Term
Unipolar-Bipolar Dichotomy (DSM-IV)
Define:
Bipolar I vs.
Bipolar II
Describe each of these, including whether each is Bipolar or Unipolar:
Cyclothymia
Major Depression
Dysthymia |
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Definition
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Term
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Definition
MDD w/:
Catatonic features
Melancholic features (postpartum onset)
Atypical features
Postpartum onset |
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Term
Distinguishing BPD from MDD
What are 7 signs your patient does not have MDD, and is instead depressed? |
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Definition
1. Obvious past or present manic/hypomanic episodes
2. Antidepressant-induced cycling acceleration, or mania/hypomania
3. Nonresponse to multiple antidepressants
4. Onset of mood symptoms in childhood or adolescence
5. Family history of BPD and/or alcoholism
6. Somatic symptoms aren't as prominent in BPD
7. More frequent suicide attempts |
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Term
Unipolar vs. Bipolar Disorder
How do the 2 courses of disease differ (age of onset, number of episodes, cycle length)? |
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Definition
Younger age of onset for bipolar (15-19) than for unipolar, more like 25-30
Higher number of episodes in bipolar
Shorter periods of time between episodes for bipolar |
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Term
3 Common NT's implicated in depression
3 less common NT's shown to be disturbed in the depressed |
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Definition
1. Serotonin
2. NE
3. DA
Less common:
1. corticotropin releasing factor (CRF)
2. glutamate
3. substance P |
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Term
| Kindling phenomenon of depression |
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Definition
| The need for stressful life events to trigger depression simply declines with time; threshold is lower, and the stressors that cause depression can be less and less serious, to the point that depression occurs without any trigger. |
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Term
| Role of the Hippocampus in Depression |
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Definition
Monkeys who are stressed have a shrunken hippocampus
Human correlation in the longer the depressive episode = the smaller the hippocampus
Hippocampus is responsible for controlling feedback mech for stress -- as you lose neurons in the hippocampus, body loses its ability to regulate levels of corticosteroids, results in high circulating hormone levels, can ultimately damage the body, including decreased dendritic branching and neuronal atrophy |
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Term
Current Treatment Options for Depression
List/describe 5 Non-pharmacologic interventions
List 3 general pharmacologic treatment options |
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Definition
Non-pharmacologic
1. Psychotherapy
2. ECT
3. Vagus nerve stim (similar treatment for epilepsy)
4. TMS - transcranial magnetic stimulation; for those that can't tolerate medication
5. Phototherapy - for SAD
Pharmacologic:
1. Antidepressants
2. Antipsychotics
3. Glutamate antagonists |
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Term
Antidepressant drugs
What is the prognosis (% wise) for patients that take antidepressants?
How much time do they typically take before effects are noticable
Any dangerous side effects?
How do they appear to work? |
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Definition
30% of patients have some positive response, and another 30% experience complete remission of depression
Take 1-2 weeks to begin to produce improvement
Potentially increase suicidality (they can get people feeling better, more energy and clear though, this is what they need to muster up the strength to kill themselves)
They appear to work by modulating monoamine NT function:
Serotonin
Norepinephrine
Dopamine
(may help with redevelopment of hippocampus) |
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Term
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Definition
BDNF is intimately involve in getting depressed, and in getting better!
BDNF = brain derived neurotrophic factor; promotes neuronal growth and survival
Glucocorticoids (released during stressed states and in the depressed) cause reduction in BDNF -- leads to atrophy/death of neurons
Decreased BDNF displayed in postmortem brain of suicide victims
vs.
Increased BDNF in hippocampal tissue of treated patients |
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Term
| What is Ketamine's action in the CNS? |
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Definition
| Its a glutamate antagonist, can be used to treat chronic depression or a suicidal individual |
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