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Brain Chemistry and the Medical Treatment  of Major Depression William J. Giakas, M.D.
What is Major Depression? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What Are The Challenges? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chemical Messengers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Choosing an Antidepressant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Identifying Target Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biological Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Single-Action Antidepressants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Serotonin and Behavior 5-HIAA LO Impulsivity HI
Serotonin Pathways
Pitfalls in SSRI Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Multi-Action Antidepressants ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tricyclic Antidepressants TCA Α 1,2 M1 NRI H 1,2 SRI
Monoamine Oxidase Inhibitors (MAOIs) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Remeron (5-HT and NE) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effexor-XR (5-HT, NE, +-DA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effexor-XR  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Wellbutrin (DA and NE) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Benefits of  “Adverse” Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Focus of Research in Depression Neurotransmitters Surface Receptors Intracellular Signaling Cascades
Hippocampus  ,[object Object],[object Object],[object Object]
Temporal Lobe and Hippocampus
Neuroplasticity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evidence Linking Hippocampal Function To Depression   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Potential Mechanisms of Cell Loss and Atrophy Glucocorticoids Neurotrophic Factors Glutamate
Glutamate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Glucocorticoids  ,[object Object],[object Object],[object Object],[object Object]
Neurotrophic Factors ,[object Object],[object Object]
Brain-Derived Nerurotrophic Factor (BDNF) ,[object Object],[object Object],[object Object]
B Cell Lymphoma Protein-2 (bcl-2) ,[object Object],[object Object]
Intracellular Signaling Source: Manji HK, Quiroz JA, Gould TD (2003)
How Antidepressants Effect Neuroplasticity ,[object Object],[object Object],[object Object]
 
Neurotrophic Effects of Li ,[object Object],[object Object],[object Object],[object Object]
What Does This Mean For The Treatment of Depression? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Electroconvulsive Therapy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ECT in Major Depression
 
 
Treatment Adequacy ,[object Object],[object Object],[object Object],[object Object],[object Object]
High Dose  vs. Low Dose  Unilateral vs. Bilateral Sackeim, et al, Arch Gen Psych, June 2000
Seizure Suppression EMG EEG
AD vs. ECT + AD Gagne et al., Am J Psych, Dec 2000
Vagus Nerve Stimulation  (VNS) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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