Grand Bahama Medical Association - Depre

RECOGNIZING DEPRESSION : 

RECOGNIZING DEPRESSION A DSM-IV-TR PERSPECTIVE AND BEYOND STEVEN H. FOX, PhD ROSS UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF INTEGRATED MEDICINE

LEARNING OBJECTIVESExposure to Following Topics: : 

LEARNING OBJECTIVESExposure to Following Topics: Dysthymic Disorder Major Depressive Disorder Melancholia An Alternative View Culture and Depression Treatment Suicide

DEPRESSION : 

DEPRESSION Sad, gloomy, dejected mood Diminished interest or pleasure

UNIPOLAR DEPRESSION : 

UNIPOLAR DEPRESSION Dysthymic Disorder Major Depressive Disorder Melancholia

Dysthymic Disorder : 

Dysthymic Disorder 2 years of depressed mood No major depressive episode during first two years

Additional Depressive Symptoms : 

Additional Depressive Symptoms Poor appetite or overeating; Insomnia or hypersomnia; Low energy or fatigue; Low self-esteem; Poor concentration or difficulty making decisions; Feelings of hopelessness.

Dysthymic Disorder : 

Dysthymic Disorder Pt. is a 33 y.o. female attorney who recently broke up with her boyfriend of 5 years. She blames her- self and despite her professional accomplishments she feels inadequate. She has been chronically depressed for several years and often feels hope- less about the future. She complains of frequently being irritable at work. She has no previous hx of a Major Depressive Episode.

Dysthymic Disorder : 

Dysthymic Disorder Pt. is a 33 y.o. female attorney who recently broke up with her boyfriend of 5 years. She blames her- self and despite her professional accomplishments she feels inadequate. She has been chronically depressed for several years and often feels hope- less about the future. She complains of frequently being irritable at work. She has no previous hx of a Major Depressive Episode.

Major Depressive Disorder : 

Major Depressive Disorder One or more major depressive episodes; i.e., at least 2 weeks of depressed mood or loss of interest and/or pleasure plus at least 4 additional symptoms of depression.

MAJOR DEPRESSIVE EPISODE : 

MAJOR DEPRESSIVE EPISODE Depressed mood* Loss of interest or pleasure* Significant weight loss or gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or guilt Concentration impairment or indecisiveness Thoughts of death, suicidal ideation, suicide attempt

Major Depressive Disorder : 

Major Depressive Disorder Betty has been very sad during the past 3 weeks. She is easily fatigued, barely able to muster the energy to eat a quart of Ben & Jerry’s chunky monkey ice cream as she inattentively stares at the television before going to bed for a 12-hour cat-nap. She has gained 8 pounds which are quite pronounced on her normally svelte frame.

Major Depressive Disorder : 

Major Depressive Disorder Betty has been very sad during the past 3 weeks. She is easily fatigued, barely able to muster the energy to eat a quart of Ben & Jerry’s chunky monkey ice cream as she inattentively stares at the television before going to bed for a 12-hour cat-nap. She has gained 8 pounds which are quite pronounced on her normally svelte frame.

MELANCHOLIA : 

MELANCHOLIA Loss of interest or pleasure – Anhedonia* Depressed mood Depression worse in the morning Early morning awakening Psychomotor agitation or retardation Significant anorexia or weight loss Excessive or inappropriate guilt

MELANCHOLIA : 

MELANCHOLIA A 67 y.o. widow is brought to hospital by family. They report she appears unhappy for past several weeks, crying much of the day. Also, decreased appetite and weight loss. She has little interest in usual ADLs with friends or grandchildren. She is often agitated and complains she is destitute though she has a sizeable inheritance. She feels very guilty about “wasting” her dead husband’s money.

MELANCHOLIA : 

MELANCHOLIA A 67 y.o. widow is brought to hospital by family. They report she appears unhappy for past several weeks, crying much of the day. Also, decreased appetite and weight loss. She has little interest in usual ADLs with friends or grandchildren. She is often agitated and complains she is destitute though she has a sizeable inheritance. She feels very guilty about “wasting” her dead husband’s money.

AN ALTERNATIVE VIEW : 

AN ALTERNATIVE VIEW Aristotle William James Sigmund Freud Kyla Dunn Christopher Layne

ARISTOTLE : 

ARISTOTLE A state of immense moral & spiritual value; Facilitates insights

WILLIAM JAMES : 

WILLIAM JAMES “The pit of insecurity beneath the surface of life”

SIGMUND FREUD : 

SIGMUND FREUD “…..we can only wonder why a man must become ill before he can discover truth of this kind.”

KYLA DUNN : 

KYLA DUNN “…..the loss of optimistic, self-enhancing biases that normally protect healthy people against assaults to their self-esteem.”

CHRISTOPHER LAYNE : 

CHRISTOPHER LAYNE Tasks of skill and tasks of chance; Depressives accurately predict; Normals overestimate performance. Implication: hyperrealism

CULTURE & DEPRESSION : 

CULTURE & DEPRESSION Buddhism – Acceptance of the human condition. Flathead Indians – Arrival into adulthood

CULTURAL TRENDS : 

CULTURAL TRENDS Nonwestern cultures somatisize; Low rate of guilt, despair, self-denigration or suicide; Western influence has changed the face of depression in West Africa.

WESTERN INFLUENCE : 

WESTERN INFLUENCE Greater localization of somatic complaints; Guilt, self-accusations, worthlessness; Increased frequency of suicidal behavior

GLOBAL TRENDS : 

GLOBAL TRENDS Incidence increases with age; Total prevalence varies by culture; But is increasing over time; Age for developing major depression is decreasing across cultures.

TREATMENT : 

TREATMENT Pharmacologic Nonpharmacologic

PHARMACOLOGIC : 

PHARMACOLOGIC MAOI’s Heterocyclics SSRI’s SSNRI’s

NONPHARMACOLOGIC : 

NONPHARMACOLOGIC Cognitive Behavioral Tx Meta-analytic findings

SUICIDE: Risk Factors : 

SUICIDE: Risk Factors Suicidal thinking Hopelessness Recurrent MDD Prior suicide attempts Prior hospitalizations Unemployment Older than 45 years, male, white Lack of social support Psychotic symptoms, co-morbid alcoholism, drug abuse