Depression by Crystal Zhou
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Learning Night, Downtown TO Nov 25, 2015
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Depression by Crystal Zhou
- 1. { Depression A state of feeling sad A serious medical condition in which a person feels very sad, hopeless, and unimportant and often is unable to live in a normal way A period of time in which there is little economic activity and many people do not have jobs
- 2. Common 350 million world wide…most likely more1 The lifetime prevalence of major depression in United States adults is 17 percent 2 Debilitating Leading cause of disability worldwide1
- 7. When is it “depression”?
- 10. MSIGECAPS – 5/9 x 2 weeks Mood changes – low or irritable Sleep changes Interest decrease or loss Guilty, hopeless, worthless Energy decrease Concentration impairment Appetite changes Psychomotor changes Suicidal Ideation Depression: Diagnosis
- 11. Genetics Early Life Adversity, Chronic Stress, Epigenetics Brain Chemistry Body Chemistry Personality and Coping Depression: Causes
- 12. Seasonal change Peripartum Life stressors “Highs” When to look out
- 13. Exercise Mindfulness Supports – family, friends, healthcare Crisis Line Distress Centre: 416-408-HELP (4357) offers access to emotional support from the safety and security of the closest telephone. The Distress Centre offers emotional support, crisis intervention, suicide prevention and linkage to emergency help when necessary What to do when you are worried about depression
- 14. Support Emergency (Hospital) Health Care Professionals What to do when you are worried about someone
- 15. Rule out other medical causes Help with concomitant substance use Psychotherapy Pharmacotherapy ECT Psychoeducation (for family and friends too) What do healthcare professionals do?
- 16. Common Multifactorial Causes MSIGECAPS It is an illness, not a choice There is treatment Key Points
- 17. Thank you!
- 18. Appendix
- 19. Genetics Monozygotic twin studies show between 30% to 50% concordance rate Dizyogtic twin studies show roughly 20% concordance rate So, genetics is definitely part of the story, but not all of it. Depression: Genetics
- 20. Epigenetics, Early Life Adversity and Chronic Stress (epigenetics = how and when genes are expressed) (early life adversity = childhood trauma, neglect, exposure to parents in conflict, etc.) Early Life Adversity and chronic stress can modify gene expression through mechanisms such as histone acetylation and DNA methylation, and thus affect other regulatory mechanisms (e.g. stress regulation mechanism of the hypothalamic- pituitary-adrenal axis) Depression: Epigenetics
- 21. Neurotransmitters implicated in the development and maintenance of depression Monoamines *where most of the current meds act Serotonin Dopamine Norepinephrine GABA Glutamate Hypothalamic-Pituitary-Adrenal Axis dysregulation The physiological stress regulation mechanism of our bodies does not function properly in patients with depression Depression: Brain Chemistry
- 22. Other processes going on your body can also affect the development of depression. Examples: Heart attack Up to 65% of patients with heart attack report depressive symptoms, and 15-22% meet the MSIGECAPS criteria for diagnosis of major depressive disorder. Thyroid disorder Hypothyroidism (decreased function of the thyroid gland) can be associated with emergence of depressive symptoms Hepatitis C liver infection treatment ¼ of people undergoing interferon treatment for Hep C develop depressive symptoms Depression: Body Chemistry
Editor's Notes
- 1: WHO fact sheet on depression 2: Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6):593.
- What are some adjectives you would use to describe depression? Your experience of being in depression, or interacting with someone in depression?
- (Image: http://41.media.tumblr.com/6373096924b18e8088e5894ea26aa723/tumblr_nt2xolz3EY1udjfuio1_500.jpg)
- Many people who are struggling with depression may present outwardly as “fine”. This can stem from existing feelings of guilt regarding their own mental health, feelings of worthlessness (“the world would be better without me”) and not wanting to “drag others down” with them. (Image: http://danmarconecounseling.com/wp-content/uploads/2014/08/Depression_imfine.jpg)
- Much like we don’t tell the cancer patient that the cancer is their fault, I would not tell a depressed patient that their depression is their fault. What I would emphasize, however, is that to begin the journey towards wellness again, they must be willing to work with their healthcare team. They cannot simply be pulled out passively. (Image: http://smope.net/wp-content/uploads/2015/08/tumblr_maec1b474G1rcn12fo1_1280.png)
- When is it “depression” as the clinical term, as opposed to a normal reaction to stressors?
