Many researchers believe there's no single gene that puts someone at risk for depression.

It's more
likely a combination of genes that lead to the disorder.

Twins – if one is diagnosed with depression, 70% chance for the twin to be diagnosed also.

Although it is widely believed that a serotonin deficiency plays a role in depression, there is no way to
measure its levels in the living brain. Therefore, there have not been any studies proving that brain
levels of this or any neurotransmitter are in short supply when depression or any mental illness
develops. Blood levels of serotonin are measurable -- and have been shown to be lower in people who
suffer from depression - but researchers don't know if blood levels reflect the brain's level.

Depression: Persons ages 40–59 years had the highest prevalence of probable depression (9.2%) relative
to persons ages 18–39 (7.6%) and ages ≥60 (6.7%). Non-Hispanic Black (9.8%) and Hispanic (9.2%)
persons had higher prevalence of probable depression than non-Hispanic White persons (7.5%) or
persons of Other race (7.2%)

Risk Factors for depression

- Biochemistry
- Genetics
- Personality
- Environmental Factors

Autoimmune: Up to 50% of patients with autoimmune diseases show an impairment of health-related

quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation
in affected organs, but also mediates behavior abnormalities including fatigue and depression-like
symptoms.

Some examples of chronic illnesses that may cause depression are diabetes, heart disease, arthritis,
kidney disease, HIV and AIDS, lupus, and multiple sclerosis (MS). Hypothyroidism (in the labs) may also
lead to depressed feelings.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the
diagnosis of a Major Depression Episode (MDE) requires five or more symptoms to be present within a
2-week period. One of the symptoms should, at least, be either a depressed mood (DM) or
anhedonia (loss of interest or pleasure - LI).

The secondary symptoms of MDE are appetite or weight changes (AW), sleep difficulties (insomnia or
hypersomnia), psychomotor agitation or retardation (PAR), fatigue or loss of energy (FE), diminished
ability to think or concentrate (C), feelings of worthlessness or excessive guilt (FW), and suicidality (SU).

These symptoms are summed to determine the presence or the absence of a major depression episode.
Types of Depression

1. Major Depression. – severe form of depression.

2. Persistent Depressive Disorder. – dysthmia or chronic depression.
3. Bipolar Disorder. - consists of periods of mania or hypomania, where you feel very happy,
alternating with episodes of depression. Manic depression is an outdated name for bipolar
disorder.
4. Seasonal Affective Disorder (SAD) - is a type of depression that's related to changes in seasons
— SAD begins and ends at about the same times every year.
5. Psychotic Depression - losing touch of the reality which can involve hallucinations and
delusions.
6. Peripartum (Postpartum) Depression. - depression suffered by a mother following childbirth,
typically arising from the combination of hormonal changes, psychological adjustment to
motherhood, and fatigue.
7. Premenstrual Dysphoric Disorder (PMDD) - is a severe form of premenstrual syndrome (PMS)
PMDD symptoms tend to be mostly psychological.
8. 'Situational' Depression - adjustment disorder with depressed mood, looks like major depression
in many respects. Is a reaction to stressful life events that brings on depressive symptoms.

Major Life Events (Both Immediate and Prolonged)

1. Divorce.
2. A breakup.
3. A death in the family.
4. Job loss.
5. The failure of a business.
6. Loss of a home to a natural disaster.
7. A serious physical injury.
8. Childbirth (known as postpartum depression)

FOR LABS

Blood test. Anemia & TSH.

Study by madiha shati that depressed participants were found to have higher frequency of anemia 73%,
as compared to non depressed participants 16%

A prevalence of 63. 5% of depressive symptoms was reported in an italian population with subclinical
hypothyroidism.
According to the American Association of Clinical Endocrinologist the diagnosis of subclinical or clinical
hypothyroidism (chronic illness that leads to depression) must be considered in pt with depression.

PATHOPHYSIOLOGY

Inflammatory, Infectious and stressful challenges ----- trigger----- activation of the resident microglia.

Activated Microglia ------- produce ----- pro inflammatory cytokines --- w/c contributes to ---
neurodegeneration and depressive disorders --- through hyperactivation of the HPA axis & in
indoleamine – 2, -3 dioxygenase (IDO) enzyme activity .

Hyper-activation of the HPA axis --- leads -- of corticotrophin-releasing hormone (CRH),

adrenocorticotropic hormone (ACTH) and cortisol --- disturb neurotransmitter homeostasis mainly
mainly noradrenergic and serotonergic systemsand the neuronal growth factor synthesis.

