Depression

Question 1

What is neurology?

Answer 1

→ Branch of medicine, diagnosis & treatment of nervous system disorders

Question 2

What is psychiatry?

Answer 2

→ Branch of medicine, diagnosis & treatment of disorders that affect the mind and psyche

Question 3

What is human behaviour a product of?

Answer 3

→ Product of brain activity

Question 4

What is the brain a product of?

Answer 4

→ Genetics and environment

→ Experience

Question 5

What is depressive disorder?

Answer 5

→ A low state marked by significant levels of sadness
→ lack of energy
→ low self worth
→ Guilt 
→ related syndromes

Question 6

What is a major depressive disorder?

Answer 6

→ A severe pattern of depression that is disabling and not caused by factors such as drugs or a medical condition

Question 7

What are characteristics of affective disorders?

Answer 7

→ Disorders of mood rather than thought/cognition

Question 8

What is unipolar depression?

Answer 8

→ mood swings in one direction

→ most common depressive illness

Question 9

How many unipolar depression cases are caused by the environment?

Answer 9

→ 75%

Question 10

How many cases of unipolar depression are caused by genetics?

Answer 10

→ 25%

Question 11

What is bipolar depression?

Answer 11

→ Oscillation between depression and mania

Question 12

What is mania?

Answer 12

→ Excessive exuberance
→ enthusiasm 
→ self confidence
→impulsive actions 
→ aggression
→ irritability 
→ delusions of grandiose

Question 13

What are the criteria used for depression diagnosis?

Answer 13

→ DSM-IV or ICD-10

Question 14

What are the criteria for depression?

Answer 14

→ Five or more of the symptoms during the same 2 week period

Question 15

What are the emotional symptoms of depression?

Answer 15

→ Apathy
→ pessimism
→ negativity
→ low self esteem 
→ feeling guilty 
→ loss of motivation
→ indecisiveness

Question 16

What are the biological symptoms of depression?

Answer 16

→ Reduced activity
→ Loss of libido
→ Sleep disturbance
→ Loss of appetite

Question 17

What are the animal models of depression?

Answer 17

→ Learned helplessness

→ mother infant separation is reversed by antidepressants

Question 18

What is the gender bias in depression?

Answer 18

→ It affects twice as many females as males

Question 19

What is the lifetime prevalence of depression in men and women?

Answer 19

→ 10-25% in women

→ 5-12% in men

Question 20

When does the first depressive episode happen?

Answer 20

→ late adolescence

→ early adulthood

Question 21

What is depression comorbid with?

Answer 21

→ terminal and chronic illness 
→ thyroid dysfunction
→ neurological disease
→ stroke 
→ drug abuse

Question 22

How many depressed individuals will attempt suicide?

Answer 22

→ 20%

Question 23

If one twin has depression what is the probability that the other will get it too?

Answer 23

→ 40-50%

Question 24

What are environmental factors that may lead to depression?

Answer 24

→ loss
→ Environmental stressors
→ Social isolation

Question 25

What is the monoamine theory for depression?

Answer 25

→ that there is a deficit of monoamines → 5-HT → dopamine → NA

Question 26

What is the evidence for the monoamine theory?

Answer 26

→ Overall reduced activity of dopaminergic and serotonergic systems → Reserpine depletes the brain of NA and 5-HT and induces depression → main antidepressant drugs increase amines in the brain

Question 27

What is the evidence against the monoamine theory?

Answer 27

→ It is difficult to show deficits in the brain of NA and 5-HT → most antidepressants take several weeks to work but increase in amines is acute → some antidepressants are weak and have no effect on amine uptake → cocaine blocks amine uptake but has no antidepressant effect → increase in 5-HT is linked to aggression and not depression

Question 28

What is the neuroendocrine theory?

Answer 28

→ there is hypersensitivity to the HPA axis

Question 29

What neurons input to the hypothalamus?

Answer 29

→ noradrenergic | → 5-HT

Question 30

Describe how cortisol is produced?

Answer 30

→ Hypothalamus releases CRH (corticotropin releasing hormone) → CRH acts on the pituitary - release of adrenocorticotropic hormone (ACTH) → Cortisol release from the adrenal cortex in response to increased ACTH in the blood

Question 31

What does CRH do?

Answer 31

→ mimics depression like symptoms

Question 32

What is cortisol and CRH like in depressed patients?

Answer 32

→ Cortisol is higher | → increased CRH in CSF

Question 33

What suppresses and increases the HPA axis?

Answer 33

→ hippocampus suppresses HPA | → Amygdala increases HPA

Question 34

What are glucocorticoid receptor gene expression regulated by?

Answer 34

→ Early experience

Question 35

What causes glucocorticoid receptor expression in the brain?

Answer 35

→ tactile stimulation after birth activates 5-HT pathways to the hippocampus → it triggers a long lasting increase in the expression of glucocorticoid receptors in the hippocampus

Question 36

How do SSRIs affect glucocorticoid receptor expression i the hippocampus?

Answer 36

→ they increase it

Question 37

Lack of what receptor is associated with depression and why ?

Answer 37

→ Decreased glucocorticoid receptors in the hippocampus (cortisol) → more cortisol is needed to bind and negatively feedback to the hippocampus → hippocampus downregulates the HPA axis

Question 38

What is the neurogenesis theory for depression?

Answer 38

→ Evidence of neuronal loss and decrease in neuronal activity in the hippocampus and prefrontal cortex

Question 39

What promotes neurogenesis?

Answer 39

→ ECT | → antidepressants

Question 40

What promotes neurogenesis during development?

Answer 40

→ 5-HT via BDNF (brain derived neurotrophic factor)

Question 41

What increases BDNF?

Answer 41

→ SSRIs

Question 42

What increases in the cortex of depressed people?

Answer 42

→ glutamate

Question 43

Why does glutamate cause depression?

Answer 43

→ excessive glutamate leads to neurotoxicity which leads to neuronal death

Question 44

Describe how excitotoxicity occurs

Answer 44

→ Chronic stress causes a big release of glutamate → Hyperactivation of NMDA receptors → Excitotoxicity occurs leading to neuronal loss

Question 45

Describe how neurogenesis occurs mediated by NA and 5HT

Answer 45

→ Noradrenaline acts on alpha 2 receptors → 5-HT acts on 5-HT1A receptors → these cause beneficial gene transcription → increased neurogenesis and inhibition of neural apoptosis

Question 46

What is an adverse effect of ECT?

Answer 46

→ Memory loss

Question 47

What does psychotherapy help with?

Answer 47

→ overcoming negative views

Question 48

What do tricyclic antidepressants do?

Answer 48

→ block reuptake of NA and 5-HT

Question 49

What is an example of an SSRI?

Answer 49

→ Fluoxetine

Question 50

What is an example of an NA selective reuptake inhibitor?

Answer 50

→ reboxetine

Question 51

What do MAOI do?

Answer 51

→ block the degradation of 5-HT and NA

Question 52

What does lithium do?

Answer 52

→ Stabilises mood