Depression

A basic understanding about depression

1. Dr. Sujit Kumar Kar Assistant professor in Psychiatry, K.G.Medical University, Lucknow

2. LEARNING OBJECTIVES

3. Sadness/ unhappy/ disappointment is not merely depression rather normal human emotions It becomes depression when these are abnormal , excessive and disproportionate leading to impairment

4. Rapidly changing life style Increased struggle Poverty , unemployment Substance abuse High expectations Conflicts Depression

5. Causes of depression

6. Parenting Stress Personality Coping skills and defense mechanisms Social support Interpersonal conflicts

7. Strong genetic linkage (chromosome 22 &18) Multiple genes are involved Positive family history is a risk factor ( if one parent is having mood disorder there is 10 -25% chance of having mood disorder among children, if both parents are affected the risk is double) Risk among twins (monozygotic -70-90%, di -zygotic – 16-35%)

8. Chronic medical illnesses- Tuberculosis, Cancers, Rheumatoid arthritis Metabolic disorders- Diabetes, hypertension, Chronic renal failure Endocrinological disorders- Hyper/ Hypothyroidism, Cushing’s disorder etc Cardiovascular – Myocardial infarction Anemia and other nutritional deficiencies Skin disorders- Psoriasis Drug induced- steroid, antihypertensives , anticancer, antiretroviral drugs etc Infections – AIDS, Hepatitis B Burn Neurological – Parkinsonism, Dementia, Stroke Post menopausal, premenstrual, postpartum period

9. Biological

10. History taking Mental status examination General / systemic examination

11. Mental status examination Generalised psychomotor retardation ( or agitation in elderly), stooped posture, slow spontaneous movements, downcast gaze decreased rate of speech with increased reaction time depressed mood and restricted affect delusions or hallucinations in perceptual disturbance Thought process- may be slow with poverty of ideas M emory may be impaired with increased impulsivity (assess for suicide) with impaired judgement (too pessimist) and insight may be impaired C lassic triad of pessimist thoughts about self, future and others

12. managing depression

13. Suicide – A serious complication/sequel of depression Suicide is preventable Clinician need to assess the risk of suicide

14. Source - Trivedi JK, Kar SK. Depression in surgically-ill patients. Depression in medically ill patients. EACB clinical update: Psychiatry. 1 st edition. 012; pp- 93 – 109. Severity of symptom Antidepressant preferred Mild SSRIs, bupropion Moderate SSRIs, Mirtazapine, bupropion Severe Mirtazapine, duloxetine, venlafaxine, SSRIs. Selection of Antidepressant on the Basis of Symptom Severity

15. Source - Trivedi JK, Kar SK. Depression in surgically-ill patients. Depression in medically ill patients. EACB clinical update: Psychiatry. 1 st edition. 2012; pp - 93 - 109

16. Choice of Antidepressants according to Drug-Drug Interactions

17. Antidepressants in special population

18. Source - Trivedi JK, Kar SK. Depression in surgically-ill patients. Depression in medically ill patients. EACB clinical update: Psychiatry. 1 st edition. 2012; pp - 93 - 109

19. Source - Trivedi JK, Kar SK. Depression in surgically-ill patients. Depression in medically ill patients. EACB clinical update: Psychiatry. 1 st edition. 2012; pp - 93 – 109.

20. Antidepressants to be avoided

21. Duration of therapy Adequate dose for adequate period of time with compliance ensured Wait for 2-3 weeks time to see response 1 st episode depression At least 6-9 months following complete remission Recurrent depression At least for 2-5years following complete remission (probably lifelong for multiple episodes)

22. When to refer

23. Pearls to remember

24. Say no to Substances ( alcohol, opium, cannabis, nicotine etc) Modify - stressful living Find happiness in small day-to-day activities Keep expectations within reach Healthy eating Regular exercise / meditation Maintaining regular daily routine Timely recognition and intervention if depression develops

25. A little effort made everyday can bring a great change in life Prevent depression – add smiles to life

26. ZINDAGI KABHI PALOON ME GUZAR JATI HAI AUR KABHI ZINDAGI BHAR EK PAL BHI NAHIN GUZARTA

27. SYMPTOMS OF DEPRESSION Persistent sad, anxious or “empty” mood Negative notions Feelings of helplessness, hopelessness, worthlessness, guilt feelings Decreased energy, fatigue, being “slowed down” Sleeplessness, early morning awakening or oversleeping Loss of interest or pleasure in hobbies and activities that were once enjoyed (including sex) Difficulty in making decisions Persistent physical symptoms that do not respond to treatment (chronic aches/ pains, increased acidity, frequent motions) Inattentiveness, forgetfulness, distractibility, inability to concentrate Loss of appetite, weight loss / overeating and weight gain Suicidal tendencies/ thoughts, suicidal attempts Extreme irritability