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Patients with mood disorders pose ethical challenges for both the clinicians who treat them and the researchers who study them. Depressed patients are often indecisive or resistant to treatment, which raises the dilemma of when to consider such resistance a reasonable refusal of consent and when the resistance is a product of the illness itself. Mood disorders, like many psychiatric illnesses, often provoke a variety of crises in the lives of patients, from loss of relationships and employment to self-destructive behavior and suicidality. The ethical problems most common to mood-disordered patients revolve around the difficult issues of capacity and informed consent. Among patients with mood disorders, there are cases where decision-making capacity is impaired to the point at which others must take over the decision-making role for the patient. The ethical problems with the schizophrenia washout studies are equally applicable to subjects with mood disorders.
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