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The most common mood disorders are major depression (unipolar depression) and manic-depressive illness (bipolar disorder). Major depression is a common disorder that continues to result in considerable morbidity and mortality despite major advances in treatment. Approximately 1 in 10 Americans will be depressed during their lifetime. Of the 40,000 suicides occurring in the United States each year, 70% can be accounted for by depression. Antidepressants are now the mainstay of treatment for this potentially lethal disorder, with patients showing some response to treatment 65 to 80% of the time.

Both major depression and manic-depressive disorders are characterized by exaggerated mood associated with physiological, cognitive, and psychomotor disturbances. Major depression generally presents as depressed mood, diminished interest in normal activities, anorexia with significant weight loss, insomnia, fatigue, and inability to concentrate. By contrast, manic episodes associated with manic-depressive illness are characterized by expansive mood, grandiosity, inflated self-esteem, pressured speech, flight of ideas, and poverty of sleep. While each condition is a diagnostic entity unto itself, it can also be secondary to specific medical problems (e.g. hypothyroidism), neurological disease (e.g., Parkinson's disease), and chronic administration of specific medications (e.g., antihypertensives). Attempting to rule out an underlying medical cause for the mood disturbance is essential before additional treatment is initiated.

This chapter covers the basic and clinical pharmacology of each class of agents demonstrating efficacy in the treatment of major depression and manic-depressive illness. The distinguishing features among agents for the treatment of each illness are their side effect profiles and relative toxicity. Physicians should understand both the appropriate agent for the treatment of specific mood disorders and pharmacological factors that allow for the individualization of medication to meet the patient's needs. A list of drugs and their half-lives are shown in Table 33.1.

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