Depression (Major Depressive Disorder) Map: An Overview
This concept map covers the key points about (Depressive Disorders) including: definition, depression types, depression etiology, depression pathophysiology, diagnosis of depression, treatment of depression.
What is depression?
What causes depression?
What are the signs and symptoms of depression?
What are the signs and symptoms of depression?
Non pharmacological treatment for depression
Pharmacological treatment of depression
Depression Concept Map
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Order the full map
What is Depression?
The map starts with the definition of depression which is a mood disorders that affects patient’s cognition, behaviour, and physical functioning. Depression is classified according to symptoms and course of the disease into:- Major depressive disorder / Major depression / Unipolar depression
- Dysthymia
- Postpartum Depression
- Seasonal Affective Disorder (SAD)
- Depressive disorder not otherwise specified
- Mixed anxiety-depression
The main type of depression and the focus of this map is Major depressive disorder (Clinical Depression)
What causes depression?
Depression etiology
It is of unknown cause, but involves hereditary,
social, developmental, and biological factors.
It is related to changes in brain monoamine neurotransmitters:
norepinephrine (NE), serotonin (5-HT), and/or dopamine (DA).
Depression pathophysiology
Although
depression is a disorder of unknown cause, many hypotheses have tried to explain
the pathophysiology of depression. Among
the most prominent of these hypotheses are those mentioned in the following map
of (Phathophysiologic Hypotheses of Depression):
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| Phathophysiologic Hypotheses of Depression - Click on the image to enlarge |
The first
one is “Catecholamines Hypothesis” which proposes that depression
is linked to decreased brain levels of the neurotransmitters norepinephrine
(NE), serotonin (5-HT), and/or dopamine (DA).
But it has been observed that the administration of antidepressants
causes immediate increase in the synaptic levels of monoamines (NE and 5-HT) producing
antidepressants adverse effects, while the antidepressive effects
are not observed until after few weeks of dosing. That observation is explained by the second
hypothesis which is (Receptor Sensitivity Hypothesis).
According to “Receptor Sensitivity Hypothesis,”
the decrease in NE and 5-HT results in low stimulation of the postsynaptic receptors
by these monoamines, and consequently increased postsynaptic receptors'
sensitivity and number. That is how long
term administration of antidepressants is responsible for decreasing the
sensitivity "desensitization" and the number "down-regulation"
of central β-adrenergic receptors and finally producing the antidepressant
effect.
Concerning the third hypothesis which is
called “The Permissive Hypothesis,” the control of emotional behavior results
from a balance between NE and 5-HT, i.e. the decrease in both 5-HT and NE causes
depression, while the decrease in 5-HT with an increase in NE causes mania.
This map provides
you with the basic knowledge to understand the nature of the disease. In the rest of the map, I link between “Depression pathophysiology” and:
- how antidepressants work (i.e. mechanisms of action) and
- what adverse effects they produce
Diagnosis of depression
In case of suspected major depressive episode:
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exclude bipolar depression;
as major depression is a unipolar disorder.
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exclude general medical
illness, drug therapy, or substance abuse, that is why patients should undergo physical examination, mental
status examination, basic laboratory work-up (CBC, thyroid function tests, and
electrolyte determinations).
- - determine depression case severity using psychometric rating
instruments as Hamilton Psychiatric Rating Scale for Depression (HAMD)
What are the signs and symptoms of depression?
DSM-IV-TR Criteria for Major Depressive Episode
A. Five (or more) of the
following symptoms occur most of the day nearly every day for the same 2-week
period;
representing a change from previous
functioning; at least one of the symptoms is either
(1) depressed mood or (2) loss of interest
or pleasure.
1. Depressed mood
2. Markedly diminished interest
or pleasure in all, or almost all, activities
3. Significant weight loss when
not dieting or weight gain (change of > 5% of body weight in a month), or
decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or
retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive
or inappropriate guilt (which may be delusional)
8. Diminished ability to think or
concentrate, or indecisiveness,
9. Recurrent thoughts of death,
recurrent suicidal ideation with/without a specific plan or an attempt
B. The symptoms cause clinically
significant impairment in social and occupational functioning
C. The symptoms are not due to
effects of a substance (e.g., a drug of abuse, a medication),
a general medical condition (e.g.,
hypothyroidism) mood-incongruent delusions or hallucinations
D. The symptoms are not better
accounted for by bereavement (loss of a loved one)
Treatment of Depression
Nonpharmacological Treatment of Depression, includes:
- Psychotherapy could be the first-line therapy in mild to moderate depression, but not used alone in case of acute severe and/or psychotic major depressive disorder.
- Electroconvulsive Therapy (ECT) is safe and effective for severe mental illnesses, including all subtypes of major depression. It is reserved for treatment-resistant cases and delusional depressions.
- Light therapy.
Pharmacological Treatment of Depression
It should be understood on the basis of depression
pathophysiology. Antidepressants
mechanisms of actions and accordingly adverse effects and –if present- drug
interactions, contraindications, patient education, advantages, drug
discontinuation symptoms and precautions of the following depression
medications are stated in the map in the form of mini-maps for each
antidepressant, linking between the key information about every medication of
the following:
- Selective Serotonin Reuptake Inhibitors (SSRIs): citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): duloxetine, venlafaxine, desvenlafaxine
- Norepinephrine-Dopamine Reuptake Inhibitors: Bupropion only
- Tricyclic Antidepressants (TCAs) and Other Heterocyclics: amitriptyline, imipramine, nortriptyline, desipramine, amoxapine
- Serotonin Modulators (5-HT2 blockers): nefazodone and trazodone
- Alpha-2 Antagonist: Mirtazapine
- Monoamine Oxidase Inhibitors (MAOIs): phenelzine, isocarboxazid, and tranylcypromine → nonselective (inhibit MAO-A and MAO-B), selegiline (transdermal patch) → inhibits only MAO-B at lower doses
- St. John’s.
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Depression Concept Map by Maha Atef, B Pharm
Last updated on: 13 June 2012
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