Topic 6: Depression Flashcards
The symptoms of MDD span 5 areas of functioning:
- emotional symptoms
- motivational symptoms
- behavioral symptoms
- cognitive symptoms
- physical symptoms
Subtypes of MDD
- melancholic features
- psychotic features
- catatonic features
- seasonal features
- postpartum onset
Etiology of MDD
- genetics: serotonin transporter gene
- brain structures
- neurotransmitters: serotonin, norepinephrine and dopamine
- endocrine system: HPA-axis, high cortisol
Treatment of MDD
- pharmacotherapy
- ECT
- DBS
- psychotherapy
Neuropsychological impairments in MDD mostly in the areas of:
- attention
- executive functions
- memory
Function of hippocampus
Amongst others relevant for memory
How is the hippocampus compromised in MDD
- atrophy (decreased volume)
- decreased neurogenesis
How can abnormalities in the HPA axis affect the hippocampus
Abnormalities of the HPA axis will lead to increased levels of cortisol during depressive episodes, have an toxic effect on the hippocampus
Where is the reduction of the hippocampal volume related to?
To the number of depressive episodes
What is the function of the basal ganglia and how is this structure impaired in MDD?
The basal ganglia are among others relevant for executive functions. In MDD it’s volume is reduced
What is the function of the medial / orbifrontal PFC and how is this structure impaired in MDD?
Amongst others relevant for executive functions. Is over-activated in MDD
What is the effect from TCA on cognition?
TCA inhibit the neurotransmitter acetylcholine and thereby may induce severe cognitive side effects
What is the effect from ECT on cognition?
ECT has significant neuropsychological side-effects (memory), presumably no great impact for the long term. Despite any possible memory impairment, most patients report an overall improvement in their quality of life following ECT
Late-onset depression shows more severe cognitive impairments. What explanations are there for that finding?
1: distinct type, because risk factors were found to be less relevant in late onset depression AND patients with late onset depression show more MRI abnormalities & cerebrovascular pathology
2: dementia, elderly patients with depression may suffer from more prominent cognitive deficits as a part of a masked, undetected, early stage of dementia
What is a pseudodementia?
A depression with severe cognitive impairments in the elderly
