Overview of Depressive disorder

Presented by Dr. Al Tarique

IMO, Medicine Department

In old Testament, King Saul described Depressive syndrome, as the story of Ajax’s suicide in Homer’s Iliad.

• About 400 BCE, Hippocrates used Mania & Melancholia (Depression).

• In 30 AD, the Roman physician Celsus described Melancholia as Depression caused by black bile.

Genesis

• In 1854, Falret described folie circulaire means alternating Depression and Mania.

• In 1882, German psychiatrist Kahlbaum, used cyclothymia, means Mania & Depression as same illness.

• In 1899, Kraepelin described Manic Depressive Psychosis , now called Bipolar Mood disorder .

DSM - IV

American Psychiatric association mentioned in Diagnostic & Statistical manual of Mental disorders (DSM – IV) as :

Bipolar I disorder: Mania + Depression Bipolar II disorder: Hypomania + Depression

What is Depression?

• Depression means ‘morbid sadness’.• It is defined as combination of both misery &

malaise.• Depression is a major cause of disability &

suicide.• Depression may come as experience, as

symptom of other disease & separate syndrome.

• Mild, Moderate, Severe.• Unipolar: Major Depressive disorder.• Bipolar: Manic Depressive Psychosis.• Recurrent Depression• Atypical Depression • Dysthymic Disorder

Types of Depressive disorder

Terminology1.Major Depression/ Unipolar Depression:

Birth 20 Yrs

Birth 30 Yrs

Depression

Mania

2.Recurrent depression:

3.Bipolar I disorder:

5. Dysthymia

6. Cyclothymia

Hypomania

Depression

4. Bipolar II disorder

Epidemiology:

Prevalence:• F - 6 to 8% (Bangladesh: F- 11.6%)• M - 3 to 5 % ( Bangladesh : M -2.9 %)• Gender: M: F=1:2• Age: Range :6-50 yrs. Mean : 30 yrs. 50% between 20-50 age.

UnemployedDivorcedSeparation

Higher Rate

Causative factors:

Biological:Genetic: Polygenic inheritance. Biochemical:• Decreased 3 monoamine neurotransmitters:

such as - Serotonin (5 HT)

Noradrenaline (NE) CatecholaminesDopamine (DA)

• Change in brain volume:– Enlarged Lateral ventricles– Decreased Hippocampal & Basal ganglia volumes

• Secondary depression :– Cushing’s syndrome.– Addison’s disease.– Hypothyroidism.– Hyper parathyroidism.– Pre menstruation.– Puerperium.– Menopause.

Psychological

• Pre morbid personality: Cyclothymic personality (Repeated & sustained mood swings).

• Stressful life events.• Bereavement

Social

• Relationship with parents.– Deprivation of maternal affection.– Family discord.– Disruption of Parent-Child relationship.– Overprotective parenting.

• Poor social support.• Empty nest syndrome: • Husband abroad syndrome

Presenting features

A. Biological features : (Vegetative/ Somatic)• Sleep disturbance (Early morning awakening).• Diurnal variation of mood (morning ↓, evening ↑).• Anorexia.• Weight loss: In few cases weight may be increased.• Constipation.• Loss of libido.• Amenorrhea.

B. Central features:

• Negative thoughts (Depressive cognition):o Guilty feeling about past.o Worthlessness about present.o Pessimistic thoughts about future.o Suicidal plan

• Anhedonia: Lack of interest & enjoyment.• Reduced energy / Psychomotor

retardation: • Crying Spell

C. Others

Delusions:• Hypochondriacal delusion: Patient

convinces that he has cancer or venereal diseases.

• Persecutory (Paranoid) delusion: Patient believes that other people harm him.

• Nihilistic delusion: Patient believes that he is moneyless/ his family are dead.• Delusion of guilt: Dishonest act will be

punished severely.

Auditory hallucination: Hearing of one 2nd person derogatory & commanding voice.

Features can be described as Mnemonic of Depression • D- Depressed mood, Drug used• E- Energy lack /Eating disturbance• P- Pessimistic thought • R- Retarded movement• E- Emotional disturbance• S- Sexual disturbance/ Speech problems• S- Suicidality• I - Insomnia • O- Obsessional rumination• N- Nihilism

Atypical Depression

Depressive symptoms with :• Increased Appetite• Weight gain• Excessive sleep

Childhood Depression

Depressed mood with :• School Phobia• Excessive clinging to parents

Depression in Adolescent

Depressed mood with :• Poor academic performance • Truancy• Anti- Social Behavior • Substance abuse • Running away• Sexual promiscuity

Depression in older age

Depressive symptoms with loss of memory, known as depressive pseudo dementia

Some Famous people suffered from Depression

• Abraham Lincoln (1809 -1865) , 16th President of USA

• Georgia O’Keeffe (1887-1986) , American artist.

• Jim Carrey (born January 17, 1962) Canadian American actor, comedian, impressionist, screenwriter, and producer.

• J. K. Rowling (born 31 July 1965), British novelist, screenwriter and film producer.

• Dilip Kumar (born on 11 December 1922) , Indian film actor.

• William James (1842 – 1910), American philosopher and psychologist.

• Vincent van Gogh (1853 –1890) ,Dutch painter.

• Agatha Christie (1890 –1976), English crime novelist and short story writer.

• Franz Kafka (1883-1924), German-language writer of novels and short stories.

• Terry Bradshaw ((born September 2, 1948), former American football quarterback.

• Sigmund Freud (1856-1939), Austrian neurologist founder of Clinical psychology.

• Buzz Aldrin (born January 20, 1930) , American engineer and former astronaut.

Source: Internet(Wikipedia)

Thank You All