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The authors of this paper present a review of actual data on the neurobiological background of suicidal behaviour. The results of epidemiological studies suggest that suicidal behaviours have certain genetic background which do not depend on the presence of concomitant mental disorders. The estimated heritability rate of suicide is about 21-50%, while the heritability rate of suicidal ideation and behaviour is about 30-55%. The genes of serotonergic and noradrenergic systems, as well as the HPA axis genes, have been scrutinised in context of suicidal behaviour. Epigenetic factors are also believed to be involved in the pathogenesis of suicide. Serotonergic, noradrenergic, glutamatergic and GABAergic systems, as well as the HPA axis, are the main neural networks involved in the pathophysiology of suicide. Disorders of opioid and endocannabinoid systems can also be found in suicide victims. Pathogenesis of suicidal behaviour also contains abnormalities of cell signalising and pathology ofglial cells. Neurobiological background of akathisia and impulsivity (clinical issues closely related to the pathogenesis of suicidal behaviour) have also been presented. Most of the available trials on neurobiological background of suicidal behaviour have significant methodological weaknesses, making the results difficult to interpret. Usually they contain small samples and only single biological variables (without adjustment on environmental factors) are being analysed.

The possible side effects of antipsychotics are extensive, varied, frequently, intolerable, too often serious and sometimes fatal. The knowledge about pharmacoepidemiological and toxicological aspects of atypical neuroleptics usage is very important in clinical practice. In this paper we described practical information about side effects, toxicological profile and unwanted drug interactions of atypical neuroleptics.

Aim: The study aimed to analyse the bipolarity features between patients with treatment-resistant depression and patients with remission of a depressive episode., Methods: The population studied included patients aged 18-65 who had a diagnosis of first or recurrent major depressive disorder. Each psychiatrist included 5 consecutive patients, from all the patients he is treating, where the depressive episode was assessed as treatment-resistant (TR) and 5 consecutive patients with a depressive episode in remission (RE). One thousand and fifty-one patients entered the study: 570 in the treatment-resistant depression group and 481 in the remission group. All patients were assessed using the Mood Disorder Questionnaire (MDQ) and Hypomania Checklist (HCL-32). The assessment of current depressive symptoms was done by means of a 17-item Hamilton Depression Rating Scale., Results: The percentage of patients screened positive by MDQ was significantly higher in TR than in RE (13.7 vs. 5.6% p < 0.001). Also, the percentage of patients having positive response to 14 or more items of the HCL-32 was significantly higher in TR than in RE (43.9% vs. 30.0%, respectively, p < 0.001). The multiple logistic regression model showed that independent risk factors for treatment resistance were: bipolar features in HCL-32 scale, scoring 6 or higher on MDQ, age at first onset < or = 20 years, more than three previous depressive episodes and partial remission after the previous depressive episode., Conclusions: Identified independent risk factors for treatment resistance suggest possible association between bipolarity and worse response to antidepressant drugs in patients with mood disorders.

In current diagnostic classifications such as the International Classification of Diseases (ICD-10) and the American Diagnostic and Statistical Manual (DSM-IV), unipolar and bipolar mood disorders are mentioned, where the differentiating factor is occurrence of mania or hypomania. In DSM-IV, bipolar mood disorder type I (bipolar I), with the episodes of mania, and bipolar mood disorder type II (bipolar II) with hypomania, have been separated. Clinical and epidemiological studies performed in recent decades using more sensitive measures of the assessment of hypomania suggest a marked prevalence of bipolar disorders of not-bipolar I type, amounting to about 3-5% of population. In 2005, Angst and collaborators introduced the Hypomania Check List-32 scale (HCL-32) aimed at a better identification of the occurrence of hypomania symptoms in patients with affective disorders. The studies carried out in many countries have demonstrated a significant sensitivity and specificity of the scale and its usefulness for the assessment of bipolar affective disorders. In the present paper, the Polish version of HCL-32 scale is presented. This version has been already employed in the all-country Polish project TRES-DEP where the features of bipolarity were assessed in depressive patients in whom treatment with antidepressant drugs was unsuccessful.

Purpose: The aim of the study was to evaluate the usefulness of proton MR spectroscopy for determining the biochemical abnormalities in acute episode of depression and after regression of the disease in course of unipolar depressive disorder., Material and Methods: Forty one patients (age 18-55 years) with known unipolar depressive disorder (a Hamilton Depression Rating Scale of 16 or greater) were evaluated by the means of HMRS during acute episode of depression and after positive therapeutic response (at least 50% reduced Hamilton score for at least 4 consecutive weeks). All patients underwent single-volume 1H MRS (TR=1500 ms, TE=35 ms) using a 1.5T scanner. Four brain areas were analyzed: both frontal lobes and both hippocampi., Results: In the acute fase of the disease patients had statistically significant increases in Cho/Cr levels in right hippocampus area and increases in ml/Cr levels in left frontal lobes relative to controls. After positive therapeutic response no significant abnormalities were found., Conclusion: These results suggest that abnormal increased brain metabolites should reverse after treatment. In the time of new imaging technics we hope that in the future 1H MRS may be helpful for determining the accuracy of the diagnosis and can improved prediction of therapeutic response in unipolar depression.

