Depression
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DEPRESSION Dr. Prasanna Prabhakar Khatawkar M.B.B.S., D.P.M., F.A.G.E., D.N.B. (Psychiatry) Consultant Psychiatrist www.mhgi.in
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Transcript of Depression
DEPRESSION
Dr. Prasanna Prabhakar Khatawkar
M.B.B.S., D.P.M., F.A.G.E., D.N.B. (Psychiatry)
Consultant Psychiatrist
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TOO MUCH TO HANDLE ???
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WHAT IS DEPRESSION?
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A. FIVE OR MORE SYMPTOMS STATED BELOW:* PRESENT FOR TWO OR MORE WEEKS* SUGGEST A DEFINITE CHANGE FROM EARLIER
BEHAVIOUR* INCLUDES AT LEAST ONE OF THE
FOLLOWING: ~ DEPRESSED MOOD ~ DECREASED INTEREST OR PLEASURE.
* SYMPTOMS INCLUDE: 1. SUBJECTIVE REPORT OF DEPRESSED MOOD
DIAGNOSTIC CRITERIA: DSM-IV
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2. DECREASED INTEREST
3. SIGNIFICANT WEIGHT-LOSS OR WEIGHT-GAIN
4. INSOMNIA OR HYPERSOMNIA
5. PSYCHOMOTOR AGITATION OR RETARDATION.
6. FATIGUE OR LOSS OF ENERGY
7. FEELINGS OF WORTHLESSNESS AND EXCESSIVE OR INAPPROPRIATE GUILT
8. RECURRENT THOUGHTS OF DEATH.
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B. SIGNIFICANT SOCIO-OCCUPATIONAL DYSFUNCTION.
C. SYMPTOMS NOT SUGGESTIVE OF SUBSTANCE OR GENERAL MEDICAL CONDITION.
D. NOT OCCURRING DURING BEREAVEMENT
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OTHER IMPORTANT FEATURES:
1. IMPROVEMENT IN SYMPTOMS TOWARDS EVENING
2. MULTIPLE SOMATIC COMPLAINTS
3. HEIGHTENED PERCEPTION TO PAIN
4. ALEXITHYMIA
5. TEARFULNESS
6. ANXIETY SYMPTOMS
7. PSEUDODEMENTIA
8. MOOD CONGRUENT PSYCHOTIC FEATURES
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COGNITIVE TRIAD of
DEPRESSION
• NEGATIVE EVALUATION OF SELF• NEGATIVE EVALUATION OF THE WORLD• PESSIMISTIC EXPECTATIONS OF FUTURE
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PATHOGENETIC AETIOLOGIC
MODEL OF DEPRESSION
•LIMBIC-DIENCEPHALIC DYSFUNCTION
•NA SYSTEM DYSFUNCTION LEADING TO ALTERED LIMBIC AND CORTICAL AROUSAL
EARLY LOSS HEREDITY GENDER
AFFECTIVE TEMPERAMENTS STRESSORS
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• 5-HT SYSTEM DYSFUNCTION• DOPAMINERGIC SYSTEM
DYSFUNCTION
• ALTERED RECEPTOR SENSITIVITY
• DYSFUNCTION OF HPA AND HPT AXES
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•ALTERATION OF SLEEP NEUROPHYSIOLOGY
•CEREBRAL METABOLIC ALTERATIONS
•IMMUNOLOGIC DEPRESSION
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REACTIVE DEPRESSION
ENDOGENOUS DEPRESSION
V/s
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ATYPICAL DEPRESSION
• REVERSAL OF VEGETATIVE SYMPTOMS, i.e.,
1. SLEEP
2. APPETITE
3. SEXUAL FUNCTION
• LEADEN PARALYSIS• REJECTION SENSITIVITY
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ANTIDEPRESSANTS
1. SSRIs (SELECTIVE 5-HT REUPTAKE INHIBITORS)
2. SDRIs (SELECTIVE DOPAMINE REUPTAKE INHIBITORS)
3. SNRIs (SELECTIVE 5-HT NE REUPTAKE INHIBITORS)
4. SARIs (SEROTONIN ANTAGONISTS/REUPTAKE INHIBITORS)
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5. NaSSAs (NA-SPECIFIC 5-HT ANTIDEPRESSANTS)
6. NRIs (NE REUPTAKE INHIBITORS)
7. TCAs (TRICYCLIC ANTIDEPRESSANTS)
8. RIMAs (REVERSIBLE INHIBITORS OF
MAO-A)9. MAOIs (MONOAMINE OXIDASE
INHIBITORS)
10. OTHER DRUGS: THYROID SUPPLEMENTS
STIMULANT DRUGS
LITHIUM
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SELECTIVE 5-HT REUPTAKE
INHIBITORS (SSRIs): ADVANTAGES
• SAFETY• TOLERABILITY• NOT LETHAL IN OVERDOSAGE• NO CARDIOTOXICITY• NO ANTICHOLINERGIC SIDE EFFECTS• WIDER THERAPEUTIC SPECTRUM.• USUAL MAINTENANCE DOSE IS THE
STARTING DOSE
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SELECTIVE 5-HT REUPTAKE
INHIBITORS (SSRIs):SHORTCOMINGS
• NOT AS EFFECTIVE AS TCAs/SNRIs IN CASES OF SEVERE DEPRESSION
• SIDE EFFECTS ARE BOTHERSOME IF NOT LETHAL
• SEXUAL DYSFUNCTION• AGITATION
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• AKATHESIA• NAUSEA• GI DISTRESS• WITHDRAWAL EFFECTS
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THANK YOU
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