All that  you ever  wanted to  know about  DEPRESSION DR. N. SHALINI, Psychiatrist, MIND FOCUS
What is depression? PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION Depression in the Bay of Bengal,  Depression in the stock...
What is Clinical Depression? <ul><li>A decrease in Neurotransmitters, responsible for normal functioning. </li></ul><ul><l...
Why talk about Depression? <ul><li>20% of any given population are currently depressed. </li></ul><ul><li>By year 2020, th...
What Causes Depression? <ul><li>Genes </li></ul><ul><li>Neurotransmitters </li></ul><ul><li>Hormones </li></ul><ul><li>Gen...
Neurotransmitters  Ideas of helplessness, worthlessness, hopelessness Suicidal ideas, death fears, worries of failure… 2 w...
Signs and Symptoms Vegetative   Sleep disturbances Appetite disturbances Decreased libido Weight changes Somatic  Aches an...
Depressive Spectrum Disorders <ul><li>Normal  – situational sadness </li></ul><ul><li>Thin skinnedness  – high sensitivity...
Rule out  : Normalcy : Teenage Crisis, Bereavement . Situational : Interpersonal conflicts, narcissistic injury Endocrine ...
Assessment of Depression   Not Several More than Nearly at all days half the every days day Over the  last 2 weeks , how o...
Assessment of Depression   (contd)   g. Trouble concentrating on things, such  as reading the newspaper or watching  telev...
Treatment options PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION <ul><li>Goal is to bring the neurotransmitters back to norm...
TREATMENT OPTIONS:   A.  PSYCHOPHARMOCOLOGICAL   APPROACHES Tri Cyclic Antidepressants (TCA) (Amitriptyline, Dothepin) Sel...
Treatment options <ul><li>Psychotherapy </li></ul><ul><ul><li>Cognitive Behaviour Therapy (CBT) </li></ul></ul><ul><ul><li...
Working strategy <ul><li>early detection </li></ul><ul><li>swift initiation of treatment </li></ul><ul><li>family educatio...
PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
THANK YOU! PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
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  • All That You Ever Wanted To Know About Depression

    1. 1. All that you ever wanted to know about DEPRESSION DR. N. SHALINI, Psychiatrist, MIND FOCUS
    2. 2. What is depression? PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION Depression in the Bay of Bengal, Depression in the stock market Depression in on the surface of the moon Clinical Depression…….?
    3. 3. What is Clinical Depression? <ul><li>A decrease in Neurotransmitters, responsible for normal functioning. </li></ul><ul><li>Adrenaline : Energizer </li></ul><ul><li>Serotonin : Tranquilizer </li></ul><ul><li>Dopamine : Motivator </li></ul>PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    4. 4. Why talk about Depression? <ul><li>20% of any given population are currently depressed. </li></ul><ul><li>By year 2020, the most common illness </li></ul><ul><li>– WHO Report. </li></ul><ul><li>THE NUMBER ONE MENTAL HEALTH HAZARD </li></ul><ul><li>Affects the person, the family and the society </li></ul><ul><li>But easy to treat if identified early </li></ul>PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    5. 5. What Causes Depression? <ul><li>Genes </li></ul><ul><li>Neurotransmitters </li></ul><ul><li>Hormones </li></ul><ul><li>Gen. Med. illness </li></ul><ul><li>Parenting, </li></ul><ul><li>Schooling, </li></ul><ul><li>Support systems </li></ul><ul><li>Coping skills </li></ul><ul><li>Attitude /personality </li></ul><ul><li>Stress factors (Retirement, fall from grace) </li></ul>Biological Social Psychological
    6. 6. Neurotransmitters Ideas of helplessness, worthlessness, hopelessness Suicidal ideas, death fears, worries of failure… 2 weeks, continuous, impairing PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION MAJOR DEPRESSIVE DISORDER SEROTONIN ADRENALINE DOPAMINE <ul><li>Peace </li></ul><ul><li>Appetite </li></ul><ul><li>Libido </li></ul><ul><li>Sleep </li></ul><ul><li>Energy </li></ul><ul><li>Mood </li></ul><ul><li>Concentration </li></ul><ul><li>Productivity </li></ul><ul><li>Drive </li></ul><ul><li>Motivation </li></ul><ul><li>Pleasure in life </li></ul><ul><li>Interest in ADL </li></ul>
