Depression

Question 1

What characteristics fall under Clinical Depression?

Answer 1

• Dysphoric mood, unhappy
• Changes in appetite and sleep
• Social withdrawal
• Difficulty concentrating
• Thoughts of suicide: 40% of population at least once

Question 2

What characteristics fall under Mania?

Answer 2

• Excessive euphoria

- Hyper-activity

Question 3

What characteristics fall under Bipolar Disorder?

Answer 3

• Periods of depression and mania

Question 4

Monoamine Hypothesis?

Answer 4

• Reserpine: depletes monoamines
• Changes in NE, DA, 5HT functioning: NT and metabolites are down-regulated
• SSRIs, TCAs, MAO-Is

Question 5

Neurogenesis Hypothesis?

Answer 5

• Brain-derived neurotrophic factors (BDNF): down-regulated by stress; up-regulated by anti-depressants; may affect functioning of monoamine synapses

Question 6

The Stress/HPA Theory?

Answer 6

Hypothalamic-Pituitary-Adrenal circuit (HPA-axis):

• HPA responses (CRH/CRF and cortisol levels) heightened: releases ACTH –> glucocorticoids
• CRH induces a “vegetative state” seen in depression
• Early life stressors found in 45% depressive episodes

Question 7

Treatments for MDD: MAO-Is?

Answer 7

Monoamine Oxidase Inhibitors

• Inhibits MAO
• Nardil
• Wine and cheese effect; contain tyromine = elevated BP = stroke

Question 8

Treatments for MDD: TCAs?

Answer 8

Tricyclic Antidepressants

• Inhibits NE and 5HT reuptake
• Tofranil
• Cardiac effects/panic attacks

Question 9

Treatments for MDD: SSRIs?

Answer 9

Serotonin Selective Reuptake Inhibitors

• Inhibits 5HT reuptake
• Prozac
• Sexual dysfunction; teen suicide risks

Question 10

Treatments for MDD: CRH/CRF antagonists?

Answer 10

• Inhibits CRH/CRF
• Antalarmin
• Effective in animals and testing in humans for toxicity

Question 11

Treatments for MDD: NMDA antagonists?

Answer 11

• Inhibits NMDA –> promotes neurogenesis
• Ketamine
• Effective, but problematic

Question 12

Alternative forms of therapy: ECT?

Answer 12

Electroconvulsive Shock Therapy

• Grand Mal seizure: better afterwards
• Memory loss

Question 13

Alternative forms of therapy: rTMS?

Answer 13

Repetitive Transcranial Magnetic Stimultion

• Left DLPFC
• Headache; seizure

Question 14

Alternative forms of therapy: DBS?

Answer 14

Deep Brain Stimulation

• Subthalamic nucleus
• Invasive; infection; headache; seizure; stroke; hardware

Question 15

Alternative forms of therapy: Vagus Nerve Stimulation?

Answer 15

• Increases NE and 5HT

- Voice/throat; headache; chest pain

Question 16

What are the neuropathological abnormalities in depression?

Answer 16

• Decreased blood flow: reduced memory and attention
• Increase glucose metabolism: amygdala (increase HPA axis activity - cortisol); orbital regions (attempt to inhibit amygdala activity/break persistent negative thoughts)
• Reduced gray matter: ACC, OFC, nucleus accumbens, and hippocampus