12. Depression

Question 1

Describe the symptoms required for diagnosis of depression, esp. 3 core symptoms.

Answer 1

Should be continuous for at least 2 weeks.

Core symptoms:

1. low mood
2. lack of enjoyment and interest (anhedonia)
3. fatigue or lack of energy

May be associated with:

4. depressive thoughts, e.g. guilt, self-blame, suicidal thoughts
5. biological symptoms, e.g. loss of appetite, weight loss, sleep disturbances (esp. early morning waking)

Question 2

Name 3 brain structures that may be involved in pathophysiology of depression.

Answer 2

Hypothesis - mood determined by functional circuits between these areas:

1. LIMBIC SYSTEM
   - mainly involved in emotion, motivation and memory (e.g. hippocampus)
2. FRONTAL LOBES
   - esp. prefrontal area (may be hypoperfused in depression)
3. BASAL GANGLIA
   - have both motor function and psychological function, e.g. emotion, cognition and behaviour

Question 3

Name 2 main NTs implicated in depressive disorders. Where are these produced and what is their function?

Answer 3

1. NORADRENALINE
   - involved in mood, behaviour (arousal and attention) and memory functions
   - produced in locus coeruleus in brainstem and transported to cortex and limbic system
   - acts at alpha1/2 and beta1/2 Rs - likely that alpha Rs play role in arousal and mood
2. SEROTONIN (better evidence)
   - involved in sleep, impulse control, appetite and mood
   - produced in brainstem raphe nuclei and transported to cortex and limbic system
   - many different pre- and post-serotonergic Rs
   - serotonin depletion associated with depressive symptoms

Question 4

Name 3 types of factors predisposing to depression.

Answer 4

1. genetics (50% vulnerability)
2. childhood experiences (e.g. quality of attachment, loss of parent, bullying)
3. female gender

Question 5

Describe the management of a P with depression.

Answer 5

1. social and psychological interventions, esp. if mild depression
   - CBT
   - psychotherapy
2. medication, only effective in moderate-severe
   - SSRIs
   - if ineffective, try combinations or mood stabilisers