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  1. 1. Depression Dr Urmila Aswar
  2. 2. What Is Depression?  A very common, highly treatable, medical illness.  Affects physical, mental and emotional well-being.  Affects basic, everyday activities like eating and sleeping.  Affects how people think about things and feel about themselves.
  3. 3. What is Depression?  In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is persistent and can interfere significantly with an individual's ability to function.  Give up like tendency  Symptoms can last months or even years.
  4. 4. Symptoms of Depression  Feeling sad, blue, or down in the dumps  Loss of interest in things you usually enjoy  Feeling slowed down or restless  Having trouble sleeping or sleeping too much
  5. 5. Symptoms of Depression  Loss of energy or feeling tired all the time  Having an increase or decrease in appetite or weight  Having problems concentrating, thinking, remembering or making decisions  Feeling worthless or guilty  Having thoughts of death or suicide
  6. 6. Symptoms of Depression  People with Major Depression experience at least five of these symptoms all day, nearly every day, for at least 2 weeks.  The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  7. 7. Causes of Depression Causes not known, but current theories include:  Genetic • Runs in families • However, depression can also occur in people who have no family history.  Environmental • A serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode.
  8. 8. Causes of Depression  Physical Illness: serious complications such as cancer, some disorders eg Cushing’s syndrome etc  Drug induced: eg betablockers and corticosteroids  Hormonal changes: postmenopausal depression, post-partum depression
  9. 9. Causes of Depression  Personality Characteristics  low self-esteem, pessimistic world view, low stress tolerance  Biological  Current thinking explores problems in brain functioning in the following areas: Limbic system, neurotransmitters and neurons, hormones and the endocrine system
  10. 10. Serotonin pathway
  11. 11. Causes of Depression  Combination  a combination of genetic, psychological, environmental, and/ or biological factors may contribute to the onset of a depressive disorder.
  12. 12. Forms of Depression  Major Depression  At least 5 of the 9 symptoms of depression present including either loss of interest/pleasure or depressed mood; symptoms interfere with daily functioning  Minor Depression  Fewer symptoms than major depression with significant disability; shorter duration than chronic depression
  13. 13. Forms of Depression  Bipolar Disorder  Cycling mood changes with severe highs (mania) and severe lows (depression)  Dysthymia  Low grade chronic symptoms of depression that last for a minimum of 2 years
  14. 14. Depression and Suicide  Of those with MDD, close to 50% report feelings of wanting to die, 33% consider suicide and 8.8% report a suicide attempt.  More than 90% of those who commit suicide have a diagnosable psychiatric illness at the time of death, usually depression, alcohol abuse or both
  15. 15. Who is at risk for Depression?  Older adults  Young adults  Women, pregnant and post partum women. women report depression about twice as often as men. This may result from a greater likelihood to discuss depression or to seek help.
  16. 16. Depression in Women  Depression is the second leading cause of disease-related disability among women  1 in 4 women will suffer from a Major Depressive Episode during the course of their lives as compared to 1 in 10 men. • Women may be more likely to discuss depression or to seek help.  Women of childbearing age are at increased risk for major depression • Pregnancy and new motherhood may increase the risk of depressive episodes
  17. 17. Depression in Older Adults  Of the nearly 35 million Americans age 65 and older, an estimated 2 million have a depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder).  Symptoms of clinical depression can be triggered by other chronic illnesses common in later life, such as Alzheimer’s disease, Parkinson’s disease, heart disease, cancer and arthritis.  Depression is one of the most common conditions associated with suicide in older adults.  Individuals age 65 and older have highest rates of suicide  High suicide rate among older people (85 and older) is largely accounted for by White men.
  18. 18. Depression in Young Adults  10% of college students have been diagnosed with depression, including 13% of college women.  Lifetime prevalence for MDE highest among young adults age 18-25 (10%)  Suicide is the third leading cause of death for those aged 15-24
  19. 19. Additional Risk Factors for Depression  Family or personal history of depression  Current substance abuse problem  A major life stressor or change in life events; i.e.: loss of a loved one or a job  Chronic disease
  20. 20. Diagnosis  Based on alterations in mood  5 symptoms with insomnia or fatigue must be present every day for more than 2 weeks.  Standarised questionnaires  Lab test: blood test---cortisol  Sleep EEG
  21. 21. Treatment for depression Psychotherapy Electroconvulsive therapy Pharmacotherapy: SSRI: Fluoxetine Tricyclic antidepressants: amitryptiline, imipramine  Monoamine oxidase inhibitors: tranylcypromine    