short answer questions
Syjdjc
508Spring2021Week2ACTUAL.pptx
GERO 508 Spring 2021
Week 2
The Mind & Body Connection
Timothy Lu Office Hours: By Appointment Email: [email protected]
Dr Paul Nash CPsychol, AFBPsS, FHEA
Office: GERO 231E
Office Hours: Thurs 09.00-12.00
(OR AGREED APPOINTMENT)
Email: [email protected]
Gillian Fennell
Email: [email protected]
Questions about assessments?
2
The session in brief
Biological – What is stress?
Biological consequences of stress
Biological models of stress
Measuring biological stress
What does stress look like?
The meaning of sex
Psychological approaches to stress
Environmental approaches to stress
Specific models of stress
Bio-Psycho-Social models of stress
Measuring psychological components of stress
3
What forms can stress take?
4
Stress – The overview
Actual Stress
- See a predator / See a car coming towards you
5
Perceived Stress
- In a situation where something may or may not happen
Which do you think happens with humans? Why?
Humans exhibit the anticipatory stress response, well done us!! Turn on stress response for psychological reasons
- memory, emotions, thoughts
NOT what stress was designed for which leads to potential for chronic stress
Essentially the aim of the stress response is to return us to the homeostatic equilibrium we are in.
Acute or Chronic?
6
The meaning of sex
7
Fight or Flight
Tend and Befriend
Evolutionary
Protection of self and offspring
Nurturing offspring under stressful situation
Protect from harm (tend)
Create / join social groups to maximize resource and protection (befriend)
Evolutionary
Protection of self
Fight a stressor
Escape a stressor
Short lived
Few mins – Alive or dead
Most research based on males until the tend / befriend hypothesis produced. Mainly due to different cyclical variation in hormones and endocrine responses making research with women less predictable.
Not the whole story and we have biological and psychological differences later in the course!
Stress – The psychological approach
8
Stress as a response
The ways in which we respond to a stressor
Storm and stress approach
Coping & resilience
Effects of prolonged stress
Stress as a stimulus
Views stress as a significant life event or change that demands response, adjustment, or adaptation
Sees change as inherently stressful
Stress is dealt with uniformly across populations
Illness outcome thresholds are uniform
Stress as a transaction
Stress is a product of the human – environment transaction
Hardiness, resilience, locus of control and self-efficacy are important constructs
Duration of transaction (Episodic, Acute, Chronic)
Environmental stressors
9
Suboptimal environmental conditions pose demands that may exceed an individuals ability to cope
The imbalance between environmental demands and response capabilities is called…..?
…Stress
Environmental stressors include:
Chronic
Noise when living by a freeway
Acute
Noise when in a tunnel
Which is more impactful?
Chronic is more impactful and more likely as individuals have less ability to escape from them: Worked example, Airports
Some environmental stressors affecting YOU in LA
10
Noise
Intensity (decibel); Frequency (pitch); Periodicity (continuous or not); Duration (acute or not)
Noise is more than sound. Characteristics affecting this are:
Intensity
Unpredictability
Uncontrollability
But what can chronic noise actually impact?
Psychological stress (Ising and Kruppa, 2007)
Increased noradrenaline levels and BP in children (Evans et al., 1998)
Increased BP in high noise work environments (Tomei et al., 2010) Reduced reading ability in children (Bronzaft, 1981)
Attention and task discrimination (Evans & Hygge, 2007) Memory (Cohen et al., 1986)
When there was control, the effects were mitigated
Some environmental stressors affecting YOU in LA
Poor neighborhood quality
Quality of municipal & retail services; recreational opportunity; traffic; transportation links; noise; crowding; community transience; healthcare; education opportunity
Similar to the others, there is a lifespan effect
But what can a poor environment actually impact?
Greater psychological distress for children in poorer environments (Gifford & Lacombe, 2006) Similar trends both longitudinally (Dalgard & Tambs, 1997) and cross-sectionally (Gary et al., 2007)
Increased physiological stress in adults and children (Hill et al., 2005; McGrath et al., 2006) Effects of community are experienced irrespective of household SES (Evans, 2004)
What can be done to improve poorer environments to reduce stress?
12
General Adaptation Syndrome (GAS)
The Alarm Phase
The alarm reaction stage refers to the initial symptoms the body experiences when under stress.
The “fight-or-flight” response – the physiological response to stress. This natural reaction prepares you to either flee or protect yourself in dangerous situations. Heart rate increases, Adrenal gland releases cortisol (a stress hormone), and you receive a boost of adrenaline, which increases energy.
Selye, 1936
13
General Adaption Syndrome (GAS)
The Resistance Stage
After the initial shock of a stressful event and having a fight-or-flight response, the body begins to repair itself. It releases a lower amount of cortisol, and your heart rate and blood pressure begin to normalize. Although your body enters this recovery phase, it remains on high alert for a while. If you overcome stress and the situation is no longer an issue, your body continues to repair itself until your hormone levels, heart rate, and blood pressure reach a pre-stress state.
Some stressful situations continue for extended periods of time. If you don’t resolve the stress and your body remains on high alert, it eventually adapts and learns how to live with a higher stress level. In this stage, the body goes through changes that you’re unaware of in an attempt to cope with stress.
Your body continues to secrete the stress hormone and your blood pressure remains elevated. You may think you’re managing stress well, but your body’s physical response tells a different story. If the resistance stage continues for too long of a period without pauses to offset the effects of stress, this can lead to the exhaustion stage.
Signs of the resistance stage include: irritability
frustration
poor concentration
14
General Adaption Syndrome (GAS)
The Exhaustion Stage
This stage is the result of prolonged or chronic stress. Struggling with stress for long periods can drain your physical, emotional, and mental resources to the point where your body no longer has strength to fight stress. You may give up or feel your situation is hopeless. Signs of exhaustion include:
fatigue
burnout
depression
anxiety
decreased stress tolerance
The physical effects of this stage also weaken your immune system and put you at risk for stress-related
illnesses.
15
Diathesis Stress model
Diathesis
Predisposition (genetic, psych, bio, environmental, situational, personality type)
Stress
Events resulting in the disruption of the psychological equilibrium
Nature v Nurture
Disorders linked with this model:
Alcoholism; Schizophrenia; Anxiety; Depression
What do you think are the protective factors?
