Lecture 4.2

Question 1

How does the DSM-5 define depression?

Answer 1

An ‘affective’ or ‘mood’ disorder.

Question 2

What is meant by ‘depressed mood’?

Answer 2

Pervasive negative affective state present for the majority of the day, nearly every day, for at least 2 weeks.

Question 3

What is anhedonia?

Answer 3

Loss of interest or pleasure in previously enjoyable activities.

Question 4

What are examples of appetite/weight disturbances?

Answer 4

Increased appetite and weight gain, or decreased appetite and weight loss.

Question 5

What are examples of psychomotor disturbances?

Answer 5

Restlessness or slowed movements. Slowing of thoughts and behaviours. Agitation.

Question 6

What is fatigue?

Answer 6

Persistent low energy and tiredness.

Question 7

What are examples of feelings of guilt and/or worthlessness?

Answer 7

Excessive self-blame or unrealistic negative evaluations of oneself.

Question 8

What does concentration and/or memory impairments refer to?

Answer 8

Difficulty focusing, remembering, or making decisions.

Question 9

How may suicidal ideation be defined?

Answer 9

Thoughts of death or suicide, with or without a specific plan.

Question 10

What is the Kindling Effect?

Answer 10

The phenomenon where future depressive episodes are more likely to occur after previous episodes.

Question 11

What are monoamines?

Answer 11

Neurotransmitters, including serotonin, dopamine, and norepinephrine.

Question 12

What is serotonin involved in?

Answer 12

Mood regulation, sleep, appetite, and pain.

Question 13

What is dopamine involved in?

Answer 13

Reward, motivation, and motor control.

Question 14

What is norepinephrine involved in?

Answer 14

The stress response, alertness, and concentration.

Question 15

What is the Monoamine Hypothesis?

Answer 15

The theory that depression is caused by a deficiency in monoamine neurotransmitters in the brain.

Question 16

What is reserpine?

Answer 16

A drug that depletes monoamines, historically used to treat high blood pressure.

Question 17

What is iproniazid?

Answer 17

The first monoamine oxidase inhibitor (MAOI) antidepressant.

Question 18

What are monoamine oxidase inhibitors (MAOIs)?

Answer 18

Drugs that inhibit the enzyme monoamine oxidase, thus increasing monoamine availability.

Question 19

What are depletion protocols?

Answer 19

Experimental procedures designed to temporarily reduce monoamine levels in the brain.

Question 20

What is therapeutic delay?

Answer 20

The lag time between the start of antidepressant treatment and the onset of therapeutic effects.

Question 21

What is mirtazapine?

Answer 21

An atypical antidepressant that enhances norepinephrine and serotonin neurotransmission.

Question 22

Clinically, how are classes of drugs classified?

Answer 22

By their primary mechanism of action.

Question 23

What are some examples of depressive disorders?

Answer 23

Major depressive disorder, persistent depressive disorder (dysthymia).

Question 24

What are some examples of affective-related disorders?

Answer 24

Bipolar disorder and cyclothymic disorder.

Question 25

What are the 9 symptoms of depression?

Answer 25

Depressed mood. Anhedonia. Appetite/weight disturbances. Psychomotor disturbances. Fatigue. Feelings of guilt/worthlessness. Concentration/memory impairments. Suicidal ideation. Sleep disturbances.

Question 26

How many symptoms of depression need to be present for a diagnosis?

Answer 26

Five or more symptoms.

Question 27

What 3 things can symptoms not be due to for a depression diagnosis?

Answer 27

Substance use, another medical condition, or bereavement.

Question 28

What does dichotomy mean in terms of certain depression symptoms?

Answer 28

Symptoms present as opposite extremes (e.g., increased or decreased appetite).

Question 29

The substantial heterogeneity in depression symptom profiles accounts for what?

Answer 29

The variability in clinical presentation and treatment response.

Question 30

What are the number of potential presentations that can qualify for a depression diagnosis? What is this caused by?

Answer 30

227, caused by interaction between aetiological factors and symptoms.

Question 31

What are the 2 depressogenic subtypes?

Answer 31

Melancholic and atypical.

Question 32

What is the prevalence of the melancholic subtype?

Answer 32

The most common subtype, affecting about 67% of depressed individuals.

Question 33

What is the melancholic subtype characterized by?

Answer 33

□ Non-reactive mood. □ Pervasive anhedonia. □ Blunted emotional responses. □ Appetite/weight loss. □ Insomnia. □ Loss of libido.

Question 34

What is the atypical subtype characterized by?

Answer 34

□ Low mood reactivity. □ Appetite/weight gain. □ Hypersomnia. □ Leaden paralysis. □ Sensitivity to interpersonal rejection.

Question 35

What are the unique features of the melancholic subtype?

Answer 35

□ Diurnal variations in mood. □ Higher completion rates of suicide. □ Higher comorbidity with psychosis. □ Overactive HPA axis.

Question 36

What are the unique features of the atypical subtype?

Answer 36

□ Underactive HPA axis. □ Prevalence increasing – obesogenic environments. □ Increased risk of chronic health conditions.

Question 37

What is the prevalence of the atypical subtype?

Answer 37

About 15-50% of depressed individuals.

Question 38

Depression is __ and __? What are the significant predictors of this?

Answer 38

Recurrent and progressive; symptom severity/duration

Question 39

When should the Kindling Effect be considered?

Answer 39

When considering long-term management and prevention of recurrence.

Question 40

How prevalent are depressive episodes?

Answer 40

All of the above; median duration of depression in 24 weeks

Question 41

What are the 3 monoamines?

Answer 41

Serotonin, dopamine, and norepinephrine.

Question 42

What were the 3 lines of evidence that led to the Monoamine Hypothesis?

Answer 42

Reserpine's effects, iproniazid's effects, and post-mortem studies.

Question 43

What effect did reserpine have on monoamines?

Answer 43

Depleted monoamine levels.

Question 44

How was the mechanism of action for antidepressants founded?

Answer 44

Through observing the effects of drugs like iproniazid.

Question 45

What did post-mortem studies show about monoamines?

Answer 45

Decreased levels of monoamines or their metabolites in the brains of depressed individuals.

Question 46

What are the 5 contradictory evidence for the Monoamine Hypothesis?

Answer 46

Therapeutic delay. Depletion protocol findings. Drugs blocking serotonin reuptake not being effective. Antidepressant efficacy vs. placebo not explaining much. Drug responsivity being influenced by many factors.

Question 47

Why is measuring synaptic monoamine concentrations not really feasible?

Answer 47

Because lumbar punctures are too invasive and may not show the original levels in the brain.

Question 48

How do depletion protocols work?

Answer 48

By using the blood-brain barrier to cross/block monoamines precursors.

Question 49

What does the therapeutic delay account for?

Answer 49

The time lag between drug administration and clinical improvement, suggesting that changes beyond neurotransmitter levels are involved.

Question 50

What drugs that block serotonin reuptake but aren't effective in treating depression?

Answer 50

Mitrazapine. Cocaine. Amphetamines.

Question 51

Antidepressant efficacy, although better than placebos, doesn't explain what?

Answer 51

No responses/delay with antidepressants.