All That You Ever Wanted To Know About Depression

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Information about All That You Ever Wanted To Know About Depression

Published on August 31, 2008

Author: psrfindia

Source: slideshare.net

All that you ever wanted to know about DEPRESSION DR. N. SHALINI, Psychiatrist, MIND FOCUS

What is depression? PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION Depression in the Bay of Bengal, Depression in the stock market Depression in on the surface of the moon Clinical Depression…….?

What is Clinical Depression? A decrease in Neurotransmitters, responsible for normal functioning. Adrenaline : Energizer Serotonin : Tranquilizer Dopamine : Motivator PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

A decrease in Neurotransmitters, responsible for normal functioning.

Adrenaline : Energizer

Serotonin : Tranquilizer

Dopamine : Motivator

Why talk about Depression? 20% of any given population are currently depressed. By year 2020, the most common illness – WHO Report. THE NUMBER ONE MENTAL HEALTH HAZARD Affects the person, the family and the society But easy to treat if identified early PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

20% of any given population are currently depressed.

By year 2020, the most common illness

– WHO Report.

THE NUMBER ONE MENTAL HEALTH HAZARD

Affects the person, the family and the society

But easy to treat if identified early

What Causes Depression? Genes Neurotransmitters Hormones Gen. Med. illness Parenting, Schooling, Support systems Coping skills Attitude /personality Stress factors (Retirement, fall from grace) Biological Social Psychological

Genes

Neurotransmitters

Hormones

Gen. Med. illness

Parenting,

Schooling,

Support systems

Coping skills

Attitude /personality

Stress factors (Retirement, fall from grace)

Neurotransmitters Ideas of helplessness, worthlessness, hopelessness Suicidal ideas, death fears, worries of failure… 2 weeks, continuous, impairing PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION MAJOR DEPRESSIVE DISORDER SEROTONIN ADRENALINE DOPAMINE Peace Appetite Libido Sleep Energy Mood Concentration Productivity Drive Motivation Pleasure in life Interest in ADL

Peace

Appetite

Libido

Sleep

Energy

Mood

Concentration

Productivity

Drive

Motivation

Pleasure in life

Interest in ADL

Signs and Symptoms Vegetative Sleep disturbances Appetite disturbances Decreased libido Weight changes Somatic Aches and Pains (KKK Syndrome) Muscle tensions Vague uneasiness Cognitive Poor attention Decreased frustration tolerance Impaired memory Negative thinking Behavioural Poor motivation   Decreased pleasure   Diminished interests   Easy fatigability Impulse Control Irritability Suicidal tendency Homicidal tendency

Depressive Spectrum Disorders Normal – situational sadness Thin skinnedness – high sensitivity Low Frustration tolerance – irritability Somatization – Aches and pains Reckless behaviour – smoking, drinking, promiscuity Substance Dependence – narcotics, alcohol OTC Dependence – Alprazolam, etc Clinical Depression – Treated / untreated Suicidal / Homicidal behaviour Psychotic fears of persecution, nihilism and guilt PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

Normal – situational sadness

Thin skinnedness – high sensitivity

Low Frustration tolerance – irritability

Somatization – Aches and pains

Reckless behaviour – smoking, drinking, promiscuity

Substance Dependence – narcotics, alcohol

OTC Dependence – Alprazolam, etc

Clinical Depression – Treated / untreated

Suicidal / Homicidal behaviour

Psychotic fears of persecution, nihilism and guilt

Rule out : Normalcy : Teenage Crisis, Bereavement . Situational : Interpersonal conflicts, narcissistic injury Endocrine : Hypothyroidism, Diabetes Mellitus Systemic : Hypertension, SLE, Anaemia, AIDS Gynaec : Post partum/ perimenopausal/ PMS Neuro: SOL, CVA- esp. Left HS, Epilepsy, PD Medication induced : Steroids, antihypertensives, etc Carcinoma: Pancreas, colon, breast, etc PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

Assessment of Depression Not Several More than Nearly at all days half the every days day Over the last 2 weeks , how often have you been bothered by any of the following problems? (less than half the days) Little interest or pleasure in doing things Feeling down, depressed, or hopeless Trouble falling or staying asleep, or sleeping too much Feeling tired or having little energy Poor appetite or overeating Feeling bad about yourself, or that you are a failure, or have let yourself or your family down 9 symptoms (a - i)

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself, or that you are a failure, or have let yourself or your family down

Assessment of Depression (contd) g. Trouble concentrating on things, such as reading the newspaper or watching television h. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual i. Thoughts that you would be better off dead, or of hurting yourself in some way Diagnosis of MDD to be made if answers to a or b and five or more of a - i are at least “more than half the days” (count i if present at all) Not Several More than Nearly at all days half the every days day Over the last 2 weeks , how often have you been bothered by any of the following problems? (less than half the days)

Treatment options PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION Goal is to bring the neurotransmitters back to normal Through: Psychopharmacology Psychotherapy Behavioural modification

Goal is to bring the neurotransmitters back to normal

Through:

Psychopharmacology

Psychotherapy

Behavioural modification

TREATMENT OPTIONS:   A. PSYCHOPHARMOCOLOGICAL APPROACHES Tri Cyclic Antidepressants (TCA) (Amitriptyline, Dothepin) Selective Serotonin Reuptake Inhibitors (SSRI) (Fluoxetine, Paroxetine, Escitalopram) Norepinephrine & Dopamine Reuptake Inhibitor (NDRI) (Bupropion) Dual Serotonin & Norepinephrine Reuptake Inhibitors (SNRI) (Venlafaxine, Duloxetine, Mirtazepine) Selective Noradrenergic Reuptake Inhibitors (Reboxetine)

Treatment options Psychotherapy Cognitive Behaviour Therapy (CBT) Emotional Intelligence Eye Movement Desensitization and Restructuring (EMDR) Cognitive Restructuring Behaviour/ Life style Modification PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

Psychotherapy

Cognitive Behaviour Therapy (CBT)

Emotional Intelligence

Eye Movement Desensitization and Restructuring (EMDR)

Cognitive Restructuring

Behaviour/ Life style Modification

Working strategy early detection swift initiation of treatment family education long term follow-up preventive strategies PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

early detection

swift initiation of treatment

family education

long term follow-up

preventive strategies

PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

THANK YOU! PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

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