Major depressive disorder, bipolar and atypical depression

Of particular interest is the question of whether pain is common to all types of atypical depression or is present only in certain forms. It has in fact been suggested that pain symptoms are more frequent in depressive forms characterized by a high incidence of irritability, tension, and agitation (Lascelles 1966; Lesse 1968) and in neurotic reactive atypical depressions.

In clinical psychiatry and psychiatric epidemiology, it is generally accepted that women more often have a histo­ry of atypical depression and depressive symtpoms, treatment for unipolar affective disorder and less severe atypical depression, and suicide attempts. Excellent review have been given by Weissman and Klerman (1977; 1985), von Zerssen and Weyerer (1980), Weissman et al. (1984), Nolen- Hoeksema (1987) and Bebbington.

This work stems di­rectly from the primary finding of an excess of stressful events occurring prior to the onset of atypical depression.

The PCA was performed on groups 1, 2 and 3, which contained scored clinical bipolar disorder symptoms , together with the three biolog­ical variables, platelet monoamine oxidase (MAO) serum melatonin and post-dexamethasone serum cortisol. 

Normal human beings show marked mood fluctuations and obviously there is a continuum from sustained ela­tion to mildly pathological states or traits. This has been frequently maintained in the literature, for instance, by Jung (1904), Schneider (1932), Wertham (1929a, b), and more recently by Kendell (1985). As early as 1910 Reiss had stressed that every distinction between normal and pathological mood is to a certain extent artificial.

In pursuing the validity of individual bipolar disorder symptoms, these methods eschew the demonstration of statistically different criteria rates between diagnostic groups, because such differences will hold for symptoms that are not useful for the diagnostician. Instead, the focus is on a conditional prob­ability analysis which computes the sensitivity, specific­ity, positive predictive power and negative predictive power symptoms of bipolar disorder and combinations of symptoms of bipolar disorder as predictors of diagnoses. 

One of methods moves one step closer to a true psychiatric genetic nosology. Instead of using pre­defined categories, these methods attempt to define new phenotypes that maximally correspond to the genetic component of bipolar disorder symptoms. 

Bipolar disorder is a mental condition, which presents in radical mood shifts. Commonly, patients have to pass through periods of elevated mood (mania) alternating with depression.

There is now mounting evidence that the pathophysio­logy of melancholia and the mechanism of action of anti­depressive treatments involve both alterations in circa­dian rhythms as well as changes in central noradrenergic sen­sitivity.