Depression (Midterm II) Flashcards
1
Q
how do patients describe depression
A
- like the world lacks colour
- stuck in their own negativity and can’t escape
- can’t get out of bed
- food doesn’t taste good anymore
- lack of purpose, low mood; patients interpret symptoms on a deeper level, connected to personality and their whole life
- it’s a loop of thinking that they can’t get out of
2
Q
DSM-V criteria for depression
A
in a two week period, 5/9 following symptoms:
- depressed mood most of the day
- diminished interest or pleasure
- decrease or increase in appetite
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive/inappropriate guilt
- recurrent thoughts of death/suicidal ideation without a specific plan
- diminished ability to concentrate nearly every day
3
Q
core and associated symptoms of depression
A
- emotional symptoms (feelings of guilt, suicidal thoughts lack of interest, sadness)
- physical symptoms (lack of energy, decreased concentration, changes in appetite, sleep and psychomotor skills)
- associated symptoms (brooding, obsessive rumination, irritability, excessive worry over physical health, pain, tearfulness, anxiety or phobias
4
Q
psychological theories of depression
A
- psychodynamic: anger directed inward
- behavioural: classical and operant conditioning
- cognitive: negative self-schemas and thinking patterns
- interpersonal theory
- learned helplessness
- evolutionary theory
5
Q
biological theories of depression
A
- monoamine
- neuroendocrine
- inflammatory
- genetic
- stress diathesis
- glutamatergic
- neuroimaging connectomics (bc neurons that fire together wire together)
6
Q
effects of reduced monoamine neurotransmission
A
- 5HT plays a role in obsessions, compulsions, and memory
- NE plays a role in alertness, concentration and energy
- DA plays a role in pleasure, reward, and motivation/drive
- all three contribute to mood and cognitive function
7
Q
serotonin
A
- produced from tryptophan in the median and dorsal raphe nuclei
- implicated in sleep, memory and learning, mood regulation, temperature regulation, sexual function, aggression and impulsivity
- receptors found in CNS, GI system, platelets and vessel walls
- linked to a number of psychiatric disorders, the most common being anxiety and depression
- studies find that the CSF of indv who are depressed or have committed suicide have low lvls of 5HIAA, a 5HT metabolite
- drugs that deplete monoamines also mimic depression
8
Q
noradrenaline
A
- produced in the locus coeruleus (an area implicated in panic attacks) (directly from DA, but the pathway precursor is tyrosine)
- receptors are found in the CNS and systemically
- implicated in the pathophysiology of depression bc depression is sometimes responsive to medications affecting the brain’s noradrenergic activity
- suggests that medications with dual 5HT and NE actions may be more efficacious
9
Q
dopamine
A
- produced from tyrosine which is converted to L-DOPA
- linked to the production of psychotic symptoms and chlorpromazine, a DA receptor blocker, was the first antipsychotic agents
- DA also linked bc of the psychotic effects of stimulants (cocaine, meth, amphetamines, etc) which increased DA lvls
10
Q
absorption
A
- some medications are better absorbed with food, which increased blood flow, changes pH, and changes gut motility
ex. ziprasodone, lurasidone, vilazodone
11
Q
metabolism
A
- some medications have active metabolites, and others are broken down and activated by metabolism (prodrugs)
- interactions may occur when two drugs use the same enzyme
- there is also variation in enzymes among people that can have predictive value
- phase 1 metabolic oxidative metabolism of many substances and psychotropic drugs is performed by the cytochrome P450 system; these evolved from animals to deactivate plant toxins and induce a liver pigment that absorbs light at peak 450 nm ; they’re classified into 8 families and subfamilies based on similarity in AA sequence
12
Q
SSRIs
A
- most commonly prescribed type of antidepressant
- principle action through inhibition of 5HT reuptake
- time of onset usually 3-6 weeks, but side effects begin immediately
13
Q
SNRIs
A
-similar side effect profiles to SSRIs, but dual action with NE effects at higher doses
14
Q
NDRIs
A
ex. bupropion
- act on both NA and DA
- effects on smoking cessation and attention related disorders such as ADHD (which are DA related)
- see less sexual dysfunction and weight gain (which are as’d with 5HT inhibition)
- may cause more initial agitation (Possibly a NA effect)
15
Q
MAOIs
A
ex. phenelzine, tranylcypromine
- mandate a low tyramine diet (the drug prevents its breakdown, which leads to an excess of NA that can cause a hypertensive crisis)
