Lecture 2: Depression

Question 1

What are the two kinds of depression?

Answer 1

Reactive → Outward cause
Endogenous → inward cause

Question 2

Which factors are risk factors for depression?

Answer 2

Sex, age, socioeconomic status, education status, early life trauma

Question 3

Define depression

Answer 3

Persistent Morbid sadness for a period of at least 2 weeks

Question 4

What are the diagnostic criteria for depression?

Answer 4

• Disruption of life
• persistent low mood
• At least 2 weeks, all day, everyday
• inability to experience pleasure
• psychomotor disturbances
• anhedonia
• confusion

Question 5

When is depression considered a threat to life?

Answer 5

When comorbid with psychosis or suicidal ideation

Question 6

What is the difference between primary and secondary depression?

Answer 6

Primary → preexisting condition which is causing depression

Secondary → no preexisting condition

Question 7

What is the difference between unipolar & bipolar depression?

Answer 7

Unipolar → just low mood, ranging from dysthymia to severe

Bipolar → cycling mood

Question 8

Seasonal affective disorder

Answer 8

Common in northern hemisphere

melatonergic treatment

young adulthood

feelings of irritability and being out of sorts

symptoms can echo major depression and interfere with daily life

Question 9

Schizoaffective disorder

Answer 9

• Psychotic depression
• often requires hospitalisation

Question 10

Typical vs atypical vs catatonic depression

Answer 10

• Typical → not eating enough, not sleeping enough

• Atypical → opposite, mood can lift if reward system is stimulated

• Catatonic → lack of motor activity, Rigid postures for hours, Repeating things over and over again, Extremely rare, Severe symptoms

Question 11

What are the symptoms of depression?

Answer 11

• Depressed mood.
• Loss of motivation, reduced energy and an in ability to experience pleasure.
• Pessimistic thinking, feelings of worthlessness and a loss of self esteem.
• Psychomotor disturbances (Retardation or agitation).
• Impairment of reality, hallucinations, delusions or confusion

Question 12

What are the genetic predisposes?

Answer 12

• 1st degree relative (3x more risk)
• not Mendelian
• susceptibility genes
• Epigenetic’s (degree of expression)

Question 13

What are the environmental predisposes?

Answer 13

Bereavement

Uncontrollable, unpredictable, severe, chronic

Pre-natal factors

Question 14

What is postpartum depression?

Answer 14

long-lasting

can interfere with a mother’s ability to care for her baby

characterised by feelings of inadequacy, insomnia, intense anger, or difficulty bonding with the baby

Question 15

Mixed anxiety and depression

Answer 15

Patient has depression accompanied with quite profound anxiety

neurotic depression

Question 16

History of Depression

Answer 16

ECT and barbiturates prior to 1950 were the only treatment

Question 17

NA

Answer 17

Catecholamine neurotransmitter which is synthesized from tyrosine

Main cell body area is in locus coeruleus (place in mid brain. Cell bodies project from there to cortex mainly, but innervate extensive areas in brain) with projections to limbic brain regions

Important in attention – plays into apathy /interest

Question 18

5HT

Answer 18

Indoleamine neurotransmitter which is synthesized from tryptophan (amino acid in the diet)

Cell body area is in Raphe Nuclei with projections to limbic brain regions (regions of the brain that regulate mood + cognition)

Behaviours with aggression/tense/irritable, fearful states

Question 19

DA

Answer 19

Reward circuitry – ability to feel pleasure

Question 20

DA, NA, 5HT

Answer 20

Serotonin + NA = anxiety

Dopamine + NA = lack of energy

Serotonin + dopamine = appetite + sex

Example One: patient cannot experience pleasure, poor motivation, lack of energy = NA/DOPAMINE
Example Two: tense, irritable, aggressive, lack of libido = NA/SEROTONIN
Example Three: anxiety + low mood + cognition (poor attention) = SEROTONIN/DOPAMINE