Tag Archives: anatomy

Depression

1 hour Lecture by Grace Nadolny, MD on 4/20/13 in Modesto, CA, CME provided by Sutter Gould Medical Foundation as part of it’s Subspecialty Lecture Series.  4 hours total of CME was provided.  Part of the 4 hours of CME included discussion about back pain and ovarian cancer.

Why this is interesting to me

  • I have learned some of this before in my NeuroScience years at Brown University.  It was good to review.
  • I have an acupuncture practice which has a good number of patients with depression.

Learning points (not all points were made in the lecture, but they were learning points for me):

Evidence Based medicine supported treatment of depression

  • includes the use of methylphenidate, exercise, and sertraline

Methylphenidate

  • Ritalin
  • NE and DA reuptake inhibitor.  (Norepinephrine adn Dopamine)
  • Psychostimulant
  • Used for ADHD, Narcolepsy, and Depression

Sertraline

  • Also known as Zoloft, Lustral
  • SSRI – selective serotonin reuptake inhibitor

Depression

  • Population affected: 20%
  • Depression is a state of chronic stress
  • CV risk
  • Diabetes risk
  • Anatomically there is decreased amount of gray matter in the brain.  Decreased size of  Cortex and Hippocampus has been found.
hippocampus

hippocampus

The hippocampus is involved in several functions of the body including:

  • Consolidation of New Memories
  • Emotional Responses
  • Navigation
  • Spatial Orientation

Current concepts of depression

  • glutamatergic theory of depression: exposition to stressful stimuli increases hippocampal glutamatergic neurotransmission and triggers excitotoxic changes.
  • Another theory: depression is closly correlated with neuronal atrophy due to a decrease in BDNF (Brain Derived Neurotrophic Factor)
  • Monoamine hypothesis is considered old school:  deficiency in monoaminergic neurotransmission.  Monoamines being Catecholamines (NE, DA) and Indolamines (5-HT).

Results of Star*D Trials

Sequenced Treatment Alternatives to Relieve Depression

  • Officed based – what is done after a patient fails first line treatment for depression?
  • Level 1 through Level 3 choices in medication to switch to.

After the lecture:  What about Acupuncture for Depression?

I asked Dr. Nadolny about what she thought of acupuncture for depression.  And she seemed very excited.  She said that she didn’t know that acupuncture was readily available in Modesto, CA.  I do hope to recommend some of my patients to Dr. Grace Nadolny in the future and other psychiatrists too, because I feel that at times combination treatment with acupuncture and excellent psychiatric care would be of greatest benefit.

Disclaimer:  I am not an expert on the topic of Depression.  These are notes from a lecture that I took and feel free to use this as a springboard for your own studies.