1. Neurological Disorders

2. Psychological Disorders 10 million people suffer from depression

3. Mood Disorders

4. Unipolar Disorder (2 wks to 9 mos) Major Depressive Disorder, Single Episode (MDDSE) rare Major Depressive Disorder, Recurrent (MDDR) family history is common Dysthymic Disorder (DD) milder symptoms chronic occurrence (2-30yrs) Double Depression combination or MDDR and DD Bipolar Disorder (2 wks to 9 mos) Bipolar I Disorder Bipolar II Disorder (hypomania) Dysphoric Mania manic episodes with simultaneous depression Cyclothymic Disorder (mild bipolar)

5. Major Depressive Episode Characteristics Onset is in early to mid 20’s but not age specific Onset age has been dropping 16% of population experience MDD in their lifetime 2:1 women to men ratio 41% occurs just before or just after menstruation

6. Depression: Etiology Biological Influence genetic predispostion neurochemical imbalance stress hormones Psychological/Behavioral Influence learned helplessness/hopelessness depressive attributional style disturbed sleep habits Social Influence stressful events serve as triggers

7. Mood Disorders among Twins

8. Depression and Neurochemistry

9. Depression and Stress Hormones

10. Depression and Sleep Phase advanced body temperature rhythms Enter REM sleep earlier in the night Spend little time in SWS

11. Depression: Treatment Medical Chemical Electroconvulsive Shock Therapy Psychotherapy Cognitive Behavioral Therapy Interpersonal Therapy

12. Chemical Treatment Tricyclic Antidepressants imipramine (Tofranil) prevents monoamine reuptake 64% respond well many side effects Monoamine Oxidase Inhibitors phenelzine (Nardil) blocks MAO enzyme which breaks down monoamines <64% respond well several lethal side effects Selective Serotonin Reuptake Inhibitors (SSRIs) fluoxetine (Prozac) blocks reuptake of serotonin minor side effects

13. Electroconvulsive Shock Therapy for patients where drugs are ineffective or that can’t wait for drugs to take effect electric shock to the cortex for less than 1 second creates seizure and mild convulsions takes about 6-10 sessions every other day some short term memory loss 50-70% beneficial 60% relapse rate (ECT)

14. Cognitive Behavioral Therapy make patient examine thought process and recognize errors arbitrary interference overgeneralization try to correct cognitive errors concentrate on less depressive thoughts - be more realistic target negative cognitive schemes use journals to identify faulty thinking do hypothesis testing put fun back into the patients life increase exercise takes about 10-20 sessions

15. Interpersonal Therapy resolve problems in existing relationships identify life stressors work on interpersonal disputes role disputes loss of a relationship acquiring new relationships identifying and correcting deficits in social skills takes about 15-20 sessions

16. Depressions Vicious Cycle Must control brain chemistry e.g., Prozac Must reshape the negative thought processes e.g., CBT