Depression: background, practice and pathophysiology

Depression: Background, paractice, essential and pathophysiology 
 *Outlines* 
Introduction
Historical background and definition 
Types of depression 
Diagnosis and management 
Pathophysiology 
Conclusion 

 *Introduction* 
 Depression affects 264 millions globally and is a major cause of disability (WHO, 2020). Depression is a multifactorial disorder (Hu _et al.,_ 2021). 
 *Historical background*
 Recognized since ancient times with Hippocrates and minimal advancement is made in it's understanding (Bourin, 2020; Hindmarch, 2021). 
The amine hypothesis defined as imbalanced of monamine neurotransmitters in the brain (Joel _et al.,_ 2014). 
 *Types of depression*
 Common types are as follows 
Major depression. 
Dysthymic depression. 
Bipolar depression. 
Psychotic depression. 
Seasonal affective depression and
 parietal depression (APA, 2013; Mayoclinic, 2020). 
 *Diagnosis and management*
 Diagnosis: Diagnosis are carried out by means of screening mayerial such PHQ-9, ZRS and CES-D Management: includes psychotherapy and pharmacotherapy.

 *Pathophysiology* 
 ETIOLOGY: 
 *Brain networks* : 
Prefrontal cortex; includes by depression lead to hyperactiviion of prefrontal cortex (Hu _et al,._ 2021). 

Amygdala;abnormal increase in volume has been found (Hamilton _et al,._ 2013).

 Basal ganglia; exhibit reduced in motivation and anhedonia (Savitz and Drevet, 2013).

Hippocampus; depression induced a reduce in hippocampal volume (Eleni, 2012; Campbell _et al,._ 2004). 

Neurotransmitter system, Tryptophan depletion, lead to development of depressive symptoms (Hu _et al,._ 2021).

 *Gut microbiomes* 
their dysregulation induces depression (Hu _et al.,_ 2021). 
 *Immunological factor* 
Proinflammatory cytokines causing peripheral to tryptophan depletion, may lead to depressive symptoms (Hu _et al.,_ 2021). 

 *Environmental factor* 
 elevate depression risk in genetically vulnerable individual (Hu _et al.,_ 2021).  

*Early life trauma* 
Traumatic childhood may lead to depressive symptoms (Hu _et al.,_ 2021).

 *Neurodegenerative disease* 
Alzheimer's disease (AD): Lead to cognition impairment. 
Lewy body disease: is associated with cognition impairment and dysfunction in mator control leading to depressive symptoms. 
Parkinson's diseases: dysregulation in dopamine, noradrenaline and serotinin neurosecretory neurons induce depressive symptoms. 
 
*Neuroendocrine abnormalities* Dysfunction of serotinin activity has been observed in depression.
The dysregulation of the HPA-axis inducing serotinin function (Holsboer, 2000). 

 *Vascular diseases*
 A Hypothesis suggest that vascular disease may impact both cognition and emotional processing. 
 *Conclusion*
Depression is a complex multifactorial condition. While has been made in understanding the depression, more research is needed for better understanding and management of the disorder.

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