Depression and Medical Illness Flashcards
Why is the relationship between depression and medical illness considered bidirectional?
Because each makes the other worse.
1 specific effect (insofar as we know these are actually effects) of depression on the brain?
Decreased neurogenesis.
2 specific effects of depression on the cardiovascular system?
Decreased HR variability.
Increased platelet activation
1 specific effect of depression on the autonomic nervous system?
Increased sympathetic tone.
3 specific effects of depression on the endocrine system?
Increased CRF
Increased HPA activity
Increased insulin resistance
2 specific effects of depression on the immune system?
Decreased cell-mediated immunity.
Increased cytokines
2 specific effects of depression on bones?
Decreased formation, density
Increased resorption.
Diseases affecting what system are most closely associated with depression?
Those affecting the brain (such as Parkinson’s or stroke).
Compared with smoking, how big is a risk for CV disease is depression?
Similar to smoking.
How does CV disease risk trend with # of criteria for depression met?
More criteria, shorter survival free of cardiac mortality.
What are 4 possible mechanisms by which depression might increase the risk for CV disease?
Behavior and lifestyle (adherence to med, smoking, diet, exercise).
Increased platelet activation / reactivity.
Decreased HR variability.
Increased inflammatory response.
4 mechanisms by which CV disease can cause depression?
Stigma of disease
Lose of roles due to disability
Grief
Fear of death / disability
Mechanism for hypercoaguability in depressed people? Does this resolve with SSRI treatment?
Increased density of 5HT-2A receptors.
Yes, it normalizes with SSRI treatment (we don’t know why).
Also high cortisol and symp. tone -> increased coagulation.
What effect of depression have on cortisol levels? How do those levels respond to the dexamethasone suppression test?
Higher cortisol, which isn’t suppressed by dexamethasone.
3 effects of elevated cortisol related to CV disease?
Promotion of atherosclerosis.
Promotion of hypertension.
Accelerates injury to vascular endothelial cells.
