Professional Documents
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bipolar disorder
Dr Mhairi Morris
mhairi.morris@dmu.ac.uk
Learning outcomes
By the end of this lecture you will:
1.Be able to describe the symptoms and diagnosis of
depression
2.Be able to discuss the evolving classifications of
depression
3.Be able to describe the overlap and differences between
depression and other similar disorders such as bipolar
disorder and addiction
4.Be able to discuss a number of different hypotheses
belying the cause of depression
5.Be able to describe the methods to treat depression,
including natural remedies and drug therapy
Introduction
Mental health:
Depression symptoms, facts, classification
Overlap with other disorders bipolar disorder, addiction
Areas of the brain involved and neurotransmission
Causes:
Stress!
Genetics?
Non-shared environment
Monoamine hypothesis
Gut microbiome
Treatment
Depression
15% of population affected
Memory
impairment
Feelings of
worthlessness
Reward/
motivation
Anhedonia
Symptoms
Anxiety
Cognitive
aspects
Guilt
Doom
Emotional
memory
Feelings of
hopelessness
Suicidality
Neurovegetative
symptoms
Too much/too
little sleep
Lack of
energy
Loss of
interest
Loss of
appetite
http://www.nimh.nih.gov/news/science-news/2006/mice-lackingsocial-memory-molecule-take-bullying-in-stride.shtml
Diagnosis
Five of the following 9 for at least 2 weeks:
1.
2.
3.
4.
5.
6.
7.
8.
Depressed mood
Loss of interest/pleasure
Significant weight or appetite alteration
Insomnia or hyposomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness
Diminished ability to think or concentrate or
indecisiveness
9. Suicidal ideation
The facts
75% of patients will have another episode
within 10 years
Suicide = high risk for mortality
High between age of 15 and 24 years
Types of depression
Early 20th Century two concepts:
Emil Kraepelin depression as a disease
Sigmund Freud depression as a manifestation of
internalised anger and loss
Recent classification:
Unipolar (depression)
Bipolar (manic depressive) disorder
Bipolar sensation
seeking and
extraversion
Bipolar disorder
Highs and lows (mania and depression)
Heritable
Also linked to stress (or physical illness)
Treatment:
Lithium mood stabiliser
Sodium valproate anti-convulsant
Anti-psychotics e.g. Olanzapine
limbic system
cingulate gyrus
Neurotransmission
Nor-adrenaline
(nor-epinephrine)
Serotonin
Chronic stress
depletion of
neurotransmitters
https://www.youtube.com/watch?v=InNhDfDfl5c
Back to depression:
what causes it?
Numerous hypotheses:
1.Stress!
2.Genetics?
3.Non-shared environment
4.Monoamine hypothesis
5.Gut microbiome
Stress!
Neurotransmitter depletion
Stress
Chronic stress fire off neurons at rapid rate to
solve problem and escape from the stress
If individual cannot escape chronic stress body
becomes depleted in one of the neurotransmitters
Excitatory
Inhibitory
Dopamine
Dopamine
Noradrenaline
Serotonin
Adrenaline
GABA
Genetics?
But the evidence is sketchy
Genetic epidemiology
Aggregates within families
Meta-analysis estimates heritability at 37%
More prevalent in women
Women reported more interpersonal stresses
Men reported more legal- or work-related stressful
life events
BUT this cannot be attributed to greater prevalence
in women
Genetic epidemiology
Genome-wide association studies (GWAS)
Nothing significant has been found!
Candidate genes
Lots of studies few in agreement!
Evidence points to genetic heterogeneity
Different diseases similar symptoms (incorrectly
identified as the same illness)
OR different pathways same outcome (different
environmental precipitants trigger MD in different
ways, according to the genetic susceptibility of the
individual)
Non-shared environment
Nature vs nurture
Non-shared environment
Aspects of the association of
parenting
Punitive and constructive discipline
Negative life events (independent
and dependent)
Peers (antisocial and prosocial)
http://tinyurl.com/ok526zu
http://tinyurl.com/powmb5z
http://tinyurl.com/om32t2n
http://tinyurl.com/q9so6ue
http://tinyurl.com/q695jpf
Monoamine hypothesis
Monoaminergic systems affect:
Mood
Vigilance
Motivation
Fatigue
Psychomotor agitation or retardation
Monoamine hypothesis
Depletion of monoamines did not induce or
worsen the symptoms of depression in
healthy controls or unmedicated patients
monoamine deficiency alone is not sufficient
for clinical syndrome
However, antidepressants require an intact
monoamine system for their therapeutic
action
Gut microbiome
Bacteria in GI tract
Gut microbiome
Lower levels of
corticosterone mouse
version of cortisol, our
stress hormone (Bravo
et al., 2011)
Conventional treatment SSRIs, NERIs
In combination with psychotherapy
Summary
Mental health:
Depression symptoms, facts, classification
Overlap with other disorders bipolar disorder, addiction
Areas of the brain involved and neurotransmission
Causes:
Stress!
Genetics?
Non-shared environment
Monoamine hypothesis
Gut microbiome
Treatment
Genetic associations:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919201/