Depression

Question 1

What is Depression?

Question 2

Features of depressive disorders

Answer 2

Patient usually have the symptoms continually for 2 weeks and consist of

• CORE SYMPTOMS

– Low mood

– Lack of energy
– Lack of enjoyment & interest

• Depressive thoughts
• Somatic symptoms/Biological symptoms

Question 3

Difference between a ‘normal’ adjustment reaction and clinical depression

Question 4

Examples of illnesses that can cause depressive symptoms

Answer 4

There are many illnesses that can cause depressive symptoms including:

• Hormone disturbance such thyroid dysfunction

• Vitamin deficiencies such as vitamin B12
• Heart and lung diseases
• Blood vessels not functioning well
• Kidney disease
• Liver disease

Question 5

2 things if misused can cause depressive symptoms?

Answer 5

• People drinking too much over a period is a well known cause of developing depressive symptoms
• A number of recreational drugs cause depressive symptoms, especially drugs that initially induce a feeling of happiness and wellbeing such as XTC or amphetamines.

Question 6

Brain structures involved in depressive symptoms

Answer 6

• Limbic system

• Frontal lobe
• Basal ganglia

Question 7

What causes people to become clinically depressed?

Answer 7

There are many different causes that can be categorised as follows:

1. Predisposing: Genetics, childhood experiences, female gender
2. Perpetuating (maintaining factors): A stressful job, studies, relationship difficulties, substance misuse, financial strain, housing, unemployment
3. Precipitating factors: Life events often related to losses such as loss of someone you love, loss of health and break up of relationships.

Question 8

3 Predisposing factors of depression

Answer 8

• Genetic
• Childhood experiences

• Female gender

Question 9

Childhood experiences causing depression

Answer 9

• Quality of attachment
• Quality of parental relationships
• Loss of a parent
• Bullying

Question 10

Limbic System laebl

Answer 10

• Cingulate gyrus

• Hippocampus
• Amygdala
• Hypothalamus

• Septum

• Olfactory Bundle
• Dentate gyrus
• Anterior nucleus of the thalamus

• Mammillary bodies

Question 11

Main 3 functions of the limbic system

Answer 11

• Emotion
• Motivation

• Memory

Question 12

Frontal lobe functions (what fraction of the whole cortex does it form?)

Answer 12

The frontal lobe form 2/3 of the total cortex

• Motor function
• Language (Broca’s area)
• Executive functions (purposeful goal directed behaviours)
• Attention
• Memory
• Mood
• Social and moral reasoning

Question 13

how is mood is determined in the brain?

Answer 13

The main hypothesis is that mood is determent by functional circuits between these brain areas. E.g. the frontal lobe projects to parts of the limbic system which in turn connects to the basal ganglia and the brainstem. This affects:

• Cognitive processed (thoughts)

• Sympathetic output
• Parasympathetic output
• Motor systems

Question 14

The 2 main neurotransmitters for depressive disorders?

Answer 14

• NE
• Serotonin

Question 15

Other neurotransmitters important in psychiatric conditions include:

Answer 15

• Dopamine
• Acetylcholine
• GABA

• Glutamate

Question 16

NE functions in brain?

Answer 16

Functions in the brain:
• Mood
• Suggests a role in behaviour (arousal and attention)

• Implicated in memory functions

Made in the locus coeruleus in the brainstem and transported to several areas of the cortex

Question 17

recepters of the NE system!

Answer 17

• 4 types of receptors: α1 and 2 and β1 and 2
• The function of the β receptors in the brain is not very clear as yet
• It is likely that α receptors play a role in arousal and mood
• See for a schematic picture of receptors next slide

Question 18

evidence that NE beingimplicate din causation of depression in the brain?

Question 19

serotonin function in the brain

where is it made?

Answer 19

• Sleep
• Impulse control
• Appetite
• Mood

Produced in the brain stem (Raphe nuclei) and transported to cortical areas and limbic system

Question 20

recepters of the seretonin

Answer 20

Complex, there are many different pre and post serotonergic receptors.

Question 21

reasons for implicating 5HT in depression?

Answer 21

5HIAA depletion in CSF (a metabolite of serotonin) in patients with depression

Tryptophan depletion (precursor for serotonin) causes depression

PET studies

SPET studies

Reserpine (depletes nerve endings from mono amines)

Anti-depressant: SSRI, TCA, SNRI’s, MAOI

Question 22

2 ‘CORE’ SYMPTOMS OF DEPRESSION

Answer 22

1. During the last month have you often been bothered by feeling down, depressed, or hopeless?
2. Do you have little interest or pleasure in doing things?

Question 23

for how long should the 2 core symptoms be present? if so? what else to ask?

Answer 23

• Fatigue/loss of energy.
• Worthlessness/excessive or inappropriate guilt.
• Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts.
• Diminished ability to think/concentrate or indecisiveness.
• Psychomotor agitation or retardation.
• Insomnia/hypersomnia.
• Significant appetite and/or weight loss.

Question 24

Differential diagnosis:

Answer 24

1. Hypothyroidism
2. Menopause
3. Chronic disease

Question 25

what is Atypical depression?

Answer 25

is a **subtype** of major depression or could be dysthymic disorder _These include:_ * *reactive mood* * *increased appetite* * *weight gain* * *excessive sleepiness* * *sensitivity to rejection.*

Question 26

*Depression is diagnosed if the person has at least **5** out of the 9 symptoms listed above, with at least **one** of these a 'core' symptom.*

Answer 26

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