A woman aged 42 years was brought with

complaints of being lethargic, does not sleep well,

occasionally becomes irritable, but mostly
remains quite and aloof. Family members have
seen her crying sometimes, which when inquired
she replies that that was nothing but she
remembered something that happened in the
past. She sometimes calls her family members
and tells them to live peacefully after her death.
During interview she reported that she is having
all these because of things she has done in the
past. Diagnosis?
DEPRESSION

Dr. Uddip Talukdar,

Assistant Professor, Dept. of Psychiatry,
Fakhruddin Ali Ahmed Medical College, Barpetea, Assam
DEPRESSION
Depression is a mental illness
One of the top 5 diseases in the world

Widely prevalent, lifetime prevalence is 5-17%

Females have higher prevalence (M 8-12%, F 20-26%)

DIAGNOSIS OF DEPRESSION
Presence of symptoms:
Depressive mood
Low self esteem
Loss of interest
Easy fatiguability
Guilt feeling
Loss of concentrtion
Anhedonia (Lack of pleasure)
Suicidal desire
Sleep disturbance
Appetite disturbance
Sexual Dysfunction
DEPRESSED MOOD
Pervasive sadness (all activities)
Persistent sadness (throughout the day)

Social withdrawal
Occupational dysfunction

Anhedonia (inability to experience pleasure)

DEPRESSIVE IDEATION /
COGNITION
Hopelessness (of future)
Helplessness

Worthlessness

Self-reproach & Guilt feeling

Poor concentration

Indecisiveness

Slowness in thinking
PSYCHOMOTOR ACTIVITY
PMA is reduced (common in young)
Slowed thinking
Monotonous voice
Reduced volume of speech
Reduced pressure
Increased reaction time
Depressive stupor

Agitation (common in elderly)

Restlessness
Feeling of unease

Anxiety
PHYSICAL SYMPTOMS

Multiple physical symptoms

Vague symptoms,
heaviness in head
general aches and pains
Hypochondriacal features
Reduced Energy and Easy Faiguability
BIOLOGICAL FUNCTIONS
Insomnia
Early morning awakeing
Loss of appetite & weight
Loss of libido
PSYCHOTIC FEATURES (IN 15-20%)
Delusions
Mood congruent
Mood incongruent
Hallucinations

Grossly inappropriate behaviour

SUICIDE
Depression one of the common cause
Death Wish

Assessment of risk of suicide

Planning
Lethality
DIAGNOSIS OF DEPRESION

Symptoms + Duration
ICD & DSM
ICD-10: Depressive Episode
Mild depressive episode
Moderate depressive episode
Severe depressive episode
DSM-IV: Major Depressive Disorder
Mild
Moderate
Severe
AETIOLOGY OF DEPRESSION: BIOLOGICAL
FACTORS

Biogenic amines:
Norepinephrin
Serotonin

Dopamine

ACh, 2-nd Messenger System, Hormones, GH,

Prolactin, Immunological factors

Structural and/or functional brain damage
AETIOLOGY OF DEPRESSION: GENETIC
FACTORS

2-3 times higher chances in family members

In twins 37%
No causative gene has been found till date
Multiple gene interaction
Gene-environment interaction
15q25.3-26.2, 12q23, 3c, 7p, 18q, 12q23,
1p36,13q31
Chr 17, Serotonin transporter gene
Chromosome 10, near p2.53 & p6.45
AETIOLOGY OF DEPRESSION: PSYCHOLOGICAL
APPROACH

Psychosocial factors:
Life events, Stress
Personality

Psychodynamics:
Cognitive theory
Learned helplessness
SPECIFIC TYPES OF DEPRESSION

Bipolar Depression
Recurrent Depressive Disorder

Cyclothymia

Dysthymia

Postschizophrenic Depression

Seasonal Affective Disorder

DIFFERENTIAL DIAGNOSIS
Medical Disorders:
Thyroid dysfunction
Hormonal disorders (GH, Prolactin)
Substance abuse
AIDS
Adverse effects of medicines: Antihypertensives
Neurological Conditions:
CVA
Parkinsons disorder
Epilepsy
Tumours
Pseudodementia
Other Mental Disorders: Grief Reaction
PHARMACOTHERAPY FOR
DEPRESSION

1951, ISONIAZID was found to relieve

depression,
IPRONIAZID (1958) works by MAO inhibitor

Specific MAO-A Inhibitors (Moclobemide)

Cheese Reaction
PHARMACOTHERAPY FOR
DEPRESSION
Tricyclic Antidepressants:
Amitriptyline (75-300mg)
Nortryptaline (40-200mg)
Imipramine (75-300mg)
SSRIs:
Fluoxetine (10-60 mg)
Sertraline (50-150mg)
Citalopram (Escitalopram) (20-60 mg)
Paroxetine (20-50mg)
Fluvoxamine (100-300mg)
DA reuptake inhibitors: Bupropion (200-400)
Other drugs: Mirtazapine, Venlafaxine, Desvenlafaxine,
Duloxetine
OTHER THERAPIES
Psychotherapy:
Cognitivebehaviour therapy
Supportive psychotherapy

ECT
Deep-Brain Stimulation
Vagus Nerve Stimulation

Phototherapy
SIDE EFFECTS OF DRUGS
Disturbed sleep: Drowsiness, Insmonia
Sexual side effects

Anticholinergic Side effects

Weight gain

GI distress
SPECIAL POPULATION
Children
Pregnant & Breast Feeding mothers

Elderly

Associated with other medical condition

THANK YOU AT ETERNITYS GATE