biom2002_mental health, depression, bipolar disorder_dr morris wk 5

7/23/2019 BIOM2002_Mental Health, Depression, Bipolar Disorder_Dr Morris Wk 5

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Mental health, depression and

bipolar disorder

Dr Mhairi Morris

[email protected]


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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

depression3.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 hypothesesbelying the cause of depression

.Be able to describe the methods to treat depression!

including natural remedies and drug therapy


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Introduction

"ental health:#$epression % symptoms! facts! classification

#&verlap with other disorders % bipolar disorder! addiction

#'reas of the brain involved and neurotransmission

#(auses:% )tress*

% +enetics,

% -onshared environment

% "onoamine hypothesis% +ut microbiome

#/reatment


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Introduction to mental health


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Depression

10 of population affected

)ymptoms

(ognitive

aspects

eward

motivation

eelings of

hopelessness

"emory

impairment

eelings of

worthlessness

+uilt

$oom

)uicidality

motional

memory

'nhedonia

'n5iety

6-eurovegetative

symptoms7

/oo muchtoo

little sleep

8ack of

energy

8oss of

appetite

8oss of

interest

http:www.nimh.nih.govnewssciencenews299micelackingsocialmemorymoleculetakebullyinginstride.shtml


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Body map energy (sensory activity)


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Diagnosis

ive of the following ; for at least 2 weeks:

1. $epressed mood

2. 8oss of interestpleasure

3. )ignificant weight or appetite alteration

4. . eelings of worthlessness

?. $iminished ability to think or concentrate or

indecisiveness

;. )uicidal ideation


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The facts# >0 of patients will have another episode

within 19 years

# )uicide high risk for mortality

% Aigh between age of 1 and 24 years

# )trong link between depression and ($# 'n5iety generally precedes depression

# 'lcohol misuse is eCually likely to pre or

postdate onset of depression


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Types of depression

# arly 29th

(entury % two concepts:% mil Draepelin % depression as a disease

% )igmund reud % depression as a manifestation of

internalised anger and loss

# )ir "artin oth and the -ewcastle +roup:% 6ndogenous7 % independent of precipitating events

% 6eactive7 % e5aggerated reaction to life events

#ecent classification:% Enipolar FdepressionG

% Bipolar Fmanic depressiveG disorder


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!eparation bet"een depression

and other disorders

# /wo disorders that overlap FdiagnosticallyG:

%'n5iety

% Bipolar disorder

# Aow linked are they,% 90 of depressed patients report one or more an5iety

disorders

% Bipolar is actually separate

# 'ge of onset is H1 years earlier# ecurs more freCuently

# 8inked with certain personality types

"$ % neuroticism

Bipolar % sensation

seeking and

e5traversion


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Bipolar disorder# Aighs and lows Fmania and depressionG

# Aeritable

# 'lso linked to stress For physical illnessG

# /reatment:% 8ithium % mood stabiliser

% )odium valproate % anticonvulsant

% 'ntipsychotics % e.g. &lanIapine


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#reas of the brain

cingulate gyruslimbic system


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$eurotransmission

-oradrenaline

FnorepinephrineG

)erotonin

(hronic stress

depletion of

neurotransmitters

https:www.youtube.comwatch,v


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Molecular basis of addiction

# 8oss of control over drug intake

# Aeritable % 90 of risk is genetic

# )imilar regions of brain involved:

%'mygdala

% Aippocampus% rontal corte5

# 'lterations in dopamine system

# epeated! e5treme perturbation of neuronsdramatic alterations in reward mechanisms

and motivational state...


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Bac% to depression&

"hat causes it'

-umerous hypotheses:

1.)tress*

2.+enetics,

3.-onshared environment

4."onoamine hypothesis

.+ut microbiome


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)tress*

-eurotransmitter depletionJ


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!tress# (hronic stress6fire off7 neurons at rapid rate to

6solve7 problem and escape from the stress

#


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+enetics,

But the evidence is sketchyJ


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*enetic epidemiology

# 'ggregates within families

# "etaanalysis estimates heritability at 3>0

# "ore prevalent in women

% Komen reported more interpersonal stresses

% "en reported more legal or workrelated stressfullife events

% BE/ this cannot be attributed to greater prevalence

in women


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*enetic epidemiology

# +enomewide association studies F+K')G

% -othing significant has been found*

# -o evidence that shared environmental factors

contribute significantly

# "ore likelyJmodel of a comple5 disorder


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+andidate genes

# 8ots of studies % few in agreement*

# vidence points to genetic heterogeneity

% $ifferent diseases % similar symptoms Fincorrectly

identified as the same illnessG% & different pathways % same outcome Fdifferent

environmental precipitants trigger "$ in different

ways! according to the genetic susceptibility of the

individualG


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-onshared environment

-ature vs nurtureJ


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$onshared environment

# 'spects of the association ofparenting

% =unitive and constructive discipline

% Negative life events Findependentand dependentG

% =eers Fantisocial and prosocialG


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/he monoamine hypothesis

-oradrenaline and dopamineJ


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http&--tinyurl.com-po"mb/0

http&--tinyurl.com-123/4pf

http&--tinyurl.com-om56t6n http&--tinyurl.com-13so2ue

http&--tinyurl.com-o%/620u


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Monoamine hypothesis

# "onoaminergic systems affect:

% "ood

% igilance

% "otivation

% atigue% =sychomotor agitation or retardation

# 'bnormal function and behaviour

%'ltered synthesis! storage or release

% $isturbed sensitivity of receptors or subcellular

messenger functions


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Monoamine hypothesis

# $epletion 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

# Aowever! antidepressants reCuire an intact

monoamine system for their therapeutic

action


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+ut microbiome

Bacteria in +< tractJ


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*ut microbiome# 195 more microbial cells

# )ymbiotic FcommensalG

# )tress alters balance

# Bacteria in +< tract can activate neural pathways and

(-) signalling systems

# (linical studies % microbiotagutbrain a5is

prevention and treatment of mental illness

# 'lterations in microbiota

influence stressrelatedbehaviours


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/reatment and therapies


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7revention and treatment

# $iet % eat a rainbow* Fand a banana a dayJG

# =robiotics* Fgenerate +'B' and enhance brain

receptors for +'B'G

# (onventional treatment % ))


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!ummary"ental health:

#$epression % symptoms! facts! classification

#&verlap with other disorders % bipolar disorder! addiction

#'reas of the brain involved and neurotransmission

#(auses:% )tress*

% +enetics,

% -onshared environment

% "onoamine hypothesis

% +ut microbiome

#/reatment


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Additional reading and resources

#

biom2002_mental health, depression, bipolar disorder_dr morris wk 5

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