Mood Disorders: Depression

Question 1

How does having a mood disorder contrast with variations in temperament?

Answer 1

A mood disorder is a significant negative change from the patient’s baseline behavior, as opposed to an inborn pattern of experience and behavior.

Question 2

Do other animals get depression?

Answer 2

No. They can get some similar signs/symptoms when exposed chronically to noxious stimuli, but it’s not really depression (says he).

Question 3

What is mood? How does it relate to affect?

Answer 3

Mood is the underlying state of mind. It can bias the way stimuli are interpreted. Affect is the external expression of mood (facial expression, posture, speech quality, etc.).

Question 4

5 features of “sadness” as opposed to “depression”?

Answer 4

• transient or shorter-lived
• has definite, understandable cause
• does not cause significant impairment
• not associated with a syndrome
• should be relieved by activities / distraction from thoughts

Question 5

6 steps on the spectrum of sadness -> depression?

Answer 5

Normal sadness
Adjustment disorder with depressed mood
Grief
Major Depressive Episode (mild-moderate)
Major Depressive Episode with melancholic symptoms
Major Depressive Episode with Psychotic symptoms

Question 6

What are the diagnostic criteria for a “major depressive episode”?

Answer 6

• sad, low mood most days for at least 2 wks
  OR
• anhedonia (loss of interest / pleasure in activities)
  PLUS at least 4 additional signs and symptoms.

Question 7

What are the additional signs and symptoms of which you must have 4 in order to be diagnosed with a major depressive episode? (7 were listed)

Answer 7

Fatigue or low energy
Insomnia or hypersomnia
Loss or increase of appetite -> weight loss/gain
Psychomotor retardation/agitation
Poor concentration
Suicidal ideation
Pathological guilt

Question 8

What are 7 clinically important subforms of Major Depressive Disorder (MDD)?

Answer 8

Neurotic (discredited?)
Melancholic
Atypical
Seasonal
Psychotic
Chronic
Post-Partum

Question 9

What’s neurotic MDD?

Answer 9

“Anger turned inward” - in Freudian days, this was thought to be the main depression caused by trauma / stressful life events. (not a term really used now. Why is it here?)

Question 10

What’s melancholia?

Answer 10

Classical “endogenous depression.” People without hard lives have major depression out of the blue in mid to late life.

Question 11

What’s atypical depression?

Answer 11

(a stupid term) Overeating, oversleeping, with mild depression. More often seen in young women. Often chronic. Now considered to be more associated with bipolar disorder.

Question 12

What’s seasonal depression?

Answer 12

Intermittent depression with regular fall-winter onset. Responds to treatment with bright light. (also more linked to bipolar disorder)

Question 13

What’s psychotic depression?

Answer 13

Most severe form of MDD, characterized by delusions and hallucinations.

Question 14

What’s chronic depression?

Answer 14

Depression lasts for at least 2 consecutive years OR

MDE on top of dysthymia.

Question 15

Time frame to be considered “Post-Partum” depression?

Answer 15

“within weeks”

Question 16

What’s a common thought for why women have higher rates of depression than men?

Answer 16

Women have more internalizing disorders in response to stressors.
Men have more externalizing disorders (e.g. alcoholism) in response to stressors.

Question 17

What’s the “kindling” concept for depression?

Answer 17

Stressful life events initiate depression, but then the depression becomes self-sustaining independent of life events.

Question 18

What’s one well-defined genetic risk factor for depression? What is required to reveal this effect?

Answer 18

5-HTT (serotonin transporter) short allele polymorphism is associated with increased risk of depression for people with at least one stressful life event.

Question 19

What has the nucleus accumbens and anterior cingulate cortex have to do with MDD?

Answer 19

Less active, less reward generated from performing activities.

Question 20

How do the amygdala and prefrontal cortex relate to MDD?

Answer 20

Overactive amygdala in MDD can produce aberrant arousal / fear.
Prefrontal cortex (esp ventrolateral) not functioning normally may impair ability to interpret info from amygdala, plan, make decisions.

Question 21

How might the insular cortex relate to MDD?

Answer 21

Affective component of sensory info might be altered.

Question 22

Might chronic stress activate many changes seen in the imaging studies of brains of patients with MDD?

Answer 22

Yup, it might. Cortisol, CRF, all that.

Question 23

How does the hippocampus tend to change in MDD?

Answer 23

Reduced volume without cell death. (loss of white matter)

Question 24

Other than neurotransmitters, what molecules are newly beginning to be thought to play a role in depression?

Answer 24

Neurotrophic factors, especially BDNF. Antidepressants such as SSRIs may actually work partly by increasing neurotrophic factors (still a hypothesis).