depression by crystal zhou
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{Depression
A state of feeling sadA serious medical condition in which a person feels very sad, hopeless, and unimportant and often is unable to live in a normal wayA period of time in which there is little economic activity and many people do not have jobs
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Common 350 million world wide…most likely more1
The lifetime prevalence of major depression in United States adults is 17 percent 2
Debilitating Leading cause of disability worldwide1
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When is it “depression”?
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MSIGECAPS – 5/9 x 2 weeks Mood changes – low or irritable Sleep changes Interest decrease or loss Guilty, hopeless, worthless Energy decrease Concentration impairment Appetite changes Psychomotor changes Suicidal Ideation
Depression: Diagnosis
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Genetics Early Life Adversity, Chronic Stress,
Epigenetics Brain Chemistry Body Chemistry Personality and Coping
Depression: Causes
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Seasonal change Peripartum Life stressors “Highs”
When to look out
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Exercise Mindfulness Supports – family, friends, healthcare Crisis Line
Distress Centre: 416-408-HELP (4357) offers access to emotional support from the safety and security of the closest telephone. The Distress Centre offers emotional support, crisis intervention, suicide prevention and linkage to emergency help when necessaryWhat to do when you
are worried about depression
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Support Emergency (Hospital) Health Care Professionals
What to do when you are worried about someone
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Rule out other medical causes Help with concomitant substance use Psychotherapy Pharmacotherapy ECT Psychoeducation (for family and friends
too)
What do healthcare professionals do?
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Common Multifactorial Causes MSIGECAPS It is an illness, not a choice There is treatment
Key Points
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Thank you!
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Appendix
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Genetics Monozygotic twin studies show between
30% to 50% concordance rate Dizyogtic twin studies show roughly 20%
concordance rate
So, genetics is definitely part of the story, but not all of it.
Depression: Genetics
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Epigenetics, Early Life Adversity and Chronic Stress (epigenetics = how and when genes are expressed)(early life adversity = childhood trauma, neglect, exposure to parents in conflict, etc.)
Early Life Adversity and chronic stress can modify gene expression through mechanisms such as histone acetylation and DNA methylation, and thus affect other regulatory mechanisms (e.g. stress regulation mechanism of the hypothalamic-pituitary-adrenal axis)Depression:
Epigenetics
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Neurotransmitters implicated in the development and maintenance of depression
Monoamines *where most of the current meds act
Serotonin Dopamine Norepinephrine
GABA Glutamate
Hypothalamic-Pituitary-Adrenal Axis dysregulation
The physiological stress regulation mechanism of our bodies does not function properly in patients with depressionDepression: Brain
Chemistry
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Other processes going on your body can also affect the development of depression. Examples:
Heart attack Up to 65% of patients with heart attack report depressive
symptoms, and 15-22% meet the MSIGECAPS criteria for diagnosis of major depressive disorder.
Thyroid disorder Hypothyroidism (decreased function of the thyroid gland)
can be associated with emergence of depressive symptoms
Hepatitis C liver infection treatment ¼ of people undergoing interferon treatment for Hep C
develop depressive symptomsDepression: Body Chemistry