Depression

Depression, ICD 10 – Diagnostic criteria for Depressive episode, DSM IV Criteria for major Depressive episode, Types of depression, Causal factors, signs, suicide, Alcohol, Treatment,........

1. DEPRESSION Deva Pramod V B M.Sc. Psychology Department of Psychology Bharathiar University, India [email protected] 1

2. DEPRESSION Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. It may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness. Depressed people may lose interest in activities that once were pleasurable, or suffer cognitive impairments (e.g., difficulty concentrating, remembering details, making decisions). 2

3. The key features of the depressive disorders are: • Low mood; • Reduced energy • Loss of interest or enjoyment . Other common symptoms include poor concentration,reduced self-confidence, guilty thoughts, pessimism, ideas of self-harm or suicide, disturbed sleep and altered Appetite. 3

4. Depression is a common disorder with serious personal, interpersonal and societal consequences, affecting about 15% of the general population and accounting for approximately 10% of consultations in primary care. 4

5. ICD 10 – Diagnostic criteria for Depressive episode The individual usually suffers from: Depressed mode Loss of interest & enjoyment. Reduced energy leading to increased fatigability and diminished activity. 5

6. Marked tiredness after only slight effort. Other common symptoms are: Reduced concentration & attention. Reduced self-esteem and self confidence. Ideas of guilt & unworthiness 6

7. Bleak & pessimistic views of the future. Ideas or acts of self harm or suicide. Disturbed sleep or diminished appetite. Duration – At least 2 weeks. 7

8. DSM IV Criteria for major Depressive episode Dysphoric Mood or loss of interest or pleasure in all or almost all usual activities and pastimes . At least 4 of the following symptoms present nearly everyday for a period of at least 2 weeks : Poor appetite or significant weight loss or increased appetite or significant weight gain. Insomnia or hypersomnia. Psycho-motor agitation or retardation . Decrease in sexual drive . Loss of energy; fatigue 8

9. TYPES OF DEPRESSION Major or clinical depression Persistent depressive disorder Postpartum depression Dysthymia (Dysthymic Disorder) Mixed Anxiety and Depressive Disorder Seasonal Affective Disorder (SAD)   9

10. Bipolar disorder Premenstrual dysphoric disorder Psychotic depression Depression and Anxiety after Bereavement 10

11. CAUSAL FACTORS Molecular genetic studies Genetic factors; Neurotransmitter disturbances; and Psychosocial factors: adverse experiences in childhood; chronic major difficulties; undesirable life events; limited social network; and low self-esteem. Social Factors 11

12. Separation from loved ones Death Loss of money, status, health, materials, power, position, property . Failure in examination, in achieving the objectives or goals, failure to compete the work or task assigned . Comments, criticisms, ill-treatment, hostility from others. Poverty, unemployment of under-employment Needs & expectations not fulfilled. Injustice, deprivation, being deceived by others Stigmatizing, life-threatening, disabling illness Non-recognition . 12

13. Scientific research Causes Genetic inheritance: Identical twins run more risks than non-identical twins (about 65%). Changes in the brain Changes in the neuro endocrine or hormone system. Changes in the neuro-transmitters in the brain. Changes in the electrical activity in the brain. 13

14. Signs of Depression Drastic change of appetite Sudden change in sleeping patterns . S uddenly loses interest in things and activities energy loss and presence of fatigue Feeling of Worthlessness losing hope becomes indecisive suicidal. 14

15. experiences melancholia . mentally disturbed physical aches Feeling of "My life is passing by“ becomes antisocial . 15

16. Suicide Factors associated with increased suicide risk after acts of deliberate self-harm include: act of deliberate self-harm planned long in advance; suicide note written; acts taken in anticipation of death (e.g. writing a will ); being alone at the time of deliberate self-harm; patient making attempts to avoid discovery ; 16

17. not seeking help after deliberate self-harm; stating a wish to die; believing the act of deliberate self-harm would prove fatal; being sorry the act of deliberate self-harm failed ; continuing suicidal intent. 17

18. Other risk factors for suicide include: older age; male gender; single status; personality disorder; history of aggression; suicidal thoughts; social isolation; physical illness; alcohol abuse; and recent suicide attempt 18

19. SUICIDE AND BEREAVEMENT Increased risk of suicidal gestures Following the death of a spouse or a parent The suicide risk for those widowed was first observed high Recent studies found that suicide was higher amongst those widowed compared to those married. 19

