Affective Disorders: Depression and Bipolar Disorders Flashcards
What is the prognosis for a depressive episode?
A third each: episodic, recurrent, chronic
The longer the episode -> the less probability of remission
50% of MDD episodes remit within 3 months
How many percent of MDD patients respond to first treatment?
about 50%
Whats the Monoamine Hypothesis?
Depression like diabetes: root cause missing mono-amins (i.e. Serotonin, dopamine, and norepinephrine).
Basis for all classical anti-depressants f.e. Selective Serotonin-reuptake-inhibitors SSRI, Serotonin-Norepinephrine-Reuptake-Inhibitors SNRI
What are some counter arguments/ counter evidence for the Monoamine Evidence?
Delay between drug and response (if it’s about amount in cleft response should be immediate)
Some Anti-depressants enhance reuptake of serotonin
Might be glutamate that matters
In general: bad studies and fraud, and psychotherapy always accompining the drug
What are some alternative hypothesis for the working of SSRI and SNRI?
Anti-depressant increase neurogenic (BDNF)
lipid metabolism
via other pathways (f.e. melatonin),
or via glutamate antagonism
What is evidence for an against a central role of the HPA axis on the aetology of MDD?
Pro: moderate increase in cortisol in MDD
Pro2: cortisol treatment increases risk for
Doubt: using it as diagnostic test no successful
Doubt2: 50% show no effect on cortisol after effective treatment of MDD
Doubt3: CRH antagonist as antidepressant failed
_> but stress and early trauma is important for MDD (also epigenetic effect)
What can we say (at the basic level) about immune system and MDD?
Acute illness can have depression like effect
Some evidence (reduction of tryptophan - precursor of serotonin - but not really)
(seee first lecture for more info here)
How might a leaky gut contribute to MDD?
Some evidence: leaky gut –> BDNF and 5HT2 (serotonin) receptors go down
What is Hypomania
less severethan Mania (intact social life etc.)
What is the difference between Bipolar 1 and Bipolar 2?
Bipolar 1: at least one manic episode >4days
Bipolar 2: at least 2 hypomanic episodes >1 week
How often does mania occur without deppressive episodes?
Unipolar Mania only in 5% of cases
What has a higher heritability? MDD or Bipolar disorder? What are the numbers?
Bipolar 85%, MDD 40%
How can you treate Manic symptoms and how are depressive symptoms treated in Bipolar disorder?
Treatment: Mania: Lithium, antiepileptic, antipsychotic,
Don’t treat depression with antidepressants -> could cause mania instead: treat with mood stabilizers
