Depression Flashcards
What are the two patterns of depressive states?
Unipolar [low level of mood affecting quality of life]
Bipolar [recurrent episodes of mania and depression]
How is a unipolar depressive state generally treated?
CBT
Antidepressants
How is a bipolar depressive state generally treated?
Antipsychotics
What is dysthymia?
Mild, chronic depression
What is cyclothymia?
Cycle of mild depression and and elevated mood
What are the 2 forms of bipolar depression?
Bipolar disorder (periods of mania and depression) Cyclothymia (periods of hypomania and mild depression)
What are the ‘core’ symptoms of depression?
Persistent low mood
Anhedonia (lack of pleasure)
Anergia (abnormal lack of energy)
What other symptoms present in people with depression?
Disturbed sleep Change in appetite/ weight Fatigue Agitation Poor concentration Feelings of worthlessness/ guilt Suicidal thoughts
What areas of the brain show decreased activity in depression?
Prefrontal cortex
Hippocampus
What areas of the brain show increased activity in depression?
Amygdala
Hypothalamus
What are the theories of depression?
Neurotransmitter (monoamines)
Neurohormonal (steroids, HPA axis)
Immune (e.g. autoimmune)
Circadian
What is the main site of production of Serotonin?
Raphe Nuclei (Brainstem)
What functions is Serotonin involved in?
Mood/ agitation OCD Anxiety Appetite Insomnia Sexual functioning Nausea/ vomiting GI function
What are the main sites of noradrenaline production?
Locus Coeruleus (Pons) Lateral Tegmental Area (Brainstem)
What are the functions of Noradrenaline?
Depression Attention Energy homeostasis Agitation Emotions Blood pressure/ Heart rate Bladder control Motor function
How does Serotonin and Noradrenaline interact?
Interactions in the brainstem speed activity
Interactions in the cortex slow activity
Depends on the distribution of adrenergic receptors on the dendrites/ presynaptic terminal which makes responses variable
What is the role of inflammation in depression?
Inflammatory mediators lead to microglia activation, cell dysfunction and cell death which can lead to a spectrum of disorders.
Damage occurs in CNS and only crosses blood-brain barrier if there is a point of weakness.
What is the gut-brain axis?
Inflammation in the gut can trigger altered brain activity.
Altered microbiota can lead to breakdown of protection known as ‘leaky gut’.
Probiotics have been shown to reduce anxiety and improve mood.
What is the role of neurogenesis in depression?
Depression associated with decreased dendritic arborisation, a decreased number of synapses and overproduction of receptors.
What treatments options are available for depression?
CBT Pharmacological Transcranial Magnetic Stimulation (TMS) Transcranial Direct Current Stimulation (TDCS) Electroconvulsive Therapy (ECT)
[Nb. important to consider exercise and lifestyle changes in all patients with mental health problems]
What pharmacological treatments are available for depression?
SSRIs
Tricyclic antidepressants
Monoamine Oxidase Inhibitors
Atypical antidepressants
What is the placebo effect?
Beneficial effect produced by placebo drug/ treatment that cannot be attributed to the placebo itself and therefore must be due to patient’s belief in the treatment.
30% of patients respond to placebo treatment and can change in neuronal activity levels.
What are the advantages of Transcranial Magnetic Stimulation?
- Can be effective in patients who do not respond to antidepressants
- Less stigma than ECT
- Fewer side effects