Major Depression

Question 1

Cognitive features of depression

Answer 1

Pervasive sadness, tearfulness, excessive or inappropriate guilt, feelings of helplessness, emptiness, worthlessness.

Recurrent thoughts of death (not just a fear of dying), suicidal ideation, or a suicide attempt or plan.

Question 2

Neurovegetative features of depression

Answer 2

Significant change in weight due to decreased or increased appetite
(females likelier to experience increased appetite).

Sleep disturbance: insomnia or hypersomnia (females likelier to
experience hypersomnia).

Psychomotor agitation (“can’t sit still”) or retardation (inertia, leaden paralysis, “can’t get going”) (females likelier to experience
retardation).

Pervasive fatigue or loss of energy.

Difficulty thinking, concentrating, or making decisions.

Question 3

What’s the female-male ratio of depression

Answer 3

F:M ratio is 1:1 until puberty, but 2:1 after puberty.

Question 4

Why Are Females Often Diagnosed with Major Depression
Twice as Much as Males?

Answer 4

X-linked depression gene(s)
Premenstrual symptoms concurrent with MDD surveys (why would
this be?)
Quality of female vs. male life in Western societies
Female masochism (Freud)
Cognitive style:
– Females tend to dwell on problems, which may perpetuate their
depression.
– Males tend to ignore or escape their problems, with drug/alcohol use or
impulsive acts.

Question 5

Neurochemical Theories of Depression: Neurotrophic Theory

Answer 5

Death of neuronal connections due to
reduced activity of neuronal growth factors (e.g., BDNF, or Brain-Derived Neurotrophic Factor) that promote neuronal growth and axonal and dendritic sprouting.

Question 6

Neurochemical Theories of Depression: Inflammatory theories

Answer 6

over-secretion of substances related to stress
and inflammatory responses in brain:
-Substance P (neuropeptide involved in pain transmission and responses to stress)
-Glutamate and Glycine through NMDA receptors

Question 7

Genesight© test

Answer 7

uses combinatorial pharmacogenomics to narrow
down medication choices, by matching 12 genes of a patient’s genotype to the pharmacology of 56 depression-related medications.

Question 8

Alternative Depression Treatments: ECT (Electroconvulsive Therapy)

Answer 8

delivery of intense shocks to patient’s head and induction of seizure

Question 9

Alternative Depression Treatments: Ketamine Infusion

Answer 9

receives slow infusion of ketamine (a “dissociative anesthetic” and party drug –
“special K”) at sub-anesthetic dose, but sufficient to place in twilight state,
accompanied by mild hallucinations and experience of depersonalization and
derealization.
– has typical course of treatment of 6-12 sessions @45 min each over 10-14 days.
Side effects are confusion, hangover hallucinations, fuzzy vision; no driving for
24 hrs.
– experiences antidepressant effect within hours, lasting days to weeks; booster
infusions provided as needed.

Question 10

General Antidepressant Classifications

Answer 10

Selective Serotonin Reuptake Inhibitors, Atypical Antidepressants (Effexor, Cymbalta[SNRI], Wellbutrin[NDRI], Pristiq, Remeron[TTCA], Trazodone[SARI]),