Social support; Network typology; Environment; Self-esteem
Expanded into the ‘Differential Susceptibility Hypothesis’ (Belsky et al., 2007) – Look it up!!
16
A stage model of stress
‘Events appraised as stressful are viewed as triggering affective states that in turn engender behavioral and biological responses having possible downstream implications for disease’
(Cohen, Gianaros & Manuck, 2016)
Combines:
Epidemiology
Defining which circumstances and experiences are deemed stressful on the basis of consensual agreement that they constitute threats to social or physical well-being
Psychology
Individuals’ perceptions of the stress presented by life events on the basis of their appraisals of the threats posed and the availability of effective coping resources
Biology
Brain-based perturbations of physiological systems that are otherwise essential for normal homeostatic regulation and metabolic control
17
A stage model of stress – more detail
Stressors trigger a brain-based perceptual appraisal which in turn triggers an affective response (stress / anxiety)
Affective responses change the way both HPA( hypothalamic– pituitary–adrenal system) & SAM (sympatho-adrenal- medullary mediators) function.
Affective responses also impact emotional responses and behavioural outcomes / health risk behaviours like drinking and smoking
Appraisals of stress and their affective sequelae can influence interpretations of physiological sensations, such as defining sensations as symptoms and symptom clusters as diseases that in turn influence health-care seeking, and adherence to medical regimens
18
A stage model of stress – Keep in mind
Common criticisms include:
Too Sequential
However, although the model is sequential, emphasizing the proximal predictive nature of each stage, this is demonstrative of the integration of the Biological, Environmental and Psychological constructs. Further, the authors repost that other mechanisms can be at play rendering some stages obsolete in different situations
Unidirectional Model
Feedback loops (e.g. depression in final stage can feed into negative appraisals) mean that the model has Omni- directionality
19
Next time…
20
| Week 3 02/04/2021 | Stress and genetics (Lu/Nash) | SEE BB | Week 2 Discussion |
GERO 508 Spring 2020 Week 2 Biological Aspects of Stress
The Mind & Body Connection
Timothy Lu
Office: Virtual
Office Hours: By Appointment
Email: [email protected]
Dr Paul Nash CPsychol, AFBPsS, FHEA
Office: GERO 231E
Office Hours: Weds 09.00-12.00
(OR AGREED APPOINTMENT)
Email: [email protected]
Gillian Fennell
Email: [email protected]
Biological Aspects of Stress
22
What are the main biological components involved in stress?
How does the brain react?
How the brain triggers the body to respond
How does acute stress differ from chronic stress?
What diseases may manifest from chronic stress? (which we’ll talk more about in future lectures)
First, a disclaimer:
23
The stress response itself is not harmful
Stress response (in general) is adaptive
It allows us to respond to threats accordingly!
Why then, does stress become an issue with us humans?
What is stress?
24
Stress is the body’s method of reacting to a condition perceived as dangerous and/or harmful, including threats, challenges and physical or psychological barriers
The body reacts to stress via the fight-or-flight response: a psychophysiological reaction in response to a perceived harmful event, attack or threat to survival
This response is regulated by the autonomic nervous system, a division of the peripheral nervous system which acts largely unconsciously to regulate bodily functions
The agents of stress are stressors, which may be internal or external. Key to stress is some amount of (perceived) loss of control over physical or psychological safety.
Physical triggers
25
Animate triggers from other species: predators, infectious agents
Inanimate triggers: floods, earthquakes, fires, avalanches, storms, hurricanes, riptides, other natural calamities
Humans and many other species can also experience stress induced by interactions with members of their own communities
Psychological/social triggers
26
Concerns about one’s place in the universe
Providing for the necessities of life
Security (physical, social, psychological)
Social achievement
Social hierarchy advancement
Relationship with peers
Concerns about the environment
Conditions which threaten homeostasis
Crisis & unrest
Many stress triggers observed in animal societies have parallels in human society
Neurons – Components of the Brain
27
Dendrites receive signals.
As neuron gets activated by incoming signals, the “summed signals” from many inputs goes to cell body.
Cell body integrates and makes decision on the importance of the signal (s).
If signals are important enough the cell body/hillock discharges and the receiving cell sends its own signal out the axon to next neuron in the sequence.
In the cell body we have the nucleus. Activity on the neuron will influence the nucleus to make proteins based on the needs of the nerve cells (using DNA expression and RNA recipes).
Neuronal Communication
28
The connection between two neurons is a space known as a synapse
Generally, this connection is chemical (although sometimes it is electrical)
Important this signal is uninterrupted
We have excitatory/inhibitory signals
What might happen if this connection is interrupted?
What is the importance of inhibitory signals?
28
Important Brain Anatomy to Know
29
Frontal Lobe – executive functions
Parietal Lobe – processing of somatosensory information
Occipital Lobe – processing of visual information
Temporal Lobe – processing of auditory information
The frontal lobe is going to be the primary decision maker – this lobe is responsible for your entire existence (from your speech decisions, motor movements, and other life choices you’ve made) and as such is a critical part of the stress response in terms of ASSESSING stressors or even being a part of them!
Frontal Brain Importance
30
Impaired function: Clinical depression, ADHD, anxiety, overactive stress response, addiction, etc;
Important Brain Anatomy for Stress Modulation
31
Amygdala – primary stress response
Basal nuclei – movement
Hippocampus – memories
Hypothalamus – bodily integration
Thalamus – sensory information gateway
Pituitary glands – hormonal release
The amygdala is the primary structure involved in the stress response. It triggers the activation of the hypothalamus to communicate with the pituitary gland and send out hormones that are important to the stress response. The hippocampus stores memories that can relate to the stress response and trigger it (such as in PTSD)
Hormones and their function
32
A hormone is any member of a class of signaling molecules produced by endocrine glands and transported by the circulatory system to target organs, where they modulate physiology and behavior
A corticosteroid is a type of hormone secreted by the adrenal glands
Adrenaline (epinephrine) increases blood flow and blood sugar levels
An important class of corticosteroids are the glucocorticoids, which regulate glucose (blood sugar) and modulate the stress response, immunity, inflammation and behavior
Cortisol increases blood glucose and suppresses immunity and inflammation
The adrenal glands – Stress hormone releaser
33
The adrenal glands are located above the kidneys and secrete two very important hormones: adrenaline and cortisol
An adrenal gland consists of two distinct anatomic divisions: the cortex and the medulla
The cortex produces steroid hormones like glucocorticoids (cortisol is only one example)
The medulla produces adrenaline
Memory and Emotions
34
Amygdala closely related to hippocampus – strong relation to memory centers
This means stressful/fear-inducing events become greatly attached to our memory
Alzheimer’s is an age-related disease that leads to the degradation of memory centers
Chronic stress can induce damage to these memory areas
Emotional events in general tend to be deeply ingrained in our memory!
