DEPRESSION AN OVERVIEW Dr Mohan Chandran DPM MD

DEPRESSION- AN OVERVIEW Dr Mohan Chandran, DPM, MD Professor and Head Dept of Psychiatry Yenepoya Medical College

MOOD DISORDERS • Major Depression • Bipolar Disorder • Dysthymic Disorder • Cyclothymia • Mood disorder secondary to general medical condition/ substance abuse 9/10/2020 2

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HISTORY • • Hippocrates – 4 th century BC Celsus – 30 AD, melancholia Falret & Baillarger – 1830, circular insanity Kraeplin – 1913, manic depressive insanity Leonhard – Unipolar vs Bipolar Freud – mourning and melancholia Rene Spitz – 1946, Anaclitic Depression 9/10/2020 5

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EPIDEMIOLOGY • Life time prevalence 4 -20% • Higher in females • Higher in separated and divorced • Major health problem affecting Qo. L and causing severe disability and even death • Under diagnosed and under treated 9/10/2020 7

Depression and Age Any age group! • In infants : Anaclitic depression • Adolescent turmoil • Premenstrual dysphoric disorder • Post partum depression 9/10/2020 8

Depression and age • • • Middle age crisis Empty nest syndrome Late onset depression (smiling depression) 9/10/2020 9

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AETIOLOGY • BIO-PSYCHO-SOCIAL MODEL ü Biogenic amines- Norepinephrine, ü Serotonin, Dopamine ü Genetic – Family studies, adoption studies ü Neuro-endocrine factors – adrenal axis, thyroid axis ü Kindling 9/10/2020 11

AETIOLOGY üPsycho-dynamic models üCognitive models üDevelopmental factors üPsychosocial factors and personality factors 9/10/2020 12

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DEPRESSIVE EPISODE • Depressive episode is different from lay use of the word depression • Time duration : 2 weeks 9/10/2020 14

CLINICAL FEATURES 3 MAJOR CRITERIA 1) Sad mood / irritability 2) Lack of interest 3) Lack of energy 9/10/2020 15

CLINICAL FEATURES 7 MINOR CRITERIA • Poor attention and concentration • Guilt feelings • Pessimistic attitude of present and future • Helplessness • Sleep disturbance • Lack of appetite • Death wishes / Suicidal thoughts 9/10/2020 16

OTHER SYMPTOMS • Lack of interest in previous pleasurable activities • Psychomotor retardation • Lack of emotional reactions • Early morning awakening • Early morning worsening of mood • Weight loss > 5% in one month • Decreased sexual interest 9/10/2020 17

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Grades of Depression v. MILD DEPRESSION v. MODERATE DEPRESSION v. SEVERE DEPRESSION (with psychotic symptoms) 9/10/2020 19

• Episodes of depression : Recurrent depression • Depression and mania: Bipolar Disorder • Chronic low mood for minimum 2 years: Dysthymia • Seasonal affective disorder : more in winter 9/10/2020 20

ATYICAL DEPRESSION Depression with atypical features Ø Over eating Ø Over sleeping Ø High anxiety symptoms Ø Interpersonal rejection sensitivity 9/10/2020 21

CO-MORBIDITY § § § § Anxiety is common with depression OCD Substance use Somatic complaints Slowed cognitions Personality disorders Medical co-morbidity 9/10/2020 22

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Depression and medical illness • • • 16 -23% major depression 15 -25% mild depression Stroke – 30% Cancer- 25% HIV- 33% Post MI 9/10/2020 24

Depression and medical illness • Diabetes- 15% • Cushing’s disease, Addison’s disease, hypothyroidism, hyperparathyroidism • In many neurological disorders – Parkinsonism, Dementia, multiple sclerosis, epilepsy, degenerative brain disorders 9/10/2020 25

Drug induced depression • • Steroids Alpha methyl dopa Oral contraceptives Clomiphene citrate Tamoxifen Cimetidine Beta blockers 9/10/2020 26

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Mental status examination • Generalized psychomotor retardation • Downcast averted gaze • Decreased rate and volume of speech • Negative view of themselves and the world • Hopelessness, helplessness , worthlessness • Suicidal thoughts • Psychotic symptoms 9/10/2020 28

TREATMENT • • • Antidepressants ECT Psychotherpy TMS Vagal stimulation 9/10/2020 29

Psychopharmacology • Despite their name, they are often used to treat a wide range of other conditions, on- or off label, for conditions such as anxiety disorders, obsessive compulsive disorder, eating disorders, neuropathic pain, migraine • Delay, with the resident Jean-Francois Buisson, reported the positive effect of isoniazid on depressed patients. 9/10/2020 30

• Tertiary amine / tricyclic antidepressants: • Amitriptyline • Imipramine • Norepinephrine-dopamine reuptake inhibitors • Bupropion 9/10/2020 31

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Psychopharmacology • • Selective serotonin reuptake inhibitors Citalopram Escitalopram Paroxetine Fluvoxamine Sertraline 9/10/2020 33

Psychopharmacology • Noradrenergic and specific serotonergic antidepressants (Na. SSA) • Mirtazapine • Serotonin–norepinephrine reuptake inhibitors • Desvenlafaxine • Duloxetine • Venlafaxine 9/10/2020 34

Psychological Interventions • Psychotherapies – Inter personal CBT Family therapy Prevention of episodes 9/10/2020 35

SUICIDE • • ‘Sui’ means “self” and ‘cide’ is “kill” Suicide Para suicide One of the leading causes of death in the young • Patients with psychiatric disorders particularly depression are at increased risk of suicide 9/10/2020 36

SUICIDE- risk factors • • • Sex Age Depressed Previous attempt Ethanol use Rationality of thinking Sickness Organized attempt No spouse / partner Support poor – financial and social 9/10/2020 37

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SUICIDE • Prediction and early intervention • Target high risk population • Assessment by psychiatrist of all cases of self harm • Treatment : ECT as an option 9/10/2020 39

• In the ECT suite at Priority House, Maidstone. 9/10/2020 40

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