20. Alcohol and Depression Alcohol , like the many other drugs that influence brain function, acts as a tranquilizer. If you are drinking alcohol regularly, you find that your present number of drinks has lesser and lesser effect. In order for you to achieve the effect you want, you tend to drink more. This effect is called the "tolerance effect" and has a powerful outcome in becoming an alcohol addict . 20

21. Alcohol and depression: The Link It tends to work in two types If you drink in excess, and often too regularly, you are likely more to be more depressed . If you take alcohol in relieving problems of depression or anxiety, you become more depressed and problematic later 21

22. Treatment 22

23. Antidepressant drugs Antidepressant would fulfil a range of criteria including : be effective across a range of depressive disorders ; be effective in short-term and long-term treatments; be effective across a range of age groups; have a rapid onset of action; involve once-daily dosage; be cost-effective; be well tolerated; 23

24. Physical treatments Electroconvulsive therapy (ECT) Sleep Deprivation Light Treatment (Phototherapy) Transcranial Magnetic Stimulation 24

25. Psychologic Therapies Cognitive – Behavior Therapy (CBT) Problem-Solving Treatment Interpersonal therapy ( IPT) Non-Directive Counselling Bereavement Counselling 25

26. Natural Treatment for Depression It Starts with the Diet Some Very Useful Herbs Cut Back on Those Soft Drinks 26

27. Avoid Depression in a Few Easy Steps Controlling Stress Avoid Drinking and Drug Use Have adequate Sleep Seek emotional support from family and friends Focus on positive aspects of your life Pace yourself, modify your schedule, and set realistic goals 27

28. Few ways on how to prevent depression S leep is an integral part of preventing depression Balance your life with enough rest and exercise everyday Try to keep some regularity in your life Sunlight and exercise can help the brain to function a higher level Make at least one warm meal daily a priority Have some fun every day. 28

29. Intervening with a Depressed person Be empathetic and understanding Don’t try to “cheer up” a depressed person Avoid critical or shaming statements Challenge expressions of hopelessness Empathize with feelings of sadness, grief, anger and frustration 29

30. Helping a Depressed Person Don’t argue about how bad things are Don’t insist that depression or sadness are the wrong feelings to be experiencing Don’t become angry even though your efforts may be resisted or rejected Advocate for their recovery from depression Emphasize that depression is treatable Seek consultation Encourage them to seek help, go with them to the counseling center Be supportive of counselor or doctor suggestions 30

31. Conclusion Depression is a mental disorder that is pervasive in the world and affects us all. Unlike many large scale international problems, a solution for depression is at hand. C ost-effective treatments are available to improve the health and the lives of the millions of people around the world suffering from depression. On an individual, community , and national level, it is time to educate ourselves about depression and support those who are suffering from this mental disorder. 31

32. Keywords Depression Major or clinical depression Persistent depressive disorder Postpartum depression Dysthymia (Dysthymic Disorder) Mixed Anxiety and Depressive Disorder Seasonal Affective Disorder (SAD) Bipolar disorder Premenstrual dysphoric disorder Psychotic depression Depression and Anxiety after Bereavement Molecular genetic studies Genetic factors; Psychosocial factors: Neurotransmitter disturbances Social Factors Suicide Bereavement Antidepressant Drugs Physical Treatments Psychologic Therapies Cognitive – Behavior Therapy (CBT) Problem-Solving Treatment Interpersonal therapy (IPT) Non-Directive Counselling Electroconvulsive therapy (ECT) Sleep Deprivation Light Treatment (Phototherapy) Transcranial Magnetic Stimulation 32

33. References David S. Baldwin & Jon Birtwistle (2002), An Atlas of DEPRESSION, The Parthenon Publishing Group. London Niraj Ahuja (2011),A Short Textbook Of Psychiatry 7 th ed. Jaypee Brothers Medical Publishers Pvt Ltd . Kaplan, H.I. & Sadock , B.J. (2007). Synopsis of Psychiatry – Behavioral Sciences/Clinical Psychiatry. (10th Edn ). NY: Williams & Wilkins. Diagnostic and Statistical Manual for Mental Disorders ( DSM-V). Fifth Edition, Washington DC, the Division of Publications and Marketing, American Psychiatrist Association. ICD-10 . (2007). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines, Geneva, World Health Organization, AITBS Publishers in India. 33

34. Thank You 34