Depression Flashcards
TRUE or FALSE: the DSM IV-TR is very different from the DSM 5
FALSE: they are very similar
What is major depressive disorder characterized by?
one or more major depressive episodes
How is major depressive order distinct from bipolar disorder?
bipolar disorder is characterized by manic episodes, whereas major depressive disorder is characterized by major depressive episodes
How is DSM 5 different from DSM IV-TR? Provide an example.
- added specifier “with mixed features”
- e.g. coexistence within a major depressive episode of at least 3 MANIC symptoms is now acknowledged by the specifier “with mixed features”
Define mania.
distinct period of abnormal persistent elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)
List the diagnostic criteria of mania? How many must persist in order to diagnose mania?
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility
- increase in goal-directed activity (socially, at work or school, or sexually)
- excessive involvement in pleasurable maladaptive activities (e.g. unrestrained buying sprees, promiscuity, foolish business investments)
- 3 (or more) must persist (4 if the mood is only irritable) and have been present to a significant degree
what is the diagnostic criteria for depression?
- presence of one or more episodes
- not accounted for by another specific disorder
- there have never been any episodes of manic or mixed mood states
- an episode is over if no occurrence of depressed mood for 2 months
What is the lifetime risk of depression for women and men?
- women: 10-25%
- men: 5-12%
What is the point prevalence of depression for adults (women and men)?
- women: 5-9%
- men: 2-3%
What is one theory for the genetic component in depression? From what kind of studies does the evidence come from?
- evidence from family and twin studies
- may follow maternal heritability pattern
First-degree biological relatives have a ____ to ____ x risk of depression.
1.5 to 3.0x risk
TRUE or FALSE: depression may begin at any age
TRUE
What is the average age of onset of depression?
mid-20s
Within what age range is depression at its highest rate?
25-44 years
Within what age range is depression at its lowest rates?
over 65 years
What is the treatment for depression?
- psychotherapy
- drug therapy
- light therapy
For the public perceptions of mental illness (depression), list what percentage of people perceive depression as:
- due to emotional weakness
- caused by bad parenting
- victim’s fault; can will it away
- incurable
- consequence of sinful behaviour
- has a biological basis; involves the brain
- due to emotional weakness - 71%
- caused by bad parenting - 65%
- victim’s fault; can will it away - 45%
- incurable - 43%
- consequence of sinful behaviour - 35%
- has a biological basis; involves the brain - 10%
What neurotransmitters are in deficit in depression? What is the name for this theory?
- 5-HT and Noradrenaline (NA) in deficit
- biogenic amine hypothesis
What is the action of drugs in treating depression?
- increase NA and or 5-HT
- act to block uptake or decrease enzymatic degradation of these amines
What percentage of depression patients who take medication as treatment are responders vs non-responders? How long does it take to see results?
- 67% responders
- 33% non-responders
- 8 weeks
What percentage of depression patients who take a placebo as treatment are responders vs non-responders? How long does it take to see results?
- 33% responders
- 67% non-responders
- 8 weeks
In patients who respond to drug and are switched to placebo, ____ % will retain their gains for 1 year, while ____ % will become depressed again within 1 year.
50, 50
During the course of treatment for depression:
- does the clinical effect increase or decrease?
- does the amount of NT decrease or increase?
- does receptor sensitivity increase or decrease?
- clinical effect increase
- amount of NT increase
- receptor sensitivity DECREASE
What are the major receptors of interest in depression?
- beta NA receptor
- 5HT receptor
What are some early antidepressant drugs? What is the mechanism.
- MAO inhibitors: phenelzine
- tricyclic reuptake inhibitors: imipramine
What is a newer antidepressant drug that does not induce as many unwanted side-effects as early antidepressant drugs? What is its mechanism?
selective 5-HT uptake inhibitor; fluoxetine (Prozac)
What are 2 pieces of evidence that link depression with low levels of 5HT?
- the observation that “pure” blockade of 5HT uptake led to the theory that 5HT was the main factor in depressed mood
- suicide is associated with low CSF levels of the 5HT metabolite 5-HIAA
What are the 5HT pathways in the human brain?
ROSTRAL RAPHE NUCLEI to:
- thalamus
- striatum
- neocortex
- ventral striatum
- amygdaloid body
- hypothalamus
- olfactory and entorhinal cortices
- hippocampus
- cingulum
- cingulate gyrus to hippocampus
CAUDAL RAPHE NUCLEI to:
- spinal cord
- intracerebellar nuclei
- cerebellar cortex
(slide 24)
What are the NA pathways in the human brain?
LOCUS CERULEUS to:
- cerebellar cortex
- amygdaloid body
- olfactory and entorhinal cortex
- neocortex
- cingulum
- thalamus
- cingulate gyrus
- hippocampus
- spinal cord
LATERAL TEGMENTAL NA CELL SYSTEM to:
- amygdaloid body
- olfactory and entorhinal cortices
(slide 25)
What is the current theory for treatment of depression?
- increased 5HT neurotransmission in the forebrain is proposed as the basis for therapeutic antidepressant drug action
- increased NA transmission MAY be effective due to interactions between NA and 5HT
Why might increased NA transmission be effective in treating depression?
increasing NA transmission will lead to down-regulation of NA alpha-2 receptors that normally inhibit 5HT neurotransmission (i.e. stop inhibition of 5HT neurotransmission)
How does NA alpha-2 receptors affect 5HT neurotransmission?
NA binding to NA alpha2 receptors inhibits 5HT transmission
TRUE or FALSE: early treatment with antidepressants increase amine availability.
FALSE: decrease
What is an emergent consequence of antidepressant-induced down regulation of 5-HT1A and 5-HT1B receptors?
increased 5-HT transmission
Where are 5HT1A and 5HT1B receptors found?
- 5HT1A on 5HT cell bodies
- 5HT1B on presynaptic 5HT terminals
What are some new treatment approaches for depression?
- N-methyl-D-aspartate modulators
- Ketamine
How do N-methyl-D-aspartate modulators treat depression?
- glutamate functioning disturbed in depression brain areas
- glutamate is the main excitatory NT in the brain
- balance between glutamate and GABA may plat a role in depression pathway
How does ketamine treat depression?
- ketamine is fast-acting
- antagonist at NDMARs in brain
- also influences BDNF, which is important for neural plasticity, and is altered in depression
- can be administered as an adjunct
Drugs used for treating schizophrenia and depression were discovered “serendipitously”. What does this mean?
these drugs to treat depression were found by chance/accident
