DEVELOPMENTAL PSYCHOBIOLOGY OF CYCLIC AFFECTIVE-ILLNESS - IMPLICATIONS FOR EARLY THERAPEUTIC INTERVENTION

The recurrent affective disorders are discussed from the perspective o f accumulating inherited and experiential effects on gene expression. Stress and episodes of affective illness are viewed as leaving biochem ical and microstructural residues in the central nervous system (CNS) in relation to their patterning, severity, and recurrence. Comorbid fa ctors such as substance abuse and developmental disturbances may also interact with these illness-related variables. In addition to the prim ary pathological processes, secondary adaptive changes can also be ind uced, which, in concert with pharmacological interventions, may be suf ficient to counter episode occurrences and illness progression. We pos tulate that the balance of primary pathological and secondary adaptive changes at multiple levels of CNS regulation accounts for recurrence and cyclicity in the affective disorders. The importance of early, eff ective, long-term interventions in the recurrent affective disorders a nd the therapeutic potential of several new treatment modalities inclu ding repeated transcranial magnetic stimulation (rTMS) are discussed.