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Depression
- 1. DEPRESSION Dr. Prasanna Prabhakar Khatawkar M.B.B.S., D.P.M., F.A.G.E., D.N.B. (Psychiatry) Consultant Psychiatrist www.mhgi.in
- 2. TOO MUCH TO HANDLE ??? www.mhgi.in
- 3. WHAT IS DEPRESSION? www.mhgi.in
- 4. DIAGNOSTIC CRITERIA: DSM-IV A. FIVE OR MORE SYMPTOMS STATED BELOW: * PRESENT FOR TWO OR MORE WEEKS * SUGGEST A DEFINITE CHANGE FROM EARLIER BEHAVIOUR * INCLUDES AT LEAST ONE OF THE FOLLOWING: ~ DEPRESSED MOOD ~ DECREASED INTEREST OR PLEASURE. * SYMPTOMS INCLUDE: 1. SUBJECTIVE REPORT OF DEPRESSED MOOD www.mhgi.in
- 5. 2. DECREASED INTEREST 3. SIGNIFICANT WEIGHT-LOSS OR WEIGHT-GAIN 4. INSOMNIA OR HYPERSOMNIA 5. PSYCHOMOTOR AGITATION OR RETARDATION. 6. FATIGUE OR LOSS OF ENERGY 7. FEELINGS OF WORTHLESSNESS AND EXCESSIVE OR INAPPROPRIATE GUILT 8. RECURRENT THOUGHTS OF DEATH. www.mhgi.in
- 6. B. SIGNIFICANT SOCIO-OCCUPATIONAL DYSFUNCTION. C. SYMPTOMS NOT SUGGESTIVE OF SUBSTANCE OR GENERAL MEDICAL CONDITION. D. NOT OCCURRING DURING BEREAVEMENT www.mhgi.in
- 7. OTHER IMPORT ANT FEATURES: 1. IMPROVEMENT IN SYMPTOMS TOWARDS EVENING 2. MULTIPLE SOMATIC COMPLAINTS 3. HEIGHTENED PERCEPTION TO PAIN 4. ALEXITHYMIA 5. TEARFULNESS 6. ANXIETY SYMPTOMS 7. PSEUDODEMENTIA 8. MOOD CONGRUENT PSYCHOTIC FEATURES www.mhgi.in
- 8. COGNITIV E TRIAD of DEPRESSION • NEGATIVE EVALUATION OF SELF • NEGATIVE EVALUATION OF THE WORLD • PESSIMISTIC EXPECTATIONS OF FUTURE www.mhgi.in
- 9. PATHOGENETI C AETIOLOGIC MODEL OF DEPRESSION EARLY LOSS HEREDITY GENDER AFFECTIVE TEMPERAMENTS STRESSORS •LIMBIC-DIENCEPHALIC DYSFUNCTION •NA SYSTEM DYSFUNCTION LEADING TO ALTERED LIMBIC AND CORTICAL AROUSAL www.mhgi.in
- 10. • 5-HT SYSTEM DYSFUNCTION • DOPAMINERGIC SYSTEM DYSFUNCTION • ALTERED RECEPTOR SENSITIVITY • DYSFUNCTION OF HPA AND HPT AXES www.mhgi.in
- 11. •ALTERATION OF SLEEP NEUROPHYSIOLOGY •CEREBRAL METABOLIC ALTERATIONS •IMMUNOLOGIC DEPRESSION www.mhgi.in
- 12. ENDOGENOUS DEPRESSION V/s REACTIVE DEPRESSION www.mhgi.in
- 13. ATYPICAL D EPRESSION • REVERSAL OF VEGETATIVE SYMPTOMS, i.e., 1. SLEEP 2. APPETITE 3. SEXUAL FUNCTION • LEADEN PARALYSIS • REJECTION SENSITIVITY www.mhgi.in
- 14. ANTIDEPR ESSANTS 1. SSRIs (SELECTIVE 5-HT REUPTAKE INHIBITORS) 2. SDRIs (SELECTIVE DOPAMINE REUPTAKE INHIBITORS) 3. SNRIs (SELECTIVE 5-HT NE REUPTAKE INHIBITORS) 4. SARIs (SEROTONIN ANTAGONISTS/REUPTAKE INHIBITORS) www.mhgi.in
- 15. 5. NaSSAs (NA-SPECIFIC 5-HT ANTIDEPRESSANTS) 6. NRIs (NE REUPTAKE INHIBITORS) 7. TCAs (TRICYCLIC ANTIDEPRESSANTS) 8. RIMAs (REVERSIBLE INHIBITORS OF MAO-A) 9. MAOIs (MONOAMINE OXIDASE INHIBITORS) 10. OTHER DRUGS: THYROID SUPPLEMENTS STIMULANT DRUGS LITHIUM www.mhgi.in
- 16. SELECTIVE 5-H T REUPTAKE INHIBITORS (SSRIs): ADVANTAGES • SAFETY • TOLERABILITY • NOT LETHAL IN OVERDOSAGE • NO CARDIOTOXICITY • NO ANTICHOLINERGIC SIDE EFFECTS • WIDER THERAPEUTIC SPECTRUM. • USUAL MAINTENANCE DOSE IS THE STARTING DOSE www.mhgi.in
- 17. SELECTIVE 5-HT REUPTAKE INHIBITORS (SSRIs): SHORTCOMINGS • NOT AS EFFECTIVE AS TCAs/SNRIs IN CASES OF SEVERE DEPRESSION • SIDE EFFECTS ARE BOTHERSOME IF NOT LETHAL • SEXUAL DYSFUNCTION • AGITATION www.mhgi.in
- 18. • AKATHESIA • NAUSEA • GI DISTRESS • WITHDRAWAL EFFECTS www.mhgi.in