Depression Flashcards
What are the 2 patterns of depressive states?
Unipolar - low level of mood affecting QoL. Dysthymia = low level, chronic, MDD - clinical depression
Treated with CBT and antidepressants
Bipolar - recurrent episodes of mania and depression. Bipolar disorder, cyclothymia, low level
Treated with antipsychotics
Name 2 key symptoms of depression
Persistent sadness or low mood and/or
Marked loss of interests or pleasure
What other symptoms should be looked out for if 2 key symptoms are present?
Disturbed sleep (more/less)
Decreased/increased appetite
Fatigue or loss of energy
Agitation/slowing of movements
Poor concentration or indecisiveness
Feeling worthless, excess inappropriate guilt
Suicidal thoughts or acts
What are the 3 grades of major depressive disorder?
Mild depression - few symptoms that result in only minor functional impairment
Moderate depression - symptoms or functional impairment are between ‘mild’ and ‘severe’
Severe depression - most symptoms that markedly interfere with functioning +/- psychosis
Which 2 areas of the brain are increased in depression?
Amygdala
Hypothalamus
Which 2 areas of the brain are decreased in depression?
Prefrontal cortex
Hippocampus
What are the 4 main theories for depression?
Neurotransmitter
- 5HT
- NA
Neurohormonal
- Steroids
- HPA axis (stress, anxiety)
Immune (?auto)
Circadian
What are the 4 main theories for depression?
Neurotransmitter
- 5HT
- NA
Neurohormonal
- Steroids
- HPA axis (stress, anxiety)
Immune (?auto)
Circadian
Where is the main site of 5HT production?
Raphe Nuclei
brainstem
Where is the main sites of NA production?
Locus Coeruleus - projects the cortex and thalamus
Lateral tegmental area - projects to cerebellum + spinal cord
Where is the main sites of NA production?
Locus Coeruleus
Lateral tegmental area
Describe the reactions between 5HT and NA
Interactions in the brainstem speed activity (cell body end)
Interactions in the cortex slow activity (dendrite end)
Describe the reactions between 5HT and NA
Interactions in the brainstem speed activity
Interactions in the cortex slow activity
What are the 5 main treatments for depression?
CBT
Pharmacological
Transcranial magnetic stimulation (TMS)
Transcranial direct current stimulation (tDCS)
Electroconvulsive therapy (ECT)
What are the 4 main families of drugs to treat depression?
Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOI-A)
Atypical Antidepressants
What are 2 major side effects of ECT?
Memory loss
Short term muscle aches
What are the first line SSRIs?
Sertraline
Citalopram
What is the MoA of SSRIs?
Answer
Inflammatory mediators in the CNS lead to (3):
Microglia activation (act as RBCs)
Cell dysfunction
Cell death
Describe the role of neurogenesis in depression
Depression is associated with decreased dendritic branching and decreased number of synapses
Also overproduction of receptors.
This results in a less profound transmission to the post-synaptic cell
Deficit can be reversed by neuronal growth factors and antidepressants.
Describe transcranial magnetic stimulation (TMS)
Magnetic pulses targeted at prefrontal cortex and limbic system
Good for severe unresponsive depression
Fewer side effects than drug therapy
Less stigma than ECT
Describe ECT
Gold standard for severe depression
50% show improvement
Side effects
- memory loss
- short term muscle aches
- stigma
What are the main classes of antidepressants?
SSRIs
Atypical antidepressants
-NRI
-SNRI
5HT partial agonists
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOI-A)
a-adrenoreceptors
Describe the mechanism of action of SSRIs
Inhibits serotonin reuptake pump
What are the 2 main SSRIs?
Sertraline
Citalopram
Describe the mechanism of action of atypical antidepressants
Noradrenaline reuptake inhibitor (same principle as SSRIs) - Reboxetine
SNRI - 5HT and NA reuptake inhibitor - Venlafaxine
5HT partial agonist - reduce activity of 5HT to increase transmitter levels (more condensed) - Buspirone
What class of drugs is reboxetine?
NRIs
NA reuptake inhibitors
What class of drugs in Venlafaxine?
SNRI
combined NA 5HT reuptake inhibitor
What class of drugs is Buspirone?
5HT partial agonist
Describe the MoA of agomelatine
Melatonin agonist
Increases slow wave sleep
What is agomelatine?
Melatonin agonist
What are the 5 main actions of tricyclic antidepressants (TCAs)?
5HT reuptake inhibitor
NA reuptake inhibitor
a1 adrenoreceptor antagonist
H1 receptor antagonist
M1 receptor antagonist
Give 2 examples of TCAs
Amitriptyline
Nortriptyline
Give the side effects of TCAs with link to the receptors they work on
a1 adrenoreceptor antagonist - postural hypotension (usually constrict smooth muscle in blood vessels)
H1 receptor antagonist - antihistamine action, cause sedation
M1 receptor antagonist - cardiac arrhythmias (cardiac smooth muscle)
What are some common side effects of TCAs?
Sedation
Postural hypotension
Confusion
Visual problems
Cardiac dysrhythmia
Mania
Drug interactions (aspirin, alcohol)
What is the mechanism of action of monoamine oxidase inhibitors?
Increases 5HT/NA levels by reversibly inhibiting the action of the enzyme monoamine oxidase A
What is the main MAOI-A?
Moclobemide
What class of drugs is moclobemide?
MAOI-A
What are some common side effects of MAOIs?
Postural hypotension
Restlessness
Convulsions
Sleep disorders
Cross drug reactions - not to be px with SSRIs/ TCAs
Cheese reaction - tyramine, enhances action of drug
Outline how a-1 and a-2 receptors work under normal conditions
α-1 receptors increase transmitter release
α-2 receptors slow transmitter release
So α-1 agonists and α-2 antagonists increase transmission
What is mirtazapine?
a-2 antagonist
increases activity of NA and 5HT in synapse
What are the 4 aims of CBT?
Identify thinking that causes problematic feelings and behaviour
Question the individual’s negative thinking/feeling in order to enable positive change in thought processes
Identify unwanted behaviour patterns
Plan goals to achieve the change sought, and the step by step process for the achievement of the goals
Name 3 drawbacks to CBT
May not be suitable for those with learning difficulties or complex health needs
Confrontation of emotions - can be difficult in early stages, patients need to be ready
Only focuses on individuals capacity for change, not wider family or systems problems
What is the ABCD approach of rational emotive behaviour therapy (REBT)?
A = activating event
B = belief about the event
C = consequences of the event
D = disputing the belief/anticipated consequences of the event
