Mood Disorders Flashcards
What is the DSM criteria for Major Depressive Disorder (MDD)? (2)
At least 5 symptoms for at least 2 weeks
At least 1 symptom of the following has to be one of the 5:
- anhedonia
- sadness
What are the symptoms of MDD? (2-7)
- anhedonia
- sadness
disturbed sleep
guilt/worthlessness
fatigue
psychomotor retardation
recurrent thoughts of death
learned helplessness
diminished ability to concentrate
What must the symptoms of MDD cause to get diagnosed? (4)
significant impairment in daily functioning
not attributable to substances or medical condition
no manic/hypomanic episode
specific severity
What is Persistent depressive disorder (PDD)?
less severe, but more chronic form of depression
What is the criteria for pre-menstrual dysphoric disorder (PMDD)? (2)
At least 1 of the core symptoms:
- irritability/anger/increased conflict
- hopelessness/self-deprecating thoughts
Plus at least 4 other symptoms
What are the symptoms of PMDD? (2-6)
- irritability/anger/increased conflict
- hopelessness/self-deprecating thoughts
early awakening
fluctuating weight/appetite
excessive guilt
overwhelmed
lack of energy
hypersomnia/insomnia
What is Prolonged Grief Disorder (PGD)/complicated grief?
a condition where grief becomes so severe and persistent that it interferes with a person’s identity and ability to function in daily life
Give the epidemiology of MDD (3)
Occurs at any age but uncommon in children
Twice as common in women due to genetic predisposition and fluctuating hormones
Occurs in episodes
Which neurotransmitters act as antidepressants? (3)
serotonin
dopamine
norepinephrine
How does dopamine act as an antidepressant?
What are symptoms of dopamine deficiency? (3)
motivates us to seek pleasure and reinforcement
- anhedonia
- apathy
- difficulty concentrating
How does serotonin act as an antidepressant?
What are symptoms of serotonin deficiency? (4)
mood, sleep, appetite, and digestion regulation
- sadness
- anxiety
- irritability
- disturbed sleep
How does norepinephrine act as an antidepressant?
What are symptoms of norepinephrine deficiency? (3)
plays a role in alertness, focus, and energy levels
- fatigue/low energy
- difficulty concentrating
- problems with sleep and appetite
What is the role of the serotonin transporter protein (SERT)?
controls the ability of the axon to reabsorb serotonin after its release
How do stressful events affect people with the 2 short forms of the 5-HTT (serotonin) gene?
Explain why
increasing the number of stressful events led to an increase in the probability of depression
since the gene is shorter, it has a shorter DNA sequence, leading to less SERT production - hence reuptake of serotonin is less efficient
Name the 5 categories of antidepressant drugs (TSSMA)
- Tricyclics (dopamine, serotonin, and norepinephrine)
- Selective serotonin reuptake inhibitors (SSRI’s)
- Serotonin norepinephrine reuptake inhibitors (SNRI’s)
- Monoamine oxidase inhibitors (MAOI’s)
- Atypical antidepressants
Describe how tricyclics, SSRI’s and SNRI’s work (2)
- block transport proteins that reabsorb serotonin/dopamine/norepinephrine into the the presynaptic neuron
- therefore the neurotransmitters remain in the synaptic cleft, where they continue stimulating the postsynaptic neuron
Describe how MAOI’s work
Monoamine oxidase are enzymes that break down serotonin into inactive forms, hence MAOI’s block monoamine oxide
Give 2 examples of atypical antidepressants and how they work (2)
Bupropion - inhibits dopamine and norepinephrine reuptake
Agomelatine - works as an agonist (facilitator) at melatonin receptors
What herbal medication is used as an antidepressant, but is not regulated by the FDA?
St Johns Wort
In what cases are antidepressants ineffective?
What is the alternative treatment?
ineffective for people who suffered abuse, neglect, or trauma during early childhood
treatment: psychotherapy
What amino acid is required for an increase in serotonin levels?
Tryptophan - precursor to serotonin
What neurotrophin do people with depression have lower than average?
Brain derived neurotrophic factor (BDNF)
What are neurotrophins?
proteins released at the synapse which aid in the survival, growth, and connections of neurons
If depressed people do not lack neurotransmitters, why do they still need antidepressants?
prolonged use of antidepressants increase BDNF production - which is needed to facilitate new learning to build new synapses
What are the non-chemical treatments for severe depression? (2)
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
Explain how ECT works (3)
electrically induced seizure
applied everyday for 2 weeks
accompanied with drug treatment, psychotherapy, and periodic ECT after initial treatment
What are the benefits of ECT? (2)
increases proliferation of new neurons in hippocampus
alters gene expression in hippocampus and prefrontal cortex
How does transcranial magnetic stimulation work?
an intense magnetic field is applied to the scalp to stimulate neurons to fire action potentials
What is bipolar disorder?
Name the 3 types
alternating states of depression and mania
3 types:
- bipolar 1 disorder
- bipolar 2 disorder
- cyclothymia
Describe bipolar 1 disorder (3)
at least 1 manic or mixed episode
mixed episode = depression combined with agitation, anxiety, insomnia, and racing thoughts
combination of high energy and low mood = high risk of suicide
Describe bipolar 2 disorder (2)
episodes of hypomania and depression
NOT full blown manic episodes
Describe cyclothymia (2)
cyclical mood swings with less severe symptoms
hypomania and mild depression
Name the common symptoms of mania (7)
- unusually high or extremely irritable
- grandiose beliefs in one’s ability
- little sleep but high energy
- talking rapidly about racing thoughts - normal person can’t keep up
- high distractibility and inability to concentrate
- impulsive/reckless
- delusions and hallucinations (severe cases)
Describe depression in bipolar people (5)
- more likely to involve irritability, guilt, unpredictable mood swings, and restlessness
- move and speak slowly
- excessive sleep
- weight gain
- psychotic depression (lost contact with reality)
What brain differences appear in bipolar people? (3)
- imbalances in dopamine, norepinephrine, serotonin
- too much activity in limbic area
- too little activity in frontal lobes
What are the treatments for bipolar disorder? (2)
Lithium
Anticonvulsant drugs
How do lithium and anticonvulsant drugs work? (2)
- Decrease activity of dopamine (only lithium) and glutamate (both)
- Increase activity of GABA
What is the biology of seasonal affective disorder (SAD)? (2)
high levels of SERT –> low serotonin
overproduction of melatonin
Why does winter induce SAD? (2)
winter –> low sunlight –> high levels of SERT –> low serotonin –> SAD
winter –> darkness –> stimulates pineal gland to produce melatonin –> high levels of melatonin –> SAD
What is the treatment for SAD?
How does it work (2)
Light therapy (bright light)
- stimulates serotonin synapses
- regulates melatonin secretion
