Major Depressive Episode criteria
Sad for 2 weeks OR anhedonia plus 4 of the following:
-Fatigue, insomnia/hypersomnia, appetite changes, poor concentration, suicidal ideation, pathological guilt
Can be melancholic or psychotic
Subtypes of MDD
- Neurotic depression (associated with life events)
- Melancholia (not related to life events)
- Atypical (reverse vegetative features ie over eating/sleeping)
- Seasonal (responsive to light therapy)
* - Psychotic (delusions and hallucinations)
- Chronic (2 years)
- Post-partum
What is the “kindling” phenomenon
With increasing depressive episodes, there is an increased risk of depression and a decreased association with stressful life events…like a sensitization of a depressed state
Serotonin transporter gene
Short allele=worse outcomes (2x greater risk)
What is the largest risk factor for depression?
Lack of social support, but risk factors are cumulative
What are the areas of the brain implicated in MDD
- Insular cortex
- emotionally relevant context for sensory experience - Hippocampus
- Memory, vulnerable to chronic stress
- See neurodegeneration before onset of illness - Amygdala
- Processing and memory of emotional reactions
- Gets increased blood flow
- Inc metab associated with elevated plasma cortisol level - Anterior cingulate cortex
- Integrates emotional stimuli and attentional functions
- Once ACC begins to atrophy, drugs work less - Medial orbitofrontal cortices
- Smaller - VLPFC
- Executive function
- Increased bloodflow
BDNF polymorphism and depression
BDNF is a neurotrophic factor that promotes learning/memory and neuronal growth and fxn. It may be down-regulated in depression.
MDD pts with met-BDNF instead of val-BDNF have smaller hippocampal volume
Treatment of MDD may restore BDNF fxn
Bipolar disorder subforms
- Rapid cycling (4+ mood episodes in 1 yr, more difficult prognosis)
- Mixed features (mania/hypomania and depression)
- Seasonal pattern
- With psychotic features (often occurs during mania)
DSM criteria for mania
7 days of abnormally elevated or irritable mood and at least 3 of:
-Grandiosity, decreased sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity/agitation, poor judgement/risky behavior
Must have impairment to occupational or social functioning and can’t be due to anything else
What is the median age of onset for BPD
17.5 (90% before 30)
Suicide in BPD
more likely than MDD to complete suicide, but risk of MDD suicide is greater
Treatment of BPD
Combo therapy! Mood stabilizers (lithium, divalproex, cabramazapine, antipsychotics) and ECT
