What are some risk factors for depression?
- Traumatic experiences e.g. bereavement, losing your job, bullying
- Genetic susceptibility i.e. family history
- Having a physical/ chronic disorder
- Having characteristic negative patterns of thinking, deficits in coping skills, impaired emotional intelligence
- Upbringing
- Lack of social support
What guidelines are used in the UK, to diagnose depression?
DSM-V (Diagnostic and Statistical manual of mental disorders)
What is the criteria to diagnose someone with Major Depressive Disorder?
≥ 1 key symptom AND ≥ 5 total symptoms
What are the key symptoms?
- persistent sadness/ low mood
- marked loss of interests or pleasure (anhedonia)
What are the associated symptoms?
- Tearfulness
- Feeling constantly tired
- disturbed sleep
- decreased/ increased appetite or weight
- anergia
- agitation or slowing down of movements + speech (psychomotor retardation)
- reduced libido
- poor concentration
- poor self-esteem
- Suicidal ideation
Which group has the highest incidence of self harm?
17-19 yr females
Which group has the highest incidence of suicide?
40-59 yr males
What is suicide?
A fatal act of self-harm initiated with the intention of ending one’s own life.
What model describes factors which contribute to depression?
Biopsychosocial model
What are some social factors which contribute to depression? (overlap)
- financial security
- family circumstances
- culture
- work/school
- social support
- traumatic life events
- interpersonal relationships
- diet/lifestyle
- drug effects
What are some psychological factors which contribute to depression? (overlap)
- attitudes and beliefs
- self-esteem
- personality
- coping skills
- traumatic life events
- interpersonal relationships
- emotions
- cognitive factors
- sleep
What are some biological factors which contribute to depression? (overlap)
- genetic vulnerability
- physical health
- neurochemistry
- immune/ stress response
- metabolic disorders
- diet/lifestyle
- drug effects
- emotions
- cognitive factors
- sleep
What are ACEs?
Adverse Childhood Events are potentially traumatic events experienced during childhood that can have negative, lasting effects on health and well-being.
Which behaviours/ morbidities have been shown to have a significant association with ACE scores (0- ≥4)?
- Binge drinking
- Heavy drinking
- Smoking
- High risk HIV behaviour
- Depression
- Disability caused by ill health
What is bias?
When systematic error is introduced into sampling or testing by selecting or encouraging 1 outcome or answer over others.
What is the monoamine hypothesis?
It suggests that a deficiency of monoamine neurotransmitters is the cause of depression.
Name some monoamine neurotransmitters.
- serotonin
- dopamine
- Noradrenaline
Name some groups of anti-depressants prescribed for those with moderate to severe depression.
- Monoamine oxidase inhibitors
- Tricyclics
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin- NA Reuptake Inhibitors (SNRIs)
- Post-synaptic serotonin receptor agonists
- Serotonin autoreceptor antagonist
How do MAOIs (first generation antidepressants) work?
They inhibit monoamine oxidase enzyme that break down monoamine neurotransmitters - this means that more neurotransmitter is available in the synapse.
Why do MAOIs have so many side effects?
They are not specific since they just target monoamine oxidase in presynaptic neurones. These are found all over the body and therefore interferes with liver metabolism and digestion.
How do tricyclics (TCAs -> first generation) work?
They block serotonin and NA reuptake channels which increases levels of the neurotransmitters in the synapse.
Why are TCAs rarely first line anti-depressants?
They are toxic if too much is taken
When are TCAs prescribed?
- bipolar disorder
- severe depression which hasn’t responded to other anti-depressants.
How do SSRIs work? (first line anti-depressants, 2nd generation anti-depressants)
They increase levels of serotonin in synapse by blocking specific serotonin reuptake channels.
