250MH.t5majDepression.txt

severe emotional disorder, presents with Hx of 1 or more major depressive episodes and No hx of manic/hypomanic episodes

• catatonic
• melancholic
• post partum onset
• seasonal affective disorder SAD
• atypical

extreme psychomotor retardation almost paralyzed, withdrawn, negativity, no speech

severe endogenous depression not related to environmental stress, more associated with time of the day: worse early in the morning and tend to have suicidal ideation

4wks after childbirth, mom have eexcessive rumination and delusional thoughts about baby indicating increased risk of harm

severe depressive episodes during fall/winter, ease up during spring/summer months
overeat, crave for carbs, no energy, reduced cerebral metabolic activity

• overeat or oversleep (vegetative signs), high level of anxiety
• occur in younger individual often misdiagnosed

presence of disorganized thoughts, delusions, hallucinations

• mild to moderate signs of depression, present most of the day, more days than not, for at least 2 yrs
• diagnosed early childhood, early adulthood
• at risk for developing MDD

• "Ive always been this way"
• "Theyve always been that way"

presenting signs are almost same, difference is duration and severity of symptoms

depression - not normal part of aging

genetic
biochemical
hormonal regulation
diathesis stress model

serotonin
norepinephrine

regulate sleep, appetite, sex drives

sleep deprivation, decreased appetite/sex drive, poor impulse, irritability

modulates attention/behavior

apathy, decreased responsiveness, slowed psychomotor activity

acetylcholine, GABA, dopamine

hyperactivity of limbic-hypothalamic-pituitary adrenal cortical axis
high levels of urine cortisol

• take into account interplay of biology and environment
• people who are more at risk of developing MDD will not have full blown disease process unless an environment tirgger is present