What do you think could occur with stress induced memory loss?
Why do you think emotions are so important to our memory?
34
What can the brain do to impact the body?
35
Brain to body interaction for stress
36
Sympathetic Nervous system (Fast)
Slow response (hormonal):
1. Second wave of energy
2. Shut off unnecessary physiology
3. Shut off stress response via negative feedback
Brain to body interaction for stress
37
Under conditions when a subject feels alert, safe and interested, phasic release of catecholamines (adrenaline and dopamine) strengthens the higher cognitive functioning of the PFC, thus allowing top-down regulation of thought, action and emotion. In primates, the PFC is topographically organized, with the dorsal and lateral surfaces mediating attention, thought and action while the ventral and medial aspects mediate emotion (tells the amygdala to SHUT UP – it inhibits the amygdala).
During stress exposure, high levels of catecholamines (adrenaline) take the PFC 'off-line' while strengthening the functions of more primitive circuits—for example, the conditioned emotional responses of the amygdala and the habitual actions of the basal ganglia. The amygdala activates brainstem stress systems, which in turn activate the sympathetic nervous system.
Stress weakens prefrontal networks: molecular insults to higher cognition
Focus on the SYMPATHETIC (stress) response
38
How does this all work together?
39
HPA Axis and the feedback loop
The hypothalamic-pituitary-adrenal (HPA) axis is the loop of our stress response.
The hypothalamus sends corticotropin releasing hormone (CRH) to the pituitary gland. The pituitary releases adrenocorticotropic hormone (ACTH) to the kidneys, specifically the adrenal glands on top of the kidneys. The adrenal glands then release cortisol (shown as corticosterone for rats) which affects the body. This cortisol creates a negative feedback loop which shuts itself off.
What we will learn is that this is not always the case in chronic stress. We will talk more about the effects of cortisol on the body.
39
Stress, socioeconomic status and ethnicity
40
Low social rank is associated with more stress across human societies
Studies indicate that this is the case even when accounting for factors like financial security, access to healthcare, education and other factors
Because more stress is associated with higher inflammation, this suggests that individuals who are members of disadvantaged social groups can be at higher risk for cardiovascular disease, neurodegenerative disorders, anxiety and depression
Members of social groups who are at higher risk for discrimination can be more likely to experience prolonged stress and its consequences
These considerations are not yet properly understood scientifically but there are substantial efforts now underway to clarify and alleviate socioeconomic and ethnic disparities in stress-related morbidity and mortality
Biological Measures of Stress
41
Measuring stress biologically comes in many forms, what do each of these tell us?
We can look at stress hormones: cortisol
We can look at other biomarkers that come from the stress response:
blood urates – byproduct of protein degradation (neuronal)
Lysozymes – antibacterial enzyme (decreases)
CRP – elevated marker of inflammation/stress
miRNAs – influence biological systems
heat shock proteins – induced by short-term stress (anti-inflammatory)
Measured in the blood and saliva
https://www.frontiersin.org/articles/10.3389/fmolb.2019.00091/full
41
Stress effects upon neural cells and brain structure
42
The hippocampus is a brain structure which plays a central role in memory formation
In stressed mice, neurons have fewer dendrites and the hippocampus is smaller
Chronic stress changes brain circuits such that we slowly lose the ability to remember things
This is the hallmark of Alzheimer’s disease
Stress effects upon brain circuitry
43
Stress/glucocorticoid excess have been linked to
Decreases in the connectivity of the hippocampus and frontal cortex
Increases in the connectivity of the amygdala, a structure involved in the processing of emotions and affect
Brain networks can be very susceptible to hormonal imbalances, such that abnormal levels of inter-connectivity between regions can be linked to anxiety and depression
Connections between the limbic system and prefrontal cortex are often affected substantially
Stress effects upon neurotransmission
44
Behavior and affect are intimately linked to the chemistry of the brain
When a neurotransmitter called dopamine is released at the synapse, it binds to receptors signaling pleasure in anticipation of a reward
Dopamine is released not when the reward arrives, but when it is anticipated: “Success is a journey, not a destination”
Positron emission tomography (PET) is an imaging technique which can be used to investigate dopamine receptor binding
PET can also be used to investigate the concentration of glucose in the brain and to study how the metabolic needs of neurons are correlated with stress
Impact of stress on the brain and body
45
Increased stress leads to decreased response to dopamine
This decrease in dopamine leads to a decreased feeling of reward
Increased stress also affects metabolism which may lead to obesity
During the semester we will explore the impact of stress on different bodily systems
More on exercise in a later lecture
45
Stress and the heart
46
Stress and atherosclerosis
47
Because stress and the resulting flood of hormones increase blood pressure, the cardiovascular system is subjected to mechanical stress associated with higher blood pressure and pulse rate
High blood pressure damages artery walls
Damaged artery walls become repositories for plaque
Plaque restricts blood flow and increases the risk of heart attack
Atherosclerosis is a condition where the interior of arteries becomes narrower because of plaque
Other Diseases Caused by Stress
48
Stress can greatly impact the body and lead to various diseases such as…
Diabetes
Atherosclerosis
Cardiovascular issues
Weakened immune response
Obesity
General Adaptation Syndrome (GAS) - RECAP
Selye, 1936
49
Diathesis Stress model – Recap
Diathesis
Predisposition (genetic, psych, bio, environmental, situational, personality type)
Stress
Events resulting in the disruption of the psychological equilibrium
Nature v Nurture
Disorders linked with this model:
Alcoholism; Schizophrenia; Anxiety; Depression
What do you think are the protective factors?