- Nope, not depression (Image: https://annablogia.files.wordpress.com/2013/06/introvert-drawing.png)
- Scenario: 2 months straight of hell at work, deadlines piling up, significant others saying you’re neglecting them at home, not being able to hang out with friends or family, and you feel sad and stressed. Is that depression? What if you began to stop eating, and losing a lot of weight unintentionally? What if you began to stop taking care of yourself? What if you suddenly became catatonic? With increasing severity comes increasing likelihood that a physician would be inclined to initiate treatment, if the patient is also willing. If the patient is at risk of harming themselves or others (e.g. a single mother with young children in her care who cannot function, or someone with depression such that they have psychotic symptoms wherein they are commanded to harm someone else), under the Canada Mental Health Act, a physician may initiate a patient’s admission to hospital even if the patient is not willing. (Image: http://www.lanternaeducation.com/wp-content/uploads/2015/02/Stressed-mouse.jpg?6e8037)
- Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
- For more details, see Appendix section
- “Highs” refer to a different mental health illness, which is also very important – Bipolar Mood Disorder (commonly known as ‘Bipolar Disorder’). Unipolar Mood Disorder = Depression Bipolar Disorder = Mania/Hypomania + Depression. Bipolar disorder has both ends of the mood spectrum, and the “happy” end can be equally damaging to a person’s wellbeing. They can have all these grand, unrealistic plans and quit their current jobs, live a “risky” lifestyle (e.g. increased recreational drug use or IV drug use, increasing number of sexual partners and having unprotected sex, excessive monetary spending), among many other symptoms. People presenting with bipolar depression are indistinguishable clinically from unipolar depression. But treatment is very different. Therefore, if you know someone has a history of “highs” with no external trigger, it is worthwhile to ensure that they mention it to their healthcare provider.
- Exercise reduces the inflammation that is associated with depression Berk et al. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine 11:200
- Psychotherapy = “talk therapy”. Examples include Cognitive Behavioural Therapy, Interpersonal Therapy, Psychodynamic Psychotherapy, etc. Pharmacotherapy = antidepressant medications. ECT = electroconvulsive therapy or “shock therapy”. One of the most effective treatments we have, with 70-90% remission rates (where depressive symptoms are gone). Mechanism of action is still under exploration. The incontrovertible fact remains that it is proven to work. Psychoeducation = explaining what we know about the underlying causes of the mental health illness, what treatment is about, answering any questions, dispelling myths about mental health conditions, and making sure everyone involved is on the same page.
- Huang et al. (2000). Concordance among monozygotic and dizygotic twins from a population-based sample for self-reported atopic triad, syndrome x, and psychiatric conditions. Genetics in Medicine (2000) 2, 79–79 McGuffin et al. (1996). A hospital-based twin register of the heritability of DSM-IV unipolar depression. Arch Gen Psychiatry. 53(2):129-36.
- Berk et al. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine 11:200 Menke et al. (2012). Epigenetics, depression and antidepressant treatment. Cur Pharm Des. 18:5879-5889 Sun et al. (2013). Epigenetics of the depressed brain: role of histone acetylation and methylation. Neuropsychopharmacology. 38:124-137 Walker et al. (2014). Stress, inflammation, and cellular vulnerability during early stages of affective disorders: biomarker strategies and opportunities for prevention and intervention. Front. Psychiatry.
- Belmaker et al. (2008). Major Depressive Disorder. New England Journal of Medicine. 358:55-68 Walker et al. (2014). Stress, inflammation, and cellular vulnerability during early stages of affective disorders: biomarker strategies and opportunities for prevention and intervention. Front. Psychiatry.
- Berk et al. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine 11:200 Thomas et al. (2001). Assessment and Treatment of Depression Following Myocardial Infarction. Am Fam Physician. 64:641-648 Udina et al. (2012) Interferon-induced depression in chronic hepatitis C: a systematic review and meta-analysis. J Clin Psychiatry. 73:1128-1138 Zingelstein (2001). Depression in patients recovering from a myocardial infarction. JAMA. 286:1621-1627