Lecture 45: Depression and Medical Illness Flashcards
(46 cards)
What is the mortality of depression?
- Annual death rate from suicide > homicide
-30,000 per year - Death by suicide is the 2nd leading cause of death (COD) for college students
3rd leading COD for 15-25
-medical students are at risk - That’s why depression is associated with an increase in DEATH RATE at any age
What is the mortality of depression?
- Annual death rate from suicide > homicide
-30,000 per year - Death by suicide is the 2nd leading cause of death (COD) for college students
3rd leading COD for 15-25
-medical students are at risk - That’s why depression is associated with an increase in DEATH RATE at any age
How is depression a systemic disorder?
Decreases neurogenesis Decreased HR variability (that responds to demand) Increased platelet activation Increased sympathetic tone Increased CRF, HPA activity Increased insulin resistance Decreased cell-mediated immunity Increased cytokines Decreased formation, density of bone Increased resorption of bone
What is minor depression?
A statistical observation…not a diagnosis
What does depression do to life expectancy?
More depression = shorter longevity
How is depression associated with medical illness?
- depression is associated with development of medical illness
- Depression is also associated with worse outcomes in medical conditions
What poor outcomes is depression implicated in?
Implicated in worse outcomes/increased incidence in
- cardiac disease
- cerebrovascular disease
- diabetes
- obesity
- cancer
- HIV and AIDs
- AD and PD
- epilepsy
- osteoporosis
- pain
What is the bidirectional relationship between depression and medical illness?
Depression leads to medical illness and worse outcome
Medical illness can lead to depression
Why does depression lead to cardiovascular mortality?
- Increased levels of cortisol atherosclerosis, HTN, acceleration of injury
- effect of depression on adherence
- effect of depression on lifestyle factors
- increased HYPERCOAGULABILITY
- decreased HR VARIABILITY!
- DECREAED immunity
- increased INFLAMMATORY response
What does SSRI treatment do for depressed patients?
Normalizes platelet function (mechanism not known)
What is the consequences of increased platelet density in depressed patients?
Hypercortisolism and increased sympathetic tone
- hyperactive HPA axis
- leads to atherosclerosis and hypertension…accelerates injury to vascular endothelial cells
What is the consequence of increased cortisol/HPA axis?
Loss of suppression of inflammatory cytokines
What cytokines are elevated in depressed patient?
IL-1
IL-6
TNF-alpha
They are CONSEQUENCES and not a cause of depression
IL-6 and TNF alpha associated with insulin resistance, diabetes and obesity
What do we see in depression and HIV infection?
A. High prevalence of depressive symptoms in HIV infection
B. Stress and depression impair immune function
C. Stress and depression associated with HIV disease progression
What is the effect of high stress AND high depression on immune suppression?
You get less CD8 T-cytotoxic/suppressor cells
What is rate of depression in cancer?
Rate of depression in cancer is roughly 2-4 times that of the otherwise healthy general population but is dependent on the type of cancer
Equal between men and women
Cancer + depression = higher levels of IL-6
What happens to IL-6 levels in cancer patients who are depressed?
Higher levels of IL-6
Was past depression a predictor of future depression?
Past depression was NOT a predictor of future depression caused by interferon
How does treatment affect disease outcomes?
Treating depression improves outcome
Spiegel et al showed that psychotherapy increased metastatic breast cancer patient lifespan by 18 months
What happened when you gave patients antidepressants (paroxetine and imipramine) with HIV?
Much better outcomes
What do antidepressants do to NK cells?
It makes them function better in vivo (what Dube found)
“depressed” NK cells do worse
“nondepressed” NK cells perform better…antidepressants can change NK cell function!
Can you prevent depression?
Yes you can
If you give an SSRI to a patient…
You can reduce the depression incidence due to IFN (alpha) … or IFN (alpha) induced depression
What are the effects of St. John’s Wort?
Potent inhibitor of enzymatic function
Fucks with Indinavir (antiretroviral medication)
That means St. John’s Wort is a CONTRAINDICAITON for other medications
Don’t treat depression with St. John’s Wort!!!
What is hypericum?
Latin for St. John’s Wort
Contains hypericin