Social support; Network typology; Environment; Self-esteem
Expanded into the ‘Differential Susceptibility Hypothesis’ (Belsky et al., 2007) – Look it up!!
50
A stage model of stress – Recap
51
‘Events appraised as stressful are viewed as triggering affective states that in turn engender behavioral and biological responses having possible downstream implications for disease’
(Cohen, Gianaros & Manuck, 2016)
Combines:
Epidemiology
Defining which circumstances and experiences are deemed stressful on the basis of consensual agreement that they constitute threats to social or physical well-being
Psychology
Individuals’ perceptions of the stress presented by life events on the basis of their appraisals of the threats posed and the availability of effective coping resources
Biology
Brain-based perturbations of physiological systems that are otherwise essential for normal homeostatic regulation and metabolic control
Bio-Psycho-Social Model
52
Back to your roots
Fight or flight today – Same as evolution indented?
Some bosses may be predators but essentially, no. But we have similar physiological if not behavioural responses
Something to consider:
What do you think the impact of social hierarchy is?
Primates, as with humans, who are higher up the social hierarchy have fewer stress hormones
Less stress
Less sickness
Bio-Psycho-Social Model
53
Take a lifecourse perspective
- People who are susceptible to high stress often have a background being bullied or abused
Back to the monkeys:
Primates have 1 alpha per pack but impossible to have a global alpha so much postulating and social domineering esp in workplaces
Removing the alphas reduces status play, harassment and increased socialization.
Can this be done with humans?
Reduce fiscal inequality; reduce vertical management hierarchy and increase autonomy in decision making; increase individual control
Bio-Psycho-Social Model
54
Which is better, the whole pizza of just the base?
Easier to allow a dominator hierarchy to form (pizza base) which controls and suppresses other aspects of personality and responses
‘Core Transformation’ suggests embracing all aspects of self, integrating not repressing
Similar principles to adjusting primate behaviour
Why do we ‘pizza base’?
Ease / laziness; Social norms; Dislike of aspects of personality; Self-presentational bias; Maintaining social standing
Just how well do you fair?
55
Holmes Social Readjustment Rating Scale
Take a pen and paper
Write down the values for each event that is relevant to you (within last 12 months)
Total your score
Reflect
| Life Event | Point Value |
| Death of spouse | 100 |
| Divorce | 73 |
| Marital separation | 65 |
| Jail term | 63 |
| Death of close family member | 63 |
| Personal injury or illness | 53 |
| Marriage | 50 |
56
| Fired from job | 47 |
| Marital reconciliation | 45 |
| Retirement | 45 |
| Change in health of family member | 44 |
| Pregnancy | 40 |
| Sex difficulties | 39 |
| Gain of new family member | 39 |
| Business readjustment | 39 |
57
| Change in financial state | 38 |
| Death of a close friend | 37 |
| Change to different line of work | 36 |
| Change in number of arguments with spouse | 35 |
| Mortgage over $10,000 | 31 |
| Foreclosure of mortgage or loan | 30 |
| Change in responsibilities at work | 29 |
| Son or daughter leaving home | 29 |
| Trouble with in-laws | 29 |
58
Nearly there…
59
| Outstanding personal achievement | 28 |
| Spouse begins or stops work | 26 |
| Begin or end school | 26 |
| Change in living conditions | 25 |
| Revision of personal habits | 24 |
| Trouble with boss | 23 |
| Change in work hours or conditions | 20 |
| Change in residence | 20 |
| Change in schools | 20 |
| Change in recreation | 19 | ||
| Change in church activities | 19 | ||
| Change in social activities | 18 | ||
| Mortgage or loan less than $10,000 | 17 | ||
| Change in sleeping habits | 16 | ||
| Change in number of family get-togethers | 15 | ||
| Change in eating habits | 15 | ||
| Vacation | 13 | ||
| Christmas | 12 | ||
| Minor Violations of the law | 11 | ||
60
Totting it up
61
150 points and below: It implies you are less likely to experience a health breakdown.
151-300 points: It implies you have a 50% chance of a major health-breakdown in the next two years.
301 points and above: It implies you have an 80% chance of a major health breakdown in the next two years.
Is it that straight forward?
62
Issues with the HSRR:
SR model
Assumes that all events have same stress value for everyone
Assumes that the anchoring is accurate
Not age-rated (all stresses have the same values at all points in the life span)
Some stress is positive
Thoughts?!?
Additional Reading
63
Social vs environmental stress https://www.sciencedirect.com/science/article/pii/S0924977X12001459
Animal models of social stress https://www.tandfonline.com/doi/full/10.1080/10253890.2018.1462327?scrol l=top&needAccess=true
Social stress models https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901160/
GERO 508 Spring 2021
Week 3
The Mind & Body Connection
Timothy Lu Office Hours: By Appointment Email: [email protected]
Dr Paul Nash CPsychol, AFBPsS, FHEA
Office: GERO 231E
Office Hours: Thurs 09.00-12.00
(OR AGREED APPOINTMENT)
Email: [email protected]
Gillian Fennell
Email: [email protected]
The session in brief
65
Nature v nurture?
Influences factors for genetic predisposition
Influence of personality types
Coping mechanisms
Appraisal models
Integrated approach to genetic predisposition
Nature vs Nurture?
66
https://www.khanacademy.org/test-prep/mcat/behavior/behavior-and- genetics/v/gene-environment-interaction
Revisiting the Diathesis Stress model
67
Diathesis
Predisposition (genetic, psych, bio, environmental, situational, personality type)
Stress
Events resulting in the disruption of the psychological equilibrium
Nature via Nurture
Factors that affect the genetic predisposition
20
What are the factors that can influence genetic predisposition?
Culture: Food Tradition Expectation Religion Others?
Intrapersonal / Interpersonal:
Internal concerns
(health, money, future etc) Communication with others
Social Network: Friends
Family
Civic engagement Confidant?
Gender:
Roles
Expectation / opportunity
Modern Life: Work hours Tech reliance
24 / 7 immersion Unhealthy lifestyle Drink / substances
Factors that affect the genetic predisposition
21
S.E.S.:
Income Education
Access to services Type of work
Leisure time / activity
Built Environment: Neighborhood type Housing stock
Green spaces / urban planning Urban vs rural
Transportation Visible incivilities Crime
Personality types: State / Trait Attitude
Locus of Control
Type A or Type B
A
High-achievers, great at multi-tasking unrelated duties and jobs, usually perform beyond par.
