TOO MUCH TO HANDLE ? ? ?
WHAT IS DEPRESSION?
<ul><li>A.   FIVE OR MORE SYMPTOMS STATED BELOW: </li></ul><ul><li>* PRESENT FOR TWO OR MORE WEEKS </li></ul><ul><li>* SUG...
<ul><li>2. DECREASED INTEREST </li></ul><ul><li>3. SIGNIFICANT WEIGHT-LOSS OR WEIGHT-GAIN </li></ul><ul><li>4. INSOMNIA OR...
<ul><li>B.  SIGNIFICANT SOCIO-OCCUPATIONAL DYSFUNCTION. </li></ul><ul><li>C.  SYMPTOMS NOT SUGGESTIVE OF SUBSTANCE OR GENE...
OTHER IMPORTANT FEATURES: <ul><li>1. IMPROVEMENT IN SYMPTOMS TOWARDS EVENING </li></ul><ul><li>2. MULTIPLE SOMATIC COMPLAI...
COGNITIVE TRIAD of DEPRESSION <ul><li>NEGATIVE EVALUATION OF SELF </li></ul><ul><li>NEGATIVE EVALUATION OF THE WORLD </li>...
PATHOGENETIC AETIOLOGIC MODEL of DEPRESSION <ul><li>LIMBIC-DIENCEPHALIC DYSFUNCTION </li></ul><ul><li>NA  SYSTEM DYSFUNCTI...
<ul><li>5-HT  SYSTEM DYSFUNCTION </li></ul><ul><li>DOPAMINERGIC SYSTEM DYSFUNCTION </li></ul><ul><li>ALTERED RECEPTOR SENS...
<ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li...
DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li...
DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li...
DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li...
DEPR SION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>I...
DEPR SION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>I...
DEP ION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMM...
DEP ION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMM...
DEP ION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMM...
DE ON <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUN...
DE ON <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUN...
D O <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOL...
<ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC...
DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>...
<ul><li>REACTIVE DEPRESSION </li></ul>ENDOGENOUS DEPRESSION V/s
ATYPICAL DEPRESSION <ul><li>REVERSAL OF VEGETATIVE SYMPTOMS, i.e.,  </li></ul><ul><li>1.  SLEEP  </li></ul><ul><li>2. APPE...
ANTIDEPRESSANTS <ul><li>SSRIs  (SELECTIVE  5-HT  REUPTAKE INHIBITORS) </li></ul><ul><li>SDRIs  (SELECTIVE DOPAMINE REUPTAK...
<ul><li>SARIs  (SEROTONIN ANTAGONISTS/REUPTAKE INHIBITORS) </li></ul><ul><li>NaSSAs   (NA -SPECIFIC  5-HT  ANTIDEPRESSANTS...
<ul><li>OTHER DRUGS: </li></ul><ul><ul><li>THYROID SUPPLEMENTS </li></ul></ul><ul><ul><li>STIMULANT DRUGS </li></ul></ul><...
SELECTIVE 5-HT REUPTAKE INHIBITORS (SSRIs):   ADVANTAGES <ul><li>SAFETY </li></ul><ul><li>TOLERABILITY </li></ul><ul><li>N...
SELECTIVE 5-HT REUPTAKE INHIBITORS (SSRIs): SHORTCOMINGS <ul><li>NOT AS EFFECTIVE AS  TCAs/SNRIs  IN CASES OF SEVERE DEPRE...
<ul><li>AKATHESIA </li></ul><ul><li>NAUSEA </li></ul><ul><li>GI  DISTRESS </li></ul><ul><li>WITHDRAWAL EFFECTS </li></ul>
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Cme.depression

  1. 1. TOO MUCH TO HANDLE ? ? ?
  2. 2. WHAT IS DEPRESSION?
