Book contents
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
15 - Future directions
Published online by Cambridge University Press: 14 August 2009
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
Summary
The madness of depression is … a storm of muck. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero. Ultimately, the body is affected and feels sapped, drained
Melancholia, a severe disturbance of mood, movement, and thought, has been recognized for millennia. It is a brain disease with abnormalities in neurochemical, neurohormonal, metabolic, and electrophysiologic processes.
The syndrome is considered moderately heritable. Under circumstances of stress at critical phases of development, the genetic predisposition is expressed, and the mood disorder develops. A prominent feature of melancholia is an “abnormal stress response state.” Recognizing melancholia is a clinical judgment that combines a signature psychopathology with identifiable hormonal and neurophysiologic perturbations.
Melancholia is well defined in the literature of medicine. Its characteristic psychopathology and laboratory testing are established in evidence, if not yet by consensus. Guidelines for the examination of melancholic patients and the differential diagnosis of depressive syndromes derive from the clinical experience and investigations of many authors. Suicide is a special risk for sufferers of melancholia, and prevention strategies are established.
Two effective treatment modalities for melancholic patients have been developed. Convulsive therapy is the oldest and the most effective intervention; guidelines for its effective application are well known. Medications are also delineated from the evidence, but the therapeutics has been distorted by the pharmaceutical industry. An objective consensus is needed. The efficacy of psychotherapies and other proposed treatment interventions has yet to be substantiated.
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- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 346 - 370Publisher: Cambridge University PressPrint publication year: 2006