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The Practical Management of Affective Disorders

Introduction The affective disorders vary in severity from mild but nevertheless distressing self-limiting alterations in mood, many of which never come to medical attention, right through to the most severe and disabling psychotic states. This article has been confined to the management of those episodes which are referred to the psychia trist, usually because of the severity of the illness or the fact that treatment by the general practitioner has failed. It is an appropriate time for a discussion of the problems associated with the treatment of affective disorders, but the present state of current research necessarily implies that present decisions on management will be based on data which may be superseded in the near future by new information and ideas. Despite an enormous amount of detailed work on the treatment of depression, much remains to be done. The impact of life events on cyclothymia and on episodes of affective illness rather than, for instance, on the symp tom of depression could be explored further. It would be of interest to examine the relation ship between life-styles and frequency of episodes, and the suitability of various milieux for promoting the most rapid recovery. There is an urgent need for the monitoring of anti depressant medication and for information on whether or not therapeutic levels have been achieved. If this facility were available it would be much easier to define those patients within the term affective disorder most suitable for a particular treatment. Meanwhile, new families of potential antidepressants have appeared whose efficacies and degrees of overlap with established remedies and other characteristics await clarification. Ability to assess the achievement of different levels of antidepressant drugs might help to unravel the problem of patients with resistant depression. Differences in rate and type of metabolic degradation of antidepressants, metabolic changes within individuals produced by con tinuous therapy, drug interactions and long term effects of various kinds may also repay further studies.