Major Depressive Disorder
9 important questions on Major Depressive Disorder
MDD: Depression categories
- MDD
- Dysthymia
- depressive disorder not otherwise specified
- bipolar I
- Bipolar II
- cyclothymia
- Mixed state
MDD: underlying brain structures
- hippocampus - reduced volume and decreased neurogenesis (memory)
- basal ganglia - reduced volume (EF)
- medial/orbitofrontal PFC - overactive (EF)
- amygdala - overactivated (emotional processing attentional bias)
- mediodorsal thalamus - overactivated (memory)
MDD: effects of treatment on cognition
- TCA inhibit acetylcholine and may induce severe cognitive side effects
- SSRI's have mild anticholinergic effects
- SSRI's have a greater positive effects compared to TCA's
- serotonine norepinephrine reuptake inhibitors (SNRI's) may even have greater positive effects on cognitive performance in patients with depression
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MDD: late onset depression
- older patients show more severe cognitive impairment than younger patients, especially those with late-onset depression
- late-onset is usually older than 60
- there are several possible explanations for finding that patients with late-onset depression show more severe cognitive deficits (distinct type, dementia)
MDD: differential diagnosis
- cognitive impairments associated with early alzheimers disease (AD) are more severe than in patients with depression in nearly every cognitive domain
- when the initial differential assessment is not clear, it can be used as a baseline for future serial evaluations
- a history of depression doubles the individuals risk for dementia and AD in particular
- depressive symptoms can be regarded as an early symptom of AD, OR, neurobiological changes related to depressive disorders may be a risk factor for AD
MDDL Depression as an early sign of dementia
- depression can represent the first symptoms for dementia for a subset of older adults
- significant relationship between early-onset depression and the onset of dementia provides evidence for depression as a true risk factor for dementia
- the risk for developing dementia increases with the number of prior depressive episode
MDD: Social cognition
- profound impairments in social functioning
- may be related to a difficulty in the ability of depressed individuals to identify and decode others social cues
Social cognition
- perception of emotion
faces, voices (prosody), and body posture - complex social cognition (ToM)
MDD: social cognition in the brain
- medial prefrontal cortex
- right temporoparietal junction
- posterior superior temporal sulcus
- inferior frontal gyrus
- interparietal sulcus
- amygdala
- anterior cingulate cortex
- anterior insula
MDD: Affect recognition
- Anger
- fear
- sadness
- disgust
- happiness
- surprise
- terrified
- upset
- annoyed
- arrogant
- fear
- sadness
- anger
- surprise
- happiness
- neutral
-studies suggest impairment of emotional perception in depression
-depressed women were impaired in the ability to identify mental states in the eyes compared to non-depressed participants
-some studies found impairments in social cognition in more complex tasks, depressed women selected fewer correct punchlines
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