Depressive Disorders Dr Rohan Mendonsa Professor Dept of

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Depressive Disorders Dr Rohan Mendonsa, Professor, Dept of Psychiatry.

Depressive Disorders Dr Rohan Mendonsa, Professor, Dept of Psychiatry.

Depression is a mood disorder • What is mood? • It is an emotional

Depression is a mood disorder • What is mood? • It is an emotional experience, sustained in time, that influences his/her behaviour and perception of the world.

Different types of depressive disorders • • Major depressive disorder Dysthymia Minor depressive disorder

Different types of depressive disorders • • Major depressive disorder Dysthymia Minor depressive disorder Mixed anxiety deoressive disorder

Epidemiology • 20 -25% of population will suffer at some point of their lifetime.

Epidemiology • 20 -25% of population will suffer at some point of their lifetime. • Higher in women • Higher- poor interpersonal relationships.

Etiopathogenesis • Interaction of Biological, Psychological and Social factors. • Biological- genetics, decreased catecholamines,

Etiopathogenesis • Interaction of Biological, Psychological and Social factors. • Biological- genetics, decreased catecholamines, increased activity of HPA axis • Psychological- worrying, pessimistic • Social- life events/adversities

Major depressive disorder • Depressive episodes lasting more than 2 weeks, last for 6

Major depressive disorder • Depressive episodes lasting more than 2 weeks, last for 6 months to 1 year if not treated • Depressed mood most of the day • Loss of interest • Decreased energy • Feelings of worthlessness, hopelessness, wish to die, suicidal thoughts • Insomnia, decreased appetite, Weight loss • Decreased ability to think/concentrate

Dysthymia • Mild chronic disorder affecting 3 -6% • Low self esteem, low mood,

Dysthymia • Mild chronic disorder affecting 3 -6% • Low self esteem, low mood, pessimistic thinking- less severe • Duration more than 2 years • Some recover, others may experience concmitant depressive episodes- Double depression.

Other types • Premenstrual dysphoric disorder- irritability, increased rejection sensitivity, crying spells, headache, breast

Other types • Premenstrual dysphoric disorder- irritability, increased rejection sensitivity, crying spells, headache, breast tenderness, fatigue etc begin about 1 week prior to menses and remit with onset of menses. • Post partum depression: one in ten women, different from ‘baby blues’ • Seasonal affective disorder (winter depression)

Diagnosis • Clinical one. • O/E – Stooped posture, downcast gaze, decreased rate and

Diagnosis • Clinical one. • O/E – Stooped posture, downcast gaze, decreased rate and volume of speech, long pauses, negative content of thinking- guilt, suicidal ideas • Rule out manic/ hypomanic, substance use, medical disorders like hypothyroidism

Differential diagnosis • • • Endocrine disorders Infections- infectious mononucleosis Neurological- Parkinsons, Alzheimer’s Cerebrovasular

Differential diagnosis • • • Endocrine disorders Infections- infectious mononucleosis Neurological- Parkinsons, Alzheimer’s Cerebrovasular Adjustment disorder Bipolar depression/Psychotic disorder/Anxiety disorder

General Treatment Approach • Short term goal is remission of symptoms • Long term

General Treatment Approach • Short term goal is remission of symptoms • Long term goal- preventing recurrences, improving functioning • Good doctor patient relationship is a must. • Psycho education. • Compliance

Different treatment modalities • Psychotherapy: Cognitive, Interpersonal • Pharmacotherapy: Antidepressants- after remission, at least

Different treatment modalities • Psychotherapy: Cognitive, Interpersonal • Pharmacotherapy: Antidepressants- after remission, at least 4 months (for single episode) and longer for prophylaxis. • ECT • Others: Exercise, Meditation are useful as adjuvants. • Best approach is to combine various modalities

Take Home Message………. • Depressive disorders are very common. • Biopsychosocial factors interact to

Take Home Message………. • Depressive disorders are very common. • Biopsychosocial factors interact to cause these disorders • Correct diagnosis depends on good history and mental state examination. • Early intervention is important to prevent complications and also to relieve suffering • Multimodal approach is the best approach.