Constantly in a race to achieve higher goals. When goals are attained, they set much loftier aspirations.
Difficult to accept failure. It is never one of their realities. For them, others fail, they don’t.
Time is an opponent that they have to beat every day. They will work to exhaustion.
Severe sense of urgency makes them edgy. Relaxation is difficult
Highly competitive. If there is no obvious competition, they create one.
Highly self-driven. Their stress levels are generally high.
22
Friedman & Rosenman (1976)
B
Know their abilities and work steadily for their goals. They enjoy their achievements.
Not too stressed out to excel. They can be disappointed when they fall short of their goals, but they are not devastated. They are more accepting of failures.
Enjoy games and competitions, not for the sole objective of winning but for the love of the game.
Reflective and innovative. They allow themselves to explore and fail, if necessary.
Sometimes they are too relaxed and laid-back that they lack the drive to reach the uppermost of their careers.
Even-tempered.
They typically live less stressful lives.
It takes 2…… or 3
71
People with Type B personality tend to be more tolerant of others, are more relaxed than Type A individuals, more reflective, experience lower levels of anxiety and display a higher level of imagination and creativity.
The Type C personality has difficulty expressing emotion and tends to suppress emotions, particularly negative ones such as anger. This means such individual also display 'pathological niceness,' conflict avoidance, high social desirability, over compliance and patience.
Coping Mechnisms: Problem focussed coping
72
Basic Principles:
undoing repairing preventing
Examples:
get information
make changes (do what is needed: ask for the raise)
escape from the situation (eg a bad relationship)
make a plan of action and follow it
Coping Mechanisms: Emotion focussed coping
25
Basic Principles:
Changing the meaning of the transaction Regulating its expression
The coping actions are focused on dealing with the emotions not the situation.
Examples:
Wishful thinking: I wish the situation would just go away or somehow be over with.
Distancing: I try to forget the whole thing.
Emphasizing the positive: I try to look at the bright side of things.
Self-blame: I realize I brought the problem on myself
Tension-reduction: I try to make myself feel better by eating, drinking, smoking, or using drugs or medications.
self-isolation: I keep others from knowing how bad things are
seeking social support: I talk to someone to find out more about the situation.
Prayer, reading Scripture
Comparing the two
74
One or the other?
75
Do you think that these coping strategies are situation driven? Individual driven? Contextual? Or enduring personality traits?
In difficult situations, there is a mix of problem focused efforts to do something to change the situation for the better and emotion focused efforts to sustain morale and feel better about the situation.
Examples: disability, pain management
Applied to older adults
76
Costa & McCrae
older people have more negative stresses (health problems, death, etc) but cope as well as younger ones do
no age differences in coping
Young (age 35-45): finances, work, taking care of household, dealing with family and friends More sense of control, equal balance of problem and emotion focused coping.
Old (65-74): health, difficulties with ADL’s.
Greater reliance on emotion focused coping.
HOWEVER….. Is it specifically age related….
Is it just about ageing?
77
Are these specifically developmental or related to life situation?
People learn to reorganize life to cope with disability, regardless of age
Aging may teach us the lessons of how to cope--despite more limited resources, it may be the experiences of loss over a lifetime that gives us the best resources to handle problems.
Key points…
78
Next time…
| Week 4 02/11/2021 | Clinical depression and stress responses (Lu/Nash) | SEE BB | Week 3 Discussion |
31
GERO 508 Spring 2020 Week 3 Genetic Aspects of Stress
The Mind & Body Connection
Timothy Lu
Office: Virtual
Office Hours: By Appointment
Email: [email protected]
Dr Paul Nash CPsychol, AFBPsS, FHEA
Office: GERO 231E
Office Hours: Weds 09.00-12.00
(OR AGREED APPOINTMENT)
Email: [email protected]
Gillian Fennell
Email: [email protected]
Genetic Overview
81
DNA is the fundamental building block of our cells
Everything that we have comes from somewhere within our DNA
DNA is not constant! It can change and mutate over our lives naturally as well as stimulated to change
These changes can be carried down across generation (epigenetics)
Stress impacts our DNA
DNA Overview
82
DNA is a molecule consisting of a double helix carrying genetic instructions used in the growth, development, functioning and reproduction of all life forms
Chromosomes are DNA molecules containing an organism’s genetic code
Nucleosomes are formed by DNA winding around core particles and are connected by linker DNA
Nucleosomes fold into looped chromatin coils
Humans have 46 chromosomes; two of them determine and contain information pertaining to sex
Genetic Variation
83
Genes are DNA sequences which code for functional molecules called proteins
Proteins are complex molecules which have specific functions within the cell
Genetic variation is the variability of biological systems (individuals and populations)
Genetic variation is partly made possible by alleles, which are variant forms of a certain gene
Example: the APOE gene encodes the APOE protein, which has a role in how fats are processed and has three major alleles (ε2, ε3, ε4)
We each have two APOE alleles, one from each parent
The ε4 allele increases the risk for Alzheimer’s disease; the ε2 allele is protective; ε3 is neutral
DNA to proteins
84
Transcription
Genes are copied from DNA to RNA in the nucleus of the cell
Translation
RNA is transported out of the nucleus to the cytoplasm
The ribosome (a cell organelle) assembles protein chains based on instructions contained in RNA
Protein synthesis (production)
Protein chains break off from the ribosome and then undergo changes in shape and structure to form proteins
DNA Replication
85
DNA is made up of four core nucleic acids: adenosine, guanosine, cytosine, and thymidine
Adenosine pairs with Thymidine
Guanosine pairs with Cytosine
We replicate DNA when we are making new cells
To do this, we unravel the DNA strands and open them up with a protein called helicase
A protein called DNA-polymerase duplicates this DNA by matching these
There are other proteins that doubles
DNA Replication
86
DNA is made up of four core nucleic acids: adenosine, guanosine, cytosine, and thymidine
Adenosine pairs with Thymidine
Guanosine pairs with Cytosine
They are paired like a zipper
We replicate DNA when we are making new cells
To do this, we unravel the DNA strands and open them up with a protein called helicase
A protein called DNA-polymerase duplicates this DNA by placing matching nucleic acids
There are other proteins that double as “spellcheckers” and makes sure that the proper nucleic acid is matched up with its pair
DNA Replication
87
