Depression is a common and treatable medical illness that affects physical, mental, and emotional well-being. It causes persistent feelings of sadness and loss of interest that interfere with daily functioning. Symptoms include changes in sleep, appetite, concentration, energy level, and thoughts of death or suicide. While the causes are unclear, depression may be related to genetic, environmental, physical, or biological factors like changes in brain chemistry. It is diagnosed based on symptoms lasting at least two weeks and is treated through psychotherapy, medication, or electroconvulsive therapy. Certain groups like women, older adults, and young adults are at higher risk.

1. Depression
Dr Urmila Aswar

2. What Is Depression?
 A very common, highly treatable, medical
illness.
 Affects physical, mental and emotional
well-being.
 Affects basic, everyday activities like eating
and sleeping.
 Affects how people think about things and
feel about themselves.

3. What is Depression?

In contrast to the normal emotional
experiences of sadness, loss, or passing mood
states, clinical depression is persistent and
can interfere significantly with an individual's
ability to function.

Give up like tendency

Symptoms can last months or even years.

4. Symptoms of Depression
 Feeling sad, blue, or down in the dumps
 Loss of interest in things you usually enjoy
 Feeling slowed down or restless
 Having trouble sleeping or sleeping too much

5. Symptoms of Depression
 Loss of energy or feeling tired all the time
 Having an increase or decrease in appetite
or weight
 Having problems concentrating, thinking,
remembering or making decisions
 Feeling worthless or guilty
 Having thoughts of death or suicide

6. Symptoms of Depression
 People with Major Depression experience at
least five of these symptoms all day, nearly
every day, for at least 2 weeks.
 The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.

7. Causes of Depression
Causes not known, but current theories include:
 Genetic
• Runs in families
• However, depression can also occur in
people who have no family history.
 Environmental
• A serious loss, difficult relationship,
financial problem, or any stressful
(unwelcome or even desired) change in life
patterns can trigger a depressive episode.

8. Causes of Depression
 Physical Illness: serious complications
such as cancer, some disorders eg
Cushing’s syndrome etc
 Drug induced: eg betablockers and
corticosteroids
 Hormonal changes: postmenopausal
depression, post-partum depression

9. Causes of Depression
 Personality Characteristics
 low self-esteem, pessimistic world view, low
stress tolerance
 Biological
 Current thinking explores problems in brain
functioning in the following areas: Limbic
system, neurotransmitters and neurons,
hormones and the endocrine system

10. Serotonin pathway

11. Causes of Depression
 Combination
 a combination of genetic, psychological,
environmental, and/ or biological factors
may contribute to the onset of a
depressive disorder.

12. Forms of Depression
 Major Depression
 At least 5 of the 9 symptoms of
depression present including either loss of
interest/pleasure or depressed mood;
symptoms interfere with daily functioning
 Minor Depression
 Fewer symptoms than major depression
with significant disability; shorter
duration than chronic depression

13. Forms of Depression
 Bipolar Disorder
 Cycling mood changes with severe highs
(mania) and severe lows (depression)
 Dysthymia
 Low grade chronic symptoms of
depression that last for a minimum of 2
years

14. Depression and Suicide
 Of those with MDD, close to 50% report
feelings of wanting to die, 33% consider
suicide and 8.8% report a suicide attempt.
 More than 90% of those who commit suicide
have a diagnosable psychiatric illness at the
time of death, usually depression, alcohol
abuse or both

15. Who is at risk for Depression?
 Older adults
 Young adults
 Women, pregnant and post partum women.
women report depression about twice as often
as men. This may result from a greater
likelihood to discuss depression or to seek
help.

16. Depression in Women
 Depression is the second leading cause of
disease-related disability among women
 1 in 4 women will suffer from a Major
Depressive Episode during the course of their
lives as compared to 1 in 10 men.
• Women may be more likely to discuss
depression or to seek help.
 Women of childbearing age are at increased
risk for major depression
• Pregnancy and new motherhood may
increase the risk of depressive episodes

17. Depression in Older Adults

Of the nearly 35 million Americans age 65 and older, an
estimated 2 million have a depressive illness (major depressive
disorder, dysthymic disorder, or bipolar disorder).

Symptoms of clinical depression can be triggered by other
chronic illnesses common in later life, such as Alzheimer’s
disease, Parkinson’s disease, heart disease, cancer and
arthritis.

Depression is one of the most common conditions associated
with suicide in older adults.

Individuals age 65 and older have highest rates of suicide

High suicide rate among older people (85 and older) is largely
accounted for by White men.

18. Depression in Young Adults
 10% of college students have been
diagnosed with depression, including 13%
of college women.
 Lifetime prevalence for MDE highest among
young adults age 18-25 (10%)
 Suicide is the third leading cause of death
for those aged 15-24

19. Additional Risk Factors for
Depression
 Family or personal history of depression
 Current substance abuse problem
 A major life stressor or change in life events;
i.e.: loss of a loved one or a job
 Chronic disease

20. Diagnosis
 Based on alterations in mood
 5 symptoms with insomnia or fatigue must
be present every day for more than 2
weeks.
 Standarised questionnaires
 Lab test: blood test---cortisol
 Sleep EEG

21. Treatment for depression
Psychotherapy
Electroconvulsive therapy
Pharmacotherapy: SSRI: Fluoxetine
Tricyclic antidepressants: amitryptiline,
imipramine
 Monoamine oxidase inhibitors:
tranylcypromine
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