1.
DEPRESSION
Dr. Prasanna Prabhakar Khatawkar
M.B.B.S., D.P.M., F.A.G.E., D.N.B. (Psychiatry)
Consultant Psychiatrist
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2.
TOO MUCH TO HANDLE ???
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3.
WHAT IS DEPRESSION?
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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
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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.
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6.
B. SIGNIFICANT SOCIO-OCCUPATIONAL
DYSFUNCTION.
C. SYMPTOMS NOT SUGGESTIVE OF
SUBSTANCE OR GENERAL MEDICAL
CONDITION.
D. NOT OCCURRING DURING BEREAVEMENT
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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
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8.
COGNITIV E TRIAD of
DEPRESSION
• NEGATIVE EVALUATION OF SELF
• NEGATIVE EVALUATION OF THE WORLD
• PESSIMISTIC EXPECTATIONS OF FUTURE
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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
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10.
• 5-HT SYSTEM DYSFUNCTION
• DOPAMINERGIC SYSTEM
DYSFUNCTION
• ALTERED RECEPTOR SENSITIVITY
• DYSFUNCTION OF HPA AND HPT
AXES
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11.
•ALTERATION OF SLEEP
NEUROPHYSIOLOGY
•CEREBRAL METABOLIC
ALTERATIONS
•IMMUNOLOGIC DEPRESSION
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12.
ENDOGENOUS DEPRESSION
V/s
REACTIVE DEPRESSION
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13.
ATYPICAL D EPRESSION
• REVERSAL OF VEGETATIVE SYMPTOMS, i.e.,
1. SLEEP
2. APPETITE
3. SEXUAL FUNCTION
• LEADEN PARALYSIS
• REJECTION SENSITIVITY
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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)
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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
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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
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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
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18.
• AKATHESIA
• NAUSEA
• GI DISTRESS
• WITHDRAWAL EFFECTS
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19.
THANK YOU
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