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
12 - Pharmacotherapy for melancholic patients in complicating circumstances
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
A mood of lassitude and dejection took possession of his spirits. He lost all pleasure in society, would sit for hours at his table, unable to bring himself to work at anything … His sleep was troubled by dreams, his waking hours by accusing voices … His shaken nerves could muster up no power of resistance … Melancholy swelled to obsession, obsessions to delusion … Once again he tried to kill himself
Melancholia that is identified early and is treated vigorously by the available methods resolves rapidly. Treatment becomes challenging, however, when the patient has a comorbid general medical or neurologic condition that affects its delivery, or is very young or very old. The presence of psychosis or a history of a manic-depressive course are also complicating circumstances, but acute treatment of a melancholic episode in these circumstances is often straightforward and is discussed in Chapter 11. So-called “treatment-resistant depression” is discussed here.
Melancholia in pregnancy and breast-feeding
From 5 to 10% of women become clinically depressed during pregnancy. A depressive mood disorder is a risk factor for obstetrical difficulties, low infant birth weight, newborn irritability, retarded child development, and neurological deficits. Depressive moods and abnormal vegetative signs during pregnancy anticipate postpartum depression.
Women with mood disorders during the childbearing years and while sexually active need to be educated about the risks for the fetus of the illness and its treatments. They and their partners need a long-range treatment plan.
- Type
- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 239 - 283Publisher: Cambridge University PressPrint publication year: 2006