Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar...

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Depression

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Transcript of Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar...

Page 1: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Depression

Page 2: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Depression•Known as a Mood/Affective Disorder Affect = emotions

Major Types•Bipolar

•Unipolar

•Seasonal Affective Disorder

Page 3: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Depression

Unipolar (major depression)

•Most common affective disorder

•19 million Americans/year (17%)•11 million clinical & major depression•15% parasuicide•Most effectively treated

Page 4: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Depression

Unipolar (major depression)

Problems with diagnosis…

Both a mental disorder & normal mood state

Page 5: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Depression

Reactive-Exogenous triggered by an obvious event

Endogenous No trigger No obvious event

Duration & Intensity

Page 6: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

•Anhedonia (experience pleasure)•Weight gain or loss•Hypersomnia, insomnia• Fatigue, loss of energy• feelings of worthlessness guilty• difficulty concentrating

Page 7: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Clinical Depression

(5 symptoms)

(2 symptoms)

Page 8: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.
Page 9: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.
Page 10: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.
Page 11: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.
Page 12: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Genetic Risk Concordance rate of 68% in monozygotic Concordance rate of 15% dizygotic Family member = 10 tx more likely

Page 13: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.
Page 14: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.
Page 15: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Theories of Depression

Page 16: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Most Dominant Theory of Depression

Monoamine Hypothesis of Depression

Depression is associated with an under activity at serotonergic and noradrenergic synapses

(Indolamines & catecholamines)

Page 17: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Evidence in Support

- CSF of depressed pt suicidal low levels of 5HIAA -Post Mortem brains from depressed pt (prefontal) above avg # of 5HT & Norepi receptors upregulation

Post Mortem Suicide• low 5HT• low Norepi

Page 18: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Evidence in Support

- Tryptophan depletion in depressed pt (Delgado, 1990)

Put on Low Trypto. Diet (salad, corn, gelatin)

Then, amino ccid cocktail (no trypto.)…so hi other amino acids

Trypto. Dropped! = relapse -Healthy…no effect of diet or cocktail…PET shows prefrontal cortex trypto less

Page 19: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Evidence in Support

-Antidepressants Work!..so, monoamineagonists

-Monoamine Antagonist = depression ex: Reserpine (Rauwolfia serpentina) 100’s years ago used to - calm insanity- treat hi BP = 15% got depressed

Page 20: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Evidence Refuting the Monoamine Hypothesis

-Antidepressants Work…in 80% of the clinical population…what’s up with the other 20%???

-“Lag Time” time it takes a drug to work in the brain vs the time we see a behavioral effect 3 to 4 weeks to see behave effect…although in the brain

Page 21: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Treatment – BiochemicalTherapies

Page 22: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Antidepressants

•Monoamine Oxidase Inhibitors (MAOIs)

•Tricyclics

•Selective Monoamine Reuptake Inhibitors (SSRIs)

Page 23: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Monoamines?

Page 24: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Monoamines

Catecholamines: Norepinephrine

Indolamines: Serotonin

Page 25: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

•Monoamine Oxidase Inhibitors (MAOIs)

- MAOIs block the enzyme monoamine oxidase… - MAO breaks down monoamines into inactive metabolites

Page 26: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

MAOIs:

•Iproniazid (eye-pron-eye-a-zid)•First antidepressant (1957)

- originally marketed as rocket fuel - TX for TB

A flop!…serendipity intervened

Page 27: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

MAOIs:•Isocarboxazid•Phenelzine•Tranylcypromine

•Side effects:• hypertension (BP): headaches, sweating, nausea, vomiting

•Side effects represent drug interactiondrug X food

Tyramine – cheese, wine, licorice, raisins MAO breaks down tyramine= too much intracranial hemorrage (stroke)

Page 28: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

MAOIs:

•“Cheese Effect”

Pharmacist G.E.F. Rowe wife was being treated with MAOIheadaches after eating cheese

Blackwell et al found that cheese causes a large increase in BP without MAO

increase in tyramine indirectly acts on sympathetic release of Norepi

Page 29: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Tricyclics

Called tricyclics because chemical structureIncludes 3-ring structure – 2 benzene rings &1 central seven membered ring

Page 30: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Tricyclics

works by preventing presynaptic reuptake

Page 31: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Tricyclics

1st tricyclic: Imipramine (Tofranil)

serendipity!

- Synthesized in 1948 as an antihistamine

- Used in Schizophrenia – no help with psychosis but less depressed

Side effects: (safer than MAOI)- block histamine receptors: produces drowsiness- block acetylcholine receptors: dry mouth, difficulty urinating- Na+ Channels: heart irregularities

Page 32: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Tricyclics

Appear to work better with:

- Early morning awakenings- Loss of appetite- Weight loss-Morning depression heightened

Contraindicated for Bipolar depression can trigger the mania

Page 33: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

Second Generation: Selective Serotonin Reuptake Inhibitors (SSRIs) “Atypical” Antidepressants

Page 34: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

SSRIs: Block Reuptake

Page 35: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

SSRIs

-Just Like the tricyclics but selective to block serotonin uptake

Fluoxotine (Prozac) -first on the market in 1980s -most prescribed -not more effective in tx depression

* fewer dangerous side effects* effective in a wide range of

affective problems lack of self-

esteem, fear of failure, OCD, Binge eating & purging (Bulimia)

Page 36: Depression. Known as a Mood/Affective Disorder Affect = emotions Major Types Bipolar Unipolar Seasonal Affective Disorder.

SSRIs (Sertraline:Zoloft, Paroxetine:Paxil (Fluvoxamine: Luvox, Citalopram:Celexa)

Side Effects:SSRIs do not effect:MAO – little risk of hypertensionDo not worry about food interaction

However side effect: nervousness 25% nausea-10% nausea (Prozac & Zoloft) Priapism (trazadone) - protracted & painful penile erectionSocial anxiety disorder, PTSD, Panic disorder, OCD)ALSO: Selective Norepi Reuptake Inhibitors (Reboxetine)


SEASONAL AFFECTIVE DISORDER - Compagnie LELA › seasonal_dossier_diffusion.pdfSon texte Seasonal Affective Disorder / Trouble affectif saisonnier est publié aux éditions Théâtrales.

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