2. DEPRESSION
• Depression is a condition characterized by episodes of
depressed mood. Each episode is characterized by
lowering of mood, reduction of energy, and decrease
in activity.
• Capacity for enjoyment, interest, and concentration is
reduced, and marked tiredness after even minimum effort
is common.
3. ETIOPATHOGENESIS
Biogenic amine hypothesis. Depression may be caused by decreased brain levels of
the neurotransmitters norepinephrine (NE), serotonin (5-HT), and dopamine (DA).
• Postsynaptic changes in receptor sensitivity. Studies of many antidepressants have
demonstrated that desensitization or downregulation of NE or 5- HT1A receptors
may relate to onset of antidepressant effects.
• Dysregulation hypothesis. This theory emphasizes a failure of homeostatic
regulation of neurotransmitter systems, rather than absolute increases or decreases
in their activities. Effective antidepressants are theorized to restore efficient
regulation to these systems.
• 5-HT/NE link hypothesis. This theory suggests that there is a link between 5-HT
and NE activity, and that both the serotonergic and noradrenergic systems are
involved in the antidepressant response.
• The role of DA. Several reviews suggest that increased DA neurotransmission in
the mesolimbic pathway may be related to the mechanism of action of
antidepressants.
4.
5. CLINICAL PRESENTATIONS
• Emotional symptoms may include diminished ability to experience
pleasure, loss of interest in usual activities, sadness, pessimistic outlook,
crying spells, hopelessness, anxiety (present in almost 90% of depressed
outpatients), feelings of guilt, and psychotic features (e.g., auditory
hallucinations, delusions).
• Physical symptoms may include fatigue, pain (especially headache), sleep
disturbance, appetite disturbance (decreased or increased), loss of sexual
interest, and GI and cardiovascular complaints (especially palpitations).
• Intellectual or cognitive symptoms may include decreased ability to
concentrate or slowed thinking, poor memory for recent events, confusion,
and indecisiveness.
• Psychomotor disturbances may include psychomotor retardation (slowed
physical movements, thought processes, and speech) or psychomotor
agitation.
6. DSM-IV CRITERIA FOR MAJOR DEPRESSIVE DISORDER (MDD)
• Depressed mood or a loss of interest or pleasure in daily activities for more than two
weeks.
• Mood represents a change from the person's baseline.
• Impaired function: social, occupational, educational.
Specific symptoms, at least 5 of these 9, present nearly every day:
1. Depressed mood or irritable most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite.
4. Change in sleep: Insomnia or hypersomnia.
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: Thoughts of death or suicide, or has suicide plan
9. CATATONIA
Catatonia is a disturbance of motor behavior that can have
either a psychological or neurological cause. Its most well-
known form involves a rigid, immobile position that is held
by a person for a considerable length of time— often days,
weeks, or longer.
Types of catatonia
• catatonic schizophrenia.
• depression with catatonic features
• catatonic disorder due to general medical condition.
11. TREATMENT:
Benzodiazepines are the drugs of choice for catatonia
• Lorazepam was the most commonly used treatment, resolving symptoms in 70% of
reported cases.
• Other benzodiazepines such as diazepam, oxazepam, and clonazepam have also been
reported to treat catatonia
• Zolpidem, like the benzodiazepines, is a GABA-A agonist and has been reported in
one case series to be effective in the treatment of catatonia
• Continue the benzodiazepines until the causative illness has been fully treated.
• Combination of lithium and an antipsychotic may be an option in treatment-
resistant catatonic stupor
ECT
• ECT alone resulted in resolution of symptoms in 85%
• In malignant catatonia, the response to ECT was 89%,
