Depressive Disorders

1
Depressive Disorders

• And Psychopharmacological Treatment
• By Matthew Miville

2
Differentiating Depression

• Depression as a result of human experiences.
• Clinical depression
• Bipolar
• Unipolar
• Major Depressive Disorder
• Dysthymic Disorder

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Major Depressive Disorder

• An individual experiences one or more depressive
  episodes that is usually accompanied by other
  common symptoms of depression
• Changes in
• Appetite
• Sleep patterns
• Energy
• Feelings of Worthlessness and guilt
• Concentration
• Thoughts of suicide
• Depressive Episode
• A period of at least 2 weeks during which there
  is either depressed mood or loss of interest in
  nearly all activities a person may feel sad,
  hopeless, discouraged, or down in the dumps
  (DSM-IV 317)

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Major Depressive Disorder

• Depressive episodes and MDD may develop from
  other disorders
• Panic Disorder
• Obsessive Compulsive Disorder
• Anorexia
• Borderline Personality Disorder
• Lifetime risk of MDD
• 10-20 of Women
• 5-12 of Men
• May be experienced at any age (Avg. about mid
  20s)
• 50 - 60 of people who have one episode may
  experience another

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Dysthymic Disorder

• An individual experiences a chronically depressed
  mood on a fairly daily basis and for at least 2
  years
• During a depressed mood several symptoms may be
  present
• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy
• Chronic low self-esteem
• Poor concentration
• Difficulty in making decisions

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Dysthymic Disorder

• Closely related symptoms to MDD
• Symptoms are usually less severe
• Depressive mood is chronic and has been around
  for several years
• Severity and persistence
• The depressive personality
• Goes unreported because people will label their
  depressive states as just the way they are
• 4 - 8 of teens suffer from Dysthymia (Ainsworth
  2001)

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Theories on Depressive Disorders

• Psychoanalytical
• Cognitive
• Behavioral
• Neurobiological
• Focus of pharmacological treatment
• Imbalance of natural brain chemicals
• Less philosophical and environmental influences
  are the cause of depressive disorders
• Real physical changes in the brain

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• The Lobes of The Brain

• Temporal
• Frontal
• Parietal
• Occipital

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The Frontal Lobe

• Approximately 1/3 of the brain
• Home to many of the neurotransmitters that are
  associated with mood

• Neurotransmitters- Brain chemicals responsible
  for sending information and instructions to and
  from the nerve cells of the brain (Ainsworth
  2001)
• Dopamine
• Norepinephrine
• Serotonin

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The Imbalance of Neurotransmitters

• People who are depressed have a smaller amount
  of certain neurotransmitters in the gap (synapse)
  between cells than people who arent depressed
  (Mayo Clinic 2001).

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Pharmacological Treatment

• 80 of depressed patients can recover (Mondimore
  2002)
• A bit of history
• Amphetamines (1940s 1960s)
• Monoamine Oxidase Inhibitors (1950s present)
• First used to treat Tuberculosis
• Catalyst for the world of antidepressants
• Tricyclics (1990s)
• Selective Serotonin Reuptake Inhibitors (1990s)

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How The Medications Work
Normal Transmission
Abnormal Transmission
Drug-assisting Transmission
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Monoamine Oxidase Inhibitors (MAOI)

• Monoamine Oxidase enzyme
• Side effects
• MAOIs do not mix well with some over-the-counter
  drugs and many foods
• Such products as
• -Cough syrup -Diet pills -Asthma
  medications
• -Cheese -Meats -Certain
  vegetables
• -Preservatives
• These products release the enzyme MAO as the
  inhibitor blocks the enzyme from breaking down.
• A build up will occur in the blood and cause high
  blood pressure that can increase chance of
  stroke.

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Tricyclics

• Considered the standard antidepressant medication
  up until the 1990s
• Treated a variety of patients
• Elderly
• Suicidal patients
• Liver diseased
• Heart attack victims
• Very adverse side effects
• Sedation
• Dry mouth
• Blurry vision
• Rapid heart rate
• Dizziness
• Weight gain
• Easier potential for overdose

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Selective Serotonin Reuptake Inhibitors (SSRI)

• Widely used today as the drugs of choice
• Targets and balances levels of serotonin with few
  side effects
• Prozac
• Zoloft
• Paxil
• Celexa
• Side effects
• Headaches
• Mild nausea
• Sleep Disturbance
• Sexual side effects

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Controversy over drug therapy

• Effectiveness
• FDA approved medications have a 60 - 80 chance
  of improving depressive symptoms
• Herbal and dietary substances
• Omega-3 Fatty Acids
• 5-HTP
• St. Johns Wort
• On-going research
• Antidepressants in the media
• Suicidal thoughts or tendencies as a side effect?
• FDA Release Notes

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Questions and Comments
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References

• Ainsworth, P. (2001). Understanding Depression.
  University Press of Mississippi Jackson, MS.
• DSM-IV. (1994). Mood Disorders. (pp. 317,
  339-348). American Psychiatric Association
  Washington, DC
• Food and Drug Administration. (2004). Public
  Health Advisory retrieved 15 April 2004 from
  lthttp//www.fda.gov/cder/drug/antidepressants/Anti
  depressanstPHA.htmgt
• Gadow, K. D. (1991). Clinical Issues in Child and
  Adolescent Psychopharmacology. Journal of
  Consulting and Clinical Psychology. Vol. 59,
  No. 6, 842-852.
• Kramlinger, K. (2001). Mayo Clinic on
  Depression. Mayo Clinic Rochester, MN.
• Mondimore, F. M. (2002). Adolescent Depression.
  Johns Hopkins University Press Baltimore, MD.