{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

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

When is it “depression”?

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

Genetics Early Life Adversity, Chronic Stress,

Epigenetics Brain Chemistry Body Chemistry Personality and Coping

Depression: Causes

Seasonal change Peripartum Life stressors “Highs”

When to look out

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

Support Emergency (Hospital) Health Care Professionals

What to do when you are worried about someone

Rule out other medical causes Help with concomitant substance use Psychotherapy Pharmacotherapy ECT Psychoeducation (for family and friends

too)

What do healthcare professionals do?

Common Multifactorial Causes MSIGECAPS It is an illness, not a choice There is treatment

Key Points

Thank you!

Appendix

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

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

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

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