In this special issue dedicated to Falret and the French contributions to the concept of cyclicity in manic depressive illness, we begin with a historical overview of the development of the concept of cyclicity and its fundamental significance in manic-depressive illness and we underscore how the concept fell into neglect only to reemerge in recent years. We then look at the intimate relationship between mania and depression. The hypothesis of the primacy of mania is discussed. The thesis is presented, supported by the examination of 100 consecutive index manias, that in most cases mania is triggered by external factors acting upon hyperthymic patients, determining an exogenous cyclicity. On the other hand, in BPII patients the temperamental mood instability (cyclothymia) is an inherent and decisive factor in determining the cyclic autonomous course of the disorder. Finally, a new distinction of Bipolar Disorders, based on premorbid temperament and course of the illness, is considered.
"While there is no evidence that oxcarbazepine interferes with CA, topiramate is well-known to inhibit several CA isoenzymes.64,65 It is unknown whether this has to do with a cyclical pattern of CA concentration, as such pattern has not been found to occur in the erythrocytes of healthy women during their menstrual cycle.66 However, acetazolamide proved to be effective in catamenial epilepsy, a condition that shares with PMDD its temporal pattern.49 "
[Show abstract][Hide abstract] ABSTRACT: The treatment of premenstrual dysphoric disorder (PMDD) is far from satisfactory, as there is a high proportion of patients who do not respond to conventional treatment. The antidiuretic sulfonamide, acetazolamide, inhibits carbonic anhydrase and potentiates GABAergic transmission; the latter is putatively involved in PMDD. We therefore tried acetazolamide in a series of women with intractable PMDD. Here, we describe a series of eight women diagnosed with DSM-IV-TR PMDD, five of whom had comorbidity with a mood disorder and one with an anxiety disorder, who were resistant to treatment and responded with symptom disappearance after being added-on 125 mg/day acetazolamide for 7-10 days prior to menses each month. Patients were free from premenstrual symptoms at the 12-month follow-up. We suggest that acetazolamide may be used to improve symptoms of PMDD in cases not responding to other treatments. GABAergic mechanisms may be involved in counteracting PMDD symptoms.
"One of Koukopoulos' most important contributions to research on bipolar disorders was his theory of the 'primacy of mania' and excited states in the course of mood disorders. The theory arose in 1973 based on findings suggesting that depression could be avoided by suppressing mania in bipolar disorder patients (Koukopoulos et al. 2006 "
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