depression by samir

8/14/2019 Depression by Samir

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Psychological TheoryPsychological TheoryOfOf

DepressionDepression

:Uploaded By:

SAMIR KHAN


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Revolution in medicine !Revolution in medicine !

Vaccination Infectious

Antibiotics diseases

Change in life style Heart DiseasesStopping smoking &alcohol Diabetes mellitus

Use of exercise and yoga.


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A GENUINEA GENUINE

SMILE IS HARDSMILE IS HARD

TO FIND INTO FIND IN

THESE DAYSTHESE DAYS

FULL OFFULL OF

STRESSSTRESS


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WhatsWhats

wrongwrongwith her?with her?


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The Definition of HealthThe Definition of Health

Health is a state ofcomplete physical,mental, and social well-being, and notmerely the absence of disease or infirmity.

(Callahan 1973).


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BigBig

5.3% of general population

Every fourth women Every sixth or seventh men.

17 % of people in their lifetime.

30-50% with acute or chronic illness.

Every fourth patient repeatedly

visiting physician for similarcomplaints

Could Suffer from depression


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Recognised

depression

Depression unrecognised bydoctors

Depressed patients who do not seek

medical advice

ICEBERG OF DEPRESSION


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DEPRESSION

is depressed mood , for most

of the day nearly every day

( for at least two weeks )

with greatly diminished

pleasurein all activities .


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Death of a loved one

Divorce or breakup in a relationship

Unemployment

Financial problems

Unexpected medical illness

Loss of independence

Environmental factorsEnvironmental factors

Precipitate, do not causePrecipitate, do not cause


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Found in close blood relatives of

depressed patientsVarious regions on chromosome

18 and a site on chromosome 21

have been implicated.

Genetic FactorsGenetic Factors


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Defects in many neurotransmitters

in the CNS are linked to the

development of depression

e.g. Serotonin (5 HT) & Noradrenaline (NA)

Neurological FactorsNeurological Factors

Hyposerotoninergic state

Hyponoredrenergic state


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SerotoninSerotonin5HT5HT andand

NorepinephrineNorepinephrineNENE in the brainin the brain

LimbicSystem

Locus Ceruleus(NE Source)

PrefrontalCortex

Raphe Nuclei(5-HT source)

Cooper JR, Bloom FE. The Biochemical Basis of Neuropharmacology. 1996.


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Co-morbid DepressionCo-morbid Depression

Chronic illness like,

1. IHD.

2. Diabetes.

3. Epilepsy.

4. Thyroid problem

Alcohol and drugs Post partum

depression


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Common Symptoms ofCommon Symptoms of

DepressionDepression Sad mood Loss of interest or pleasure in activities

Fatigue / lack of energy

Low motivation / difficulty starting activities

Problems concentrating and thinking

Increased or decreased appetite & weight

Changes in pattern of sleep

Feeling worthless or guilty

Suicidal thoughts or plans


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Depression. Its not only a state of mind.Depression. Its not only a state of mind.

Reference: Adapted from

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.

Fourth Edition,Text Revision. Washington, DC; American Psychiatric Association. 2000:345-356,489.

The symptoms of depressionEmotional Symptoms

Include:

Sadness

Loss of interest or pleasure

Overwhelmed

Anxiety

Diminished ability to think or

concentrate, indecisivenessExcessive or inappropriate guilt

Physical SymptomsInclude:

Vague aches and pains

Headache

Sleep disturbances

Fatigue

Back pain

Significant change in appetiteresulting in weight loss or gain


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The neurotransmitter pathway storyThe neurotransmitter pathway story

Adapted from References:

1. Stahl SM. J. Clin Psych. 2002;63:203-220.

2. Verma S, et al. Int Rev Psychiatry. 2000;12:103-114.3. Blier P, et al. J Psychiatry Neurosci. 2001;26(1):37-43.

Dysregulation of Serotonin (5HT) andNorepinephrine (NE) in the brain are stronglyassociated with depression

Dysregulation of 5HT and NE in the spinalcord may explain an increased pain

perception among depressed patients1-3

Imbalances of 5HT and NE may explain thepresence of both emotional and physicalsymptoms of depression.

Its not all in your head

Descending Pathway

Ascending

Pathway

Ascending

Pathway

Descending

Pathway


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How to diagnose ?How to diagnose ?

