Chapter 7: Drugs to Treat Affective Disorders: Depression and Bipolar Syndrome

INTRODUCTION

Affective disorders comprise the group of mental conditions that includes depression, bipolar syndrome (manic-depression), and several others that are characterized by a marked disturbance in a patient’s mood.¹ Patients with an affective disorder typically present with feeling persistent and/or profound sadness (dysthymia or major depressive disorder), or have fluctuations between periods of depression and mania (bipolar disorder).

Because these mental health conditions are relatively common, many rehabilitation specialists will work with patients who are receiving drug therapy for an affective disorder. Also, serious injury or illness may precipitate an episode of depression in the patient undergoing physical rehabilitation. Consequently, this chapter will discuss the pharmacological management of affective disorders and how antidepressant and antimanic drugs may influence the patient involved in physical therapy and occupational therapy.

DEPRESSION

Depression is a mental health condition characterized by intense feelings of sadness and despair. It is considered to be the most prevalent mental health condition in the United States, with approximately 7.1 percent² of adults experiencing major depression at some point in their lives.^3,4 Likewise, the incidence of depression varies in different age groups, and women tend to experience depression more than men² during their lifetime compared to men.⁴ While a certain amount of sadness is a normal part of everyday life, a diagnosis of clinical depression indicates that these feelings are increased in both intensity and duration that may impact everyday function.

Depressive disorders are characterized by a general dysphoric mood (sadness, irritability, feeling “down in the dumps”) and by a general lack of interest in previously pleasurable activities. Other symptoms include changes in appetite,⁵ sleep disorders, fatigue, lack of self-esteem, somatic complaints, and irrational guilt. Diminished interest in activities and/or feelings of hopelessness are two features used to diagnose depression. Some people may have thoughts of death and/or suicide as well.⁵ To initiate effective treatment, a proper diagnosis must be made; depression must not be confused with other mental health conditions that also may influence mood and behavior (e.g., schizophrenia). The American Psychiatric Association has outlined specific criteria for diagnosis in order to standardize the terminology and aid in recognizing depression.⁷ Depressive disorders can also be subclassified according to the type, duration, and intensity of the patient’s symptoms.^7-9 For the purpose of this chapter, we use the term depression to indicate major depressive disorder, but you should be aware that the exact type of depression may vary somewhat from person to person.

The causes of depression seem to be complex and unclear. Although a recent stressful incident, misfortune, or illness can certainly exacerbate an episode of depression, some patients may become depressed for no apparent reason. The role of genetic factors in depression has been explored but remains uncertain. Over the past few decades, it has been suggested that a central nervous system (CNS) neurochemical imbalance ...