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Depression Pathophysiology (Dr. Bessac)

Terms in this set (41)

Melancholic Depression
Depressed mood
Loss of interest/pleasure
Even happy news will not enhance the mood
Atypical Depression
Typical symptoms, but mood improves to positive news.
Typical symptoms: weight gain, excessive sleep, heaviness in limbs, hypersensitivity to perceived interpersonal rejection
Catatonic Depression
Rare and severe
Mute, immobile or exhibits purposeless or even bizarre movements
Postpartum Depression
Depression after giving birth
Seasonal Affective Disorder (SAD)
Depression in autumn or winter
Directly related to daylight exposure (?)
Associated features/risks of depression
Chronic pain
Disorders of disrupted monoamines
High glucocorticoid
ONE of these is required for a DSM-V diagnosis of depression
Depressed mood
Apathy/Loss of interest
4+ of these are required for a DSM-V diagnosis of depression
Weight/appetite changes
Sleep disturbances
Psychomotor
Fatigue
Guilt/worthlessness
Executive dysfunction
Suicidal ideation
Theory of Depression
Continuous self-punishment and inescapable stress results in depression
Unescapable stressors
Self blame/excessive association of the world with one's self
Grief
Anxiety/Fear
Despair
Learned-hopelessness
Brain areas affected
Dysfunctional HPA axis
Hyperactive amygdala
Hyperactive VM PFC
Low DL PFC activity
Bandura's and Rotter's Locus of Control
Self-centered (absorbed) blame for everything
Continuous endogenous stressors or behavioral stressors induce...
A learned help/hopelessness depression
Loss of controlling stress events will lead to...
Helplessness, despair and depression
People who are allowed to do tasks that they have control over...
Are less likely to be depressed than those that have no control
(This is a big issue in nursing homes)
Continuous endogenous stressors or conditions mimicking/inducing stress without any mechanism for control...
Will induce depression
Brain areas of unescapable depression
Amygdala (Hyperactive)
VM PFC (Hyperactive)
DL PFC (Low DL activity)
Amygdala functions
"Fear" center
Punishment feedback
Emotional learning
Risk/caution
Ventromedial Prefrontal Cortex functions
Processing risk and fear
Extinction of emotional memory
Everything is fearful and risky
All actions are wrong
These actions are your fault
Dorsolateral Prefrontal Cortex functions
Decision making, execution, planning, cognition, and motivation
Biological-Behavioral Theory of Major Depression
1. Apathy is too little activation of the biological systems of positive reinforcement
2. Depression is too much activation of the biological systems of positive punishment and stress which is perceived as unescapable
Operant Conditioning
Positive reinforcement and negative reinforcement (Chocolate vs. humiliation)
Positive punishment and negative punishment (humiliation vs. no chocolate)
HPA Axis disruptions
Normally CRH is released and this binds on the pituitary and ACTH from the pituitary will bind to the the adrenal cortex to release cortisol and glucocorticoids.
(MR and GR receptors)
Glucocorticoid and Mineralocorticoid regulate gene expression...
And negatively feedback on stress pathways and HPA axis
CRH in the brain is linked with...
Fear
Anxiety
Stress behaviors
Sleep disturbances
Cortisol Circadian Rhythm is ______ in depression, implying _____.
Flattens
Hippocampal regulation dysfunction
DEX Nonsuppressors have high ______.
High suicide risk
Continuous cortisol _____ BDNF expression
Lowers
Continuous cortisol _____ glucocorticoid receptor expression.
Lowers
(This causes the loss of negative feedback on brain stress pathways)
Mood disorders are common in people with _______.
High CORT secretion
Patients with hypercortisolism (Cushing's)...
Often have mood problems such as depression
____ BDNF and resulting ______ is involved in depression.
Low
Low hippocampal connectivity
BDNF action?
Regulates/enhances dendrite-axon synapses in the hippocampus
Low monoamine GPCR activity may ____ BDNF
Lower
Glucocorticoids ____ BDNF.
Lower
Antidepressants _____ BDNF and reverse the effects of _____.
Increase
Glucocorticoids
Glucocorticoid receptors inhibit BDNF at the ____ level.
DNA
Antidepressants ____ connections of the hippocampus, ____ amygdala activity/VM PFC activity, and ____ DL PFC activity.
Restores
Lowers
Raises
Low ___ or altered ____ levels are involved in depression.
Monamine (MA)
Receptor
Low monamine activity can lead to _____ of the ____ and _____ and _____ of the _____.
Hyperactivity
VM PFC
Amygdala
Hypoactivity
DL PFC
People with depression have less ____ (sleep), and their _____ is faster.
Slow Wave Sleep
REM latency (they enter into REM sleep faster)
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