08/05/2020

Patho-physiology

DEPRESSION

Depression:
Major Depressive disorder/ Clinical Depression
Depression is a mood disorder
characterized by persistently low
mood and a feeling of sadness and
loss of interest.
It is a persistent problem, not a
passing one, To be diagnosed with
depression, the symptoms must be
present for at least two weeks
It can affect person’s thoughts,
behaviour, feelings and sense of
wellbeing

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Sadness vs. Depression

Depression is different from the
fluctuations in mood that people
experience as a part of normal life.
Sadness is temporary state of mind
triggered by difficult, hurtful,
challenging, or disappointing event,
experience, or situation. Sadness is
result of something!
Depression is an abnormal emotional
state, a mental illness that affects our
thinking, emotions, perceptions, and
behaviors in pervasive and chronic
ways. In Depression, Sadness is
result of everything!!

Types of Depression
Major Depressive disorder
Persistent depressive disorder (Dysthymia): is a
depressed mood that lasts for at least two years. mild
Postpartum depression: full-blown major
depression during pregnancy or after delivery.
Psychotic depression: occurs when a person has
severe depression plus some form of psychosis
(False beliefs or see or hear something)
Seasonal affective disorder is characterized by the
onset of depression during the winter months, when
there is less natural sunlight.
Bipolar disorder: Episodes of depression followed
by mania

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Wide range of Symptoms.. Not all

1. depressed / low mood
2. reduced interest or pleasure in activities previously
enjoyed, loss of sexual desire
3. unintentional weight loss (without dieting) or low appetite
or weight gain
4. Insomnia (difficulty sleeping) or hypersomnia
(excessive sleeping)
5. psychomotor agitation, for example, restlessness, pacing
up and down
6. delayed psychomotor skills, for example, slowed
movement and speech
7. Fatigue or loss of energy
8. feelings of worthlessness, guilt or helplessness
9. impaired ability to think, concentrate, or make decisions

Symptoms

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Causes & Risk factors

Exact cause is unknown, variety of factors
may be involved
Genetic Factors: heritable, first degree
relatives are more likely to develop
depression.
Biological factors: reduced level of
neurotransmitters, hormonal imbalance
Environmental Factors: Stress, peer
pressure
Psychological –social factors: Childhood
trauma, Divorce, death of parents, work
issues, financial problems etc., Abuse of
alcohol, amphetamines, and other
recreational drugs, prescription drugs
like corticosteroids,

Pathophysiology
1) Monoamine
Hypothesis:
depression is
related to a
deficiency in the
amount or
function of
cortical and limbic
serotonin (5-
HT),
norepinephrine
(NE), and
dopamine (DA).

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Patho-physiology
2) Neurotrophic hypothesis:
Brain Derived growth factor (BNDF)
promotes the growth and
development of immature neurons
including mono-aminergic neurons,
enhances the survival and function
of adult neurons.
Low BNDF level may be
responsible for loss of mono-
aminergic neurons and loss of
function or atrophy of hippocampus
and other brain areas.
Hippocampus lose its ability to
inhibit CRF release by
hypothalamus leading to increased
release of glucocorticoids.

Pathophysiology
3) Neuroendocrine hypothesis:
• Dexamethasone supression test doesn’t reduce
cortisol level in 50% of depression patient;
indicates imbalance in stress HPA axis
(hypothalamus-pituitory- adrenal gland axis).
• Dysregulation in HPA axis results in increased
corticotropinc releasing factor (CRF) from
hypothalamus (result of hippocampus atrophy),
Enlarged adrenal gland and increased secretion of
cortisol (glucocorticoids).
• Dysregulation in HPT axis (hypothalamus-pituitory-
thyroid) creates thyroid hormone defiency, which
may be seen in depression.

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Stress

•CRF level remain

elevated
Hypersecretio Impaired •5-HT, NE,
n feedback Dopamine levels
inhibition
decrease
•Cortisol level
increase
Hypertroph •Decrease
y feedback inhibition
from hippocampus
Hypersecretion

Pathophysiology..Summary

Monoamine Hypothesis
-
5-HT Dopamin Nor-
e adrenaline
Stress

-
CREB

BNDF
- HPA axis

Glucocorticoi
Monoamine ds
Neuronal Cortisol
Atrophy
Neurotrophic hypothesisHippocampus
atrophy Neuroendocrine
hypothesis
Depressi
on

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The worst part about

Depression
People Who Don’t
Have It They Just
Don’t Get It!!