A General Overview of Depressive Disorder and its type

1. Overview of Depressive
disorder
Presented by
Dr. Al Tarique
IMO, Medicine Department

2. In old Testament, King Saul described
Depressive syndrome, as the story of Ajax’s
suicide in Homer’s Iliad.
• About 400 BCE, Hippocrates used Mania &
Melancholia (Depression).
• In 30 AD, the Roman physician Celsus
described Melancholia as Depression caused
by black bile.
Genesis

3. • In 1854, Falret described folie circulaire
means alternating Depression and Mania.
• In 1882, German psychiatrist Kahlbaum, used
cyclothymia, means Mania & Depression as
same illness.
• In 1899, Kraepelin described Manic
Depressive Psychosis , now called Bipolar
Mood disorder .

4. DSM - IV
American Psychiatric association mentioned in
Diagnostic & Statistical manual of Mental
disorders (DSM – IV) as :
 Bipolar I disorder: Mania + Depression
 Bipolar II disorder: Hypomania + Depression

5. What is Depression?
• Depression means ‘morbid sadness’.
• It is defined as combination of both misery &
malaise.
• Depression is a major cause of disability &
suicide.
• Depression may come as experience, as
symptom of other disease & separate
syndrome.

6. • Mild, Moderate, Severe.
• Unipolar: Major Depressive disorder.
• Bipolar: Manic Depressive Psychosis.
• Recurrent Depression
• Atypical Depression
• Dysthymic Disorder
Types of Depressive disorder

7. Terminology
1.Major Depression/ Unipolar Depression:
Birth 20 Yrs
Birth 30 Yrs
Depression
Mania
2.Recurrent depression:
3.Bipolar I disorder:

8. 5. Dysthymia
6. Cyclothymia
Hypomania
Depression
4. Bipolar II disorder

9. Epidemiology:
Prevalence:
• F - 6 to 8% (Bangladesh: F- 11.6%)
• M - 3 to 5 % ( Bangladesh : M -2.9 %)
• Gender: M: F=1:2
• Age: Range :6-50 yrs. Mean : 30 yrs.
50% between 20-50 age.
Unemployed
Divorced
Separation
Higher Rate

10. Causative factors:
Biological:
Genetic: Polygenic inheritance.
 Biochemical:
• Decreased 3 monoamine neurotransmitters:
such as -
Serotonin (5 HT)
Noradrenaline (NE) Catecholamines
Dopamine (DA)

11. • Change in brain volume:
– Enlarged Lateral ventricles
– Decreased Hippocampal & Basal ganglia volumes
• Secondary depression :
– Cushing’s syndrome.
– Addison’s disease.
– Hypothyroidism.
– Hyper parathyroidism.
– Pre menstruation.
– Puerperium.
– Menopause.

12. Psychological
• Pre morbid personality: Cyclothymic
personality (Repeated & sustained mood
swings).
• Stressful life events.
• Bereavement

13. Social
• Relationship with parents.
– Deprivation of maternal affection.
– Family discord.
– Disruption of Parent-Child relationship.
– Overprotective parenting.
• Poor social support.
• Empty nest syndrome:
• Husband abroad syndrome

14. Presenting features
A. Biological features : (Vegetative/ Somatic)
• Sleep disturbance (Early morning awakening).
• Diurnal variation of mood (morning ↓, evening ↑).
• Anorexia.
• Weight loss: In few cases weight may be increased.
• Constipation.
• Loss of libido.
• Amenorrhea.

15. B. Central features:
• Negative thoughts (Depressive cognition):
o Guilty feeling about past.
o Worthlessness about present.
o Pessimistic thoughts about future.
o Suicidal plan

16. • Anhedonia: Lack of interest &
enjoyment.
• Reduced energy / Psychomotor
retardation:
• Crying Spell

17. C. Others
Delusions:
• Hypochondriacal delusion: Patient
convinces that he has cancer or venereal
diseases.
• Persecutory (Paranoid) delusion: Patient
believes that other people harm him.

18. • Nihilistic delusion: Patient believes that
he is moneyless/ his family are dead.
• Delusion of guilt: Dishonest act will be
punished severely.
Auditory hallucination: Hearing of one
2nd person derogatory & commanding
voice.

19. Features can be described as Mnemonic of Depression
• D- Depressed mood, Drug used
• E- Energy lack /Eating disturbance
• P- Pessimistic thought
• R- Retarded movement
• E- Emotional disturbance
• S- Sexual disturbance/ Speech problems
• S- Suicidality
• I - Insomnia
• O- Obsessional rumination
• N- Nihilism

20. Atypical Depression
Depressive symptoms with :
• Increased Appetite
• Weight gain
• Excessive sleep

21. Childhood Depression
Depressed mood with :
• School Phobia
• Excessive clinging to parents

22. Depression in Adolescent
Depressed mood with :
• Poor academic performance
• Truancy
• Anti- Social Behavior
• Substance abuse
• Running away
• Sexual promiscuity

23. Depression in older age
Depressive symptoms with loss of memory,
known as depressive pseudo dementia

24. Some Famous people suffered from Depression
• Abraham Lincoln (1809 -1865) , 16th President of USA
• Georgia O’Keeffe (1887-1986) , American artist.

25. • Jim Carrey (born January 17, 1962) Canadian American actor,
comedian, impressionist, screenwriter, and producer.
• J. K. Rowling (born 31 July 1965), British novelist, screenwriter
and film producer.

26. • Dilip Kumar (born on 11 December 1922) , Indian film actor.
• William James (1842 – 1910), American
philosopher and psychologist.

27. • Vincent van Gogh (1853 –1890) ,Dutch painter.
• Agatha Christie (1890 –1976), English crime novelist and
short story writer.

28. • Franz Kafka (1883-1924), German-language writer of novels
and short stories.
• Terry Bradshaw ((born September 2, 1948), former American
football quarterback.

29. • Sigmund Freud (1856-1939), Austrian neurologist founder of
Clinical psychology.
• Buzz Aldrin (born January 20, 1930) , American engineer and
former astronaut.
Source: Internet(Wikipedia)