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Jayson B Bascos MD

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Pathological mood Sustained emotional state

Affective disorder

Expression of a transient emotional state

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Symptoms sustained over weeks to months

Departure from a persons normal functioningwith a tendency for recurrence

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And there is a subjective feeling of greatdistress

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Decreased energy Decreased interest

Feelings of guilt Difficulty concentrating Loss of appetite Thoughts of death or suicide

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Activity levelCognitive abilities

SpeechVegetative functionssleep, sex and other biological rythms

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Impaired interpersonal, social andoccupational functioning.

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King saul

Saul's initial conflict with Samuel occurred after Saul offered asacrifice to God, thereby assuming Samuel's office. Samuelrebuked Saul and proclaimed that Saul's dynasty would not becontinued on the throne of Israel. Their second disagreement tookplace after Saul retained the war booty of the defeatedAmalekites, Israel's traditional enemy, and spared the life of theirking, Agag. Samuel publicly pronounced Saul's deposition fromthe throne. Saul fell into a state ofmelancholia that developedinto an emotional disorder.

Saul's fits of depression and his moody, suspicious temperamentcaused him to attack the lad David, who had been brought into hishousehold to soothe him by playing music. Jealous of David, Saulpersecuted him, attacked him, sent him on perilous expeditions,and finally made him into an outlaw.

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Suicide of Ajax:

When Achilles was killed, his armor was to be

awarded to the next greatest Greek hero. Ajaxthought it should go to him. Ajax went mad andtried to kill his comrades when the armor wasawarded to Odysseus, instead. Athenaintervened by making Ajax think cattle were hisformer allies. When Ajax realized he hadslaughtered the herd, he committed suicide ashis only honorable end. Ajax used the swordHector had given him to kill himself.

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Seen in more females than males

Hormonal differences

Effects of childbirth

Differing psychosocial stressors for men andwomen

Behavioral models of learned helplessness

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Mean of 40 yrs old50% seen between 20 to 50 years old

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Increased in:

Persons without close interpersonal relations

Divorced

Separated

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Biological factors

Biogenic amines

Norepinephrine Downregulation of beta adrenergic receptors

Clinical antidepressant response

Indicates a direct role for the noradrenergic system indepression

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Serotonin

Biogenic amine neurotransmitter most associated

with depression SSRIs and serotonergic antidepressants are

effective in depression therapy

Depletion may precipitate suicide in pxs

Low csf concentrations of serotonin metabolites

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Chances for mood disorder decreases asdegree of relationships widens

2nd

degree vs 1st

degree relatives

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Life events and environmental stressors

Stressful life events precedes mood disorders

Alter functional states of various neurotransmitter andintraneuronal signaling systems, changes that may eveninclude the loss of neurons and an excessive reduction insynaptic contacts.

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Personality factors

No single personality trait or type predisposes a

person towards depression All humans of whatever pattern can and will

become depressed under the appropriate

conditions

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1. Disturbances in the infant-motherrelationship in the oral phase (10-18months)

2. Depression can be linked to real orimagined object loss

3. Introjection of the departed object is adefense mechanism invoked to deal with the

distress connected with the objects loss 4. lost object is regarded with a mixture of

love and hate, feelings of anger are directedinward and to the self

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Depressogenic schemata

Self

negative self precept Environment experiences it as hostile and

demanding Future suffering and failure

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Cognitive triad self, environment and future

Schemas

ways of organizing andinterpreting experiences

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Specific abstraction focus on single detail Arbitrary inference concludes without

evidence Magnification/ minimization over or

undervaluing event Personalization self reference external

events without basis Absolutist thinking all or none

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A. five or more of the following symptomshave been present during the same 2 week

period and represents a change fromprevious functioning. At least one of thesymptoms is either

1. depressed mood 2. loss of interest or pleasure

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1) depressed mood most of the day, nearlyeveryday as indicated by either subjective

report or observation by others

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2) markedly diminished interest or pleasure inall or almost all activities most of the day,

nearly everyday

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3) significant weight loss when not dieting orweight gain; decrease or increase in appetite

nearly everyday

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4) insomnia or hypersomnia nearly everyday

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5) psychomotor agitation or retardationnearly everyday

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6) fatigue or loss of energy nearly everyday

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7) feelings of worthlessness or excessiveinappropriate guilt

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8) diminished inability to think orconcentrate, or indecisiveness, nearly

everyday

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9) recurrent thoughts of death

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B. the symptoms do not meet criteria formixed episode

C. symptoms cause clinically significantimpairment in social/ occupationalfunctioning

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D. Symptoms are not due to direct physiologiceffects of a substance or a general medical

condition

E. Symptoms are not better accounted for bybereavement

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Zung self-rating depression scale

20 item report scale

Normal score is 34 or less Depressed score is 50 or more

Provides a global index of severity of a patients

depression

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Hamilton depression rating scale

Widely used scale of 24 items

Rated as 0-4 or 0-2 per item Total score of 0-76

Guilt, suicide, sleep habits and other symptoms of

depression

Based on clinicians assessment/ interview

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1. Guarantee patients safety

2. Complete diagnostic evaluation must becarried out

3. Treatment plan must address immediate

symptoms and patients prospective wellbeing

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Cognitive therapy

Alleviate depressive episodes and prevent

recurrence Identify and test negative cognitions

Develop alternative, flexible and positive ways of

thinking

Rehearse and develop new cognitive responses

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Interpersonal therapy

Current interpersonal conflicts are likely to have

roots from early disfunctional relationships

Current interpersonal conflicts are involved inprecipitating or promoting depressive symptoms

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Behavior therapy

Maladaptive behavioral patterns result from a

persons receiving little positive feedback and

perhaps outright rejection from society

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Individual patients may respond to oneantidepressant and not to another

Most antidepressants interact withserotonergic or noradrenergicneurotransmission or with both

Antidepressants doubles the chance thatdepression will resolve within 1 month

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All currently available antidepressants maytake 3-4 weeks to exert significant

therapeutic effect Fluoxetine, sertraline, mirtazapine and

venlafaxine are safer and have bettertolerance profiles than previously used drugs

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The principal indication for antidepressants isa major depressive episode

First symptom to improve are often poorsleep and appetite patterns Agitation anxiety depressive episodes and

hopelessness are the next symptoms to

improve

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