BY VISHAL RAJ SAXENA

PHARMD 2ND YEAR

Depression

Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too. Depression can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life isn't worth living.

DEFINATION:

TYPES

MAJOR DEPRESSION

DYSTHYMIA DEPRESSION

BIPOLAR DEPRESSION

MAJOR DEPRESSION

SYMPTOMS1. Feelings of sadness or unhappiness2. Loss of interest or pleasure in normal activities

3. Insomnia or excessive sleeping

4. Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort

5. Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right

6. Frequent thoughts of death, dying or suicide

DYSTHYMIA DISORDER

Dysthymia, the depression symptoms can linger for a long period of time, often two years or longer. Those who suffer from dysthymia can also experience periods of major depression.

sadness or depressed mood most of the day or almost every day

major change in weight (gain or loss of more than 5% of weight within a month) or appetite

BIPOLAR DISORDERBipolar disorder (also known as manic depression) causes serious shifts in mood, energy, thinking, and behavior–from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months.

SYMPTOMS OF BIPOLAR DISORDER

Feeling unusually “high” and optimistic ORextremely irritable.

Unrealistic, grandiose beliefs about one’s abilities or powers.

Racing thoughts; jumping quickly from one idea to the next.

Impaired judgment and impulsiveness.

Acting recklessly without thinking about the consequences.

Delusions and hallucinations (in severe cases)

Talking so rapidly that others can’t keep up.

Epidemiology of Bipolar Disorder

Prevalence: 1% of population Adults = Adolescents

Males = Females

2-3 million American adults are diagnosed with bipolar disorder

NIMH estimates that one in very one hundred people will develop the disorder

Heritability

Evidence for heritability is much stronger for bipolar than for unipolar disorders

Specific genetic association has not been consistently replicated

FAMILY STUDIES

The majority of individuals with bipolar disorder have a positive family history of some type of mood disorder

About 50% of all bipolar I patients have at least one parent with a mood disorder

Alcohol Use

Alcohol use occurs in 30-50% of cases

Impairs memory and executive functioning

Other studies have reported cognitive deficits in non substance abusing BP patients

Iatrogenic Lithium

Memory and psychomotor functioning

Valproate and Carbemazepine Attentional deficitis

Neuroleptics Sustained attention

Visuomotor speed deficits

Benzodiazapines Memory

Biogenic Amine Hypothesis: ↓ NE

The Biogenic Amine Hypothesis states that depression is caused by a deficiency of monoamines, particularly noradrenaline.

It proposes that depression is due to a deficiency of monoamines, such as norepinephrine and , at certain key sites in the brain. Conversely, the theory envisions that mania is caused by an overproduction of these neurotransmitters.

Biogenic Amine Hypothesis

MONOAMINE DEFICIENCY

Permissive Hypothesis: ↓ 5-HT

According to this theory, both the manic phase and the depressive phase of bipolar disorder are characterized by low central serotonin function. The Permissive Hypothesis postulates that low levels of serotonin permit abnormal levels of noradrenaline to cause depression or mania. On the other hand, if the level of serotonin falls and the level of noradrenaline becomes abnormally high, the patient becomes manic.

Serotonin (5-HT) Norepinephrine (NE)

Sex

Appetite

Aggression

Concentration

Interest

Motivation

Depressed

Mood

Anxiety

Irritability

Thought

process

• Both serotonin and norepinephrine mediate a broad spectrum of depressive symptoms

Serotonin5HT and NorepinephrineNE in the brain

Limbic System

Locus Ceruleus (NE Source)

Raphe Nuclei (5-HT

source)

Prefroal Cortex

The neurotransmitter pathway story Dysregulation of Serotonin

(5HT) and Norepinephrine(NE) in the brain arestrongly associated withdepression

Dysregulation of 5HT andNE in the spinal cord mayexplain an increased painperception among depressedpatients

Imbalances of 5HT and NEmay explain the presence ofboth emotional and physicalsymptoms of depression

Descending

Pathway Ascending

Pathway

The Neuroendocrine Hypothesis

According to this hypothesis, pathological mood states are explained or contributed to by altered endocrine function. This theory historically grew out of observations that altered mood states were associated with thyroid or Cushings disease. Current explorations of pathophysiology using neuroendocrine theories have tended to result in research tools such as the dexamethasone suppression test becoming diagnostic tools

Neurotrophins and depression

The neurotrophic factors are among the growth factors that have been studied for their role in the adult nervous system. Of these endogenous proteins, brainderived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) have been shown to promote the function and growth of 5-HT-containing neurones in the adult brain.

Assessment/Diagnosis of Bipolar Disorder

Often very complicated; it mimics many other disorders and has comorbidity (presents with other disorders)

Alphabet soup diagnosis

Half of bipolar children have relatives with bipolar disorder

Other Organic Diagnoses

It is important to first rule out the possibility of any other organic diagnosis:

Thyroid disorder

Seizure disorder

Multiple sclerosis

Infectious, toxic, and drug-induced disorders

Medications

Mood Stabilizers

Lithium

Divalproex Sodium (Depakote)

Carbamezapine

Newer Agents

Neurontin

Lamictal

Topamax

Gabatril

Atypical antipsychotics

Atypical Antipsychotics

Risperidol

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Abilify

Geodon

Atypical Antipsychotics (ctd.)

Increasingly used because they can cause rapid patient stabilization

Zyprexa can help with depression, mania and psychosis

Weight gain

It will help patient to be inspired by us, rather than the other way

around

Thank You!