Subtopics: introduction, clinical feature, DSM 5, Differential diagnosis, treatment, etiology. presented in American University of Barbados.

1. MAJOR
DEPRESSIVE
DISORDER.

2. OUTLINE • Introduction
• Etiology
• Clinical features
• Diagnostic criteria
• Differential
diagnosis
• Treatment.

3. INTRODUCTION

4. What is
major
depressive
disorder?
● Major depressive disorder is
also known as Clinical
depression
● Common mental health
disorder
● Estimated to affect 15% of the
adult population

5. What is major
depressive disorder?
Major depressive disorder
impacts a person’s
● Mood
● Cognition
● Behavior

6. Types of
Major
depressive
disorder.
There are several types of Major
depressive disorder;
● Seasonal affective disorder
● Psychotic depression
● Postpartum depression
● Melancholic depression
● Catatonic depression
● Bipolar disorder
● Persistent depressive disorder

7. Types of Major
depressive disorder.
● Seasonal affective
disorder - Occurs mostly in
the winter months and
generally lifts during spring
and summer.

8. Types of
Major
depressive
disorder
● Postpartum depression
Present in new mothers and is
much more than “baby blues”.
Involves major depression
consisting of feelings of sadness
and anxiety.
●

9. Types of
Major
depressive
disorder.
● Catatonic depression - This is
characterized by muscular
rigidity or motor difficulties or
stupor.
● Bipolar disorder - Although
different from depression, the
individual experiences episodes
of extremely low moods Known
as Bipolar depression.
https://www.youtube.com/watch?v=_s1lzxHRO4U

10. Types of Major
depressive disorder.
Persistent depressive disorder-
This is also known as Dysthymia.
● Episodes of major depression
accompanied with periods of less
serious symptoms.
● MUST last for 2 years.

11. ETIOLOGY

12. Etiology
● Causes of Major depressive
disorder is generally a
combination of factors;
● Genetics
● Biological factors
● Environmental factors
● Psychological factors

13. Genetic
factors ● Risk is increased in individuals
with family members that have
had a history of depression .

15. Environmental
factors
Specific events surrounding an
individual like
● Death of a loved one
● Sexual abuse
● Physical abuse

16. CLINICAL FEATURES

17. “SIG-E-CAPS”
• S leep changes
• I nterest (loss)
• G uilt (worthless)
• E nergy (lack)
• C ognition/C oncentration
• A ppetite disturbance
• P sychomotor
• S uicide

18. Depression
symptoms in
children
• Sadness
• Irritability
• Clinginess
• Refusing to go to
school
• Being
underweight

19. Depression
symptoms in teens
• Anger
• Feeling negative and
worthless
• Poor performance or poor
attendance at school
• Feeling misunderstood
and extremely sensitive

20. Depression
symptoms
in teens
Using recreational
drugs or alcohol
Eating or sleeping too
much, self-harm
Loss of interest and
avoidance of social
interaction

21. Depression
symptoms
in older
adults
• Memory difficulties
• Physical aches or pain
• Sleep problems or loss of
interest in sex — not caused
by a medical condition or
medication
• Loss of interest in socializing
or in activities
• Suicidal thinking or feelings,
especially in older men

22. DIFFERENTIAL
DIAGNOSIS OF
MDD

23. Diagnosis of
MDD is also
related with
other
condition.
 Major Depressive Disorder has
relation with a few medical
conditions, psychiatric conditions
and other conditions.
It is most commonly confused with
Bipolar Disorders and other types
of Depressive disorders previously
mentioned.

24. Medical
Conditions
Neurological abnormality (e.g.,
Parkinson’s disease, Huntington
disease, Multiple sclerosis,
Dementia).
Renal or Cardiopulmonary disease.
Cancer (pancreatic) and
gastrointestinal tumors.
Viral illness (e.g., pneumonia,
influenza, AIDS)
Nutritional deficiency (e.g., Folic
acid, B12).

25. Psychiatric
and related
conditions
Anxiety disorder, Schizophrenia,
Eating disorder, Somatic symptom
disorder.
Normal reaction to a life loss .
Drug and alcohol use (Particularly
use of Sedatives and withdrawal from
stimulants).
Prescription drug use (like steroids,
antihypertensives, antineoplastics.

26. MDD DSM 5

27. MDD
DSM5
A. Five or more of the
following symptoms either
(1)depressed mood or
(2)loss of interest or
pleasure)have been
present during the same
2-week period.

