depressive disorder Flashcards
what is depression
severe or persistent enough to interfere with normal functioning
- depressed mood, psychomotor dysfunction, fatigue, decreased
interest or pleasure in activities
what is the etiology of depression
- exact ‘cause’ is not well understood and likely involves multiple factors
- genetic (e.g. single nucleotide polymorphisms)
- altered neurotransmitter levels (monoamines)
- altered neuroendrocrine function
- psychosocial factors
what is the Major depressive disorder
- depressive symptoms every day for two weeks
- at least 5 depressive symptoms from a list of 9, and must include
depressed mood, or loss of interest or pleasure - other symptoms include sleep disturbance, fatigue, suicidal thoughts
what is the Persistent depressive disorder
at least two depressive symptoms persist for two years
what is the interaction between the limbic system activity and cognitive control
there is reciprocal interconnection between the limbic system activity and the cognitive control as the limbic system activity increase the cognitive control decrease
what is the anterior cingulate cortex
has connection to both the limbic area of the brain and the cortical brain network
what are the cortical region
dorsaltral
ventromedial
ventrolateral
what is the limbic system structure
thalamus
amygdala
hippocampus
how do Tricyclic Antidepressants work
act by blocking reuptake of 5-HT and NE
which receptors do the Tricyclic Antidepressants block
also bind and antagonize many other receptor targets: 5-HT (2A, 2C, 6, 7),
alpha1, NMDA, histamine H1 and H2, muscarinic acetylcholine
what are the side effects of the Tricyclic Antidepressants
many more including anxiety, nausea, drowsiness, cardiac
(tachycardia and bradycardia)
give me a name of the Tricyclic Antidepressants medication
clomipramine
how do Monoamine oxide inhibitors (MOAIs) work
inhibit the oxidative deamination of 5-HT, NE, and DA
give two medications that are MOAIs
Nardil ( phenelzine) and Manerix ( moclobemide)
what is the hypertensive crisis in the MOAIs
when MOAIs are ingested along with food containing
tyramine or dopamine
which medication is a new reversible MOAI that is selective for MOA-A
Manerix
give some meds of SSRIs
fluoxetine (Prozac), sertraline, citalopram, escitalopram
how does SSRIs work
(1) SSRI – increased amount of 5-HT in the synaptic cleft
(2) desensitization of the presynaptic 5-HT 1A autoreceptor
- increased 5-HT 1A autoreceptor in postmortem studies
- chronic SSRI treatment may downregulate these autoreceptors
(3) desensitization of the postsynaptic 5-HT 2A receptor
(4) anti-inflammation: downregulation of pro-inflammatory cytokines:
IL-1β, IL-6, interferon-γ, tumor necrosis factor α
what is the The Inflammation Hypothesis
an imbalance to the interaction between the immune system and brain
what are the evidences for the Inflammation Hypothesis
- major depressive disorder occurs more often with chronic inflammation
(e.g. diabetes or rheumatoid arthritis) - systemic administration of interferon-γ, or elevation to tumor necrosis
factor α and IL-6, correlate with depressive symptoms - in many cases, levels of these cytokines are increased in the
cerebrospinal fluid of patients with major depressive disorder - these same cytokines can upregulate the function of monoamine
reuptake pumps such as the 5-HT transporter
which neurotransmittors does Inflammation Hypothesis affects
an imbalance to
serotonin and
glutamate
neurotransmission
what are SNRIs
similar to the tricyclic antidepressants, inhibit reuptake of 5-HT and NE
- very similar clinical efficacy and adverse effects as SSRIs
- some adverse effects (e.g. sexual dysfunction) may be milder
give two meds of the SNRIs
effector ( venlavaxine), cymbalta ( Duloxetine)