Background: Transcranial magnetic stimulation (TMS) is known as method of depression therapy., Results: The paper presents the results of clinical 2nd phase investigation or safety and efficacy of TMS as compared to electroconvulsive therapy and standalone pharmacotherapy., Results: It was shown that in all three groups of patients a significant improvement of clinical state (decrease of depressive symptoms) was achieved. The strongest effect was observed in the group of patients treated with electroconvulsive therapy (as well as drugs). However, trans-cranial magnetic stimulation combined with pharmacotherapy did not prove to be more effective than standalons pharmacological treatment. The authors discuss possible explanations of inefficacy of transcranial magnetic stimulation therapy., Conclusions: None antidepressive efficacy of TMS was observed. Forthcoming examinations of TMS are necessary for optimalization of stimulation parameters and conditions.

Aim: The aim of the presented study was an analysis and comparison of patients and psychiatrists beliefs regarding the most important aspects of bipolar disorder (BD) treatment., Method: A group of 100 psychiatrists (with at least 5 years professional experience) and a group of 100 remitted patients fulfilling ICD-10 and DSM IV-TR BD criteria (aged 18-65) were enrolled. Their beliefs were investigated with a 41-item structuralized questionnaire (doctors group) and 27-item self evaluation inventory (patients group). The construction of both tools made it possible to compare the results and was based on hierarchical ranking of answers included in each item., Results: A number of important concordances were indicated between doctors and patients beliefs e.g. both groups considered that: 1) the depression is the most burdensome episode in the course of BD; 2) the pharmacotherapy is the most crucial element of treatment; 3) the improvement of life quality is the most important aspect of recovery. On the other hand the results revealed that patients are convinced that doctors consider improving their life quality as much less important than alleviating symptoms severity. The hierarchy of problems proposed by the patients as the main obstacles in taking drugs appeared to be the exact antithesis of doctors beliefs in this issue. The patients indicated drug side effects as the main cause whereas doctors considered compliance as a crucial problem. Discrepancies in beliefs were also observed regarding the perceived importance of different psychoeducation topics: coping abilities and life quality improvement--two most important issues in patients opinion, were placed on the remote rank in doctors hierarchy, giving place to early recognition of relapse symptoms and suicidality prevention., Conclusion: Discrepancies of psychiatrists and patients beliefs regarding crucial aspects of BD treatment that were revealed in the study may be responsible for worsening of compliance quality.

Bipolar disorder (BD) is one of the most difficult to diagnose among all psychiatric disorders. BD is often misdiagnosed as recurrent depressive disorder, schizophrenia, anxiety or personality disorders. In 40% of patients BD is not detected at the first examination and in 2/3 of cases the proper diagnosis is made after about 10 years. The consequence of this condition is inadequate treatment leading to the worsening of the course of BD or increased risk of substance misuse and suicidal behavior. Those data reveal that the better detection of bipolar spectrum is strongly needed. It may be achieved by the application of the Mood Disorder Questionnaire (MDQ) in clinical practice. MDQ is a self rating questionnaire created by Hirschfeld et al. for screening of bipolar spectrum. According to previous data the usefulness of MDQ in populations of psychiatric patients (especially those with affective disorders) is unquestionable high. The significant limitation of MDQ is a relatively low sensitivity for BD type II. That's why the concomitant use of MDQ (as an excellent tool for detection of BD type I) and the other instrument characterized by the higher sensitivity for hypomania and BD type II (e.g. The Hypomania Symptom Checklist by Angst et al.) seems to be the best and recommended solution. This article describes the properties and structure of MDQ. The capabilities, advantages and limitations of MDQ were also presented. The authors discussed the results of validation studies of different language versions of MDQ and summarized--DEP-BI and TRES-DEP--Polish studies using MDQ.

The clinical efficacy of current antidepressant therapies is unsatisfactory; antidepressants induce a variety of unwanted effects, and, moreover, their therapeutic mechanism is not clearly understood. Thus, a search for better and safer agents is continuously in progress. Recently, studies have demonstrated that zinc and magnesium possess antidepressant properties. Zinc and magnesium exhibit antidepressant-like activity in a variety of tests and models in laboratory animals. They are active in forced swim and tail suspension tests in mice and rats, and, furthermore, they enhance the activity of conventional antidepressants (e.g., imipramine and citalopram). Zinc demonstrates activity in the olfactory bulbectomy, chronic mild and chronic unpredictable stress models in rats, while magnesium is active in stress-induced depression-like behavior in mice. Clinical studies demonstrate that the efficacy of pharmacotherapy is enhanced by supplementation with zinc and magnesium. The antidepressant mechanisms of zinc and magnesium are discussed in the context of glutamate, brain-derived neurotrophic factor (BDNF) and glycogen synthase kinase-3 (GSK-3) hypotheses. All the available data indicate the importance of zinc and magnesium homeostasis in the psychopathology and therapy of affective disorders.

