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CORNELL HD 3700 - Depression
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HD 3700 1st Edition Lecture 13Outline of Last Lecture I. Brain ImagingII. Ophelia’s DilemmaIII. How the brain is organized IV. NeuronsV. NeurotransmissionOutline of Current LectureI. Polonius the psychiatristII. Defining depressionIII. Beck’s Cognitive TheoryIV. The brain and depressionV. Neurons and depressionVI. MAO inhibitors/tricyclics/SSRIs and how they work on serotonergic and noradrenergic pathwaysCurrent LectureI. Act II Scene II—Polonius the Psychiatrist- Polonius is the fool of the play and doesn’t know it- Gertude is not intelligent either- Claudius is the best reader of the play- Polonius is the bad psychiatrist—says “I know what’s wrong with that person” but he has no idea—biggest mistake made by clinicians is jumping to conclusionsII. Defining depression- There is a debate about the whole idea of diagnosis—labels follow someoneo Must take your time with diagnosis—especially with childreno Diagnosis necessary to frame their problem and treat them—don’t want to underpathologize patients- Range of moodo Severe maniao Hypomania (mild to moderate mania)o Normal/balanced moodo Mild to moderate depressiono Severe depression- Range of mood much more variable in young people- Kinds of depressiono Dysthymia (mild depression) Never so depressed that they can’t function Down a lot of the time Persistent Depressive Disorder- Depressed mood for most of the day, for more days than not- Poor appetite or overeating- Insomnia or hypersomnia- Low energy or fatigue- Low self-esteem- Poor concentration- Feelings of hopelessness - Present for 2 yearso Unipolar depression (depression only) Recurrent experiences of severe depressive episodes Major Depressive Disorder- Depressed mood most of the day, nearly every day- Diminished interest or pleasure in all activities- Significant weight loss or weight gain- Insomnia or hypersomnia- Psychomotor agitation or retardation- Fatigue or loss of energy nearly every day- Feelings of worthlessness - Diminished ability to think or concentrate- Recurrent thoughts of death/suicidal ideationo Bipolar Depression I (depression/mania) Manic depression—cycle with periods of severe depression with periods of psychotic maniao Bipolar Depression II (depression/hypomania) If you have relative with Bipolar I, you might have something that seems like Bipolar I but less serious  More common than Bipolar I Hypomanic episodes followed by severe depressive episodeso Cyclothymia (dysthymia/hypomania) Periods of dysthymia and hypomania- Dysthymiao Depressed mood for most of the day- Prevalenceo 5 -11% lifetime prevalenceo 10-15 million people a yearo 50% recurrence after a single episodeo Rule of 7s 1/7 with recurrent depressive illness commits suicide 70% of suicides have depressive illness 70% of suicides see their primary physician within 6 weeks of suicide Suicide is the 7th leading cause of death- Ways to explain depressiono Anger turned toward the self—Freud/psychoanalysts o Defense: Sadness blocks Anger (and Guilt)o Attributional Style: Global, Permanent, Internal Depressive attributions I’m bad all around, this will never be different, and I’m inadequateo Problems with Attachment: depression=mourning See this in kids with foster careo Biological Disorder Some evidence for this with major depressive disorder and bipolardisorderIII. Beck’s Cognitive Model- Beck’s Cognitive model of the emotionso Event  thought (interpretation)  emotiono Interpret the event differentlyo Micro thought that interprets the event and triggers the feelingso Psychotherapy is about changing the interpretation Fixing the distorted interpretations- Attributional “style” and depression: why we think things happeno Non-depressed: external, single event, specific domaino Depressed: internal, permanent, globalo Cognitive treatment of depression is getting the patients to become aware of these interpretations and change the outcomes Freud: “changing the association”IV. The brain and depression- Classical model of inherited diseaseo 100% will develop the inherited diseaseo But if we think of depression as a disease, why is it that identical twins don’t always both get depression?- The “Multi-Hit” Modelo Biological risk factors  Enzyme production Brain development in utero Brain development in adolescence o Environmental risk factors Early trauma Physical abuse Lost a parent Witnessed violenceo Life events and how you are taught to cope  Interact with genetic vulnerability factors- Three kinds of peopleo Those who don’t suffer from depression or dysthymia, who have bad days, will grieve a loss, but don’t spiral down into a major depressive episode.o Those who usually don’t suffer from depression but, when stressed beyond a certain point, develop depressive symptoms and benefit from a short-term use of medication and therapy to come out of it. When the stress or crisis resolves, they often taper off their meds without a relapse.o Those who are chronically depressed without medication. Psychotherapy may be helpful in that it provides insight and ways to minimize stress, but these people only experience substantial relief with medication. 5% of people- What can the brain tell us about depression?o Structure o Pathwayso Neuron action- Brain structure: Depression, Stress, and the HPA-Axiso When you feel threatened, the hypothalamus sends out cortico-tropin-releasing hormone (CRH) which releases adrenocorticotropin hormone (ACTH) from the pituitary gland. ACTH surges through the body releasing stress reducing hormones such as cortisol from the adrenal gland. Once cortisol reaches a certain level, the hypothalamus shuts off the CRH.o But in depressed people, this shutdown fails, possibly because the perceived stress is chronic, leading to excess amounts of CRH. This alsoleads to dentrite damage in the hippocampus neurons that have CRH receptors. Damaged hippocampal dendrites are linked to depression and prolonged grief.o Evidence for this in rats: with constant stress exposure, exhibit depressionand damage in hippocampal neuronso Being chronically depressed is keeping the body agitated and damaging part of the brain- Brain Structure: depression’s neuroanatomical circuitryo Study this diagram for the prelim!! Figure 8.1o Prefrontal Cortex – decreased volume and increased activity linked to depressiono Hippocampus also seems


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CORNELL HD 3700 - Depression

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