This document provides an overview of depression including its definition, history, epidemiology, etiology, clinical features, and classification. Depression is defined as an abnormal response to loss or misfortune that is out of proportion or prolonged. It involves changes in mood such as lowered self-esteem and pessimistic thinking. Major depressive disorder lasts at least 2 weeks and involves at least 4 symptoms from a list including changes in appetite, sleep, energy levels, feelings of guilt, and thoughts of death or suicide. The history, epidemiology, etiology, clinical features, and classifications of depression are also summarized.

1. DEPRESSION
-Meru Yale(intern)

2. Topics
• Definition
• History
• Epidemiology
• Etiology
• Clinical features
• Classification

3. depression
• Depression is a normal response to loss or misfortune.
• Depression is abnormal when it is out of proportion to the misfortune or
unduly prolonged.
• Depressive mood coupled with other changes- lowering of self esteem,self
criticism and pessimistic thinking.
• Sad person has characteristic expression- turned corners of mouth,furrowed
brow, hunched dejected posture.

4. • According to Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-
TR), a major depressive disorder occurs without a history of manic,mixed,or
hypomanic episode.
• A major depressive episode must last at least for 2 weeks, and typically a person
with a diagnaosis of a major depressive episode also experiences at least 4
symptoms from a list that includes
1. -change in appetite and weight
2. -changes in sleep and activity
3. -lack of energy
4. -feelings of guilt
5. -problems thinking and making decisions
6. -recurring thoughts of death or suicide

5. history
• The old testament describes King saul as suffering from severe depressive
episodes and responding to Davids soothing music.
• Aretaeus first described mania and depression
• Emil Kraepelin – Kahlbaum,Falret and Baillarger described manic-depressive
illness.

6. epidemiology
Lifetime risk 10-20%
Sex ration(M:F) 1:2
First degree relatives 10-15%
Average Age of onset 27 years

7. etiology
• Genetics
• Abnormalities in neurotransmitters
• Low O2 and glucose utilization
• Cognitive theories
• Social and environment

8. Clinical features
• Low mood
• Lack of enjoyment
• Negative thinking
• Reduced energy

9. Appearance
• Dress and grooming neglected
• Gestural movements are reduced
Mood
• Misery
• Often experienced as different from ordinary
sadness
• Diurnal variation- mood is worse first thing in the
morning.
Depressive cognitions(negative thoughts)
• Worthlessness
• Pessimism-hopelessness
• guilt
Goal directed behaviour
• Lack of interest and enjoyment(anhedonia)
• Withdraws from social encounters.
Psychomotor changes
• Psychomotor retardation is frequent, walks
and acts slowly
• Agitation is a state of restlessness that is
experienced by patient as inability to relax
Biological symptoms
• Sleep disturbance
• Loss of appetite
• Loss of weight
• Constipation
• Loss of libido
• amenorrhoea

10. classification
• Based on presumed aetiology- (reactive v/s endogenous)
• Based on symptomatic picture-(melancholic v/s neurotic)
• Based on course -(unipolar versus bipolar)