“DEPRESSION AND

PSYCHOSIS”

By
Stuthi Kunder

Under Guidance of
Dr. Priti P. Patel
• Depression (By WHO): Common mental disorder that presents with
depressed mood ,loss of interest or pleasure, feelings of guilt or low
self-worth, disturbed sleep or appetite, low energy and poor
concentration.

• Psychosis: Gross impairment in reality testing (not in contact with

reality).
The current subtyping of depression is based on the Diagnostic and
Statistical Manual of mental disorders (DSM-IV-TR).

• Bipolar 1
• Bipolar 2
• Mixed
• Major or Unipolar
• Cyclothymic
• Agitated
• Atypical
• Melancholic
• Recurrent brief disorder
• Seasonal
• Dysthymic disorder
• Bipolar Disorders

Bipolar 1: Periods of severe mood episodes from mania to depression.

Bipolar2: Involving milder episodes of hypomania that alternate with periods of severe depression.
Cyclothymic Depression: Describes brief periods of hypomaniac symptoms alternating with brief periods of
depressive symptoms .
Unspecified: An unspecified depressive disorder is one that exhibits some or all of the symptoms from the
various types of mood disorder.
Mixed :Mixed depression, defined by three or more co-occurring hypomanic symptoms.
• Major Depressive Disorder:
It is also called as unipolar depression.
A constant sense of hopelessness and despair is a sign you may have
major depression, also known as clinical depression. Low mood, loss of
interest and pleasure in usual activities.
• Melancholia Depression:
It is severe form of depression. Characterised by complete loss of pleasure in
everything or almost everything.

• Psychotic Depression: People with depressive disorder can lose touch with
reality and experience psychosis.

• Antenatal or Post-natal depression: Women are at an increased risk of

depression during pregnancy(atenatal) , And also in the year following child
birth (post-natal).

• Atypical depression: According to DSM-IV-TR, the atypical features

specifier is defined by mood reactivity plus weight gain or increased eating,
hypersomnia.
• Seasonal affective disorder: Seasonal affective disorder is thought to be
mainly caused by lack of light in winter (short photo period).

• Dysthymic disorder:According to DSM-IV-TR, dysthymic disorder is a

lowgrade, persistent depression, causing clinically significant distress or
impairment of functioning.

• Recurrent brief depressive disorder: Characterised by frequently

occurring brief depressive episodes lasting less, than two weeks.
 PATHOPHYSIOLOGY:
• Genetics and Psychosocial stress:
Studies show the same thing: shared family environment has no
contribution whatever, genetic factors account for around 40% of the
variance, and environment unique to the individual accounts for a large part
of the rest.

• Gene-Environment Interactions: the serotonin transport gene:

In a cohort study of children born in Dunedin, New Zealand, Caspi and his
colleagues (2003)have shown that those with the homozygous long version
(31% of this population) are relatively resilient in that they tend not to
develop depression even when they have experienced several stressful
events.
1.Stress hormones and cytokines.
2. Hippocampal Dysfunction and Neuroendocrine Dysregulation.
3. BDNF, Depression, Antidepressants .
Monoamine hypothesis
• Brain Imaging

• GABAergic Deficit Hypothesis

There is abundant evidence that GABA plays a prominent role in the brain control of stress,
the most important vulnerability factor in mood disorders.
GABAergic transmission plays an important role in the control of hippocampal neurogenesis and
neural maturation.
• The Receptor Sensitivity Hypothesis
Result of Pathological Alteration (upregulation and supersensitivity in receptor sites).
Desensitization (uncoupling of receptors).
Decrease in number of receptor sites.

• Serotonin only Hypothesis

Emphasizes the role of serotonin in depression and down plays noradrenaline
This theory does not explain the role of noradrenaline.

The Permissive Hypothesis

Balance between NA and Serotonin
Low level of both the neurotransmitters in patient, the patient becomes
depressed .Level of serotonin decreases and Level of NA increases this cause
Mania.

• The Electrolyte membrane hypothesis

Hypocalcemia causes Mania
Hypercalcemia causes Depression.
CURRENT AVAILABLE THERAPIES IN TREATMENT OF DEPRESSION
• Lifestyle changes to treat depression. • Psychotherapy
• ANTIDEPRESSANTS

ANTIDEPRESSANTS

TRICYCLIC SELECTIVE SEROTONIN

MONO AMINE OXIDASE ATYPICAL ANTI
ANTIDEPRESSANTS REUPTAKE INHIBITORS
INHIBITORS DEPRESSANTS
Eg Imipramine, Fluoxetine, Sertraline,
Phenelzine ,Isocarboxacid Bupropion, Trazodone.
Amitriptyline,Desipramine Paroxetine.
• ADVANCES IN THE TREATMENT OF DEPRESSION AND NOVEL TARGETS.

Modulators of CRF and glucocorticoids

Substance P antagonists
Transdermal selegiline
Triple reuptake inhibitors
Focal brain stimulation
Transcranial magnetic stimulation
Magnetic seizure therapy
Deep brain stimulation
• ANIMAL MODELS OF DEPRESSION.
• The criteria for the “ideal” model of depression
Ideally, an appropriate animal model of human depression should fulfill the following criteria as
much as possible: strong phenomenological similarities and similar pathophysiology (face
validity),
comparable etiology (construct validity),
and common treatment (predictive validity).
1)Learned helplessness.
• Chronic mild stress (CMS) Social defeat stress
• Behavioral tests on AD activity
Forced Swim Test

Tail Suspension Test