- Major Depressive Disorder
- Lasts for weeks at a time
- Symptoms
- Little pleasure from sex or food
- Thoughts of suicide or death
- Don’t enjoy usual activities
- Feel worthless, sad, guilty
- Lack energy & pleasure
- Pull away from friends
- Trouble concentrating
- Suicidal thoughts
- Trouble sleeping
- Helpless
- Sad
- Findings
- React normally to sad images
- React normally to fearful images
- Rarely smile are happy images
- Rarely laugh at jokes
- Decreased R to likely reward
- 5% of US adults
- Childhood depression
- Equal for boys and girls
- Beyond 14, more common in female
- Range
- Long-term depression
- More common to have episodes
- periods of normal mood
- First episode longest
- More intense first episode
- Easier to start another
- Causes
- 1. Genetics
- Early-onset (before age 30)
- More relatives with depression
- Bulimia, irritable bowel syndrome
- Alcohol or marijuana abuse
- Anxiety & migraines
- ADHD & OCD
- Late onset (after 45 to 50)
- Relatives have circulatory problems
- 2. Infections
- Viral infections in farm animals?
- Borna disease
- 1/3 have it
- Infectious neurotropic virus
- Abnormal behavior
- Death
- 3. Estrogen
- More women than men
- Postpartum depression
- 20% of mothers
- Recover quickly
- 4. Brain Abnormalities
- Hemisphere Dominance
- Decreased activity in left hemisphere
- Increased activity in right prefrontal cortex
- 1. Genetics
- Treatments
- Untreated
- Recover within few months
- Episodes
- Drugs
- Some respond to one drug and not another
- Takes effect minutes to hours
- Weeks before mood elevation
- Untreated
- Antidepressant drugs
- 1. Tricyclics
- Prevent reuptake of serotonin+
- 2. SSRIs
- Prevent reuptake of serotonin
- fluoxetine (Prozac)
- 3. SNRIs
- Block reuptake of serotonin & norepinephrine
- 4. MAOIs
- Monoamine oxidase inhibitors
- Block enzyme from metabolizing
- 5. Atypical antidepressants
- bupropion (Wellbutrin)
- inhibits reuptake of dopamine & some norepinephrine
- bupropion (Wellbutrin)
- 1. Tricyclics
- Placebo vs drug
- Mild to moderate depression, no clear benefit
- Severe depression, drugs don’t always work
- ECT (Electroconvulsive Therapy)
- Seizures with electric shock
- Every other day for two weeks
- Invented by Ladislas Meduna
- 1930’s for schizophrenia
- Ineffectual on schizophrenia
- Overused in 1950’s
- Major side effect = memory loss
- Lasts for several months
- 50% relapse within 6 months if used alone
- Altered Sleep Patterns
- Sleep problems precede mood changes
- More eye movements in REM
- Enter REM within 45 minutes
- 80 minutes for non-depressed
- Like jet lag
- Change sleep cycle
- Stay awake all night
- Alternate sleep schedule
- Exercise
- Regular, non-strenuous exercise
- increase blood flow to brain
- Regular, non-strenuous exercise
- Unipolar vs Biploar
- Unipolar
- Between depression & normal
- Bipolar disorder
- (also called manic-depressive)
- between depression & mania
- Manic
- Side effects of steroids & SSRIs
- Drug intoxication
- (cocaine & amphetamine)
- Tumors
- Mood disorder
- Presence of mania = bipolar
- Don’t need to have been depressed
- Cyclical changes in mood
- Even if never hit depression
- Sleep (too much, too little)
- Unipolar
- Bipolar I
- Large swings
- Switch between
- good moods (happy, highly active, up)
- bad moods (irritable, angry, depressed)
- Men & women (about equal)
- Starts early: 15-25 years old
- Also called manic-depression
- At least 1 manic episode
- Often many depressive episodes
- Mania can last for day or months
- Unknown cause
- More likely among relatives
- Triggers
- Medications (antidepressants, steroids)
- Sleeplessness
- Drug abuse
- Childbirth
- Manic Symptoms
- Elevated mood; boost of energy
- Don’t sleep much (not tired)
- Easily distracted
- Racing thoughts
- Bursts of cleaning, doing
- Talking more or faster
- Overestimate abilities
- Poor self control
- Binge eating, drinking or drugs
- Promiscuity
- Spending
- Temper
- Restless activity
- Excitement & laughter
- Self-confidence
- Rambling speech
- Loss of inhibitions
- Bipolar
- I = large swings
- II = sad and guilty
- Cyclothmia = “bipolar light”
- Bipolar II
- Never had manic episode
- Alternate between
- Sad and guilty
- High energy-impulsiveness
- Milder episodes
- Also called hypomania
- More common in women
- More depression
- More “mixed” episodes
- mania & depression at same time
- Women 3x more likely to also have:
- Alcoholism
- Anxiety disorder
- 1+ episode per year
- Genetics
- Strong hereditary basis
- Twin studies
- Two genes increase probability of bipolar II
- Same genes
- predispose major depression
- predispose bipolar disorder
- Same genes
- All Types
- High risk of suicide
- Both when manic & depressed
- Manic & depressive moods can overlap
- Treatment
- Drugs for mood stabilization
- Carbamazepine (anti-convulse)
- Lamotrigine (anti-seizure)
