depression

Question 1

2 ways of treating depression?

Answer 1

CBT or pharmacotherapy

-side effects to drugs

Question 2

what can cause depression?

Answer 2

• premature death

- disability

Question 3

2 types of depression?

Answer 3

unipolar or bipolar

Question 4

explain unipolar depression

Answer 4

most common type, mood swings in 1 direction
75% of cases are reactive/environmental
25% of cases are genetic

Question 5

explain bipolar depression

Answer 5

less common, oscillation between depression and mania, mood swings in 2 directions

• mania is excessive exuberance, self confidence, aggression, irritability
• more based on genetics

Question 6

depressive disorder

Answer 6

low state, feelings of guilt, sadness, low self worth

Question 7

major depressive disorder

Answer 7

severe pattern of depression that is disabling, not caused by factors like drugs/general medical condition

Question 8

what is the name of major depressive disorder that is chronic?

Answer 8

dysthymic disorder

Question 9

is diagnosing depression easy?

Answer 9

no

you can do a clinical interview and ask questions, and use the book

Question 10

what is DSM IV?

Answer 10

what psychiatrists use to diagnose a person with any mental illness

• need 5 or more of the symptoms present in the same 2 week period
  eg. significant weight loss, insomnia, feeling of low self worth, recurrent thoughts of death, low energy, not able to concentrate

Question 11

how can the symptoms of depression be categorised?

Answer 11

emotional symptoms
-pessimism, loss of motivation, low self esteem, indecisiveness

biological symptoms
-decreased appetite, sleep disturbance, loss of libido

Question 12

how does depression differ between males and females?

Answer 12

affects twice as many females

Question 13

how does depression differ between age groups?

Answer 13

1st episode of depression usually late adolescence/early adulthood

Question 14

suicide

Answer 14

20% of depressed patients attempt suicide

Question 15

depression and comorbidity

Answer 15

depression is often comorbid with other psychiatric conditions
-eg. cancer, pain

Question 16

name some medical conditions where you would find depression:

Answer 16

• terminal illness
• chronic illness
• neurological disease
• stroke
• drug abuse
• parkinsons disease
• anxiety

Question 17

what are comorbid?

Answer 17

depression and anxiety

Question 18

is there a genetic predisposition to depression, and how do we know this?

Answer 18

yes there is, we know this because of twin studies

-the environment also plays a role

Question 19

explain the monoamine theory of depression

Answer 19

depression is caused by monoamine deficiencies

• reduced activity of noradrenergic/serotonergic systems
• antidepressant drugs increase amine concentration in the brain

Question 20

explain the neuroendocrine theory of depression

Answer 20

depression is caused by hypersensitivity of the HPA axis

• stress activates the hypothalamus to release CRH, ant pit releases ACTH, adrenal cortex (zona fasiculata) releases cortisol
• HPA activated in situations which normally wouldn’t even be considered stressful
• results in increased basal cortisol levels
• increased CRH levels have been found in cerebrospinal fluid, and increased plasma cortisol levels in depressed patients
• decreased hippocampal glucocorticoid receptors

Question 21

what controls the HPA?

Answer 21

HPA releases cortisol, which acts positively on the hippocampus
-hippocampus inhibits the HPA
-amygdala stimulates the HP
so, hyperactive amygdala or hypoactive hippocampus can cause depression

Question 22

role of tactile stimulation?

Answer 22

tactile stimulation after birth activates 5-HT pathways to the hippocampus
-5-HT triggers long lasting increase in the expression of glucocorticoid receptor gene
-therefore, increase in glucocorticoid receptors in hippocampus
this is why abused/neglected babies can end up with mental illnesses

Question 23

how do SSRIs affect glucocorticoid receptors?

Answer 23

they increase glucocorticoid receptors in hippocampus

Question 24

hippocampus and pre frontal cortex

Answer 24

neuronal loss and decreased neuronal activity in depression

Question 25

what does 5-HT promote?

Answer 25

neurogenesis during development (BDNF) | BDNF promotes survival of cells in the brain

Question 26

how does exercise have an anti-depressant effect?

Answer 26

increased BDNF levels, therefore increased neurogenesis

Question 27

chronic stress consequences

Answer 27

1. increased cortisol levels will stimulate the detrimental gene transcription response 2. increase glutamate release, hyper activation of NMDA receptors, causing excitotoxicity neuronal death and depression

Question 28

what inhibits the detrimental gene transcription response?

Answer 28

activation of alpha 2 or 5HT-1A | -ie high levels of NA or serotonin

Question 29

treatments for affective disorders?

Answer 29

- ECT | - Psychotherapy (CBT)

Question 30

ECT

Answer 30

electroconvulsive therapy, - localised electrical stimulation - evidence of neurogenesis but side effect of MEMORY LOSS

Question 31

psychotherapy

Answer 31

treats mild-moderate depression - overcome negative views - based on the idea that social interaction has a big anti-depressant effect

Question 32

all drugs that treat depression work by....

Answer 32

increasing NA or serotonin levels -neurons get activated, NA released and binds to post-synaptic receptors, gets back inside the neurones via NA transporter

Question 33

drugs treatments

Answer 33

``` Monoamine Oxidase Inhibitors (MAOIs) Tricyclic Antidepressant Drugs (TCAs) Selective Serotonin Re-uptake Inhibitors (SSRIs) mixed 5HT/NA reuptake inhibitors (SNRIs) NA reuptake inhibitors ```

Question 34

Tricyclic antidepressants (TCAs)

Answer 34

- block reuptake of 5HT and NA, increase levels of these 2 in the synaptic cleft - down regulation of presynaptic receptors and therefore increase in transmitter release - long time to produce effects - good but not ideal - cardiovascular effects - also affects other receptors eg. muscarinic

Question 35

Monoamine Oxidase Inhibitors (MAOIs)

Answer 35

- increased cytoplasm levels of 5HT/NA, increased leakage of these 2 monoamines - increased levels in the synaptic cleft

Question 36

Selective Serotonin Re-uptake Inhibitors (SSRIs)

Answer 36

5-HT reuptake inhibitor - Increase in 5HT in synaptic cleft - autoreceptors down regulated

Question 37

benefits and consequences of Selective Serotonin Re-uptake Inhibitors (SSRIs):

Answer 37

no cardiovascular problems because they don't affect NA, but side effects include: - insomnia and sexual dysfunction due to activation of 5-HT2A receptor - nausea, diarrhoea and headache due to 5-HT3 receptor activation

Question 38

how long does the anti-depressant effect take?

Answer 38

antidepressant effect takes several weeks

Question 39

how do anti-depressants dampen down the HPA hyperactivity?

Answer 39

Increased hippocampal glucocorticoid receptor expression