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!