Week 6: Depression Flashcards
Prevalence of Depression
- 20% of Australians over 16 will experience a mental illness in any year
Common illnesses are:
- Depression, anxiety or substance abuse
- 45% will experience a mental illness in their lifetime
Depression is the 4th most common problem managedby GPs
- Diabetes is 2x more prevalent and smoking rates are 3x greater in people with depression
- Number 1 cause of non fatal disability
Define Major vs Minor Depressive Disorder
Major Depressive Disorder
- 5 or more symptoms have been present for most of the day during the same two week period and cause a change in functioning
Minor Depressive Disorder
2 to 4 symptoms have been present for most of the day during the same two week period and cause a change in functioning
Symptoms for Diagnosis of Major Depression
Must have atleast one of:
- Depressed mood most of the day
- Loss of interest/pleasure in all or most activities
Other symptoms:
- Increase/Decrease in appetite
- Insomnia/excessive sleeping
- Restlessness/agitation or slowness in movement
- Fatigue (often a common symptom)
- Feelings of worthlessness or excessive/inappropriate guilt
- Reduced concentration or indecisiveness
- Recurrent thoughts of death or suicide
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Number of symptoms can increase overtime
What are the common types of depressive disorders?
Dysthymia: Mild but long term. Lasts for atleast 2 years
Atypical: Involves some symptoms of major depression (increased appetite, weight gain, sleepiness, extremely sensitive to rejection)
Seasonal: Normal mental health throughout most of year, but experience symptoms in summer or winter
Bipolar: Maniac-depressive disorder, alternating episodes of depression
Postnatal: affects mostly women but can affect men. Usually developed 4-6 weeks after childbirth
Premenstrual: Collection of emotional symptoms with or without physical symptoms related to womens menstrual cycle
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What is the significance of cognitive impairments on late life depression?
Lack of cognitive improvement is associated with increased risk of dementia
Depression with mild cognitive impairment is associated with a twofold risk of developing Alzheimers
Slide 135 in Week 6
What causes Depression?
External Factors
- Family conflict
- Interpersonal Conflict
- Recent loss/dissapointment
Internal
- Past bad Experiences
- Personality
- Patterns of thinking
- Family inherited dispositing –> chemical changes and thus high anxiety
- Medical illness or current treatments
Slide 137 in Week 6
Proposed mechanisms behind improvement in depressive symptoms
Neurotrophic Factors
BDNF is lower in adults with major depression
IGF-1
is a growth factor that has been shown to increase with antidepressant treatment
Inflammation / Catabolic Factors
- C-reactive protein & Interleukin 6 are associated with development of depression later in life
- HPA axis dysregulation: waking, afternoon and night time cortisol levels are higher in adults with depression
- Cortisol is known to be neurotoxic and has catabolic effects systemicaly
HIGH STRESS LEVELS ARE GOING TO BE INCREASING CORTISOL LEVELS
= BAD
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What are the common medications used for Depression?
Selective Serotonin Reuptake inhibitors (SSRI)
- Blocks the reuptake of serotonin and incrases amount present in the synapse this making, flooding the brain with more serotonin
- Functions to improv mood, memory, sleep and cognition
Tricyclic Antidepressents (TCA)
- Increasing levels of neurotransmitters such as serotonin in the brain
- not as commonly prescribed as SSRI
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What medication for Depression is found to be not useful?
Benzodiazepines
They increase the risk of falls, hip fractures and confusion
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What is the first step in RANZCP for management of major depressive disorders?
First step in the guideline is to counsel on lifestyle factors
e.g. smoking cessation, EXERCISE and healthy diet
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Non-Pharmacological treatments for Depression
- Cognitive Behavioural Therapy
- Stress management & Relaxation
- EXERCISEE!!!
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Exercise Recommendations to manage depression
- Ex shown to be equally as effective as antidepressent therapy
- PRT and Aerobic both show dose response, favouring high intensity program
- PRT may outperform aerobic training in reductions in symptoms
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What is the goal of exercise for mental health outcomes?
- Decrease symptoms
- Decrease social isolation
- Improve sleep quality
- Reduce cravings and withdrawal in substance use disorders
- Increasing self esteem
- Improve quality of life
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What is the mechanism behind the improvements in depressive symptoms with exercise?
Still unclear, However it may be due to:
- BDNF / IGF-1
- Chronic inflammation
- HPA axis (cortisol levels)
167 in week 6
Tools to assess depression in clinical practice
- Beck Depression Inventory (BDI)
- Depression Anxiety & Stress Scales (DASS)
- Hamilton Depression Scale (HAM-D)
- Pittsburg Sleep Quality Index (PSQI)
Due to sleep being a common complaint in depression
