Mood disorders Flashcards
(37 cards)
Symptoms of depression (4)
Low mood, Lack of motivation, Anxiety, Disturbed sleep
Prevalence stat for depression
Nearly a fifth of UK adults Predicted leading cause of burden of disease in the world by 2030 by WHO
Risk factors (7)
Stressful life events Adverse childhood experience Genetics Infection Personality Diet Gender
First gen antidepressant
iproniazid
4 types of AntiDEPs
Monoamine oxidase inhibitors Tricyclic SSRIs SNRIS
Name a MOI
iproniazid
Name a tricyclic
amitriptyline
SSRI
Fluoxetine
SNRI
Duloxetine
Where are the neurophysiological abnormalities?
Multiple areas of the PFC, amygdala, related parts of the striatum and thalamus. Some of these such as orbital and medial PFC persist following symptom remission
Drevets (1992)
PET to measure differences in cerebral blood flow. Amygdala hyperactivation in depression, correlating with symptom severity.
Kennedy (2005)
Subgenual cingulate region metabolically overactive in TR depression. Chronic DBS of WMTs adjacent to SCA associated with sustained remission in 4/6 patients.
Berlim (2014)
Meta-analysis of DBS- 12month response rate of 39.9%.
Critique of DBS (2)
Can’t do sham operations as risk of intracerebral haemorrage is 2%. Most studies still small scale and may not illustrate adverse effects.
Delgado (1999)
Rapid depletion of plasma TRP transiently reverses the antidepressant response in many patients on fluoxetine
Ruhe (2007)
Meta-analysis of TRP depletion studies. No simple direct correlation 5HT or NR levels in brain or mood. Depletion affects mood in unmedicated patients or healthy patients with family history. Monoamine systems therefore probs important in vulnerability to become depressed
Caspi (2003)
Prospective longitudinal study showed functional polymorphism in the promoter region of the serotonin transporter was found to modulate the influence of stressful life events on depression.
Malberg (2000)
BrdU (thymidine analog) used as a marker for dividing cells. Chronic antidepressant treatment increases the number of BrdU-labelled cells in the dentate gyrus of hippocampus.
Huang (2008)
Chronic fluoxetine treatment did not increase hippocampal neurogenesis in mice
Pringle (2011) theory
Cognitive neuropsychological model of antidepressant action- repeated treatment promotes synaptic plasticity and neurogenesis, reversing cellular changes of depressive state. Beck - gradual increase in salience of + info, decrease -.
Holmes and Rahe
Seminal linkage of stressful life events and illness.
Bargawagar (2005)
elevates post-wakening surge in salivary cortisol in depressed, non-medicated patients. Cushings and therapeutic corticoids also induce depressive phenotype in some.
Qin (2016)
Female rhesus macaques - sig correlations found between stress, cortisol and depressive behaviour. Controlled environment, avoiding confounding effects that hinder studies in humans.
Cortisol and hippocampus?
Cortisol is toxic to hippocampus and bilateral reduced vol. associated with depression- may contribute to memory impairment.
