The document discusses clinical depression and its treatment. It defines clinical depression as a decrease in neurotransmitters that affects mood, sleep, appetite, and other functions. Depression affects 20% of the population and is the most common mental health issue. It has biological, social, and psychological causes. Treatment aims to restore neurotransmitter balance through medication, psychotherapy, and behavioral changes.

1. All that you ever wanted to know about DEPRESSION DR. N. SHALINI, Psychiatrist, MIND FOCUS

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…….?

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

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

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)

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)

16. PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION

17. THANK YOU! PSYCHIATRIC SERVICES AND RESEARCH FOUNDATION