Approach to depression

1. MANAGEMENT OF
DEPRESSION
BY DR RONAK RAHEJA
(ITS NICE TO FINALLY HAVE DR BESIDE THE NAME)

2. INTRODUCTION
 Treatment is divided into three phases (acute, continuation, and
maintenance)
 Acute treatment aims at full symptom remission and restoration of full
function
 Continuation treatment aims to sustain those gains, thereby preventing
the return of the index episode(RELAPSE)
 Maintenance treatment is designed to prevent a new episode (recurrence).
Typically, maintenance phase treatment is indicated if there have been at
least two and certainly three or more episodes, especially if there has been
incomplete interepisode recovery or if the index episode has been chronic
(>2 years).

3. ACUTE TREATMENT
 (WHERE ?)When initiating acute treatment, clinicians must elect the best
setting (e.g., inpatient, outpatient, or day hospital) guided by (1) an
estimate of imminent suicidal risk, (2) the capacity of patients to recognize
and adhere to recommendations, (3) the level of psychosocial support, and
(4) psychosocial stress and functional impairment
 (HOW ?)Next, the type of treatment (the strategy) must be chosen. For
most, the choices are medication, psychotherapy, the combination, or
electroconvulsive therapy (ECT) or, for some, light therapy alone or in
combination with medication or therapy. Factors affecting this choice
include acceptability, severity, acuity (e.g., for ECT), seasonal pattern (for
light therapy), and chronicity. Chronic depressions appear to do best with a
combination of medication and psychotherapy.

4. CONTINUATION PHASE
 For the continuation phase, typically the same types and doses of medication are
recommended. For psychotherapy, the visits may be reduced in frequency, but evidence
supports the need for continuation phase psychotherapy in most cases. Light therapy is
continued until the light–dark cycle lengthens. For ECT, medication monotherapy or
combinations are recommended for continuation phase treatment. Continuation phase
ECT may be useful in some, but overall its efficacy is about the same as lithium
combined with nortriptyline in a recent multisite study
 Continuation treatment typically lasts 4 to 9 months. In theory, the duration depends on
an estimate of when the episode would have spontaneously remitted. Thus, patients
with longer prior episodes (e.g., 9 to 15 months) who have had only 2 months of a
current depression, for example, would be candidates for 5 to 11 months of
continuation treatment, assuming that acute treatment lasted 2 months. For those with
psychotic depressions, follow-up studies 1 year after acute phase treatment indicate a
poorer prognosis than for nonpsychotic depression. Thus, continuation phase treatment
for psychotic depressions should be longer.

5. OKAY, SO WHAT MAKES UP THERAPY
AS SUCH
 A]PSYCHOTHERAPY-
 1)INTERPERSONAL therapy
 2)cognitive therapy,
 3)behavioral therapy, and
 4)cognitive-behavioral analytic system of psychotherapy [CBASP]
 B]MEDICATION
 C]COMBINED THERAPY
 D]ELECRTOCONVUSIVE THERAPY
 NOTE- IF PRIMARY THERAPY FAILS A SPECIAL SECONDARY THERAPY
SHOULD BE CRAFTED FOR THE PATIENT

6. DIFFERENT KINDS OF DEPREESED
PATIENTS AND CORRESPONDING
THERAPY FOR THEM

8. HOW IS THIS A DISEASE?
 BEFORE I CAME TO PSYCHIARTY POSTINGS I ALWAYS WONDERED HOW
MEDICATION COULD HELP A PERSONS BRAIN ,I HONESTLY THOUGHT
THE TRICK WAS TO SEDATE EVERYONE AND PUT THEM TO SLEEP,BUT
WHEN I SAW A FEW PATIENTS SAY THEIR IMPROVEMENT WAS ABOVE 80
PERCENT I GOT MY FAITH BACK IN MEDICATION FOR SUCH ILNESSES
 IT WAS A BIG PUZZLE, ANOTHER THING I NOTICED IN POSTINGS WAS
KASHYAP SIR TELLING A PATIENT MEDICATION WONT IMMIDIATELY ACT
I WAS LIKE WHY SHOULD THAT HAPPEN ? MEDICATION USUALLY
INCREASE SERITONIN – WHICH RELIVES DEPRESSSION –THEN WHY
DOESN’T IT IMMIDIATELY ACT?

9. THE PSYCHEDELIA IN PSYCHIATRY
 3 NEUROTRANMITTERS
 DOPAMINE
 SERITONINE
 NOREPINEPHRINE

10. MEDICATION USED IN DEPRESSION

11. HOLD A PRAM IN YOUR TEENS ,LOL
DEPRESSION

12. BOTH NE AND 5HT

13. OTHER DRUGS

14. DID YOU KNOW ?
EVERY TIME YOU HAVE AN EXPERIENCE – THERE IS A CIRCUIT MADE IN YOUR BRAIN
PLASTICITY OF THE BRAIN

15. HOW ARE THESE CIRCUITS MADE ?

16. THE WOW PART
 IN DEPRESSION – DECREASED SERITONINE ,DECREASED NEUROTROPINS,
LEADS TO ATROPHY OF AMYDALA,HIPPOCAMPUS ,NUCLEUS
ACCUMBENS AND PRE FRONTAL CORTEX
 THAT’S WHY IN TREATMENT NEW NEUROTROPINS HAVE TO BE RELEASED
AND HENCE IT TAKES TIME TO START WORKING
 ANYWAYS THANK YOU GUYS