- Valproic acid (anti-seizure)
- Lithium salts (anti-manic)
- Most effective therapy
- Don’t know why
- Consistent sleep schedule
- Seasonal Affective Disorder (SAD)
- Usually in winter
- Most common closest to poles
- Treatment
- Expose to very bright lights
- for about an hour
- early in morning or evening
- Anxiety Disorders
- Generalized Anxiety Disorder
- Obsessive-Compulsive
- Panic Disorder
- Social Phobia
- PTSD
- 1. Generalize Anxiety Disorder
- Extremely worried
- Little or no reason to worry
- Anxious about getting thru day
- Fear things will go bad
- Develops slowly
- Often starts as teen
- Symptoms come & go
- Worse under stress
- Symptoms
- Headaches
- Trouble falling asleep
- Excessive worry
- Aware you’re worrying
- Unexplained pain
- Stomach aches
- Difficulty swallowing
- Tremors, twitches
- Can run in families
- No clear genetic link
- Treated with combo of:
- Medications
- Anti-anxiety
- Anti-depressants
- Therapy
- Thinking, breathing
- Medications
- Extremely worried
- 2. Obsessive-Compulsive
- OCD
- Episodes
- Obsessions: upsetting thoughts
- Compulsions: stress reducers
- Development
- Starts in childhood or teen
- Most diagnosed by age 19
- Symptoms
- Need to repeatedly check things
- Repeated thoughts or images
- Fear of dirt, gems, intruders
- Routines & rituals
- Spend 1+ hrs per day
- Prefer round numbers (lucky)
- Count lines in paragraph
- Wash hair three times
- Morning routine
- Runs in families
- No direct genetic link
- Treatment
- Cognitive therapy
- fear without obsessive thoughts
- Exposure-Response prevention
- See image, change response
- Medication
- Anti-anxiety medications
- Antidepressants
- Work better than anti-anxiety
- 2-3 months to work
- 3. Panic Disorder
- Frequent periods of anxiety
- Occasional attacks
- Rapid breathing
- Increased heart rate
- Sweating
- Symptoms
- Fear for several minutes
- Fear of disaster
- Fear losing control
- May feel like heart attack
- Worry about next attack
- Young Women
- More common in women
- More in adolescent & young adult
- Treatment
- GABA
- main inhibitory NT in amygdala
- GABA blockers induce panic
- Benzodiazepines
- Diazepam
- Chlordiazepoxide
- Alprazolam
- Bind to GABAA receptor
- receptor changes shape
- attach easily & bind more
- Affect amygdala, midbrain & hypothalamus+
- Can be addictive
- Temporary relief
- Beta-blockers
- Less sweat & pounding heart
- Propranolol
- Drug
- Affects synapses in amygdala
- Interferes with protein synthesis
- Weakens emotional R
- Persisting decrease in fear intensity
- GABA
- Runs in families
- No direct genetic link
- 4. Social Phobia
- Strong fear of being judged
- Strong feeling of embarrassed
- Fear gets in way of work, etc
- Afraid of doing common things in front of others
- sign a check in front of a cashier
- eat or drink in front of others
- use a public restroom
- Know its irrational but can’t control the fear
- Starts as child-adolescent
- Diagnoses if symptoms last 6 months+
- Can last for many years
- Symptoms
- Anxious being with other people
- Hard time talking to others
- Self-conscious
- Afraid others will judge them
- Worry for days before an event
- Avoid groups & crowds
- Blush or sweat around people
- Feel nauseous when with others
- Afraid of being called on in school
- Hate to meet with my boss
- Don’t eat lunch with co-workers
- Worried about being stared at
- Heart pounds if go to meeting
- Can’t eat or sleep for days before staff meeting
- 5. PTSD
- Some get, not most
- See event (observer)
- In event (participant)
- Anyone
- Any age
- Symptoms
- Three categories:
- 1. Re-experiencing symptoms
- Flashbacks
- Bad dreams
- Frightening thoughts
- 2. Avoidance symptoms
- Stay away from places, events
- Avoid reminders of experience
- Emotionally numb
- Guilty, depressed or worried
- Loss of interest hobbies, etc
- Difficulty remembering event
- 3. Hyperarousal symptoms
- Relatively constant symptoms
- Not triggered
- Easily startled
- Feel tense or “on edge”
- Trouble sleeping
- Angry outbursts
- Diagnosis
- 1 month+
- 1+ re-experiencing symptom
- 3+ avoidance symptoms
- 2+ hyperarousal symptoms
- Most people don’t get PTSD
- Risk factors
- Previous dangerous events
- History of mental illness
- Getting hurt
- Seeing people hurt or killed
- Lack of social support after event
- Resilience factors
- Support group
- Feeling did right thing
- Coping strategies
- Respond even though afraid
- Medications
- 1. Zoloft
- 2. Paxil
- Both are antidepressants
- sadness, worry, anger & numb
- Side effects
- annoying but go away (few days)
- headaches, nausea, sleepy
- Other medications
- Benzodiazepines
- relax and sleep
- may cause memory problems or become dependency
- Antipsychotics
- Tend to gain weight
- Benzodiazepines
- Other antidepressants
- Prozac & Celexa
- Feel less tense or sad
- Co-occurring depression
Leave a Reply