Affective Disorder Syndromes

When secondary causes have been sufficiently evaluated, treatment of depression can be initiated. Treatment may include psychological therapies (supportive psychotherapy and behavior therapy) as well as pharmacological agents. Nearly 80 percent of patients with major and most chronic minor depressions respond to drug therapy, including tricyclic antidepressants, specific serotonin reuptake inhibitors, and MAO inhibitors. Electroconvulsive therapy may be necessary if medications fail or their use is not tolerated, if immediate therapy is indicated, or in some patients with psychotic depressions.

When manic symptoms are mild (hypomania), the patient may be followed as an outpatient with home supervision by family members. These patients may benefit by a short course of an antipsychotic drug. If they are manic, patients require hospitalization and may require acute antipsychotic therapy in combination with a benzodiazepine. These medications should be tapered and discontinued when the initial phase of the manic episode has subsided and the effects of more definitive therapy using lithium carbonate, carbamazepine, or valproic acid have been established. Third-line therapies include clonazepam, clonidine, clozapine, and verapamil.

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