• unlike sadness, affect multiple physiological symptoms, and is less responsive/ unresponsive to positive environmental events
• emotional, physical, cognitive elements

MUST BE FOUR OF THESE IN TWO WEEKS, but 1 and 2 must be there

1. depressed moood most of the day (observed or self reported)
2. diminished interest or pleasure in all activities (observed or self reported)
3. significant weight loss when not dieting or weight gain (decrease/increase appetite)
4. insomnia/hypersomnia
5. psychomotor agitation, retardation nearly every day
6. fatigue/loss of energy
7. feelings of worthlessness or excessive/ inappropriate guilt nearly everyday
8. diminished ability to concentrate or indecisiveness
9. recurrent thoughts of death, recurrent suicidal ideation w/o specific plan, suicide attempt or specific plan to commit suicide

1. symptoms dont meet criteria for mixed episode (bipolar)
2. symptoms cause clinically significant distress or impairment in social, occupational, and other important areas of function
3. symptoms are not due to physiological effects of substance or medical condition
4. not accounted for by bereavement

• genetic
• early experience
• current stress

• monoamines
  • serotonin
  • norepinepherine
  • dopamine
• excitatory- Glu

Psychotherapy types that are used in depression treatment

exploratory therapy

cognitive behavioral therapy

interpersonal therapy

Used in mild to moderate depression along with medication.

Exploratory therapy

• usually focused on personal history
• can be brief or long-term
• longer term treatment can lead to positive changes beyond recovery from depression

Cognitive behavioral therapy

What do antidepressants affect as far as symptoms go?

It makes all the symptoms better, but somatic symptoms get better first (more energy, but emotionally still bad, which is a suicide risk factor)

• monoamine oxidasae inhibitors
• tricyclics
• SSRI's
• seratonin norepi. reuptake inh.
• norepi. dopamine reputake inh.

Mech. of action of MO inhibitors. major side effect of it and how to prevent? ex.

• ex: Selegiline
• side effect- hypertensive crisis (low tyramine (no cheese) diet)
• mech of action- prevent catabolism of ALL monoamines

Mechanism of action of tricyclics

• cholinergic
• histamine
• alpha adrenergic

Generally block reuptake of seratonin and norepi.

• side effects- more serious due to effect on many receptors
• ex: Lamitriptyline, nortriptyline, desipramine

• ex: fluoxetine, sertraline, paroxetine, citalopram, escitalopram
• mech of action- prevent reuptake of serotonin
• side effects- sexual side effects

venlafaxine

duloxetine

• ex: bupropion
• side effects- low risk of sex side effects, weight gain
• alos helps with ADHD

• mechanism of action- enhance central noradrenergic and seratoninergic activity by blockin alpha 2 R's and selectively antagonizing 5HT2 and 5HT3 R's
• side effects- weight gain, sedation

Compare different antidepressants as far as effectiveness

Primary cause of suicide