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.
CRF levels in depression?
Are high.
3 cytokines elevated depression? Effect?
IL-1, IL-6, TNF
Associated w/ insulin resistance, diabetes, and obesity.
Associated with atherosclerosis.
3 interactions between depression and HIV?
High prevalence of depressive symptoms in HIV infection.
Stress and depression impair immune function.
Stress and depression are associated with HIV disease progression (less progression-to-AIDS-free survival).
What 2 mentioned cells of the immune system seem to be under-active in depression?
CD8s and NKs
Do depression and cancer go together?
Yeah, but the rates depend on the cancer. (very high in pancreatic cancer)
What highlighted treatment for cancer increases rates of depression and suicidality?
Interferon.
Can treating depression prolong the survival of some cancer patients?
Probably - the positive data on breast cancer patients is controversial, though.
Can treating depression reverse depression-mediated immune suppresion?
Probably.
What did people studying the safety of SSRIs on people with CV disease find?
Risk of morbidity and mortality was reduced vs. controls.
What can you do to prevent medication-induced depression?
Give prophylactic SSRIs.
Why is self-medication of depression with St. John’s Wort bad for a few diseases?
Induces cytochrome P450 -> reduced concentrations of crucial drugs such as indinavir (an HIV protease-inhibitor) and cyclosporin.
