Mood Disorders Flashcards
Treatments for depression that aren’t psychotherapy or medications?
Aerobic exercise, mediation/mindfulness, brain stimulation, ECT, TMS, DBS. Good for body = good for mind
Bridge between the psychotic disorders and depressive disorders
Bipolar disorder
Reduced gray matter density and cortical thickness, smaller white matter volume, thinner parahippocampus, thinner right orbitofrontal cortex, thicker temporoparietal and left superior motor cortices
Bipolar disorder
What is important about the depression risk without any stressful life events?
It is greater than 0 for all people
Concordance rate among identical twins in bipolar disorder
70-80%
How is the HPA axis involved in MDD?
Can create increased levels of cort leading to sustained stress and depression
What meds are used to treat depression?
MAOI, SSRI, SNRI
What do effective antidepressant drugs do?
Increase monoamine activity
Play an essential role in regulation of sleep and wake cycles
Monoamines (5HT, SAD, NE are wake NTs)
Symptoms of bipolar disorder
Mania and depression
How does inflammation relate to depression?
Inflammation leads to dec NT metabolism, dec neurogenesis, inc glutamate excitotoxicity which leads to altered neurocircuitry which leads to depression
What does oxidative stress cause in bipolar disorder?
More apoptosis, higher amounts of DNA damage, accelerated aging similar to dementia
Functions as a hard reset of the brain. Not plan A
ECT (electroconvulsive therapy)
Why do depression patients show more NE and 5HT receptors but have less of the NTs?
Their bodies are trying to increase the chances of binding
Reduced volumes in the hippocampus and amygdala, reduced left frontal lobe activity and right parietal lobe activity, abnormal anterior cingulate cortex activity during decision making
Depression structural abnormalities
What stages of sleep are seen in depression patients?
No stage 3 and 4 and too much REM sleep and wakeful episodes
The Dutch Hunger Winter of 44-45 and depression
Stressful environment lead to more depression cases
What does the monoamine theory state?
Increasing monoamine activity effectively helps treat depression
What NTs do depression meds target?
5HT and NE (wakeful NTs)
Block 5HT reuptake
SSRIs
Block NE reuptake
SNRIs
What psychotherapy is used to treat depression?
CBT
What is oxidative stress (more free radicals) related to?
Bipolar disorder
Block reuptake of NE only, but have many side effects
Tricyclins
Better at not having sexual side effects compared to SSRIs
SNRIs
What often serves as a trigger for depressive episodes and why?
Stress bc of prolonged cortisol release
What do drugs that block neurogenesis also prevent? IMPORTANT
Therapeutic effects of antidepressants
What must accompany the short 5HT transporter gene for depression to come about?
Stressful life events
Block enzyme that degrades 5HT and NE in the terminals
MAOI (monoamine oxidase inhibitors)
What happens in accelerated aging caused by oxidative stress in bipolar disorder?
Inflammation, more amyloid and less neurotrophic activity, earlier onset and higher rates of cardiovascular disease, cancer, and autoimmune disease
Increased levels of what have been found in depression patients and patients who died by suicide?
Increased ACTH and glucocorticoids (cortisol)
These meds have a high risk for high blood pressure and cardiovascular side effects
MAOIs
Why do many BD patients stop using lithium?
Toxicity and side effects
Depression patients circadian rhythms
Irregular or missing circadian rhythms rather than orderly phase advance or delay
How can mani be linked to creativity?
It can be focuses on a specific task
What is found in the brain and CSF of patients who die by suicide?
Lower concentrations of 5HT
Characterized by at least 1 lifetime episode of mania, usually followed by depression period but not required for diagnosis
Bipolar disorder
What can antidepressants and ECT stimulate in the hippocampus? IMPORTANT
Neurogenesis in the hippocampus
What are some examples of monoamines?
5HT, NE, epinephrine, dopamine
How does the short version of the 5HT transporter gene account for an inc risk of depression?
Less transcription of the transporter gene accounts for depression and anxiety traits and changes in brain structure
What medication is used to treat bipolar disorder (especially manic phase)?
Lithium salts
HPA axis pathway and how it contributes to MDD
- sensory info about perceived threat to amygdala
- hypothalamus released CRH
- anterior pituitary releases ACTM
- adrenal glands release cort
- body prepares for fight or flight
- hippocampus receptors for cort act to inhibit CRH release
- feedback loop doesn’t function properly in depression patients
What is dexamethasone and how does it impact depression patients?
Potent synthetic glucocorticoid that normally results in the suppression of cortisol release. In depression patients, about 75% don’t show the expected suppression of cort. The HPA axis isn’t shut off
Block ACh (blurred vision, dry mouth, urinary retention), block histamine (sedation), and have sympathetic effects (postural hypotension, dizziness, irregular heartbeat
Tricyclins
Bipolar disorder heritability
More than 80%. Highest out fo all psych disorders
What is neurogenesis correlated with in MDD? IMPORTANT
MDD remission (recovery)
Prenatal events may contribute to a vulnerability for this
Depression
What correlation do omega 3 fatty acids have with BD?
More omega 3s (seafood) leads to less risk for BD
Biochemistry of manic and depressive episodes
Mania = enhanced NE Depression = decreased 5HT
How can sleep deprivation reduce depression?
It takes away the excess REM sleep experienced in depression patients
Side effects include weight gain, dizziness, loss of labido (sexual desire)
SSRIs
Levels out mood fluctuations, promotes neurogenesis in the hippocampus, produces antioxidant effects (prevents free radical damage)
Lithium salts
Bipolar brain abnormalities are similar to what other disorder?
Schizophrenia
What must patients using MAOIs avoid?
Alcohol, foods containing tyramine (hard lifestyle to maintain)
Linked to enhanced creativity
Bipolar disorder
Treatments for bipolar disorder
CBT, lithium, lifestyle changes
When is bipolar disorder normally diagnosed? How much of pop? Women to men?
25, 0.8, 3:2
Effective used of SSRIs and SNRIs?
Use them together