IDO --- syenthesis of serotonin. TAKE NOTE: that low levels of serotonin are linked to depression. ---
switched the balance to tryptophan and production of kyneuric acid (KYN) and quinolic acid (QUIN).

DEPLETION of serotonin ---- leads to depressive symptoms.

QUIN acts as a neurotoxin, gliotoxin, pro-inflammatory mediator that can alter the integrity of the
blood–brain barrier (BBB).

ANATOMY AND PHYSIOLOGY

Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus

Amygdala: The amygdala is part of the limbic system, a group of structures deep in the brain that's
associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. The amygdala is
activated when a person recalls emotionally charged memories, such as a frightening situation. Activity
in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues
even after recovery from depression.

Thalamus: The thalamus receives most sensory information and relays it to the appropriate part of the
cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement,
thinking, and learning. Some research suggests that bipolar disorder may result from problems in the
thalamus, which helps link sensory input to pleasant and unpleasant feelings.

Researchers also found that the size of the affected areas of the thalamus in subjects with MDD was 16
percent larger than those in the other groups.
"The thalamus is often referred to as the secretary of the cerebral cortex - the part of the brain that
controls all kinds of important functions such as seeing, talking, moving, thinking and memory," Dr.
German said. "Most everything that goes into the cortex has to go through the thalamus first.

"The thalamus also contains cells that are not involved with emotion. Our studies found these portions
of the thalamus to be perfectly normal. But the ones that are involved in emotion are the ones that
were abnormal."

Severe depression associated with greater number of nerve cells in thalamus region of brain. Individuals
who suffer from severe depression have more nerve cells in the part of the brain that controls emotion,
researchers at UT Southwestern Medical Center at Dallas have found

Hippocampus: The hippocampus is part of the limbic system and has a central role in processing long-
term memory and recollection. Interplay between the hippocampus and the amygdala might account
for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are
confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of
dogs you come across later in life. The hippocampus is smaller in some depressed people, and research
suggests that ongoing exposure to stress hormone impairs the growth of nerve cells in this part of the
brain.

Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI
study published in The Journal of Neuroscience, investigators studied 24 women who had a history of
depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with
those who were not depressed. The more bouts of depression a woman had, the smaller the
hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe
stress can suppress the production of new neurons (nerve cells) in the hippocampus.

Selective serotonin reuptake inhibitors (SSRIs) are a widely used type of antidepressant. They're mainly
prescribed to treat depression, particularly persistent or severe cases, and are often used in combination
with a talking therapy such as cognitive behavioural therapy (CBT). Citalopram (Celexa)

Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)
SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical
messengers (neurotransmitters) that carry signals between brain nerve cells (neurons). SSRIs block the
reabsorption (reuptake) of serotonin into neurons.

Fluoxetine exerts its effects by blocking the reuptake of serotonin into presynaptic serotonin neurons by
blocking the reuptake transporter protein located in the presynaptic terminal. Fluoxetine also has mild
activity at the 5HT2A and 5HT2C receptors.

Prozac is selective serotonin reuptake inhibitor (SSRI). It works by blocking the absorption of the
neurotransmitter serotonin in the brain. Regulating the amount of serotonin helps brain cells transmit
messages to each other. This results in a better and more stable mood. Fluoxetine helps many people
recover from depression, and it has fewer unwanted effects than older antidepressants.

Prozac (fluoxetine) recommends it be taken in the morning because it can make some people feel more
energized, especially at the beginning of treatment

For panic disorder: Adults—At first, 10 milligrams (mg) per day as a single dose in the morning. Your
doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.

CEPHALO CAUDAL ASSESSMENT

CNS

According to the American Psychological Association, older adults with depression have more difficulties
with memory loss and reaction time during everyday activities compared with younger adults with
depression.

DIGESTIVE SYSTEM

While depression is often thought of as a mental illness, it also plays a heavy role in appetite and
nutrition. Some people cope by overeating or bingeing. This can lead to weight gain and obesity-related
illnesses, such as type 2 diabetes. You may even lose your appetite entirely, or fail to eat the right
amount of nutritious food. A sudden loss of interest in eating in older adults can lead to a condition
called geriatric anorexia

CV & IMMUNE SYSTEM

Depression and stress are closely related. Stress hormones speed heart rate and make blood vessels
tighten, putting your body in a prolonged state of emergency. Over time, this can lead to heart disease.

SUICIDE PREVENTION

If you think someone is at immediate risk of self-harm or hurting another person:

Call 911 or your local emergency number.

Stay with the person until help arrives.

Remove any guns, knives, medications, or other things that may cause harm.

Listen, but don’t judge, argue, threaten, or yell.