    7. 7. Signs and Symptoms Vegetative Sleep disturbances Appetite disturbances Decreased libido Weight changes Somatic Aches and Pains (KKK Syndrome) Muscle tensions Vague uneasiness Cognitive Poor attention Decreased frustration tolerance Impaired memory Negative thinking Behavioural Poor motivation   Decreased pleasure   Diminished interests   Easy fatigability Impulse Control Irritability Suicidal tendency Homicidal tendency
    8. 8. Depressive Spectrum Disorders <ul><li>Normal – situational sadness </li></ul><ul><li>Thin skinnedness – high sensitivity </li></ul><ul><li>Low Frustration tolerance – irritability </li></ul><ul><li>Somatization – Aches and pains </li></ul><ul><li>Reckless behaviour – smoking, drinking, promiscuity </li></ul><ul><li>Substance Dependence – narcotics, alcohol </li></ul><ul><li>OTC Dependence – Alprazolam, etc </li></ul><ul><li>Clinical Depression – Treated / untreated </li></ul><ul><li>Suicidal / Homicidal behaviour </li></ul><ul><li>Psychotic fears of persecution, nihilism and guilt </li></ul>PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    9. 9. Rule out : Normalcy : Teenage Crisis, Bereavement . Situational : Interpersonal conflicts, narcissistic injury Endocrine : Hypothyroidism, Diabetes Mellitus Systemic : Hypertension, SLE, Anaemia, AIDS Gynaec : Post partum/ perimenopausal/ PMS Neuro: SOL, CVA- esp. Left HS, Epilepsy, PD Medication induced : Steroids, antihypertensives, etc Carcinoma: Pancreas, colon, breast, etc PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    10. 10. Assessment of Depression Not Several More than Nearly at all days half the every days day Over the last 2 weeks , how often have you been bothered by any of the following problems? (less than half the days) <ul><li>Little interest or pleasure in doing things </li></ul><ul><li>Feeling down, depressed, or hopeless </li></ul><ul><li>Trouble falling or staying asleep, or sleeping too much </li></ul><ul><li>Feeling tired or having little energy </li></ul><ul><li>Poor appetite or overeating </li></ul><ul><li>Feeling bad about yourself, or that you are a failure, or have let yourself or your family down </li></ul>9 symptoms (a - i)
    11. 11. Assessment of Depression (contd) g. Trouble concentrating on things, such as reading the newspaper or watching television h. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual i. Thoughts that you would be better off dead, or of hurting yourself in some way Diagnosis of MDD to be made if answers to a or b and five or more of a - i are at least “more than half the days” (count i if present at all) Not Several More than Nearly at all days half the every days day Over the last 2 weeks , how often have you been bothered by any of the following problems? (less than half the days)
    12. 12. Treatment options PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION <ul><li>Goal is to bring the neurotransmitters back to normal </li></ul><ul><li>Through: </li></ul><ul><li>Psychopharmacology </li></ul><ul><li>Psychotherapy </li></ul><ul><li>Behavioural modification </li></ul>
    13. 13. TREATMENT OPTIONS:   A. PSYCHOPHARMOCOLOGICAL APPROACHES Tri Cyclic Antidepressants (TCA) (Amitriptyline, Dothepin) Selective Serotonin Reuptake Inhibitors (SSRI) (Fluoxetine, Paroxetine, Escitalopram) Norepinephrine & Dopamine Reuptake Inhibitor (NDRI) (Bupropion) Dual Serotonin & Norepinephrine Reuptake Inhibitors (SNRI) (Venlafaxine, Duloxetine, Mirtazepine) Selective Noradrenergic Reuptake Inhibitors (Reboxetine)
    14. 14. Treatment options <ul><li>Psychotherapy </li></ul><ul><ul><li>Cognitive Behaviour Therapy (CBT) </li></ul></ul><ul><ul><li>Emotional Intelligence </li></ul></ul><ul><ul><li>Eye Movement Desensitization and Restructuring (EMDR) </li></ul></ul><ul><ul><li>Cognitive Restructuring </li></ul></ul><ul><li>Behaviour/ Life style Modification </li></ul>PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    15. 15. Working strategy <ul><li>early detection </li></ul><ul><li>swift initiation of treatment </li></ul><ul><li>family education </li></ul><ul><li>long term follow-up </li></ul><ul><li>preventive strategies </li></ul>PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    16. 16. PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION
    17. 17. THANK YOU! PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

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