Rona ChongDecember 13, 2012

Psych 30Dr. Brown

Depression

Depressed? The Definition• Major Depressive Episode• A. Depressed mood or loss of interest/pleasure• B. Several of these symptoms for 2 weeks or more:

– Change in appetite or significant change in weight– Consistent insomnia or hypersomnia– Restlessness or slowness– Fatigue or loss of energy– Feelings of worthlessness or excessive or inappropriate guilt – Diminished ability to think or concentrate, or indecisiveness– Recurrent thoughts of death, suicidal ideation

• C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• D. The symptoms are not due to drugs or another illness• E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved

one; the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Personal Connection

Personal Connection

What this person said…

diagram from Graffiti – Tony White, psychotherapist

Advances in the Neurobiology of Depression

• Genetic• Molecular• Neuroimaging

Genetic Findings

• Shift away from focus on genes affecting monoamines (neurotransmitters)

• New focus on metabolic pathways related to antidepressants– glucocorticoid receptor genes– Monoamine oxidase A gene– BDNF gene– glutamate receptor genes

• Genes related to serotonin reuptake

Molecular Findings

• Peripheral hormone-type factors affect the physiology of the brain depression

• Altered levels of growth/neurotrophic factors– e.g. decreased levels of BDNF

• Increased levels of proinflammatory cytokines• Altered regulation of the hypothalamic-

pituitary adrenocortical axis

Findings from Neuroimaging

• Specific functional abnormalities in neural systems• In reaction to negative stimuli:– Increased activity in amygdala, ventral striatal, and

medial prefrontal cortex• In reaction to positive stimuli (also reward stimuli):– Reduced ventral striatal activity

• Reduced grey matter in amygdala; pathology in neural and glial cells in prefrontal cortex

Findings from Neuroimaging

• Reduced resting activity in dorsolateral prefrontal cortex

The Big Picture

The Bigger Picture

References• Clark, D. A., & Beck, A. T. (2010). Cognitive theory and

therapy of anxiety and depression: Convergence with neurobiological findings. Trends In Cognitive Sciences, 14(9), 418-424.

• Disner, S. G., Beevers, C. G., Haigh, E. P., & Beck, A. T. (2011). Neural mechanisms of the cognitive model of depression. Nature Reviews Neuroscience, 12(8), 467-477.

• Kupfer, D. J., Frank, E., & Phillips, M. L. (2012). Major depressive disorder: New clinical, neurobiological, and treatment perspectives. The Lancet, 379(9820), 1045-1055.