PSYC 415 -- Dr. King -- Study Points for Depression

I. classification
   A. reactive vs. endogenous - environmentally causes vs. biologically caused
   B. continuous vs. episodic
   C. unipolar vs. bipolar ("manic depression")
II. several different "types"
   A. major depressive disorder (MDD) - endogenous (no obvious environmental cause)
   B. bipolar disorder - alternating periods of depression and mania
   C. dysthymia - continuous low, dark, or sad mood but not as bad as major depression
      1. at one time called neurotic depression
      2. more likely to be reactive than MDD (so says the conventional wisdom)
III. prevalence - book says 3-7% (MDD); about twice as prevalent in women as men
IV.symptoms - despair, guilt, unworthiness, hopelessness, apathy, anhedonia,
   amotivational state; 15% attempt suicide
V. major depressive disorder is heritable
   A. twin studies -69% concordance in MZ twins; 13% concordance in DZ twins
   B. studies of biological relatives
   C. genes coding for the serotonin transporter are implicated
VI. treatments
   A. traditional talking psychotherapies have not been very useful (for MDD)
   B. drug treatment
      1. MAOIs - monoamine oxidase inhibitors
      2. tricyclic antidepressants
      3. SSRIs - selective serotonin reuptake inhibitors (e.g., Prozac)
      4. SNRIs - serotonin and norepinephrine reuptake inhibitors (e.g., Cymbalta)
      5. lithium carbonate - for bipolar disorder
   C. 20-40% of patients are drug resistant
   D. other treatments that have proven successful
      1. electroconvulsive therapy (ECT)
      2. sleep deprivation (temporarily)
      3. phototherapy (for seasonal affective disorder)
      4. deep brain stimulation - to the subgenual anterior cingulate cortex
      5. vagus nerve stimulation
VII. monoamine hypothesis - some combo of serotonin, norepinephrine, and/or dopamine
     are deficient in depressed individuals
   A. most popular theory for decades
   B. depletion of brain MAs can cause depression (reserpine, tryptophan depletion)
   C. suicidal depression is associated with low 5-HIAA levels
   D. based primarily on the kinds of drugs that work - monoamine agonists
   E. role of dopamine is unknown (but suggested by use of drugs like Welbutrin)
VIII. sleep cycles (and circadian rhythms in general) are abnormal in depressives
   A. seasonal affective disorder
   B. disorganized sleep cycles
      1. very little if any deep slow-wave sleep
      2. scattered and broken up REM periods
      3. frequent awakenings
   C. sleep deprivation is an effective treatment for depression
      1. total sleep deprivation has a temporary effect
      2. selective REM deprivation over several weeks has a longer lasting effect
      3. all drugs that suppress REM sleep are effective antidepressants
   D. Wu and Bunney theory - we produce a depressogenic substance while we sleep
      which is broken down during waking
IX. the resiliance theory - very "hot" these days
   A. stress and stress hormones damage brain cells
   B. most of us can repair this damage - our brains are resiliant
   C. people prone to depression cannot repair this damage for some reason
   D. brain damage (e.g., repeated concussions) make people much more susceptable
   E. antidepressant drugs and ECT promote neurogenesis in the hippocampus
X. amygdala, subgenual anterior cingulate cortex, and prefrontal cortex are
   implicated by scanning studies
XI. depression and the frontal lobes - possible role of executive functions
XII. in summary
   A. something biological is clearly going on in people with MDD
   B. 50 years of research into what that might be has led to no breakthroughs
   C. resiliance theory is promising
   D. as of now, drug therapy, cognitive-behavioral therapy, and ECT are the best
      we have to offer