DNA is made up of four core nucleic acids: adenosine, guanosine, cytosine, and thymidine
Adenosine pairs with Thymidine
Guanosine pairs with Cytosine
We replicate DNA when we are making new cells
To do this, we unravel the DNA strands and open them up with a protein called helicase
A protein called DNA-polymerase duplicates this DNA by matching these
There are other proteins that doubles
Mutations
88
Mutations are alterations in the genetic code of a cell; their study is central to the discipline of genetics
Mutations at certain locations in the genome may affect the organism’s resilience to stress, which can itself lead to mutations
Mutations are random and often occur during replication they can also happen during the process of reproductive inheritance (production of a zygote)
Inheritance
89
Heredity is the passing-on of traits from parents to their offspring via reproduction
Through heredity, variations between individuals can accumulate and cause species to evolve by natural selection
Heredity plays an important role in stress vulnerability
This is the foundation of epigenetics: DNA from the parents can be passed through to the offspring
The DNA passed is based on the parent’s CURRENT DNA makeup (i.e. mutations and methylation)
Epigenetics
90
The genotype is the part of the genetic makeup of a cell (e.g. genes) which determines the phenotype (e.g. proteins)
The phenotype of an organism is the composite of its observable characteristics (traits), including its physical form, its developmental processes and behavior
Epigenetics is the study of heritable phenotype changes which do not involve DNA sequence alterations
Epigenetic changes often affect gene activity and expression as a result of environmental factors, e.g. stress and aging
Types of epigenetic changes include DNA methylation and histone modification
How DNA is read (and why it matters)
91
Not all your DNA is “readable”
Some of it is locked up away in what is known as a “histone”
These histones must be opened so that the genes may be read and make the appropriate protein
The opening/closing of your DNA is mediated by methylation and acetylation
That means the available genes for your body are based on this methylation/acetylation and can be modified through epigenetic experiences
DNA Methylation
92
A methyl group is a type of molecule containing the –CH3 group of atoms
DNA methylation is a process whereby methyl groups are added to DNA, thus changing DNA segment activity without changing the actual DNA sequence
DNA methylation is a powerful suppressor of gene transcription (the process whereby DNA is transcribed into RNA), which is the first step of protein synthesis
Abnormal levels of DNA methylation have been implicated in cardiovascular diseases (CVDs) like atherosclerosis, and there is hope that DNA methylation measures could be used as early CVD biomarkers
There is a global loss of methylation in aging, and twin studies indicate that methylation rates diverge as a result of environmental factors
Histone Modification and Stress
93
Histone modification refers to changes in the DNA histone structure which will either methylate (turn off) genes or demethylate (turn on) genes
Environmental factors play into this histone modification
Primarily, these are known as stressors (starvation, drug/alcohol abuse, extreme temperatures, etc;)
This is a genetic “memory” of this stressor which leads to modification of the histone aiming for “adaptation”
This “memory” is passed down to the future generation (epigenetics) and leads to greater adaptation
Optional Reading: Histone Methylation and Memory of Environmental Stress(Fabrizio et. al, 2019) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523599/
We’ll see why ‘adaptation’ is in quotes
93
Stress Impact on Telomeres
94
Telomeres are cap-like structures at the ends of chromosomes which protect them when cells divide; over time, due to ongoing cell division, telomeres shorten
Telomere length is an indication of age and general health
Enzymes are molecules which act as catalysts to accelerate biochemical reactions
Telomerase is an enzyme which lengthens telomeres
Stress accelerates telomere shortening; fetuses exposed to high maternal stress have higher disease risk
Responding to stress adaptively rather than maladaptively is crucial to a long, rewarding life
Stress, genetics, and HPA regulation
95
Prenatal stress influences HPA regulation and causes it to be hyperactive, which leads to a greater vulnerability to abnormal circadian rhythms, insomnia and chronic fatigue syndrome in adulthood
Maternal stress during gestation is related to intellectual impairment of the fetus, speech problems, attention deficits, and disorders like autism, ADHD, depression and anxiety in offspring
Exposure to high stress early in life increases vulnerability to stress throughout adulthood
There is a critical period during childhood when HPA axis calibration occurs, and if stress interferes with this then the individual may suffer the consequences throughout her/his entire life, including accelerated epigenetic aging
Maternal grooming affects HPA axis calibration and epigenetically prepares the offspring to withstand stress
How genetics impacts stress response
96
Your genetics may also impact your ability to respond to stress
We have stated fetuses exposed to high levels of stress tend to be poorly adapted to stress in life
Example: Children birthed during starvation periods are more likely to have “thrift phenotype” which becomes a maladaptive stress response leading to obesity, hypertension, and metabolic syndrome (Billack et. al, 2012)
Meaning there is actual changes happening to your DNA phenotype as a fetus due to high levels of maternal stress impacting you as an adult
TED TALK: Ancestral Ghosts in your Genome (20:18)
PTSD Lingers in next generation (6:16)
Epigenetic Drift
97
Epigenetic drift refers to the phenomenon where the accumulation of epigenetic changes is directly proportional to the age of the individual
Epigenetic drift contributes to differences between chronological age and biological age
Epigenetic drift has been found to be dependent upon lifestyle, but lifestyle is partly predicated upon susceptibility to stress an upon maternal stress
In genomic imprinting, both the mother and father contribute to the epigenetic patterns at various locations in the genomes of their germ cells
In developed countries, parental age at procreation has been increasing steadily, and so have the incidence rates for autism, ADHD, clinical depression, anxiety, obesity and certain cancers
Stress research suggests that these phenomena may not be entirely coincidental
Reversibility of stress-related epigenetic aging
98
Exercise is associated with epigenetic changes which benefit health and can assist the recalibration of the HPA axis
A healthy diet can reduce the rate of DNA methylation
Foods high in antioxidants (e.g. fruits, vegetables) contribute to good health and can reduce the rate of epigenetic changes
Berries contain large concentrations of antioxidants and studies have found that a berry-rich diet is beneficial to good health