28. Depressed
mood:
• For children and
adolescents, this
can also be an
irritable mood.

29. Anhedonia:
• Loss of interest or
pleasure in almost
all activities.

30. Weight loss or
gain.
Appetite
disturbance

31. INSOMNIA OR
HYPERSOMNIA:

32. Psychomotor
agitation or
retardation:

33. FATIGUE:

34. FEELINGS OF
WORTHLESSNESS

35. DECREASED CONCENTRATION:

36. THOUGHTS OF DEATH/SUICIDE:

37. MDD
DSM5
B.The symptoms cause clinically
significant distress or
impairment in social,
occupational or other
important area.
C.The episode is not attributable
to the physiological effects of a
substance or to another
medical condition.

38. MDD
DSM5
D.The occurrence of major
depressive episode is not
better explained by other
disorders.
E.There has never been a
manic episode or hypomanic
episode.

39. TREATMENT

40. Psychotherapy
• Psychotherapy or
talk therapy is a
common term for
treating depression by
talking about your
condition and related
issues with a mental
health professional.

41. Cognitive behavioral therapy or
Interpersonal therapy are forms that are
also used.
Psychotherapy can help you:
• Identify and replace negative habits
with healthy, positive ones
• Develop positive interactions with
others

42. CONT’D
• Regain a sense control in life.
• Adjust to a crisis or other current
difficulty

43. Selective serotonin reuptake inhibitors
(SSRIs)
• SSRIs are generally
used.
• SSRIs include
citalopram, fluoxetine,
sertraline and
vilazodone

44. Serotonin-norepinephrine reuptake
inhibitors (SNRIs)
• SNRIs include desvenlafaxine, levomilnacipran and
duloxetine

45. Atypical antidepressants
• They include bupropion, mirtazapine , nefazodone, trazodone
and vortioxetine

46. Tricyclic antidepressants
• Drugs such as
imipramine, doxepine,
nortriptyline,
trimipramine are
effective but have
severe side effects
than recent
antidepressants..

47. Monoamine
oxidase inhibitors
• MAOIs such as tranylcypromine,
phenelzine and isocarboxazid are
used as a later option.
• However dangerous interactions
may occur with foods such as
certain cheeses, pickles and wines
and other herbal supplements.

48. • Selegiline, a recent MAOI has fewer side effects than other
MAOIs do. These medications can't be combined with
SSRIs

49. Other medications
• Other medications may be used
to enhance antidepressant
effects.
• Short term use of Anti-anxiety
medications and stimulants.

50. Other
treatment
options
• Electroconvulsive
therapy (ECT) is
used in depression to
impact the function
and effect of
neurotransmitters in
the brain.

51. CONT’D
• Transcranial
magnetic stimulation
(TMS) uses magnetic
pulses to stimulate nerve
cells in the brain that
are involved in
regulation of mood.

52. Lifestyle
and home
remedies
In addition to professional
treatment
oStick to treatment plan
oLearn to pay attention to
warning signs
oAvoid taking alcohol and
recreational drugs.

53. Mind-body connections
Acupuncture
Relaxation techniques e.g Yoga
Meditation session and guided
imagery

54. CONT’D
Massage therapy
Art or music therapy
Aerobic exercises

56. Reference • https://www.nimh.nih.gov/health/
topics/depression/index.shtml
• https://www.healthline.com/healt
h/clinical-depression
• https://www.mayoclinic.org/disea
ses-
conditions/depression/symptoms-
causes/syc-2035600
• https://www.webmd.com/depress
ion/guide/major-depression#1

57. Reference • DSM-5 Criteria for Major Depressive Disorder. (n.d.).
Retrieved from https://www.mdcalc.com/dsm-5-
criteria-major-depressive-disorder#use-cases
• Depression Clinical Presentation: History, Physical
Examination, Major Depressive Disorder. (2019, April
23). Retrieved from
https://emedicine.medscape.com/article/286759-
clinical#b4
• American Psychiatric Association: Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition.
Arlington,VA, American Psychiatric Association, 2013.

58. Reference
Depression. (n.d.). Retrieved from
https://www.nimh.nih.gov/health/topics/depression/index.
shtml
Major Depressive Disorder. (2019, April 01). Retrieved from
https://www.therecoveryvillage.com/mental-health/major-
depressive-disorder/