This document discusses depression, including its definition, signs, prevalence among various medical illnesses, drugs that can cause it, and treatment options. Regarding treatment, it describes both pharmacological (antidepressant medications) and nonpharmacological (psychotherapy like CBT, IPT, PDT) approaches. It notes that current antidepressant therapy has limitations like slow onset of action and inadequate response for many patients. Psychotherapy techniques aim to help patients identify and change inaccurate perceptions as well as improve communication skills and self-esteem. The overall message is that depression management requires comprehensive assessment, formulation of an individualized treatment plan including medications and therapy, and proactive follow-up to prevent relapse.

1. PRESENTER-HABIBUR RAHAMAN
1ST YEAR PGT,
DEPT OF GENERAL MEDICINE
NRS MEDICAL COLLEGE
KOLKATA,WB,INDIA
CHAIRPERSON DR.UMA SINHARAY,
ASSISTANT PROFESSOR

2. DEPRESSION
THEME
2017

3. DEFINATION:
• DEPRESSION (By WHO) : Common mental
disorder that presents with depressed mood,
loss of interest or pleasure, feelings of guilt
or low self worth,disturbed sleep or
appetite, low energy, and poor
concentration.

6. SIGN OF DEPRESSION

9. Medical illness Prevalence of depression
1. Cancer 0-38%
2. Cardiovascular disease 17%–27%
3. COPD 20-50%
4. Stroke 14-19%
5. Diabetes 9-26%
6. Epilepsy 20-55%
7. Idiopathic Parkinson disease 2.7%–90%
Depression and physical illness. James S Olver and Malcolm J
Hopwood
MJA Open 2012; 1 Suppl 4: 9-12

10. DRUG CAUSING DEPRESSION

11. TREATMENT OF DEPRESSION
Current treatment option:-
 Pharmacologic
 Antidepressant medications
 Nonpharmacologic
 Psychotherapy
 CBT
 IPT
 PDT
 ECT
 Phototherapy
 RTMS
 VNS

12. Principles of
treatment;Collaborative Care
 1.Interdisiplinary coordiniation between
physicians,psychiatrists,GP,nurses etc.
 2.Proactive follow up to monitor outcome
 3.Pharmacological drug therapy and psychological
treatment.
 4.Self management training & supports for
patients/families.

16. FACTORS THAT DETERMINE
SELECTION OF DRUGS

17. The Utility of Antidepressant
Therapy
 50-60% of depressed patients respond to any given
antidepressant, and 80% to 95% respond to one or a
combination of therapeutic interventions if multiple
therapies are tried (Thase and Rush, Psychopharmacology:
Fourth Generation of Progress, 1995).
 Half of depressed patients will experience a remission
within 6 months of an index case of depression, and
perhaps more than 75% will remit by 2 years (Keller et al,
Arch Gen Psychiatry, 1992).
 Antidepressants appear effective in reducing relapse rates

18. Limitations of Antidepressant
Therapy
 The percentage of patients who remain well during
the18-month period following successful treatment for
depression is disappointingly low: 19% to 30% in one
study (Shea, et al. Arch Gen Psychiatry, 1992).
 At least 20% of treatment naïve patients fail to achieve
remission even 4 sequential treatment trials with
monotherapy and combinations (Rush et al, NEJM,
2006)
 More than half of patients fail to ever attain remission
in acute trials, and those that do commonly may not
sustain remission

19. Deficiencies in Current
Antidepressant Therapy
 Slow onset of action
 Inadequate response for many patients
 Expense
 Toxicity
 Stigma

20. Nonpharmacologic therapy
Psychotherapy
 Psychotherapy is often the first form of treatment
recommended for depression. It actually involves a
variety of treatment techniques. a person with
depression talks to a licensed and trained mental
health care professional who helps the person
identify and work through the factors that may be
triggering the depression.
 Taking care of the psychological and psychosocial
aspects of depression are just as important as
treating its medical care.

21. Types of psychotherpy
1.CBT: It helps people with depression to identify and change
inaccurate perceptions that they may have of
themselves and the world around them. To help
thinking by directing attention to both the "wrong"
and "right" assumptions they make about themselves
and others.
CBT is recommended for patients: -
 Who think and behave in ways that trigger and perpetuate depression.

With mild-to-moderate depression as the only treatment or in addition
to treatment with antidepressant medication.

Who refuse or are unable to take antidepressant medication.

Of all ages who have depression that causes suffering, disability, or
interpersonal problems.

24. .Interpersonal therapy(IPT)
&Psychodynamic therapy(PDT)
 IPT focuses on the behaviors and interactions a
depressed patient has with family and friends. The
primary goal of this therapy is to improve
communication skills and increase self esteem .
Therapy usually lasts 3-4 months .
 PDT and IPT help patients resolve depression caused
by:
 Loss (grief)
 Relationship conflicts
 Role transitions (such as becoming a mother or a
caregiver)

32. TAKE HOME MESSAGE
 Management of depression involves
 1.comprehensive assessment and proper establishment
of diagnosis.
 2. Formulation of treatment plan involves deciding
about treatment setting, medications and
psychological treatments to be used.
 3.Proactive follow up to prevent relapse .
 4.ENCOURAGE TO ALL “LET’S TALK ABOUT
DEPRESSION,NOT TO HIDE”