DEPRESSIONBy: SATHISH Rajamani,

Lecturer

What is Depression?

Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.

DEFINITION

• Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

• Depression is the leading cause of disability as measured and the 4th  leading contributor to the global burden of disease (DALYs) in 2000. By the year 2020, depression is projected to reach 2nd place of the ranking of DALYs calculated for all ages, both sexes. Today, depression is already the 2nd cause of DALYs in the age category 15-44 years for both sexes combined.

PREVALENECE

• Depression occurs in persons of all genders, ages, and backgrounds.

• Facts• Depression is common, affecting

about 121 million people worldwide.• Depression is among the leading

causes of disability worldwide.• Depression can be reliably diagnosed

and treated in primary care.• Fewer than 25 % of those affected

have access to effective treatments.

What are the different forms of depression?

There are several forms of depressive disorders.1. Major depressive disorder, or major

depression2. Dysthymic disorder, or dysthymia3. Minor depression

• Psychotic depression,• Postpartum depression

• Seasonal affective disorder (SAD)4. Bipolar disorder

Signs And Symptoms Of Depression

Persistent sad, anxious, or "empty" feelings

Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or

helplessness Irritability, restlessness Loss of interest in activities or hobbies

once pleasurable, including sex Fatigue and decreased energy

S&S Cont….

Difficulty concentrating, remembering details, and making decisions

Insomnia, early-morning wakefulness, or excessive sleeping

Overeating, or appetite lossThoughts of suicide, suicide attemptsAches or pains, headaches, cramps, or digestive

problems that do not ease even with treatment.

What illnesses often co-exist with depression?

Post-traumatic stress disorder (PTSD)Obsessive-compulsive disorderPanic disordersocial phobiaGeneralized anxiety disorderDepression also may occur with other serious

medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease

CAUSES OF DEPRESSION

1. Genetic or Hereditary2. Biological / Biochemical / Medication3. Dietary4. Environmental5. Socio Cultural Factors / Situations /

Relationships / Personality

DIAGNOSIS•History Collection•Mental Status Examination•ICD – 10 Criteria

Management

• Antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine.

ANTI DEPRESSANTS

• Selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression.

ANTI DEPRESSANTS

• Tricyclics are older antidepressants. Tricyclics are powerful, but they are not used as much today because their potential side effects are more serious.

Examples: Imipramine and Nortriptyline

ANTI DEPRESSANTS

• Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. They can be especially effective in cases of “atypical" depression.

• People who take MAOIs must avoid certain foods and beverages (including cheese and red wine) that contain a substance called tyramine.

PSYCHOTHERAPY

• Cognitive - behavioral therapy (CBT)CBT helps people with depression

restructure negative thought patterns.

• Interpersonal therapy (IPT)IPT helps people understand and work

through troubled relationships that may cause their depression

ELECTROCONVULSIVE THERAPY

• For cases in which medication and/or psychotherapy does not help relieve a person's treatment-resistant depression, electroconvulsive therapy (ECT) may be useful.