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Lecture 5

2LA2 Lecture 5: Depression

6 Pages
75 Views
Fall 2016

Department
NURS
Course Code
2LA2
Professor
Dr.Helli
Lecture
5

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What are the two main categories of depression?
1) Major Depressive Disorder (MDD): characterized by a persistent unpleasant mood,
depressed mood or the loss of interest/pleasure in nearly all activities.
2) Persistent Depressive Disorder (PDD): dysthymia, characterized by chronic mild
depressive symptoms. Depressed mood for most of the day, more days than not, for at
least 2 years.
What is anhedonia?
Depressive mood and inability to experience pleasure, a symptom of depression.
What are the DSM criteria for Major Depressive Disorder?
Presence of 5 or more of the following symptoms during a 2-week period, must
represent a change from previous functioning:
Anhedonia, feelings of worthlessness or excessive guilt, decreased concentration,
psychomotor agitation or retardation, insomnia or hypersomnia, decreased libido,
change in weight or appetite, thoughts of death and suicidal ideation.
What are the risk factors for depression?
Childhood emotional, physical or sexual abuses
Prior episode of depression
Family history of depressive disorder
Lack of social support
Stressful life event
Current substance abuse
Economic difficulties
What is the etiology of depression?
Multifactorial and has a dynamic interplay amongst: genetic predisposition,
environment, life history, development and biological challenges.
Does heritability or environment contribute more to depression?
Hereditability for depression has been estimated form twin studies as 31-42%
Environment contribution is 58-67%
How does the polymorphism of serotonin transporter gene increase or decrease the risk of
depression?
Polymorphism can give rise to long and short alleles, therefore different combinations
of genes can arise. The short alleles slow down the synthesis of the serotonin
transporter leading to a dysregulation of serotonin, and this process has been
implicated in depression.
What is Brain Derived Neurotropic Factors (BDNF) and is it increased or decreased in MDD?
Growth factor important for survival and maturation of brain cells during development.
It activates DNA binding factors that stimulate gene transcription of genes involved in
serotonin function.
People with MDD have lower levels of BDNF.
What are the genes that code for BDNF? And what gene increases the chance for depression?
Val ad Met alleles i gees ode for BDNF, the Met alleles irease a perso’s hae
for depression.
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find more resources at oneclass.com
Why is the hippocampus significant in depression, what effect does the Met allele have on it?
Met alleles do the following: small hippocampus at birth, hippocampal hypo activity at
rest, hippocampal hyper activity during learning, poor hippocampus dependent
memory.
Hippocampus is significant because it modulates cognitive aspects of depression such as
memory impairments and feelings of hopelessness, guilt, doom and sucicidiality.
Do we diagnose people simply by looking at low levels of BDNF?
No, we diagnose them with DSM 5 symptoms. It is important to look at BDNF to figure
out what is the best way to increase BDNF levels.
What does the neurobiological theory suggest in terms of depression?
MDD is caused by a deficiency or dysregulation in the CNS concentration of
neurotransmitters.
1) Where can you find neurotransmitter
acetylcholine (Ach) in the brain?
2) What is the effect on the brain?
3) What does under/over activity
implicate?
1) High concentrations in basal ganglia and
motor cortex.
2) Can be excitatory and inhibitory,
depending on area of brain.
3) Under activity implicates in Alzheimer
disease.
1) Where can you find neurotransmitter
dopamine (DA) in the brain?
2) What is the effect on the brain?
3) What does under/over activity
implicate?
1) Substantia nigra and ventral segmental
area of midbrain, derived from tyrosine.
2) Usually excitatory. Involved in motivation,
thought and emotional regulation.
3) Over activity thought to be involved in
schizophrenia and other psychotic disorders.
1) Where can you find neurotransmitter
norepinephrine (NE) and epinephrine
(E) in the brain?
2) What is the effect on the brain?
3) What does under/over activity
implicate?
1) Locus ceruleus in brain stem.
2) Can be excitatory or inhibitory, depending
on area of brain.
3) Under activity thought to be involved in
some depressions.
1) Where can you find neurotransmitter
serotonin (5-HT) in the brain?
2) What is the effect on the brain?
3) What does under/over activity
implicate?
1) Raphe uleus i rai ste that’s ai
function is to release serotonin to rest of
brain.
2) Involved in regulation of attention and
complex cognitive functions.
3) Under activity thought to be involved in
some depressions and OCD.
1) Where can you find neurotransmitter
y-aminobutyric acid (GABA),
glutamate and glycine in the brain?
1) No single main source.
2) GABA and glycine are usually inhibitory;
glutamate excitatory.
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find more resources at oneclass.com

