Depression

Question 1

Krishnan and Nester, 2008

Answer 1

Review of the molecular neurobiology of depression
Cause of depression is not just monoamine deficiency - MAOI’s and SSRI’s take effect on monoamine concentration in the synaptic cleft almost immediately but it takes 2 weeks to take effect

Question 2

Knol et al., 2006

Answer 2

Ppl with MDD are more likley to be diagnosed with coronary artery disease or Type 2 diabetes

Question 3

Pittenger and Duman, 2008 (Hormones)

Answer 3

The monoamine hypothesis

Question 4

Lopez-Leon et al., 2008 (Genes)

Answer 4

Meta-analysis of genetic heritability studies in MDD and found 6 genes that may increase susceptibility -
No strong and consistent genetic risk modifiers

Question 5

Ruhe et al., 2007 (Hormones)

Answer 5

Experimental depletion of monoamines in healthy controls does not effect their mood

Question 6

Duman and Monteggia, 2006 (Neurotrophins/Neurogenesis)

Answer 6

BDNF hypothesis - Neurodevelopmentally expressed growth factors (like BDNF) regulate plasticity in the adult brain
Stress reduces the expression of BDNF whereas chronic use of antidepressants increases it

Question 7

Brain Derived Neurotrophic Factor

Answer 7

A growth factor that is expressed in limbic areas

Question 8

Groves, 2007 (Neurotrophins/neurogenesis)

Answer 8

Research has not been able to replicate the stress/chronic antidepressant use effect on BDNF
Some studies have found the opposite effect

Question 9

Pezawas et al., 2008 (Neurotrophins/Neurogenesis)

Answer 9

Complex interactions between a BDNF polymorphism, a serotonin transporter gene polymorphism and stressful life events exists
BDNF hypothesis is too simplistic

Question 10

Kemperman, 2008 (Neurotrophins/Neurogenesis)

Answer 10

Antidepressant treatment is shown to increase the levels of growth factors in the hippocampus that influence neurogenesis - This may allow hippocampal networks to adapt and learn new experiences
In tact neurogenesis during a stressful life-event may create maladaptive learning and subsequently depression

Question 11

Peters et al., 2003

Answer 11

Pps w depression reported average unpleasant experiences but less than average positive experiences

Question 12

Papakostas, 2014

Answer 12

Cognitive symptoms of MDD are associated with earlier illness onset and longer episode duration
Can have adverse effects of treatment and recovery

Question 13

Caspi et al., 2003 (Genetics)

Answer 13

Pps who had 2 long copies of the 5-HTTLPR gene had a 40% increased risk of MDD after a stressful life event, pps with a copy of the long and short gene had a 30% and pps with two copies of the short gene have a 18% risk
5-HTTLPR could magnify response to stressful life events
Still a 5-10% risk of MDD even with no stressful life events

Question 14

Risch et al., 2009 (Genetics)

Answer 14

Could not recreate the results of Caspi et al., 2003

Question 15

Wray et al., 2009 (Genetics)

Answer 15

Inaccuracy of biological gene tracking methods may explain Caspi et al., 2003

Question 16

Parker et al., 2003 (Hormones)

Answer 16

40-50% MDD patients have cortisol hypersecretion

Question 17

Gibney and Drexhage, 2013 (Hormones)

Answer 17

Dysregulated immune system is an underlying mechanism of depression - this is linked to thyroid hormone function

Question 18

Berent et al, 2014 (Hormones)

Answer 18

Found low concs of free thyroid hormone to increase depression severity and reduce positive treatment outcomes

Question 19

von Wolff et al., 2013 (Tricyclics)

Answer 19

Meta-analysis of tricyclics - efficacious in increasing response rates compared to placebo
SSRI’s had fewer drop out rates indicating better acceptability
Most evidence came from patients with dysthymia, not MDD

Question 20

Qin et al., 2014 (Tricyclics)

Answer 20

Found SSRI’s improved depression rating scale scores and response in symptoms than ppl of tricyclics
More patients on tricylics discontinued their treatment

Question 21

Barth et al., 2016 (SSRI’s)

Answer 21

Although people on SSRI’s reported more adverse effects than people of placebo, this was not shown to effect treatment

Question 22

Jakubovski et al., 2016 (SSRI’s)

Answer 22

High doses of SSRI’s work better for people with sever MDD - however the effect is counteracted by the lack of tolarablitity to the high dose

Question 23

Chuicariello et al., 2014 (MAOI’s)

Answer 23

MAO-A is elevated in the PFC and anterior cingulate cortices during a depressive episode
Elevated MAO-A levels were associated with more sever and reversed neurovegetative symptoms

Question 24

Zajecka and Zajecka, 2014 (MAOI’s)

Answer 24

Second gen MAOI’s have reduced safety concerns surrounding diet and medication interactions - less restrictive diet

Question 25

Pherson et al., 2015 (MAOI’s)

Answer 25

MAOI’s can induce improved cognitive functioning in MDD patients

Question 26

Gibson et al., 2016

Answer 26

56% people have a positive experience with antidepressants, 28% have a mixed experience - antidepressants seen as necessary, life saving, helping them to meet social obligations and is a stepping stone for further help
16% have a negative experience with antidepressants as they provide a lack of control and emotional authenticity, unbearable side effects and they mask real problems

Question 27

McGrath et al., 2013

Answer 27

6 limbic and cortical regions were identified as biomarkers for treatment options
Insula hypometabolism favoured CBT > escitalopram
Insula Hypermetabolism favoured escitalopram > CBT