Q. 1 Do you feel sadness for most of theday,nearly every day past two weeks?

Q. 2 Have you lost interest or pleasure

in habitually pleasurable activities for

past two weeks?

Ask2 Questions !

No Depression !


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How to diagnose ?How to diagnose ?

Q. 1 Do you feel sadness for most of theday,nearly every day past two weeks?

Q. 2 Have you lost interest or pleasure

in habitually pleasurable activities for

past two weeks?

Ask2 Questions !

Strongly indicates depression!


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What else to look for ?What else to look for ?

Sleep : insomnia or hypersomnia

Appetite : Change in appetite leading to

weight loss or weight gain.

Activities : Slow or Agitated (restless).


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What else..?What else..?

Fatigue / Lack of energy.

Concentration difficulties,

forgetfulness


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What else..?What else..?

Feeling of worthlessness.

Excessive of inappropriate guilt.

Recurrent thoughts of death andsuicide.


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What to look for ?What to look for ?

Irritability.

Psychomotor retardation / Slow

activities.

Downward gaze.

Tearful affect.


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When will you suspect ?When will you suspect ?

Any patient ( female ) with no medical

illness coming with pain,headache,

insomnia, fatigue, anxiety.Any patient with pain at more than 2 sites.

Old patients where symptoms are

disproportionate to the physical illness.Any patient with long standing illness.

Like HT, IHD, Diabetes,Epilepsy.


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Difference Between Normal andDifference Between Normal and

Real DepressionReal Depression

Normal Depression

Normal reaction to lifeevents (e.g. death of lovedone, major changes)

Mood described as blue

Few symptomsShort duration

Little, if any, impairmentin functioning

Mood

Clinical Depression

Mood described as black

Many symptoms Longer duration (weeks months) Significant impairment in

functioning (can be debilitating)


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Increased morbidity and mortality.

Disrupts marital, familial, social life.Affects work, leads to job related problems.

Increased incidence of medical

illnesses,accidents.Risk of suicide.


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What shall I do ?What shall I do ?

Non drug treatment:

Counseling.Psychotherapy.


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What should I use?What should I use?

Once a diagnosis of depression has

been made, an anti-depressant should

be started, no matter what the cause of

the depression.

All Antidepressants are effective, butdiffer in their side effect profile.


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In any case, Reversal of DepressionIn any case, Reversal of Depression

Should be possible byShould be possible by

IncreasingIncreasing

5HT5HT NANACNS Neuronal TransmissionCNS Neuronal Transmission


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Anti-depressantsAnti-depressants1. Tricyclics : Imipramine, Amytriptyline, Clomipramine, Dothiepin, Doxepin,

Nortriptyline.

2. Tetracyclics : Amoxapine, Mianserin

3. Specific Serotonin Reuptake Inhibitors (SSRIs) : Fluoxetine, Sertraline,Fluvoxamine, Paroxetine, Citalopram.

4. Serotonin Antagonists & Reuptake Inhibitors : Trazodone

5. Serotonin & Noradrenaline Reuptake Inhibitors : Venlafaxine

6. Reversible Inhibitors of Monoamine Oxidase : Moclobemide

7. Noradrenaline & Specific Serotonin Anti-depressant : Mirtazapine

8. Noradrenaline & Dopamine Reuptake inhibitor : Bupropion, Tianeptine

9. Noradrenaline reuptake Inhibitors: Reboxetine


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Drug Treatment.Drug Treatment.

Older drugs: Amitriptyline,Imipramine.

Both 75 to 150 mgin daily divided doses.

Still used as effective drugs.Side effects like sedation,hypotension,constipation, urinary

retention.


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Drug Treatment.Drug Treatment.

Newer drugs: Treatment of Choice.

Escitalopram ( 5 to 10 mg OD)

Sertraline (25 to 150 mg OD).

Well tolerated.

Few side effects like headache , anxiety, sexual

side effects.Duration : 6 9 months.


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Know this too !Know this too !

Electro-convulsive therapy ( Shock

treatment) forseverely depressed andsuicidal patient


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The mind is its own place, and in itself

Can make a Heavn of Hell, a Hell of Heavn.

John Milton 1608-74


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SPREAD ASPREAD A

SMILESMILE

IT CAN MAKEIT CAN MAKE

A WORLD OFA WORLD OF

DIFFERENCEDIFFERENCE

THANKTHANKYOUYOUSAMIR KHAN

depression by samir

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