Depression Flashcards
How is depression diagnosed?
DSM-5
ICD-10
How is a mental disorder characterised?
Clinically significant disturbance in cognition, emotion regulation or behaviour
Reflecting dysfunction in the psychological, biological or developmental prep eases underlying mental functioning
Other depressive disorders
- mood dysregulation disorder
-major depressive disorder (MDD) - persistent depressive disorder (dysthymia)
- premenstrual dysphoric disorder
- substance/medication-induced depressive disorder
- depressive disorder due to another medical condition
- other specified depressive disorder, and unspecified depressive disorder
- disruptive mood dysregulation disorder (for children up to 12 years)
DSM-V criteria for depression?
- discrete episodes of at least 2 weeks’ duration
- clear-cut changes in affect, cognition, and neurovegetative functions
- inter-episode remissions
What fraction of adults have depression in the UK?
1 in 4
What fraction of children have depression in the uk?
1 in 10
Deaths per year due to suicide in the UK?
6,000
People diagnosed with depression worldwide?
300,000,000
Symptoms of depression?
- Depressed mood
- Diminished interest or pleasure in all, or almost all the activities
- Change in weight and/or appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Suicidal thought/attempts
Risk factors for depression?
- Temperamental: negative affectivity (neuroticism) is a risk factor for the onset of depression
- Environmental: adverse childhood experiences, stressful life events
- Genetic: ~40% heritability, 2-4 times higher in family members of depressed individuals
- Physiological
- Course modifiers: other disease that are commonly accompanied by depression – for example, substance use and anxiety; chronic debilitating medical conditions such as diabetes and cardiovascular disease
Original name for depression?
Melancholia
First theory of depression?
Hippocrates 400BC
Agony of soul expressed by fear, despondency, sadness and gloom
Humoral theory - black bile (melancholic)
Treatment - diet, exercise, purgatives and bleeding
Celsus’s theory?
25-50BC
Demonic possession
Treatment - exorcism, burning, beating, solitary confinement, restrain with chains and manacles
Theory of the 17th century?
René Descartes - Cartesian dualism (mind and body dualism)
Two collateral histories
- what happens in and to the body
- what happens in and to the mind
First history - physical world
Second history - mental world
Where did René Descartes say the soul was?
Pineal gland
Charles Darwin’s hypothesis
‘Grief muscles’
1872 - The expression of the Emotions in Man and Animals
Key brain regions implicated in depression
Amygdala Prefrontal cortex Insular cortex Anterior cingulate cortex Hippocampus Nucleus accumbens
Tuberculosis treatment drug?
Iproniazid- 1952
Elevated mood
Which three drugs prompted the monoaminergic theory?
- Imipramine (increases noradrenaline release)
- Iproniazid (inhibits monoamine oxidase - MAO)
- Reserpine (inhibits VMAT)
When was serotonin discovered?
1964
Vasoconstricting substance in serum
What does imipramine do?
Increases noradrenaline and serotonin release
Enhanced mood
What does iproniazid do?
Inhibits monoamine oxidase (MAO)
The enzyme that catalyses
Adrenaline and noradrenaline —> dihydroxymandelic acid
Serotonin —> 5-hydroxyindoleacetic acid
Enhanced mood
What does reserpine do?
Inhibit vesicular monoamine transporter (VMAT)
Therefore - depletes serotonin
Low mood
Different antidepressants?
- MAOA inhibitors
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitors (SSRIs)
