A CASE STUDY ON DEPRESSION

1. A CASE STUDY ON DEPRESSION
UNDER THE GUIDANCE OF SUBMITTED BY :
MR. P. RANA KISHORE K.GOWRI PRIYA
19AB1T0011
1

2. DEPRESSION
DEFINITION:
It is a common mental disorder that is characterized by depressed mood, loss of interest or pleasure, feeling of guilt
or low self worth, disturbed sleep or appetite, low energy or poor concentration.
CAUSES:
 Genetics, family history
 Environmental & biochemical factors
 Endocrine factors & hormonal imbalance
 Mental health, lack of support , loneliness
 Physical illness
 Drug abuse & alcohol
 Drug induced ( anticonvulsants, antipsychotics)
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3. DEPRESSION
PATHOPHYSIOLOGY:
There are 6 types of hypothesis involved in Depression.
1. BIOGENIC AMINE HYPOTHESIS: Deficiency of monoamines i.e., noradrenaline, serotonin.
2. RECEPTOR SENSITIVY HYPOTHESIS : Alteration of receptor sites
3. SEROTONIN ONLY HYPOTHESIS: Low levels of serotonin
4. PERMISSIVE HYPOTHESIS; Imbalance between noradrenaline & serotonin
5. ELECTROLYTE MEMBRANE HYPOTHESIS: Hypercalcemia in depression
6. NEUROENDOCRINE HYPOTHESIS: Altered endocrine function
These 6 hypotheses results in loss of emotional behaviours & leads to Depression
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4. DEPRESSION
SYMPTOMS:
 Emotions : sadness, anxiety, guilt, anger, mood swings
 Thoughts: self criticism, confusion, suicidal thoughts
 Actions: social withdrawl, decreased activity level , poor self care
 Physical state: chronic fatigue, lack of energy, increased sleeping.
 Behaviour: changes in personal appearance, & neglecting responsibilities
DIAGNOSIS:
 History collection
 Mental state examination ( via depression Rating scales)
 Blood tests, LFT, TFT
 ICD – 10 & DSM – IV criteria
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5. DEPRESSION
TREATMENT:
 NON PHARMACOLOGICAL THERAPY: Psychotherapy, ECT
 PHARMACOLOGICAL THERAPY:
o Monoamine uptake inhibitors: Tricyclic inhibitors (IMIPIRAMINE)
SSRIs (FLUOXETIN)
SNRIs ( VENLOFAXINE) .
o MAO inhibitors: SELEGILINE, PHENELAZINE.
o MAO receptor antagonists : MIRTAZEPINE, TRAZADONE.
o Others: MIANSERIN, AGOMELATIN, AMINOKETONE
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6. SOAP NOTES
PATIENT DETAILS :
NAME: XXX
AGE: 48 YEARS
GENDER: FEMALE
SUBJECTIVE DATA :
C/o: lack of sleep, lack of food intake, silly fighting, crying from about
one month, lack of self care, lack of day to day activities from about one year.
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7. OBJECTIVE DATA :
PAST SUPAST MEDICAL HISTORY: Patient had 1st episode 17 years ago; 2nd
episode 8 years ago.
RGICAL HISTORY: NIL
PAST MEDICATION HISTORY: NIL
FAMILY HISTORY: NIL
SOCIAL HISTORY: NIL
ALLERGIES: NIL
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8. OBJECTIVE DATA :
 VITALS & PHYSICAL EXAMINATION:
-Blood Pressure: 110/80 mmHg
- Respiratory rate: 18 cycles/min
- Temperature: 98.6 °F
- Pulse rate: 82/min
- CVS: S1, S2 Present
- CNS: NFND
- Respiratory system: NVBS+
- GU & GI: Soft
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9. OBJECTIVE DATA :
COMPLETE BLOOD COUNT :
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PARAMETER RESULT NORMAL RANGE
Hemoglobin 7.6 gm/dl 12-16 gm/dl
Total WBC count 5400 cells/mm³ 4000-11000 cells/mm³
Total RBC count 4.0 million cells/mm³ 3.8-4.8 mill/mm³
Total platelets 3.02 lakh/mm³ 1.5-4 lakhs/mm³
Packed cell volume 25.7 % 35-46 %
DC P-17, L-20.2, E-2.7,
M-6.0,B-0.1
P: 40-70, L: 20-40, E: 1-6, M :2-10,
B: <1

10. OBJECTIVE DATA :
RENAL FUNCTION TESTS:
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PARAMETER RESULT NORMAL RANGE
Blood urea nitrogen 7mg/dl 7-17 mg/dl
creatinine 0.7 mg/dl 0.8-1.5 mg/dl
BLOOD SUGAR PROFILE:
PARAMETER RESULT NORMAL RANGE
RBS 100 mg/dl 80-140 mg/dl
FBS 97 mg/dl 70- 140 mg/dl

11. OBJECTIVE DATA :
LIVER FUNCTION TESTS:
PARAMETER RESULT NORMAL RANGE
Total protein 7.0 g/ dl 6.3-8.2 g/ dl
Albumin 3.7 g/dl 3.5-5 g/ dl
Globulin 2.9 g/dl 1.5-3 g/ dl
Total bilirubin 0.3 mg/dl 0.2-1.3 mg/ dl
Direct bilirubin 0.1 mg/dl 0.0-0.2 mg/ dl
SGOT 28 IU/L 14-36 IU/L
SGPT 39 IUL 9-52 IU/L
ALP 182 IU/L 38-126 IU/L
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12. OBJECTIVE DATA :
PARAMETER RESULT NORMAL RANGE
Sodium 140 mmol/L 134 - 144 mmol/L
potassium 3.8 mmol/L 3.5 – 5.1 mmol/L
chloride 103 mmol/L 98 – 106 mmol/L
Bicarbonates 21 mmol/L 21 – 28 mmol/L
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ASSESSMENT:
The tests and other symptoms confirms the diagnosis as Depression

13. PLAN:
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SL
no.
NAME OF DRUG GENERIC
NAME
DOSE ROUTE
OF
ADMINI
STRATI
ON
FREQUENCY DAYS
1. CAP.PRODEP FLUOXETINE 20 mg ORAL HS 4 DAYS
2. TAB.IMIPRAMINE IMIPRAMINE 25 mg ORAL HS 4 DAYS
3. TAB.TRINICALM PLUS TRIFLUOPERAZINE 5 mg ORAL TID 4 DAYS
4. TAB.NITROSUN NITRAZEPAM 5 mg ORAL HS 4 DAYS

14. FARM NOTES
FINDING: FLUOXETINE + IMIPRAMINE
ASSESSMENT: Concurrent use of both drugs may cause sedation, dry mouth,
blurred vision, constipation, urinary retention & may also leads to serotonin syndrome
risk.
RESOLUTION: Avoid concurrent use of both drugs
MONITORING: Monitor patient’s symptoms carefully.
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