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INTRODUCTION

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Affective disorders comprise the group of mental conditions that includes depression, bipolar syndrome (manic-depression), and several others that are characterized by a marked disturbance in a patient's mood.1 Patients with an affective disorder typically present with an inappropriate disposition, feeling unreasonably sad and discouraged (major depressive disorder), or fluctuating between periods of depression and excessive excitation and elation (bipolar disorder).

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Because these forms of mental illness are relatively common, many rehabilitation specialists will work with patients who are receiving drug therapy for an affective disorder. Also, serious injury or illness may precipitate an episode of depression in the patient undergoing physical rehabilitation. Consequently, this chapter will discuss the pharmacological management of affective disorders and how antidepressant and antimanic drugs may influence the patient involved in physical therapy and occupational therapy.

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DEPRESSION

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Depression is a form of mental illness characterized by intense feelings of sadness and despair. It is considered to be the most prevalent mental illness in the United States, with approximately 15 to 20 percent of adults experiencing major depression at some point in their lives.2,3 Likewise, the incidence of depression varies in different age groups, and women tend to be approximately twice as likely to experience depression during their lifetime compared to men.3 While a certain amount of disappointment and sadness is part of everyday life, a diagnosis of clinical depression indicates that these feelings are increased in both intensity and duration to an incapacitating extent.

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Depressive disorders are characterized by a general dysphoric mood (sadness, irritability, feeling “down in the dumps") and by a general lack of interest in previously pleasurable activities. Other symptoms include anorexia, sleep disorders (either too much or too little), fatigue, lack of self-esteem, somatic complaints, and irrational guilt. Recurrent thoughts of death and suicide may also help lead to a diagnosis of depression. To initiate effective treatment, a proper diagnosis must be made; depression must not be confused with other mental disorders that also may influence mood and behavior (e.g., schizophrenia). The American Psychiatric Association has outlined specific criteria for diagnosis in order to standardize the terminology and aid in recognizing depression.4 Depressive disorders can also be subclassified according to the type, duration, and intensity of the patient's symptoms.57 For the purpose of this chapter, we use the term depression to indicate major depressive disorder, but you should be aware that the exact type of depression may vary somewhat from person to person.

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The causes of depression seem to be complex and unclear. Although a recent stressful incident, misfortune, or illness can certainly exacerbate an episode of depression, some patients may become depressed for no apparent reason. The role of genetic factors in depression has been explored but remains uncertain. Over the past few decades, it has been suggested that a central nervous system (CNS) neurochemical imbalance may be ...

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