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The past decade has witnessed a substantial increase in the knowledge available to psychiatrists about that most ubiquitous of human afflictions - depression. In a development which has clarified earlier confusing and overlapping designations of “psychotic depression,” “manic-depressive, depressed,” and “neurotic depression,” clinical researchers have recently established criteria for delineating major primary affective illness which can be further subdivided into unipolar or bipolar based on the absence or presence, respectively, of a prior history of mania. These research diagnostic criteria are expected to become the basis for the APA's forthcoming “Diagnostic and Statistical Manual of Mental Disorders, 3rd ed.” (DSM III).
Paralleling these developments in descriptive nosology are a host of research findings, including new data on the genetic predisposition to major affective illness, some biochemical “clues” from studies of central amine neurotransmitters and of hypothalamic neuroendocrine function, and a more specific pharmacotherapy based on the concept of biochemically meaningful clinical sub-groups with differential responses to specific drugs.
Currently a great deal of attention, both within the profession and in the public eye, is focused on the simple salt, Lithium carbonate. Although initially employed as a treatment for acute mania, the drug has more recently proven its value in reducing the frequency and severity of recurrent affective illness, both mania and depression, when taken in maintenance doses. Thus, Lithium has advanced from the relative obscurity of a specific treatment for a relatively uncommon disorder to a possible role in treating and/or preventing “depression.” Herein lies the difficulty, for a medicine which offers promise in “depression” can easily acquire the tempting allure of a “wonder drug.” The public is being deluged with books and articles about Lithium. It restored one of the characters in the Rex Morgan comic strip to happiness