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Depression Presented By:Abhinav and Ishika


Contents Introduction : Definition Types Epidemeology Etiology Pathophysiology Clinical Manifestation Treatment Pharmacological Nonpharmacological Health Awareness Programs

Introduction :

Introduction Depression is an affective disorder which affect many individuals; The term ‘affect’ refers to the feeling pleasant and unpleasant, such feeling may be mild or strong but altogether they regulate the emotional and mental state at any one of time. It is an illness that affects your thoughts, feelings, behavior and overall health . It can even have physical effects on your body. Types: Major Depression Dysthymia Depression Bipolar Depression


Types Major Depression: It is diagnosed when five of at least nine symptoms are present most of the day nearly everyday for at least two weeks; Depressed mood all the day Marked Decreased interest or pleasure in most all activities Apetite or weight change Isomnia Fatigue Worthlessness Decreased ability to think Thoughts of death

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Dysthymia: It is characterized by chronic mood disturbance not more than two years depressed mood most of the day Two or more symptoms are required Symptoms: Poor appetite/over eating Insomnia/ Hypersomnia Fatigue Low self esteem Hopelessness Bipolar or manic depression: In mania the mood is elated or irritable over activity is usually unproductive Symptoms lasting atleast one week atleast 3 of ; Inflated self esteem Decreased need for sleep More talkative Marked impairment in occupational functioning

Epidemeology :

Epidemeology Depression may occur any age including infancy average age of onset of depression is in late 20’s The estimated lifetime prevalence of major depression in individuals aged 65 to 80 recently was reported to be 20.4% in women and 9.6% in men. Approx 8% to 18% of patients with major depression have atleast one first degree relative with a history of depression,compared with 5.6% of the first degree relative of a normal control group

Etiology :

Etiology Genetic Factor: Under this,20% the incidence of affective disorder in first degree of relatives is 20% which is almost 3 times the risk for relatives in control group Environmental Factor: Environmental stresses can often be identified prior to an episode of manic or depression .like loss of loved once,poverty Biochemical Factor: Deficiency of Neuro transmitters(Nor-Adrenaline,5 Hydroxy tryptyline and dopamine) Endocrine Factor: Some endocrine disorders ( Hypothyrodism and cushing’s syndrome have been associated with changes in mood) Physical illness and side effects of medication: Drugs : Analgesic,Anti-hypertensive,Anti-convulsant and Steroids Physical Illness:Carcinoma,Diabetes,Thyroid Disease


Pathophysiology Biogenic amine hypothesis NE Permissive Hypothesis 5-HT Post synaptic change in receptor sensitivity Dysregulation Hypothesis The role of Dopamine DA

Clinical Manifestation :

Clinical Manifestation Emotional Symptoms: Loss of interest in usual activities Sadnes s Hopelessness Anxiety Feelings of guilt Physical Symptoms Fatigue Pain Sleep disturbance Loss of sexual interest Gastrointestinal Intellectual Symptoms Decreased ability to concentrate Poor memory for recent events Confusion Psychomotor Disturbance Psychomotor retardation


Diagnosis Mental and behavioural disorders are commonly classified using the international classification of disease,ICD10(WHO 1992). The American psychiatric association (1994) has developed a precise system of diagnosis,based on the description of symptoms in the Diagnostic and Stastical manual of mental disorders,now in its 4 th edition ( DSMth ) The following tests are conducted for the diagnosis: Rating Scales:Two of the more commonly used rating scales are the Back Depression Inventory and the Hamilton Depression Rating Scale Dexamethasone Supression :- Test 1 Mg of dexamethasone administered at 11 pm-next Day samples taken at 8 AM,4 PM and 11 PM If it is found serum cortisol levels are elevated between 9 and 24 hours after the administration of dexamethasone This is taken as positive result,that is dexamethaseone has failed to suppress normal cortisol secretion


Treatment Non Pharmacological : Electro convulsive therapy(ECT) It is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. use as a treatment for severe depression . Psychotherapy often the first form of treatment recommended for depression. Called "therapy" for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with depression talks to a licensed and trained mental health care professional who helps the person identify and work through the factors that may be triggering the depression . Light therapy consists of exposure to daylight or to specific wavelengths of light using lasers,fluorescent lamps, usually controlled with various devices. The light is administered for a prescribed amount of time and, in some cases, at a specific time of day.

Pharmacological Therapy:

Pharmacological Therapy Drugs which are used to treat Depression : Tricyclic antidepressants (TCAs) They have more side effects, so they usually aren't the first drugs used. Drug used Amitriptyline Brand Name: Elavil Monoamine oxidase inhibitors (MAOIs) Drug Phenelzine Brand Name ( Nardil ) Side effects of MAOIs:Diarrhea,Dry mouth,Altered sense of taste Nervousness Selective serotonin reuptake inhibitors (SSRIs) Fluoxetine (Prozac, Prozac Weekly, Sarafem ) Side effects: Nausea,Dry mouth.Headache Serotonin and norepinephrine reuptake inhibitors (SNRIs) Duloxetine ( Cymbalta ) Side effects: Dry mouth,Dizziness,Insomnia,Sleepiness,Constipation

Various Health Awareness Program:

Various Health Awareness Program National Depression Screening Day Weller Health Education Center developing depression education program SAHET( Suicide Awareness Health Education and Training) Depression and Suicide Prevention Program Mental Health Awareness and Stigma Reduction Adolescent Depression Awareness Program (ADAP) National Mental Health Programme (NMHP )

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