Depression

Question 1

How do we classify depression?

Answer 1

• Has to have impact on life
• low mood
• loss of interest and enjoyment you would usually find enjoyable (anhedonia)
• reduced energy

Question 2

Name 5 biological symptoms of depression

Answer 2

• early morning waking
• Loss of appetite
• reduced concentration and attention
• loss of libido
• diurnal variation in mood

Question 3

Give 5 cognitive symptoms of depression

Answer 3

• reduced confidence/low self-esteem
• worthlessness and guilt
• helplessness
• pessimistic views of the future
• ideas of self-harm/suicide

Question 4

How do we define the severity of depression?

Answer 4

• mild = 2 core symptoms and 2 others - none to an intense degree, some difficulty in continuing normal activities
• moderate = 2 core symptoms and 3/4 others - considerable difficulty in continuing normal activities
• severe = core and 4 others with some of severe intensity - unlikely to be able to continue to do normal activities

Question 5

What other less obvious symptoms can depression present as?

Answer 5

• headache
• other pain disorders (chest,lower back, facial)
• fatigue
• weight loss
• poor memory

Question 6

Bipolar vs Unipolar depression

Answer 6

• Lifetime Prevalence: Much higher for Uni vs bi
• 6-12 month prevalence: bi is more likely to stay forever, uni can come and go
• onset age: bi (17-21), uni (27)
• Gender: bi (equal), uni (female 2x more)
• Comorbidity: both substance misuse and anxiety disorder

Question 7

What are some risk factors for depression?

Answer 7

• internalising (things that happen that affect what you do) such as genetics, low self-esteem, early-onset anxiety disorder, neuroticism
• Externalising factors (things that you do that affects other things) such as genetics, substance misuse, conduct disorder
• adversity - trauma, stressful life events, bereavement, low social support/education

Question 8

What is the monoamine hypothesis of depression?

Answer 8

• MAOIs and TCAs treat depression
• reduced concs of serotonin precursors in depressed patients/post-mortem
• drugs that deplete NA induce depressive symptoms
• decreased dopamine metabolites in CSF

Question 9

What NTs are linked with depression?

Answer 9

• Serotonin
• NA
• DA
• GABA/glutamate
• BDNF - antidepressants/ECT increase this

Question 10

What neuroendocrine factors are there?

Answer 10

• 50% Cushing’s sufferers have depression - cortisol hypersecretion
• BDNF decreased by cortisol
• CRH may act as NT in limbic system (increased in CSF)
• Free T3 decreased - 25% depressed patients have reduced TSH response to TRH
• Thyroxine treatment works for resistant depression

Question 11

What Psychological factors are there?

Answer 11

• negative thoughts about the self, the world and the future (Beck’s cognitive triad)
• Ignore successes, think everything is all or nothing, overgeneralise from the bad things that happen

Question 12

What social factors are there?

Answer 12

• personality - perfectionism, controlling, self-blame

- early environment - parental separation, parental style, recalled childhood abuse