Aim: This is a pilot study of the multicenter TRES-DEP (Treatment Depression) Project. Its' aim was the detection and analysis of bipolar spectrum features in drug resistant unipolar depression patients in comparison to depressive patients who responded to standard antidepressant treatment and remitted. Sociodemographic and clinical parameters of the patients were also described., Method: 50 drug-resistant (group 1) and 50 non-drug resistant (group 2) 18-65 year old patients, fulfilling ICD-10 criteria for depressive episode or recurrent depressive disorder were included in the study. The main exclusion criteria were: >18 scores in the 17-item Hamilton Depression Rating Scale, treatment with mood stabilizers, the diagnosis of substance misuse, dementia, severe neurological or other somatic disease. The presence of bipolar spectrum was detected by Mood Disorder Questionnaire (MDQ) and Hypomania Checklist Scale (HCL)., Results: There was statistically significant more patients fulfilling MDQ or HCL bipolar spectrum criteria in group 1 than in group 2 (44% vs. 12%, p<0.001 and 62% vs. 34%, p<0.005 respectively,). Significantly more drug resistant patients comparing to non-refractory patients, considered their last remission as partial (88% vs. 52%, p=0.001). Non-refractory patients had a history of fewer depressive episodes (5.1+/-3.8 vs. 8.5+/-5.0; p=0.001) and reported a longer time from the last hospitalization (41.9+/-71.1 vs. 14.8+/-26.5 months, p<0.005). Significantly more patients from group 1 reported a family history mental disorders, especially of alcoholism., Conclusion: The results of the study suggest that misdiagnosed and inadequately treated bipolarity may be one of the main reasons of non-response in the treatment of depression.

Aim: To asses the relationships between sociodemographic and clinical data and the bipolar spectrum features in treatment resistant patients. (A sub-analysis of data of the pilot study for the multi-center TRES-DEP (Treatment Resistant Depression) Project., Method: 50 drug-resistant 18-65 year old patients, fulfilling ICD-10 criteria for depressive episode or recurrent depressive disorder (F32, F33) were included in the study. Drug resistance was defined as non-response to two adequate antidepressant treatments. The main exclusion criteria were: > 18 scores in the 17-item Hamilton Depression Rating Scale, treatment with mood stabilizers, the diagnosis of: substance misuse, dementia, severe neurological or other somatic disease. The presence of bipolar spectrum was detected by the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist Scale (HCL)., Results: Statistically significant more drug-resistant patients fulfilling MDQ bipolar spectrum criteria (MDQ (+))comparing to patients without bipolar spectrum features by MDQ (MDQ(-)): 1) considered the last remission as partial or reported lack of remission (100% vs. 21%; p<0.05), 2) reported treatment non-adherence (41 vs. 18%, p=0.055). Moreover there were more suicidal attempts in MDQ(+) patients (0.86+/-1.28 vs. 0.25+/-0.59; p<0.05)., Conclusion: Results of the study suggest that the presence of bipolar spectrum may worsen the course and outcome of drug-resistant depression. A further multicenter study is needed.

Introduction: Electroconvulsive therapy (ECT) is the most effective treatment in a variety of psychiatric syndromes (especially mood disorders). However one of its adverse effects is neurocognitive dysfunction. Declarative memory impairment after ECT is unquestionable and well investigated. There are only few ambiguous studies focused on nondeclarative and immediate memory changes during ECT., Method: A study of immediate (working) memory changes in depressed patients treated with ECT (n=10; bitemporal ECT 3 times a week) or imipramine or desipramine (150-250 mg/day; n=10) was conducted in patients who fulfilled DSM-IV criteria for major unipolar depression. Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI) were used to assess the efficacy of antidepressant therapy. Cognitive functions were assessed with neuropsychological tests: Stroop A and B, TMT (Trial Making) A and B. The patients' status was evaluated 1 day before the treatment and 1 day, 2 weeks, 1 month and 6 months after the first ECT procedure., Results: 1 day after first ECT treatment, patient's working memory was slightly impaired, but this was not statistically significant. Both groups showed statistically significant improvement in working memory I month after start of treatment. However there were statistically significant differences between ECT and pharmacologically treated groups at the first month of therapy., Conclusion: ECT treatment only temporally affects working memory function. The improvement of function may be a result of clinical recovery from depressant symptomatology.

