Jayson B Bascos MD

Pathological mood Sustained emotional state Affective disorder

Expression of a transient emotional state

Symptoms sustained over weeks to months

Departure from a persons normal functioning with a tendency for recurrence

And there is a subjective feeling of great distress

Decreased energy Decreased interest Feelings of guilt Difficulty concentrating Loss of appetite Thoughts of death or suicide

Activity level Cognitive abilities Speech Vegetative functions sleep, sex and other biological rythms

Impaired interpersonal, social and occupational functioning.

King saul

Saul's initial conflict with Samuel occurred after Saul offered a sacrifice to God, thereby assuming Samuel's office. Samuel rebuked Saul and proclaimed that Saul's dynasty would not be continued on the throne of Israel. Their second disagreement took place after Saul retained the war booty of the defeated Amalekites, Israel's traditional enemy, and spared the life of their king, Agag. Samuel publicly pronounced Saul's deposition from the throne. Saul fell into a state of melancholia that developed into an emotional disorder. Saul's fits of depression and his moody, suspicious temperament caused him to attack the lad David, who had been brought into his household to soothe him by playing music. Jealous of David, Saul persecuted him, attacked him, sent him on perilous expeditions, and finally made him into an outlaw.

Suicide of Ajax:

When Achilles was killed, his armor was to be awarded to the next greatest Greek hero. Ajax thought it should go to him. Ajax went mad and tried to kill his comrades when the armor was awarded to Odysseus, instead. Athena intervened by making Ajax think cattle were his former allies. When Ajax realized he had slaughtered the herd, he committed suicide as his only honorable end. Ajax used the sword Hector had given him to kill himself.

Seen in more females than males

Hormonal differences Effects of childbirth

Differing psychosocial stressors for men and

women Behavioral models of learned helplessness

Mean of 40 yrs old 50% seen between 20 to 50 years old

Increased in:
Persons without close interpersonal relations Divorced

Separated

Biological factors
Biogenic amines Norepinephrine
Downregulation of beta adrenergic receptors Clinical antidepressant response Indicates a direct role for the noradrenergic system in depression

Serotonin
Biogenic amine neurotransmitter most associated

with depression SSRIs and serotonergic antidepressants are effective in depression therapy Depletion may precipitate suicide in pxs
Low csf concentrations of serotonin metabolites

Chances for mood disorder decreases as degree of relationships widens

2nd degree vs 1st degree relatives

Life events and environmental stressors

Stressful life events precedes mood disorders Alter functional states of various neurotransmitter and intraneuronal signaling systems, changes that may even include the loss of neurons and an excessive reduction in synaptic contacts.

Personality factors
No single personality trait or type predisposes a

person towards depression All humans of whatever pattern can and will become depressed under the appropriate conditions

1. Disturbances in the infant-mother relationship in the oral phase (10-18months) 2. Depression can be linked to real or imagined object loss 3. Introjection of the departed object is a defense mechanism invoked to deal with the distress connected with the objects loss 4. lost object is regarded with a mixture of love and hate, feelings of anger are directed inward and to the self

Depressogenic schemata
Self negative self precept Environment experiences it as hostile and demanding Future suffering and failure

Cognitive triad self, environment and future

Schemas ways of organizing and interpreting experiences

Specific abstraction focus on single detail Arbitrary inference concludes without evidence Magnification/ minimization over or undervaluing event Personalization self reference external events without basis Absolutist thinking all or none

A. five or more of the following symptoms have been present during the same 2 week period and represents a change from previous functioning. At least one of the symptoms is either 1. depressed mood 2. loss of interest or pleasure

1) depressed mood most of the day, nearly everyday as indicated by either subjective report or observation by others

2) markedly diminished interest or pleasure in all or almost all activities most of the day, nearly everyday

3) significant weight loss when not dieting or weight gain; decrease or increase in appetite nearly everyday

4) insomnia or hypersomnia nearly everyday

5) psychomotor agitation or retardation nearly everyday

6) fatigue or loss of energy nearly everyday

7) feelings of worthlessness or excessive inappropriate guilt

8) diminished inability to think or concentrate, or indecisiveness, nearly everyday

9) recurrent thoughts of death

B. the symptoms do not meet criteria for mixed episode

C. symptoms cause clinically significant impairment in social/ occupational functioning

D. Symptoms are not due to direct physiologic effects of a substance or a general medical condition

E. Symptoms are not better accounted for by bereavement

Zung self-rating depression scale

20 item report scale Normal score is 34 or less

Depressed score is 50 or more

Provides a global index of severity of a patients

depression

Hamilton depression rating scale

Widely used scale of 24 items Rated as 0-4 or 0-2 per item

Total score of 0-76

Guilt, suicide, sleep habits and other symptoms of

depression Based on clinicians assessment/ interview

1. Guarantee patients safety

2. Complete diagnostic evaluation must be carried out 3. Treatment plan must address immediate symptoms and patients prospective well being

Cognitive therapy
Alleviate depressive episodes and prevent

recurrence Identify and test negative cognitions Develop alternative, flexible and positive ways of thinking Rehearse and develop new cognitive responses

Interpersonal therapy
Current interpersonal conflicts are likely to have

roots from early disfunctional relationships Current interpersonal conflicts are involved in precipitating or promoting depressive symptoms

Behavior therapy
Maladaptive behavioral patterns result from a

persons receiving little positive feedback and perhaps outright rejection from society

Individual patients may respond to one antidepressant and not to another Most antidepressants interact with serotonergic or noradrenergic neurotransmission or with both
Antidepressants doubles the chance that depression will resolve within 1 month

All currently available antidepressants may take 3-4 weeks to exert significant therapeutic effect Fluoxetine, sertraline, mirtazapine and venlafaxine are safer and have better tolerance profiles than previously used drugs

The principal indication for antidepressants is a major depressive episode First symptom to improve are often poor sleep and appetite patterns Agitation anxiety depressive episodes and hopelessness are the next symptoms to improve