psychology, psychophysiology, neurology

1. Depression
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2. Introduction
• Depression is a mood disorder that
causes a persistent feeling of sadness
and loss of interest.
• Also called major depressive disorder
or clinical depression.
• Clinical depression is a serious
condition that negatively affects how
a person
Thinks
Feels
Behaves
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3. Introduction
• In contrast to normal sadness, clinical
depression is persistent, often
interferes with a
Person’s ability to experience or
anticipate pleasure
Significantly interferes with
functioning in daily life.
• Untreated, symptoms can last for
weeks, months, or years.
• If inadequately treated, depression
can lead to
Significant impairment
Other health-related issues
In rare cases, suicide.
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4. Symptoms of Depression
At least one of the five symptoms must be either (1)
depressed mood or (2) loss of interest or pleasure.
 Depressed mood most of the day, nearly every day
 Markedly diminished interest or pleasure in
activities most of the day, nearly every day
 Changes in appetite that result in weight losses or
gains unrelated to dieting
 Changes in sleeping patterns
 Loss of energy or increased fatigue
 Feelings of anxiety, restlessness or irritability
 Feelings of worthlessness, helplessness, or
hopelessness and inappropriate guilt
 Difficulty thinking, concentrating, or making
decisions
 Thoughts of death or attempts at suicide
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5. Depression symptoms in children
In younger children, symptoms of depression may include
• Sadness and irritability
• Clinginess and worry
• Aches and pains
• Refusing to go to school
• Or being underweight
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6. Depression symptoms
in teenagers
• Sadness, irritability, feeling negative,
worthless and anger
• Poor performance or poor attendance at
school
• Feeling misunderstood and extremely
sensitive
• Using recreational drugs or alcohol
• Eating or sleeping too much
• Self-harm
• Loss of interest in normal activities
• Avoidance of social interaction
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7. Depression symptoms in older
adults
• Memory difficulties or personality
changes
• Physical aches or pain
• Fatigue, loss of appetite, sleep problems
or loss of interest in sex not caused by a
medical condition or medication
• Often wanting to stay at home, rather
than going out to socialize or doing new
things
• Suicidal thinking or feelings, especially
in older men

8. Types of Depression
Major
depressive
disorder (MDD)
Bipolar
depression
Perinatal and
postpartum
depression
Persistent
depressive
disorder (PDD)
Premenstrual
dysphoric disorder
(PMDD)
Psychotic
depression
Seasonal
affective
disorder (SAD)

9. Etiology
Risk factors
Biological factors

10. Risk factors
Personality traits, such as low self-esteem and being too dependent, self-
critical or pessimistic
Traumatic or stressful events, such as physical or sexual abuse, the death or
loss of a loved one, a difficult relationship, or financial problems
Blood relatives with a history of depression, bipolar disorder, alcoholism or
suicide
Abuse of alcohol or recreational drugs

11. Risk factors
History of other mental health disorders,
such as anxiety disorder, eating disorders or
post-traumatic stress disorder
Serious or chronic illness, including cancer,
stroke, chronic pain or heart disease
Certain medications, such as some high blood
pressure medications or sleeping pills (talk to
your doctor before stopping any medication

12. Biological factors
The biological factors that
are link with depression
are
•Genetics factors
•Hormonal changes
•Brain chemicals

13. Genetics factors
A study was conducted on Identical and fraternal
twins to see the genes effect in depression.
If genes are part of the cause then identical twin to
have a much higher risk of disease than a patient’s
non-identical twin.
The finding of the study indicated that heritability is
probably 40-50%.
This could mean that in most cases of depression,
around 50% of the cause is genetic, and around 50% is
unrelated to genes (psychological or physical factors).

14. Hormonal
changes
Changes in hormone production or functioning
could lead to the onset of depressive states.
Any changes in hormone states
including menopause, childbirth, thyroid
problems, or other disorders could cause
depression.
With postpartum depression, mothers develop
symptoms of depression after giving birth.

15. Brain
chemicals
The brain chemicals also know as
neurotransmitters.
Neurotransmitters in the brain specifically
• Serotonin
• Dopamine
• Norepinephrine
Affect feelings of happiness and pleasure and
may be out of balance in people with depression.