  3. 3. <ul><li>A. FIVE OR MORE SYMPTOMS STATED BELOW: </li></ul><ul><li>* PRESENT FOR TWO OR MORE WEEKS </li></ul><ul><li>* SUGGEST A DEFINITE CHANGE FROM EARLIER BEHAVIOUR </li></ul><ul><li>* INCLUDES AT LEAST ONE OF THE FOLLOWING: </li></ul><ul><li>~ DEPRESSED MOOD </li></ul><ul><li>~ DECREASED INTEREST OR PLEASURE. </li></ul><ul><li>* SYMPTOMS INCLUDE: </li></ul><ul><li>1. SUBJECTIVE REPORT OF DEPRESSED MOOD </li></ul>DIAGNOSTIC CRITERIA: DSM-IV
  4. 4. <ul><li>2. DECREASED INTEREST </li></ul><ul><li>3. SIGNIFICANT WEIGHT-LOSS OR WEIGHT-GAIN </li></ul><ul><li>4. INSOMNIA OR HYPERSOMNIA </li></ul><ul><li>5. PSYCHOMOTOR AGITATION OR RETARDATION. </li></ul><ul><li>6. FATIGUE OR LOSS OF ENERGY </li></ul><ul><li>7. FEELINGS OF WORTHLESSNESS AND EXCESSIVE OR INAPPROPRIATE GUILT </li></ul><ul><li>8. RECURRENT THOUGHTS OF DEATH. </li></ul>
  5. 5. <ul><li>B. SIGNIFICANT SOCIO-OCCUPATIONAL DYSFUNCTION. </li></ul><ul><li>C. SYMPTOMS NOT SUGGESTIVE OF SUBSTANCE OR GENERAL MEDICAL CONDITION. </li></ul><ul><li>D. NOT OCCURRING DURING BEREAVEMENT </li></ul>
  6. 6. OTHER IMPORTANT FEATURES: <ul><li>1. IMPROVEMENT IN SYMPTOMS TOWARDS EVENING </li></ul><ul><li>2. MULTIPLE SOMATIC COMPLAINTS </li></ul><ul><li>3. HEIGHTENED PERCEPTION TO PAIN </li></ul><ul><li>4. ALEXITHYMIA </li></ul><ul><li>5. TEARFULNESS </li></ul><ul><li>6. ANXIETY SYMPTOMS </li></ul><ul><li>7. PSEUDODEMENTIA </li></ul><ul><li>8. MOOD CONGRUENT PSYCHOTIC FEATURES </li></ul>
  7. 7. COGNITIVE TRIAD of DEPRESSION <ul><li>NEGATIVE EVALUATION OF SELF </li></ul><ul><li>NEGATIVE EVALUATION OF THE WORLD </li></ul><ul><li>PESSIMISTIC EXPECTATIONS OF FUTURE </li></ul>
  8. 8. PATHOGENETIC AETIOLOGIC MODEL of DEPRESSION <ul><li>LIMBIC-DIENCEPHALIC DYSFUNCTION </li></ul><ul><li>NA SYSTEM DYSFUNCTION LEADING TO ALTERED LIMBIC AND CORTICAL AROUSAL </li></ul>EARLY LOSS HEREDITY GENDER AFFECTIVE TEMPERAMENTS STRESSORS
  9. 9. <ul><li>5-HT SYSTEM DYSFUNCTION </li></ul><ul><li>DOPAMINERGIC SYSTEM DYSFUNCTION </li></ul><ul><li>ALTERED RECEPTOR SENSITIVITY </li></ul><ul><li>DYSFUNCTION OF HPA AND HPT AXES </li></ul>
  10. 10. <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>DEPRESSION
  11. 11. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  12. 12. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  13. 13. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  14. 14. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  15. 15. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  16. 16. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  17. 17. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  18. 18. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  19. 19. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  20. 20. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  21. 21. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  22. 22. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  23. 23. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  24. 24. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  25. 25. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  26. 26. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  27. 27. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  28. 28. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  29. 29. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  30. 30. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  31. 31. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  32. 32. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  33. 33. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  34. 34. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  35. 35. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  36. 36. DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  37. 37. DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  38. 38. DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  39. 39. DEPRE SSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  40. 40. DEPR SION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  41. 41. DEPR SION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  42. 42. DEP ION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  43. 43. DEP ION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  44. 44. DEP ION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  45. 45. DE ON <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  46. 46. DE ON <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  47. 47. D O <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  48. 48. <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  49. 49. DEPRESSION <ul><li>ALTERATION OF SLEEP NEUROPHYSIOLOGY </li></ul><ul><li>CEREBRAL METABOLIC ALTERATIONS </li></ul><ul><li>IMMUNOLOGIC DEPRESSION </li></ul>
  50. 50. <ul><li>REACTIVE DEPRESSION </li></ul>ENDOGENOUS DEPRESSION V/s
  51. 51. ATYPICAL DEPRESSION <ul><li>REVERSAL OF VEGETATIVE SYMPTOMS, i.e., </li></ul><ul><li>1. SLEEP </li></ul><ul><li>2. APPETITE </li></ul><ul><li>3. SEXUAL FUNCTION </li></ul><ul><li>LEADEN PARALYSIS </li></ul><ul><li>REJECTION SENSITIVITY </li></ul>
  52. 52. ANTIDEPRESSANTS <ul><li>SSRIs (SELECTIVE 5-HT REUPTAKE INHIBITORS) </li></ul><ul><li>SDRIs (SELECTIVE DOPAMINE REUPTAKE INHIBITORS) </li></ul><ul><li>SNRIs (SELECTIVE 5-HT NE REUPTAKE INHIBITORS) </li></ul>
  53. 53. <ul><li>SARIs (SEROTONIN ANTAGONISTS/REUPTAKE INHIBITORS) </li></ul><ul><li>NaSSAs (NA -SPECIFIC 5-HT ANTIDEPRESSANTS) </li></ul><ul><li>NRIs (NE REUPTAKE INHIBITORS ) </li></ul><ul><li>TCAs (TRICYCLIC ANTIDEPRESSANTS) </li></ul><ul><li>RIMAs (REVERSIBLE INHIBITORS OF MAO-A) </li></ul><ul><li>MAOIs (MONOAMINE OXIDASE INHIBITORS) </li></ul>
  54. 54. <ul><li>OTHER DRUGS: </li></ul><ul><ul><li>THYROID SUPPLEMENTS </li></ul></ul><ul><ul><li>STIMULANT DRUGS </li></ul></ul><ul><ul><li>LITHIUM </li></ul></ul>
  55. 55. SELECTIVE 5-HT REUPTAKE INHIBITORS (SSRIs): ADVANTAGES <ul><li>SAFETY </li></ul><ul><li>TOLERABILITY </li></ul><ul><li>NOT LETHAL IN OVERDOSAGE </li></ul><ul><li>NO CARDIOTOXICITY </li></ul><ul><li>NO ANTICHOLINERGIC SIDE EFFECTS </li></ul><ul><li>WIDER THERAPEUTIC SPECTRUM. </li></ul><ul><li>USUAL MAINTENANCE DOSE IS THE STARTING DOSE </li></ul>
  56. 56. SELECTIVE 5-HT REUPTAKE INHIBITORS (SSRIs): SHORTCOMINGS <ul><li>NOT AS EFFECTIVE AS TCAs/SNRIs IN CASES OF SEVERE DEPRESSION </li></ul><ul><li>SIDE EFFECTS ARE BOTHERSOME IF NOT LETHAL </li></ul><ul><li>SEXUAL DYSFUNCTION </li></ul><ul><li>AGITATION </li></ul>
  57. 57. <ul><li>AKATHESIA </li></ul><ul><li>NAUSEA </li></ul><ul><li>GI DISTRESS </li></ul><ul><li>WITHDRAWAL EFFECTS </li></ul>

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