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The subclassifications include major depressive disorder and dysthymia 1 Major depressive disorder A major depressive disorder (eg, endogenous unipolar disorder, melancholia) consists of at least one episode of serious mood depression that occurs at any time of life Many consider a physiologic or metabolic aberration to be causative Complaints vary widely but most frequently include a loss of interest and pleasure (anhedonia), withdrawal from activities, and feelings of guilt Also included are inability to concentrate, some cognitive

Bipolar disorders consist of episodic mood shifts into mania, major depression, hypomania, and mixed mood states The ability of bipolar disorder to mimic aspects of many other Axis I disorders and a high comorbidity with substance abuse can make the initial diagnosis of bipolar disorder difficult 1 Mania A manic episode is a mood change characterized by elation with hyperactivity, over involvement in life activities, increased irritability, flight of ideas, easy distractibility,

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The next set of menus is application defined, but should begin with the File and Edit menus and end with an optional Window menu. The system automatically supplies the Help menu. The File menu provides commands for document management, such as opening an existing document, creating a new document, or printing a document. The Edit menu contains commands for editing application documents and sharing applications data via the clipboard. The Window menu holds commands for displays and maneuvering application windows. The Help menu provides users with access to application help. At far right on the menu bar is the Application Task menu, which lists all instantiated applications and enables you to change between programs.

and little need for sleep The overenthusiastic quality of the mood and the expansive behavior initially attract others, but the irritability, mood lability with swings into depression, aggressive behavior, and grandiosity usually lead to marked interpersonal difficulties Activities may occur that are later regretted, eg, excessive spending, resignation from a job, a hasty marriage, sexual acting out, and exhibitionistic behavior, with alienation of friends and family Atypical manic episodes can include gross delusions, paranoid ideation of severe proportions, and auditory hallucinations usually related to some grandiose perception The episodes begin abruptly (sometimes precipitated by life stresses) and may last from several days to months Spring and summer tend to be the peak periods Generally, the manic episodes are of shorter duration than the depressive episodes In almost all cases, the manic episode is part of a broader bipolar (manic-depressive) disorder Patients with four or more discrete episodes of a mood disturbance in 1 year are called rapid cyclers (Substance abuse, particularly cocaine, can mimic rapid cycling) These patients have a higher incidence of hypothyroidism Manic patients differ from patients with schizophrenia in that the former use more effective interpersonal maneuvers, are more sensitive to the social maneuvers of others, and are more able to utilize weakness and vulnerability in others to their own advantage Creativity has been positively correlated with mood disorders, but the best work done is between episodes of mania and depression 2 Cyclothymic disorders These are chronic mood disturbances with episodes of depression and hypomania The symptoms must have at least a 2-year duration and are milder than those that occur in depressive or manic episodes Occasionally, the symptoms will escalate into a full-blown manic or depressive episode, in which case reclassification as bipolar I or bipolar II disorder would be warranted

soluble ones Infrequently, disulfiram and anticholinesterase drugs may be associated with symptoms of depression All stimulant use results in a depressive syndrome when the drug is withdrawn Alcohol, sedatives, opiates, and most of the psychedelic drugs are depressants and, paradoxically, are often used in self-treatment of depression

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Since depression may be a part of any illness either reactively or as a secondary symptom careful attention must be given to personal life adjustment problems and the role of medications (eg, reserpine, corticosteroids, levodopa) Schizophrenia, partial complex seizures, organic brain syndromes, panic disorders, and anxiety disorders must be differentiated Subtle thyroid dysfunction must be ruled out

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