Mood Disorders

Jeffrey Rakofsky, MD; ; Mark Rapaport, MD; Behavioral Neurology and Psychiatry p. 804-827 June 2018, Vol.24, No.3 doi: 10.1212/CON.0000000000000604
Review Articles
Article as PDF
Article Level Metrics
-- Select an option --

PURPOSE OF REVIEW: This article discusses the prevalence of the major mood disorders (major depressive disorder and bipolar disorder) in the community and within neurologic settings, articulates the steps taken to make a diagnosis of major depressive disorder or bipolar disorder, and reviews old and newer treatment options with proven efficacy for the treatment of these two conditions.

RECENT FINDINGS: New medications are available as treatment options for major depressive disorder and bipolar disorder, such as intranasal and IV ketamine, and somatic treatments, such as deep brain stimulation and vagal nerve stimulators, are being used to target treatment-resistant depression.

SUMMARY: Mood disorders are common in neurologic settings. They are disabling and increase morbidity and mortality. Clinicians should have a high index of suspicion if they suspect their patients seem more distressed or incapacitated than would be warranted by their neurologic disorders. If a patient does have a mood disorder, validating the patient’s experience, initiating treatment, and, if necessary, referring the patient to a primary care physician or psychiatrist are appropriate steps.

Address correspondence to Dr Jeffrey Rakofsky, 12 Executive Park Dr, Room 348, Atlanta, GA 30329,

RELATIONSHIP DISCLOSURE: Dr Rakofsky receives research/grant support from ACADIA Pharmaceuticals Inc; the American Board of Psychiatry and Neurology; Assurex Health; AstraZeneca; Janssen Global Services, LLC; the National Institute of Mental Health (RO1MH073719-05A1, 7R01MH104964-02); and the National Center for Complementary and Integrative Health (1UG3AT008857). Dr Rapaport serves as editor-in-chief of Focus: The Journal of Lifelong Learning in Psychiatry and on the editorial boards of CNS Neuroscience and Therapeutics; CNS Spectrums; Current Psychiatry; Depression Research and Treatment; Innovations in Clinical Neuroscience; Journal of Addictive Behaviors, Therapy & Rehabilitation; The Journal of Clinical Psychiatry; and Shanghai Archives of Psychiatry. Dr. Rapaport receives research/grant support from the National Center for Complementary and Integrative Health (UG3 AT008857-01, R01 AT009169-01) and the National Institute of Mental Health (MH100023-01, 1R25MH101079-01).

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Rakofsky and Rapaport discuss the unlabeled/investigational use of buspirone, pramipexole, and thyroid hormone as adjuncts to an antidepressant in the treatment of major depression and ketamine for treatment-resistant patients who are depressed and suicidal.


© 2018 American Academy of Neurology