Aim: The aim of the study was to investigate the spectrum and course of depressive symptoms in cardiac ischemic disease (CAD) patients before and after successful coronary angioplasty (PCI) in one year follow-up., Method: 227 patients with CAD selected for PTCA were enrolled. 156 patients with full clinical and angiographic success and without restenosis within 4 weeks after the intervention were included in further analysis. Patients' status was assessed four times (one day before and at 1, 6 and 12 months after the intervention), with Beck's Depression Inventory (BDI), Rosenberg's Self-Esteem Scale (RS), Beck's Hopelessness Scale (HS), Automatic Thoughts Questionnaire (ATQ)., Results: Mild and moderate depressive disorders with the prevalence of non-specific somatic symptoms were observed one day before PTCA in 75 (48%) patients. One month after the PCI, depressive symptoms persisted in 33 subjects. Moreover in the group of patients who were free of depressive symptoms a day before PTCA, twelve patients (15%) developed depressive symptomatology. Depressive symptoms and depressive disorders of thinking (especially hopelessness) recognized 4 weeks after PTCA had a tendency to persist at 6 and 12 months. The tendency was associated with more severe affective-cognitive and somatic symptoms of the depressive syndrome, more frequent negative automatic thoughts and stronger hopelessness detected at the beginning of the study., Conclusions: The results of the study suggest that successful PCI is not a sufficient determinant for the improvement of depressive symptoms. Diagnosis of depression in CAD patients needs special attention, because of a tendency to persist.

Magnesium and copper are important modulators of NMDA-receptor activity. Recent data indicate that disturbances of glutamatergic transmission (especially via NMDA-receptor) are involved in pathogenesis of mood disorders. Magnesium deficiency, the same as disturbances in turn over of copper, are related to a variety of psychological symptoms especially depression. There are many reports indicating significant changes in blood levels of magnesium or copper during a depressive episode. Moreover magnesium exhibits antidepressant-like and anxiolytic-like effects in animal models of depression, in rodents. This article reviews the alterations in central and peripheral magnesium and copper homeostasis in relation to pathophysiology and treatment of depression.

Zinc is an important modulator of glutaminergic transmission. Recent data indicate that pathology of amino-acidergic neurotransmission may contribute to mood disorders and may be involved in antidepressant-like actions in laboratory models. A growing body of evidence implicates a derangement of zinc homeostasis in mood disorders. The zinc deficiency is related to a variety of psychological symptoms especially depression. There are many reports indicating significant changes in blood levels of zinc during a depressive episode. Moreover zinc exhibits antidepressant-like and anxiolytic-like effects in animal models of depression, in rodents. Recent data revealed that zinc enhances the antidepressant effect in laboratory animals. This article reviews the alterations in central and peripheral zinc homeostasis in relation to pathophysiology and treatment of depression.

This article is a review of the current state of knowledge about possibilities of clinical use of selective serotonin reuptake inhibitors in different areas of psychopharmacotherapy. The authors presented information about pharmacodynamic and pharmacokinetic differences between SSRI's, and described emerging clinical consequences. The paper contains data about the most common and typical side effects and possible drug interactions. The reports and information about new therapeutic proposals concerning SSRI's are also discussed.

A growing body of evidence implicates a derangement of zinc homeostasis in mood disorders. In general, unipolar depression is connected with low blood zinc levels that are increased by effective antidepressant therapy. A placebo-controlled, double blind pilot study of zinc supplementation in antidepressant therapy was conducted in patients who fulfilled DSM IV criteria for major (unipolar) depression. Patients received zinc supplementation (6 patients; 25 mg of Zn2+ once daily) or placebo (8 patients) and were treated with standard antidepressant therapy (tricyclic antidepressants, selective serotonin reuptake inhibitors). Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) were used to assess efficacy of antidepressant therapy, and patients' status was evaluated before the treatment and 2, 6 and 12 weeks after its commencement. Antidepressant treatment significantly reduced HDRS scores by the 2nd week of treatment in both groups, and lowered BDI scores at the 6th week in zinc-treated group. Zinc supplementation significantly reduced scores in both measures after 6- and 12-week supplementation when compared with placebo treatment. This preliminary study is the first demonstration of the benefit of zinc supplementation in antidepressant therapy. The mechanism(s) may be related to modulation of glutamatergic or immune systems by zinc ion.

This paper is a literature review of current knowledge about postpartum depression. It presents the course and clinical picture of this disorder with regard of possible complications. The stress was laid on early and efficient diagnosis and differentiation. The general rules of prophylaxis and treatment were also described. The authors also presented new hypothesis concerning biological basis of postpartum depression. The article should be useful not only for psychiatrists, but also for physicians of other specializations with special regard of obstetricians, paediatrists and general practitioners.