Pharmacotherapy of emotional disturbances

Disorders of emotional expression, experience, and/or regulation may be direct manifestations of neurological illness or side effects of its treatment, or they may be caused by primary alterations of the neural systems subserving these neuro-psychiatric functions Regardless of cause, disorders of mood and affect are among the most common problems encountered in the practice of Behavioral Neurology & Neuropsychiatry (BN&NP). Several types of emotional disturbance occur in patients with neurological disease. Much of the time, emotional changes are symptoms of a comorbid mood disorder, which may be expressed directly as depressed, elated, irritable, or anxious mood or which may be altered by right-sided brain disease (i.e., aprosodia). This chapter provides an overview of the principles of pharmacotherapy for disorders of mood and affect. The typical clinical features and differential diagnoses of these disturbances are described briefly. Thereafter, the pharmacologic treatments of the conditions are outlined. Primary mood disorders Major depressive disorder Major depressive disorder is the most common primary mood disorder, and is characterized by the occurrence of one or more major depressive episodes (Box 34.1) without a history of hypomanic, manic, or mixed mood episodes [1, 2]. Although this mood disorder may begin at any age, the average age of onset is in the middle of the third decade of life. The lifetime risk for major depressive disorder is 10–25% among women and 5–12% among men, and the point prevalences in women and men are 5–9% and 2–3%, respectively [2]. Major depressive disorder is 1.5–3 times more common among first-degree relatives of persons with this condition than in the general population.