Block 4 Lecture 6 -- Depression Flashcards

1
Q

Define unipolar depression.

A

mental disorder;

    • pervasive and persistent low mood
    • low self esteem
    • loss of interest/self-pleasure
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2
Q

What are the types of unipolar depression?

A

1) major depressive disorder
2) persistent depressive disorder
3) psychotic depression
4) postpartum depression
5) substance- or med-induced depressive disorder
6) PMDD
7) SAD

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3
Q

What is persistent depressive disorder?

A
    • depressed mood ≥ 2 years

- - episodes of major depression w/ period of less severe sxs

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4
Q

How effective is light therapy in SAD?

A

50%

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5
Q

What populations are most likely to get depression?

A

1) females
2) indians, alaskans, whites, hispanics
3) prevalence decreases with age

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6
Q

What are the categories of symptoms of depression?

A

1) psychological symptoms

2) somatic symptoms

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7
Q

psychological symptoms of depression:

A
    • intense sadness, pessimistic worry, depressed mood, reduced self-esteem
    • loss of interest/enjoyment
    • suicidal thinking
    • impaired cognition, memory
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8
Q

somatic symptoms of depression:

A
    • agitation
    • fatigue, loss of drive & libido
    • reduced appetite, weight change
    • bowel disturbances
    • motor retardation
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9
Q

What are the theories for pathology in depression?

A

1) monoamine hypothesis

2) neurotrophic hypothesis

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10
Q

What is the monoamine hypothesis?

A

1) deficiency in monoamine signaling: synthesis, storage, or release
2) deficiency in monoamine signaling due to receptor insensitivity

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11
Q

What is the neurotrophic hypothesis?

A

BDNF is decreased in depression

– decreased neuronal plasticity (dendritic sprouts)

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12
Q

What is the function of BDNF?

A

regulation of…

1) neuronal plasticity
2) growth
3) resilience
4) neurogenesis

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13
Q

What is CREB?

A

cAMP response element binding protein

– yields BDNF

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14
Q

What substances affect [CREB]?

A

increased by:

    • monoamines
    • Glu
    • BDNF

decreased by:
– glucocorticoids

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15
Q

What is the DSM-5 criteria for diagnosis?

A

5+ symptoms for 2+ weeks

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16
Q

How is mild-moderate depression treated?

17
Q

How is MDD treated?

A

CBT + other things

18
Q

What non-drug therapies are used for depression?

A

CBT

exercise, light therapy, group therapy, mediation/yoga

19
Q

Why is stress implicated in depression?

A

yields cortisol
– decreased CREB
yields Glu
– acts on NMDAr to result in neural apoptosis

20
Q

What are the strengths of the monoamine hypothesis re: receptor insensitivity?

A

1) chronic antidepressant administration causes change in expression/function of receptors
2) receptor plasticity correlates with time course of improvement

21
Q

What are the weaknesses of the monoamine hypothesis re: receptor insensitivity?

A

some drugs don’t work on the monoamine system

22
Q

What are the strengths of the monoamine hypothesis re: synthesis, storage, release?

A

1) reserpine led to depression
2) most antidepressants work on monoamines
3) studies show change in monoamine function
4) polymorphism in promoter of SERT in depression

23
Q

What are the weaknesses of the monoamine hypothesis re: synthesis, storage, release?

A

1) neurochemical effects in 1-2 days, but improvement takes 10-21 days
2) studies show normal monoamine levels in depression
3) some drugs don’t act on monoamines

24
Q

Describe effect of NE binding receptor in depression?

A

Gs

– increase CREB

25
Describe the 5-HT receptor.
Gi - - but, use PLC, IP3, PKC pathway - - yields CREB 5-HT 1A and 1B are presynaptic
26
Describe the NE receptors involved in monoamine antidepressant signaling.
Gs | -- yield CREB
27
What are the strengths of the neurotrophic hypothesis?
1) antidepressant increase neurogenesis and change synaptic connectivity 2) pain, stress = decreased BDNF 3) structural changes, loss of volume observed in hippocampus 4) BDNF = antidepressant-like effects in rodents 5) BDNF gene mutation = altered anxiety and depressive behavior in animals and humans
28
Describe weaknesses of the neurotrophic hypothesis.
1) BDNF KO mice don't exhibit depression/anxiety | 2) increased [BDNF] in animals after social stress
29
What are the effects of increasing NE, 5-HT, BDNF in depression?
1) decrease detrimental gene transcription 2) increase beneficial gene transcription - - improve neurogenesis - - inhibit apoptosis
30
Depression is associated with:
1) shorter life expectancy - - death 2x - - suicide 26x - - susceptibility to other infections 2) recurrence if sxs have not fully resolved (80% of MDD)