 16
The Symptoms of Major Depression 23
“Normal” Depression? 26
The Classifi cation of Depression 29
3. Treatment 38
Medications 38
Electroconvulsive Therapy 58
Other Brain Stimulation Techniques 62
Complicated Depression 64
Tests for Mood Disorders 72
4. Bipolar Disorder 75
What Is Bipolar Disorder? 75
The Hypomanic Syndrome 80
Another Duality 81
“Mood Swings” and Cyclothymia 82
Is There a Spectrum of Mood Disorders? 84
The Chemistry of Bipolar Disorder 85
The Treatment of Bipolar Disorder 86
Length of Treatment in Bipolar Disorders 99
Treating “Soft” Bipolar Disorders 101
part ii VARIATIONS, CAUSES, AND CONNECTIONS
5. Variations of the Mood Disorders 105
Major Depression in the Elderly 105
Mood Disorders in Children and Adolescents 110
Mood Disorders in Women 114
Depression and Stroke 119
Depression and Pain 123
Seasonal Affective Disorder 127
Schizoaffective Disorder 131
Panic Attacks and Mood Disorders 132
6. Causal Factors and Associations 139
The Heredity of Mood Disorders 139
Alcohol and Drug Abuse and Mood Disorders 141
Medical Causes of Mood Disorders 146
Sleep and Depression 152
part iii GETTING BETTER
7. Advice for Patients with Mood Disorders and
Their Families 159
Who Can Help? The Mental Health Professionals 160
Living with a Mood Disorder 165
Community Support and National Organizations 185
The Family 186
How to Help with Depression 186
8. Summing Up and Looking Ahead 191
Further Reading 195
Support and Advocacy Organizations 197
Index 201
viii contents
■
Preface
When the fi rst edition of Depression, the Mood Disease appeared in 1990,
there were very few medications available to treat depression. The medica-
tions that were available were toxic, had a lot of side effects, and were hardly
ever prescribed by medical professionals other than psychiatrists. There was
a lot of disagreement about how long people with depression should con-
tinue to receive treatment with medication. Some professionals still argued
that depression and anxiety should never be treated with medications—that
medication only “covered up” the symptoms of deep-rooted psychological
maladjustments that needed to be treated with talk therapy. The idea that
medication could help with depression was unfamiliar to most people.
Fortunately, those days are over for good. Now dozens of different medi-
cations are used to treat depression, medications with far fewer side effects
and far less toxicity. The medical fi eld now has more than fi fty years of ex-
perience in treating these illnesses, and we are much better informed about
their course and prognosis. Family practice physicians have become much
more aware of the illness of depression, and most persons with depression
are now treated by a doctor who is not a psychiatrist. The idea that depres-
sion is a medical illness that needs medical treatment is accepted by the vast
majority of mental health professionals as a proven fact, and even the general
public has become at least somewhat familiar with the medical (as opposed
to psychological) treatments for depression—you can see commercials for
antidepressants on television any day of the week.
ix