Depression Flashcards
What pathways are affected by noradrenaline?
Alertness
Arousal
Sensory perception
Motor tone
What pathways are affected by serotonin?
Sleep Food intake Thermoregulation Sexual behaviour Pain Motor tone
Give 4 types of unipolar depression.
Major depressive disorder
Dysthymia
Seasonal affective disorder
Postnatal depression
What is often the main focus of treatment?
CBT in order to change mindset and promote positive behaviour
What areas of the brain and neurotransmitters are responsible for loss of pleasure/motivation?
Dorso-lateral and pre-frontal cortex
Dopamine
What areas of the brain and neurotransmitters are responsible for sadness and suicide?
Ventro-medial and pre-frontal cortex
Serotonin, noradrenaline and dopamine
What areas of the brain and neurotransmitters are responsible for fatigue/loss of energy?
Dopamine
Noradrenaline
Serotonin
What areas of the brain and neurotransmitters are responsible for sleep, appetite and libido?
Nucleus accumbent and hypothalamus
Serotonin, noradrenaline and dopamine
What areas of the brain and neurotransmitters are responsible for attention, concentration and problem solving?
Dorso-lateral and pre-frontal cortex
Dopamine, ACh, serotonin, noradrenaline, GABA, histamine
Give examples of emotional symptoms of depression.
Loss of pleasure and motivation
Sadness
Suicidal thoughts
Give examples of somatic symptoms of depression.
Fatigue Loss of energy Sleep changes Appetite changes Loss of libido
Give examples of cognitive symptoms of depression.
Attention
Concentration
Problem solving
What are the 4 physical interventions that may be used in depression?
Electroconvulsive therapy
Electromagnetic therapy
Deep brain stimulation
Vagal stimulation
Describe the features of the serotonergic synapse?
Serotonin is returned from synapse to pre-synaptic terminal via re-uptake transporter
Auto-receptors on presynaptic membrane can be used to back synthesis and release of serotonin, activated by serotonin in the synapse
What is the major problem with MAOI antidepressants?
Dietary tyramine is a precursor for monoamine synthesis
Inhibition of MAO enzyme increases transmitter levels when these foods are eaten
Large hypertensive response, can cause haemorrhage
Describe the acute effect of antidepressants on serotonin levels.
Acute use of antidepressants causes blockage of transporters, increasing serotonin around the cell body
Increased activation of auto-receptors, reducing firing and release
Describe the chronic effect of antidepressants on serotonin levels.
Re-uptake blockade causes serotonin to remain in the synapse for longer allowing it to exert an effect and cell firing is restored
How is depression diagnosed?
Patient must meet 5 out of 9 DSM-5 criteria with at least one core symptom.
What are the DSM-5 core symptoms?
Low mood
Loss of pleasure
What are the DSM-5 symptoms?
Fatigue/loss of energy
Worthlessness, guilt
Recurrent thoughts of death, suicidal thoughts/attempts
Reduced ability to think or concentrate, indecisiveness
Psychomotor agitation or retardation
Insomnia/hypersomnia
Weight loss or gain
When is pharmacological treatment for depression considered?
Moderate/severe depression
Past history of moderate/severe depression
Sub-threshold symptoms for 2 years
Sub-threshold symptoms or persistent mild depression after other interventions
Give examples of SSRIs.
Sertraline Citalopram Escitalopram Fluoxetine Paroxetine
What is first line pharmacological treatment for depression?
SSRI
What are the adverse effects and dangers of SSRIs?
Hyponatraemia
Bleeding risk
QT prolongation with citalopram and escitalopram
