DepressionDepression

Unipolar DepressionUnipolar DepressionDSM - IV Criteria (5 or more symptoms over a 2 week DSM - IV Criteria (5 or more symptoms over a 2 week

period)period)

depressed mooddepressed mood

diminished interest or pleasure (anhedonia)diminished interest or pleasure (anhedonia)

weight or appetite increase or decreaseweight or appetite increase or decrease

sleeping too much or too littlesleeping too much or too little

feeling very agitated or physically slowedfeeling very agitated or physically slowed

loss of energyloss of energy

feelings of worthlessness or guiltfeelings of worthlessness or guilt

difficulty concentrating or making decisionsdifficulty concentrating or making decisions

thoughts of death or suicidethoughts of death or suicide

Population FrequencyPopulation Frequency

9-26% females lifetime will get uni-9-26% females lifetime will get uni-polar depressionpolar depression

5-12% males will get uni-polar 5-12% males will get uni-polar depressiondepression

for both m/f only 1 % will come down for both m/f only 1 % will come down with Bipolar disorder.with Bipolar disorder.

Left frontal lobe =Left frontal lobe =

approach/joyapproach/joy

Right frontal lobe = Right frontal lobe =

withdrawal/distresswithdrawal/distress

Underactive left frontal EEG in adults Underactive left frontal EEG in adults and in childrenand in children

Unipolar Depression continued

Children of depressed mothers: Children of depressed mothers: Frontal EEG activity during play at Frontal EEG activity during play at one year of ageone year of age

Left about equal to rightLeft about equal to right

Children of non-depressed mothers:Children of non-depressed mothers:

left greater than rightleft greater than right

University of Washington Research (Dr. Dawson)

Unipolar DepressionUnipolar Depression Low levels of norepinephrine, Low levels of norepinephrine,

dopamine, and serotonindopamine, and serotonin Biochemical treatments raise these Biochemical treatments raise these

neurotransmittersneurotransmitters amino acids: phenylalanine and or amino acids: phenylalanine and or

tyrosine can raise dopamine and tyrosine can raise dopamine and norepinephrinenorepinephrine

Tryptophan can raise serotoninTryptophan can raise serotonin SAM-e (S-Adenosyl Methionine)SAM-e (S-Adenosyl Methionine) can increase dopamine and can increase dopamine and

epinephrineepinephrine

Unipolar DepressionUnipolar Depression

MAO inhibitors raise both MAO inhibitors raise both norepinephrine and serotoninnorepinephrine and serotonin

SSRI’s (Selective Serotonin Reuptate SSRI’s (Selective Serotonin Reuptate Inhibitors) raises sertonin (e.g., Inhibitors) raises sertonin (e.g., prozac, paxil, zoloft)prozac, paxil, zoloft)

Efficacy and Tolerability of Ze 117 Efficacy and Tolerability of Ze 117 St. John’s Wort Extract in St. John’s Wort Extract in Comparison with Placebo, Comparison with Placebo,

Imipramine and Fluoxetine for the Imipramine and Fluoxetine for the Treatment of Mild to Moderate Treatment of Mild to Moderate

Depression according to ICD-10. Depression according to ICD-10. An Overview.An Overview.

R. KR. Kääufeler, B. Meier, A. ufeler, B. Meier, A. BrattstrBrattströömm

Volume 34; Suppl1: S49-S50. 2001.

St. John’s Wort Extract Ze 117 St. John’s Wort Extract Ze 117 ((Hypericum perforatumHypericum perforatum) Inhibits ) Inhibits Norepinephrine and Serotonin Norepinephrine and Serotonin

Uptake into Rat Brain Slices and Uptake into Rat Brain Slices and Reduces Reduces ß-Adrenoceptor ß-Adrenoceptor

Numbers on Cultured Rat Brain Numbers on Cultured Rat Brain CellsCells

U. Kientsch, S. BU. Kientsch, S. Bürgi, C. ürgi, C. Ruedeberg, S. Probst, U.E. Ruedeberg, S. Probst, U.E.

HoneggerHoneggerVolume 34; Suppl1: S56-S60. 2001.