Staging of unipolar affective illness

Abstract

In this article, a concept of staging of unipolar affective illness (recurrent depression) is presented. In respective subchapters, three most important aspects of this issue have been discussed: 1) staging of unipolar affective illness; 2) staging of treatment-resistant depression; and 3) conversion of unipolar into bipolar affective illness. The evidence for so called neuroprogression of the illness, accumulated in recent years, has allowed for a classification of staging based on a concept of allostasis and allostatic load. In the course of illness, changes in neuroendocrine system (mainly hypothalamic pituitary-adrenal (HPA) axis), immunological system, mechanisms of oxidative stress, neurotransmitters, neurotrophic factors as well as structural and functional changes of the brain occur. In their paper of 2007, Fava and Tossani elaborated a concept of staging of unipolar affective illness presenting a continuum model of five consecutive stages with specific clinical features. In the present paper, a concept of treatment-resistant depression and staging of treatment resistance is presented in the context of several models. An important determinant of treatment-resistant depression is so called subthreshold bipolarity which is connected with worse efficacy of antidepressant drugs. In the course of illness, there is a possibility of changing diagnosis from recurrent depression into bipolar affective illness. The studies on this issue show that frequency of such diagnostic conversion is 1,5% of depressed patients per year.

The effect of lithium on hematopoietic, mesenchymal and neural stem cells

“…The course and treatment of bipolar disorder has been 533 intensively studied in recent years [88]. The use of lithium, the 534 unique drug for this condition, is a cornerstone for the long-term 535 treatment of BD [89].…”

Development of a Novel Staging Model for Affective Disorders Using Partial Least Squares Bootstrapping: Effects of Lipid-Associated Antioxidant Defenses and Neuro-Oxidative Stress

“…Our staging models show significant differences from previous models proposed by Berk et al [2], Kapczinski et al [10] and Ferensztajn et al [11]. For example, these models did not take into account the existence of a suicidal-regression phase (our stage 3) and did not consider ELT to be part of the model criteria.…”

“…As such, affective disorders are not stage-defined, although diagnostic criteria based on staging may provide more appropriate and targeted treatments to prevent further episodes and progression into the later stages, which are characterized by functional and cognitive decline [8]. Recently, some authors proposed staging models by dividing bipolar disorder or major depression into relevant stages based on risk factors, such as family history of mental illness, prodromal patterns, relapses of episodes, refractory states, and interepisodic functioning including cognitive impairments, comorbidities and functional impairments [9][10][11]. Nevertheless, these staging models were not based on predictive mathematical algorithms derived from biomarkers and clinical data including ELT, recurrent episodes and suicidal behaviors, neurocognitive deficits and functional impairments.…”

Augmentation of Pharmacotherapy by Sleep Deprivation with Sleep Phase Advance in Treatment-Resistant Depression

“…Maintaining balance may result in altered cortisol secretion during persistent high levels of pro-inflammatory cytokines. In the case of constant maintenance of such condition, it leads to the allostatic overload, resulting in disturbed processes of neuroplasticity and structural changes in the brain [36] and consequently a disease progression and treatment-resistance [37].…”