16. Dopamine
Dopamine creates positive feelings associated with reward or reinforcement
that motivate us to continue with a task or activity.
Dopamine is believed to play an important role in a variety of conditions
affecting the brain, including Parkinson's and schizophrenia.
There is also evidence that reduced dopamine levels can contribute to
depression in some people.
When other treatments have failed, medications that affect the dopamine
system are often added and can be helpful for some people with depression.

17. Norepinephrine
Norepinephrine is both a
neurotransmitter and a
hormone.
It plays a role in the "fight
or flight response" along
with adrenaline.
It helps send
messages from one
nerve cell to the next.
In the 1960s, Joseph J. Schildkraut
suggested norepinephrine was the brain
chemical of interest for depression when
he presented the "catecholamine"
hypothesis of mood disorders.

18. Norepinephrine
Schildkraut proposed
depression occurred when
there is too little
norepinephrine in certain
brain circuits.
Changes in norepinephrine
levels do not affect mood in
every person.
Further, medications
specifically targeting
norepinephrine may alleviate
depression in some people,
but not in others.

19. Serotonin
In addition to helping regulate mood, serotonin has a number of different
jobs throughout the body from gut to blood clotting to sexual function.
In relation to its role in depression, serotonin has taken center stage in the
past few decades thanks to the advent of antidepressant medications like
Prozac (fluoxetine) and other selective serotonin reuptake inhibitors (SSRIs).
Arthur J. Prange, Jr. and Alec Coppen's "permissive hypothesis" suggested
low serotonin levels allowed norepinephrine to fall as well, but that
serotonin could be manipulated to indirectly raise norepinephrine.

20. Role of brain in depression
Studies show that the three
areas are most affected
which are
• Hippocampus
• Amygdala
• Prefrontal cortex.
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21. Hippocampus
Also known as the memory center, the hippocampus is
responsible for producing stress hormone, cortisol.
Excessive release of cortisol, either from high-anxiety situations
or from chemical imbalances, can cause neurons to shrink.
This reaction can be linked to symptoms of major depression
such as memory loss and troubles concentrating.

22. Amygdala
Your amygdala decides whether feel pleasure or fear in result to situations.
The excessive release of cortisol due to depression causes the amygdala to
become hyperactive and enlarged.
This results in the release of unnecessary chemicals and hormones, which
cause further complications.
Hyperactivity in the amygdala is also responsible for any disruptions in
your sleep pattern.

23. Prefrontal Cortex
The prefrontal cortex has a lot of responsibilities, and they
aren’t small.
It regulates emotions, helps make decisions, and assists in the
formation of memories. When the hippocampus releases
extra cortisol, the prefrontal cortex shrinks as a result.
This shrinkage causes the inability to think, remember
information, and/or causes issues with making decisions.

24. Treatment
• Depression is among the most treatable of mental disorders.
Between 80% and 90% percent of people with depression
eventually respond well to treatment.
• Before a diagnosis or treatment, a health professional should
conduct a thorough diagnostic evaluation, including an
interview and a physical examination.
• In some cases, a blood test might be done to make sure the
depression is not due to a medical condition like a thyroid
problem or a vitamin deficiency (reversing the medical cause
would alleviate the depression-like symptoms).

25. Medication
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Antidepressants can help change brain chemistry that causes depression. Classes of antidepressants are:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Tricyclic and tetracyclic antidepressants
Noradrenaline and dopamine reuptake inhibitors (NDRIs)
Monoamine oxidase inhibitors (MAOIs)

26. Therapies
Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression;
for moderate to severe depression, psychotherapy is often used along with antidepressant
medications.
Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT
is a form of therapy focused on the problem solving in the present. CBT helps a person to
recognize distorted/negative thinking with the goal of changing thoughts and behaviors to
respond to challenges in a more positive manner.
Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly
reserved for patients with severe major depression who have not responded to other
treatments. It involves a brief electrical stimulation of the brain while the patient is under
anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12
treatments.

27. Video

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