MDD

Question 1

What is MDD and what are symptoms of MDD?

Answer 1

Cognitive:
- Anxious thoughts
- Feelings of guilt and sadness
- Frequent negative thoughts
- Low self esteem
- Irrational hopelessness
- Low concentration
Physical/Sociocultural:
- Loss of interest
- Suicidal thoughts
- Social isolation and withdrawl
Biological:
- Loss of energy
- Insomnia or hypersomnia
- Weight loss or gain
- Loss of appetite or excessive hunger

Question 2

Explain one aetiology of MDD.

Answer 2

Genetics:
- How parents pass traits to offspring through genes
- Includes physical attributes, individual’s social attitudes, personality, preferences and intellect
- Many mental health issues such as depression are genetic to some degree
- This means individuals with a specific gene variant are more likely to develop MDD than those without this gene (genetic predisposition)
- The 5HTT gene, or serotonin transporter gene regulates serotonin by removing it from the synaptic cleft and is said to significantly contribute to MDD
- 5HTT has 2 versions, long and short, and the length of the gene impacts MDD. Those with the shorter version have higher chance of MDD diagnosis and vice versa.
- Genetics cannot be a sole cause of MDD, it must interact with other factors such as environmental stress.
High stress=greater risk
Low stress=lower risk

Question 3

Explain one treatment of MDD.

Answer 3

ECT:

• Electroconvulsive therapy
• Used to quickly treat severe depressive, manic or psychotic symptoms
• Used as a last resort when the situation is life threatening and all other treatments have failed and relieves symptoms more effectively than any other treatments like therapy or antidepressants

Question 4

Explain ECT procedure.

Answer 4

• Patient is given general anesthesia and a muscle relaxant
• Electrodes are placed on one or both sides of the scalp
• Electric currents pass between the electrodes until a brief generalised seizure occurs
• The person does does feel anything or convulse due to anesthetic and muscle relaxant
• Mouth guard used to keep the airway open
• Patient wakes up 5-10 minutes after the procedure, and does not remember the time around treatment. Treatment given 2-3 times a week for 3-6 weeks, lasting an hour a session depending on illness severity

Question 5

What does ECT do?

Answer 5

• Stimulates neurons and prefrontal cortex, stopping misfiring neurons
• Changes how brain cells communicate with one another at synapses
• Stimulates development of new brain cells and floods the brain with neurotransmitters (e.g. serotonin, dopamine)
• There are many consultations between mental health specialists and patients prior to the decision to use ECT being made

Question 6

Explain one case study related to ECT.

Answer 6

Aim- to investigate whether ECT should be considered for a “treatment-resistant” MDD patient​

Participant: 72-year-old Ms A​

Background information: She reports a history of mild postpartum depression 40 years previously; her mother had committed suicide in her thirties after a “nervous breakdown.” Ms. A’s current episode started 2 years ago, with onset of sad mood, loss of interest in her usual activities, and suspiciousness that soon progressed to frank paranoia. A suicide attempt resulted in 5-week hospitalisation. It should be noticed that any previous medication did not work prior to the ECT.

Method: An ECT consultation results in the recommendation of a trial of outpatient ECT. A course of eight right unilateral ultrabrief pulse treatments results in nearly complete symptom resolution (the patient’s score on the 24-item Hamilton Depression Rating Scale went from 38 to 6) and very modest recent memory impairment

Results: Ms A was able to continue everyday activities (along with taking venlafaxine and psychotherapy) with interest and became well 1 year later