Some teas (white tea, green tea, chamomile, herbal teas) but not all (black tea) contain anti-oxidants
Chamomile tea contains several serotonin precursors which may alleviate anxiety and improve sleep in addition to having anti-bacterial, anti-viral and anti-inflammatory properties
Foods which are high in saturated and poly-saturated fats (e.g. processed foods) should be avoided as they increase oxidative stress
How to best prepare for epigenetics
99
Maternal care can contribute to the appropriate calibration of the HPA axis to reduce offspring’s susceptibility to depression, anxiety and accelerated aging later in life
Epigenetic biomarkers of disease risk will likely be developed in the coming decades to assist with monitoring and reversing deleterious health trends in the population
Epigenetic age acceleration is highly heritable in newborns but shows markedly decreased heritability later in life, which suggests that positive interventions can rectify the trajectory of stress-related effects upon the offspring
Building a foundation of healthy stress responses may lead to less histone modification
Example: instead of just “coping/dealing” with stressors seeking stress relief through therapy, counseling, social activity, hobbies, meditation, and exercise may be beneficial
Appraisal model of gene and environment
1
Basic Principles:
Giant feedback loop
Starts and ends with environmental disequilibrium / accommodation
Cognition and appraisal
Coping strategies
Responses
Potential storm / stress/ accommodation equilibrium
Lazarus & Folkman (1984)
Primary Appraisals
Beliefs and commitments form the basis of appraisal
4 component attitude model
Links to personality type, LOC etc
Appraisal of benign if belief congruent
Threats require action (bio and/or psych) to eliminate
B&C explains individual difference
101
Secondary Appraisals
Adaptive responses to limit / avoid hard
Indiv. Coping strategies / behaviours
Overt coping (put sweater on)
Covert coping (adjustments related to problem and the emotional impact – increase education about dementia)
Responses include:
Cognitive approach
Behavioural adjustments
Realignment of goals / commitments
Psychological approaches (denial etc)
Coping can be problem focused or emotion focused
102
Dynamic processes
Emotion focused – Initially less energy; long term draining on coping recourse and minimal impact on the problem event
Problem focused – costly in energy & initial time commitment; lower the stressor value if effective
Emotion focused (eg denial) – stress reducing with serious and terminal illness; problem focused can be more anxiety provoking (Kreitler, 1999)
Both strategies aim to reduce nervous system activation; negative affect and physiological activation
When strategy used, can enter into evaluation process again
Beliefs and commitments are updated
Overall cog. Regulation over emotion and state of distress
103
An integrated approach
Basic Principles
Giant feedback loop
Incorporation of individual sensory interpretation (beliefs and experience)
Emotional triggers for biological and psychological pathways
System appraisal of biological input on sensory intake
Biological outcomes and mediation from emotional appraisal
Starts and ends with disequilibrium / accommodation
Coping strategies reflect lifecourse & genetics
104
GERO 508 Spring 2021
Week 4
The Mind & Body Connection
Timothy Lu Office Hours: By Appointment Email: [email protected]
Dr Paul Nash CPsychol, AFBPsS, FHEA
Office: GERO 231E
Office Hours: Thurs 09.00-12.00
(OR AGREED APPOINTMENT)
Gillian Fennell
Email: [email protected]
What were the key points from last time?
106
Nature v nurture?
Influences factors for genetic predisposition
Influence of personality types
Coping mechanisms
Appraisal models
Integrated approach to genetic predisposition
The session in brief
107
What does depression look like
The DSM
Unipolar depression
Gender differences
Types and incidence rates
Treatment
Depression in later life
Substance misuse
What is depression?
108
What do you understand by depression?
Depression, otherwise known as major depressive disorder or clinical depression, is a common and serious mood disorder. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. Aside from the emotional problems caused by depression, individuals can also present with a physical symptom such as chronic pain or digestive issues.
DSM V
109
Five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
Isn't depression just being sad?
110
The difference doesn’t lie in the extent to which a person feels down, but rather in a combination of factors relating to the duration of these negative feelings, other symptoms, bodily impact, and the effect upon the individual’s ability to function in daily life.
Sadness is a normal emotion that everyone will experience at some point in his or her life. Be it the loss of a job, the end of a relationship etc. sadness is usually caused by a specific situation, person, or event
A person suffering from depression feels sad or hopeless about everything. This person may have every reason in the world to be happy and yet they lose the ability to experience joy or pleasure
With sadness, you might feel down in the dumps for a day or two, but you’re still able to enjoy simple things like your favorite TV show, food, or spending time with friends. This isn’t the case when someone is dealing with depression. Even activities that they once enjoyed are no longer interesting or pleasurable.
self-harm and suicidal inclinations don’t arise from non-depressive sadness.
Those struggling with severe depression may have thoughts of self-harm, death, or suicide, or have a suicide plan
Major Depression (Unipolar)
111
Characterized by a persistent feeling of sadness or a lack of interest in outside stimuli
Unipolar depression is solely focused on the ”lows,” or the negative emotions and symptoms that you may have experienced
Major depression is well understood in the medical community and is often easily treatable through a combination of medication and talk therapy….. Not so with others…
How big of an issue is it…?
Even in children, according to analysis of the 2005 census, a significant proportion are experiencing MDE’s Why? Worse now?
…But that’s not the sum…
Gender differences
112
The lifetime incidence of depression in the United States is more than 20-26% for women and 8-12% for men
The median age for the onset of major depression is age 32
About 7 percent of the adult U.S. population has this debilitating mental health condition at any given time
Woman and men differ, but why?
The most commonly cited physiological reason for women experiencing major depression more than men is due to fluctuating hormones and genetic predisposition, particularity around the times of puberty, childbirth, and menopause
Depression tends to co-occur with other illnesses and mental conditions incl. pregnancy
25% of cancer patients, one third of HIV patients, and one third of heart attack survivors suffer from major depression
Approximately 80% of patients who seek treatment for major depression show improvement within four to six weeks
If left untreated, can have fatal results Why do people not seek treatment?
