Lecture 2: Depression Flashcards
What are the two kinds of depression?
Reactive → Outward cause
Endogenous → inward cause
Which factors are risk factors for depression?
Sex, age, socioeconomic status, education status, early life trauma
Define depression
Persistent Morbid sadness for a period of at least 2 weeks
What are the diagnostic criteria for depression?
• Disruption of life
• persistent low mood
• At least 2 weeks, all day, everyday
• inability to experience pleasure
• psychomotor disturbances
• anhedonia
• confusion
When is depression considered a threat to life?
When comorbid with psychosis or suicidal ideation
What is the difference between primary and secondary depression?
Primary → preexisting condition which is causing depression
Secondary → no preexisting condition
What is the difference between unipolar & bipolar depression?
Unipolar → just low mood, ranging from dysthymia to severe
Bipolar → cycling mood
Seasonal affective disorder
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
Schizoaffective disorder
• Psychotic depression
• often requires hospitalisation
Typical vs atypical vs catatonic depression
• 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
What are the symptoms of depression?
• 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
What are the genetic predisposes?
• 1st degree relative (3x more risk)
• not Mendelian
• susceptibility genes
• Epigenetic’s (degree of expression)
What are the environmental predisposes?
Bereavement
Uncontrollable, unpredictable, severe, chronic
Pre-natal factors
What is postpartum depression?
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
Mixed anxiety and depression
Patient has depression accompanied with quite profound anxiety
neurotic depression
History of Depression
ECT and barbiturates prior to 1950 were the only treatment
NA
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
5HT
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
DA
Reward circuitry – ability to feel pleasure
DA, NA, 5HT
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