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Description
What are the two main categories of depression? 1) Major Depressive Disorder (MDD): characterized by a persistent unpleasant mood, depressed mood or the loss of interest/pleasure in nearly all activities. 2) Persistent Depressive Disorder (PDD): dysthymia, characterized by chronic mild depressive symptoms. Depressed mood for most of the day, more days than not, for at least 2 years. What is anhedonia?  Depressive mood and inability to experience pleasure, a symptom of depression. What are the DSM criteria for Major Depressive Disorder?  Presence of 5 or more of the following symptoms during a 2-week period, must represent a change from previous functioning:  Anhedonia, feelings of worthlessness or excessive guilt, decreased concentration, psychomotor agitation or retardation, insomnia or hypersomnia, decreased libido, change in weight or appetite, thoughts of death and suicidal ideation. What are the risk factors for depression?  Childhood emotional, physical or sexual abuses  Prior episode of depression  Family history of depressive disorder  Lack of social support  Stressful life event  Current substance abuse  Economic difficulties What is the etiology of depression?  Multifactorial and has a dynamic interplay amongst: genetic predisposition, environment, life history, development and biological challenges. Does heritability or environment contribute more to depression?  Hereditability for depression has been estimated form twin studies as 31-42%  Environment contribution is 58-67% How does the polymorphism of serotonin transporter gene increase or decrease the risk of depression?  Polymorphism can give rise to long and short alleles, therefore different combinations of genes can arise. The short alleles slow down the synthesis of the serotonin transporter leading to a dysregulation of serotonin, and this process has been implicated in depression. What is Brain Derived Neurotropic Factors (BDNF) and is it increased or decreased in MDD?  Growth factor important for survival and maturation of brain cells during development. It activates DNA binding factors that stimulate gene transcription of genes involved in serotonin function.  People with MDD have lower levels of BDNF. What are the genes that code for BDNF? And what gene increases the chance for depression?  Val and Met alleles in genes code for BDNF, the Met alleles increase a person’s chance for depression. Why is the hippocampus significant in depression, what effect does the Met allele have on it?  Met alleles do the following: small hippocampus at birth, hippocampal hypo activity at rest, hippocampal hyper activity during learning, poor hippocampus dependent memory.  Hippocampus is significant because it modulates cognitive aspects of depression such as memory impairments and feelings of hopelessness, guilt, doom and sucicidiality. Do we diagnose people simply by looking at low levels of BDNF?  No, we diagnose them with DSM 5 symptoms. It is important to look at BDNF to figure out what is the best way to increase BDNF levels. What does the neurobiological theory suggest in terms of depression?  MDD is caused by a deficiency or dysregulation in the CNS concentration of neurotransmitters. 1) Where can you find neurotransmitter 1) High concentrations in basal ganglia and acetylcholine (Ach) in the brain? motor cortex. 2) What is the effect on the brain? 2) Can be excitatory and inhibitory, depending 3) What does under/over activity on area of brain. implicate? 3) Under activity implicates in Alzheimer disease. 1) Where can you find neurotransmitter 1) Substantia nigra and ventral segmental area dopamine (DA) in the brain? of midbrain, derived from tyrosine. 2) What is the effect on the brain? 2) Usually excitatory. Involved in motivation, 3) What does under/over activity thought and emotional regulation. implicate? 3) Over activity thought to be involved in schizophrenia and other psychotic disorders. 1) Where can you find neurotransmitter 1) Locus ceruleus in brain stem. norepinephrine (NE) and epinephrine 2) Can be excitatory or inhibitory, depending (E) in the brain? on area of brain. 2) What is the effect on the brain? 3) Under activity thought to be involved in 3) What does under/over activity some depressions. implicate? 1) Where can you find neurotransmitter 1) Raphe nucleus in brain stem that’s main serotonin (5-HT) in the brain? function is to release serotonin to rest of 2) What is the effect on the brain? brain. 3) What does under/over activity 2) Involved in regulation of attention and implicate? complex cognitive functions. 3) Under activity thought to be involved in some depressions and OCD. 1) Where can you find neurotransmitter 1) No single main source. y-aminobutyric acid (GABA), 2) GABA and glycine are usually inhibitory; glutamate and glycine in the brain? glutamate excitatory. 2) What is the effect on the brain? 3) Implicated in anxiety disorders. 3) What does under/over activity implicate? Where are neurotransmitters usually stored?  In vesicles in the presynaptic axonal terminal. What process released the neurotransmitters into the synaptic cleft?  Exocytosis When an excitatory neurotransmitter binds to the postsynaptic receptor what is the outcome?  Results in the opening of an ion channel, such as the sodium channel. What do presynaptic receptors function as?  Function in a negative feedback manner to inhibit further release of neurotransmitters. What are the three ways of removing the neurotransmitter from the synaptic cleft?  Be taken back up into the neuron in process called reuptake, diffuse out of the synaptic cleft or be broken down by enzymes into inactive substances or metabolites. What does the biogenic amine hypothesis suggest?  Suggests that decreased levels of serotonin and norepinephrine in the synaptic cleft, due to either decreased presynaptic release or decreased postsynaptic sensitivity, is the underlying pathologic process in depression. What contradicts the biogenic amine hypothesis and supports genetic and environmental?  We know that when serotonin levels are depleted experimentally in humans by oral treatment by decreasing the level of tryptophan (precursor to serotonin) healthy individuals that don’t’ have a history of MDD tend not to show mood changes.  While individuals who have successfully been treated with SSRI’s will relapse into depression. What does decreased and increased dopamine activity indicate?  Decreased activity in depression and increased activity in mania. Why do patients with
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