Depression in the US
113
Types of depression
15
Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
16% of women experience this
Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
About 2 % of the American population have a depression type
that's less severe than major depression, but is still very real
Types of depression
16
Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness. Up to 20% of people with depression experience psychosis
Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder. 4-6% of US citizens
Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.” 2-3% population and highest risk of suicide
Depression and health
Depression alters biological systems
Endocrine
Immune
Cardiovascular
Metabolic
Neurocognitive
Depression promotes inflammation
High inflammation associated with:
cardiovascular disease, diabetes, metabolic syndrome, rheumatoid arthritis, asthma, multiple sclerosis, chronic pain, psoriasis. These diseases pose an elevated risk of depression
116
Depression cycles
117
Depression can sensitize the inflammatory process
Depression and stress increase risks of infection, prolonged infections and delayed wound healing
Difficulties with ADLs increase risk of depression
Depression predicts frailty and frailty predicts depression
Sleep cycles and depression
Distress increases risk for depression; depression affects sleep; sleep loss stimulates production of proinflammatory cytokines, increasing depression risk
Depression and CV Disease
118
Major depressive disorders projected to become the leading cause of worldwide disability by 2030
Mostly due to association with diseases for reasons other than inflammation:
Symptom burden
Psychological stress
Financial hardship
Functional limitations
Cardiovascular disorders may cause depression but depression is also a risk factor for cardiovascular disorders in healthy populations and predicts adverse cardiovascular outcomes among populations with preexisting cardiovascular disorders
Whooley & Wong (2013)
Mechanisms for CV disease and depression interaction
20
Depression higher in those with cardiovascular disease than cancer, diabetes, hypertension, arthritis, or chronic lung disease, even 8 years after diagnosis
Physical activity accounts for most of the risk of cardiovascular mortality due to depressive symptoms (32%)
Medication non-adherence accounts for some of the risk due to depression (5%)
Smoking may be a form of self-medication & smoking may cause neurologic changes in the systems that can lead to depressed mood. It accounts for 10% of the risk of cardiovascular mortality due to depression.
Treating Depression - Psychotherapies
21
Interpersonal therapy is relatively short in duration. Sessions are highly structured. It's based on the idea that your relationships are at the forefront of depression. The goal of treatment is to help patients improve skills, such as communication skills and conflict- resolution skills.
Social skills therapy teaches patients how to establish healthy relationships. The goal is for patients to improve communication and learn how to build a strong social network with individuals based on honesty and respect.
Cognitive behavioral therapy focuses on helping people identify and replace cognitive distortions and behavioral patterns that reinforce depressive feelings. It is usually short- term and it focuses on present problems and skills teaching.
Psychodynamic therapy is often featured in movies or pop culture. It involves helping patients explore their unconscious and unhealed emotional wounds from the past.
The goal is to help people learn how their depression is related to past experiences and unresolved conflicts. The therapist helps patients address those issues so they can move forward in a productive manner.
Treating Depression - Psychotherapies
22
Supportive counseling is unstructured and focuses on listening to the patient. Patients are invited to address whatever issues they want to talk about and the therapist uses empathy to provide understanding and support
Behavioral activation raises awareness of pleasant activities. The therapist seeks to increase positive interactions between the patient and the environment. By getting active and engaging in more pleasurable activities, symptoms of depression may be reduced
Problem-solving therapy aims to define a patient's problems. Then, multiple solutions are offered. The therapist helps the patient evaluate options and choose a solution
Treating Depression – Pharmaceutical
23
There are many different medications that can help reduce the symptoms of depression. Most studies have found medication is most effective when it is used in conjunction with therapy
Tricyclic antidepressants (TCAs) — were among the first developed antidepressants. They have more side effects than newer antidepressants but can be more effective
for certain patients. These include Elavil (amitriptyline), Tofranil (imipramine) and Pamelor (nortriptyline)
Monoamine oxidase inhibitors (MAOIs) — are another older type of antidepressant. If you are taking an MAOI, you will have to follow certain dietary restrictions to prevent a reaction that can cause high blood pressure. You will also have to be careful about interactions with certain other medications. Like tricyclics, these are not generally used first line, but can sometimes be helpful for more difficult to treat depressions. MAOIs include Marplan (isocarboxazid), Nardil (phenelzine) and Parnate (tranylcypromine)
Selective serotonin reuptake inhibitors (SSRIs) — are the most commonly prescribed medication for depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) Celexa (citalopram) and Luvox (fluvoxamine) are commonly prescribed brand names. Compared to other antidepressant types, SSRIs tend to have fewer side effects. SSRIs should not be prescribed in conjunction with the older MAOIs due to the potential for a dangerously high level of serotonin to build up, which can cause serotonin syndrome.
Treating Depression – Pharmaceutical
123
Norepinephrine and dopamine reuptake inhibitors (NDRIs) — Wellbutrin (bupropion) is in a class all by itself. Wellbutrin is less likely to have the sexual side effects that are common in the other antidepressants.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) — are a newer type of antidepressant that works similarly to SSRIs only they also block the reuptake of norepinephrine along with serotonin. Common medications in this class are Effexor (venlafaxine), Cymbalta (duloxetine) and Pristiq (deslavenfaxine).
Something a little different…
124
https://www.washingtonpost.com/national/health-science/a-one-time-party-drug-is-helping-people-with-deep-depression/2016/02/01/d3e73862-b490-11e5-a76a- 0b5145e8679a_story.html?noredirect=on&utm_term=.09a40627d095
Ketamine works differently from traditional antidepressants, which target the brain’s serotonin and noradrenalin systems. It blocks N-methyl-D-aspartate (NMDA), a receptor in the brain that is activated by glutamate, a neurotransmitter.
“Ketamine almost certainly modifies the function of synapses and circuits, turning certain circuits on and off,” explains Carlos Zarate Jr., NIMH’s chief of neurobiology and treatment of mood disorders, who has led the research on ketamine. “The result is a rapid antidepressant effect.”
A study published in the journal Science in 2010 suggested that ketamine restores brain function through a process called synaptogenesis. Scientists at Yale University found that ketamine not only improved depression-like behavior in rats but also promoted the growth of new synaptic connections between neurons in the brain.
This drug is 75 percent effective
Depression in later life
125
Major depression - less common than at any other stage of life
However… isolated symptoms are much more frequent