DEPRESSION: INTRODUCTION, DEFINITION,TYPES ETIOLOGY, PATHOPHYSIOLOGY, CLINICAL MANIFESTATIONS,DIAGNOSIS, TREATMENT

DEPRESSION: INTRODUCTION, DEFINITION, ETIOLOGY, PATHOPHYSIOLOGY, CLINICAL MANIFESTATIONS, DIAGNOSIS, TREATMENT

1. DEPRESSION A.HIMAJA REDDY PHARM D GEETHANJALI COLLEGE OF PHARMACY

2. INTRODUCTION Depression or Depressive disorder is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living. Depression results from a complex interaction of social, psychological and biological factors .For example people who have undergone an abuse, loss of loved ones, problems at school and workplace etc. This is different from regular mood changes and feelings about everyday life.Depressive episodes last most of the day, nearly every day for atleast two weeks. More than just about of the blues, depression isn’t a weakness and people can’t simply ‘’snap out’’ of it. Most people with depression may feel better with medication, psychotherapy or both. Prevention programmes have been shown to reduce depression.there are also effective psychological treatments and medications for depression.However these are often absent or inaccessible in low and middle income countries.

3. TYPES OF DEPRESSION The American Psychiatric Association's Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies depressive disorders as the following: Clinical depression (major depressive disorder): A diagnosis of major depressive disorder means you've felt sad, low or worthless most days for at least two weeks while also having other symptoms such as sleep problems, loss of interest in activities or change in appetite. This is the most severe form of depression and one of the most common forms. Persistent depressive disorder (PDD): Persistent depressive disorder is mild or moderate depression that lasts for at least two years. The symptoms are less severe than major depressive disorder. Healthcare providers used to call PDD dysthymia. Disruptive mood dysregulation disorder (DMDD): DMDD causes chronic, intense irritability and frequent anger outbursts in children.Symptoms usually begin by the age of 10.

4. TYPES OF DEPRESSION Premenstrual dysphoric disorder[PMD D ]: With PMDD person have premenstrual syndrome(PMS) symptoms along with mood symptoms,such as extreme irritability,anxiety or depression.These symptoms improve within a few days after your period starts but they can be severe enough to interfere with your life. Depressive disorder due to other medical condition : Many medical conditions can create changes in your body that cause depression.Examples include hypothyroidism,heart diseases,Parkinson’s disease and cancer.If the underlying condition can be treated,the depression usually improves as well. There are also specific forms of major depressive disorder, including: Seasonal affective disorder(seasonal depression): This is a form of major depressive disorder that typically arises during the fall and winter and goes away during the spring and summer. Prenatal depression and postpartum depression : Prenatal depression is depression that happens during pregnancy. Postpartum depression is depression that develops within four weeks of delivering a baby. The DSM refers to this as major depressive disorder(MDD) with peripartum onset.

5. TYPES OF DEPRESSION Atypical Depression : Symptoms of this condition, also known as major depressive disorder with atypical features, vary slightly from "typical" depression. The main difference is atemporary mood improvement in response to positive events (mood reactivity). Other key symptoms include increased appetite and rejection sensitivity. People with bipolar disorder also experience the episodes of depression in addition to maniac or hypomanic episodes.

6. ETIOLOGY Brain Chemistry : There may be a chemical imbalance in parts of the brain that manage mood , thoughts, sleep, appetite and behaviour in people who have depression. Hormone levels : Changes in female hormones oestrogen and progesterone during different periods of time like during menstrual cycle, postpartum period, perimenopause or menopause may all rise a person’s risk for depression. Family History : You are at a higher risk for developing depression if you have a family history of depression or other mood disorder. Early Childhood Trauma : Some events affect the way your body reacts to fear and stressful situations. Substance Use : A history of substance or alcohol misuse may affect your risk.

7. ETIOLOGY Brain Structure : There is a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms. Medical Conditions : Certain conditions may put you at higher risk such as chronic illness, insomnia, chronic pain, heart attack, Parkinson’s disease, stroke and cancer. Pain : People who feel emotional or chronic physical pain for long periods of time or significantly more likely to develop depression.

8. EPIDEMIOLOGY Depression is common. Researchers estimate that nearly 7% of adults in the United States have depression every year which reports the highest depression rates globally. About 280 million people around the world have depression and according to the report published by the WHO about 56 million people suffer from depression i.e 4.5% of Indian population and the count is still increasing. However, researchers believe that these estimates are lower than reality, as many people don't seek medical help for symptoms of depression and don't receive a diagnosis. Depression is 50% more common in women than men. Worldwide more than 10% of pregnant women and who have just given birth experience depression. More than 7,00,000 people die due to suicide every year.

9. PATHOPHISIOLOGY

10. CLINICAL MANIFESTATIONS Feelings of sadness, tearfulness and hopelessness. Sleep disturbances including insomnia or sleeping too much. Tiredness, lack of energy, reduced sexual desire and cognitive abilities. Reduced appetite and weight loss or increased cravings for food and weight gain. Feelings of guilt fixating on past failures or self-blame. Trouble thinking, concentrating, making decisions and remembering things. Irritability, clinginess, aches and pains, worry, sadness or anger, extremely sensitive. Fatigue, angry outburst or frustration even over small matters. Restlessness or agitation, frequent thoughts of death or suicide.

11. DIAGNOSIS Physical exam :Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem. Lab tests : For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly. Psychiatric evaluation: Your mental health professional asks about your symptoms, thoughts, feelings and behaviour patterns. You may be asked to fill out a questionnaire to help answer these questions. DSM-5: Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

12. TREATMENT Psychotherapy : Psychotherapy (talk therapy) involves talking with a mental health professional. Your therapist helps you identify and change unhealthy emotions, thoughts and behaviours. There are many types of psychotherapy — cognitive behavioural therapy (CBT) is the most common. Sometimes, brief therapy is all you need. Other people continue therapy for several months or years. Medication : Prescription medicine called antidepressants can help change the brain chemistry that causes depression. There are several different types of antidepressants, and it may take time to figure out the one that’s best for you. Some antidepressants have side effects, which often improve with time. If they don’t, talk to your healthcare provider. A different medication may work better for you. Complementary medicine : This involves treatments you may receive along with traditional Western medicine. People with mild depression or ongoing symptoms can improve their well-being with therapies such as acupuncture, massage, hypnosis and biofeedback.

13. TREATMENT Brain stimulation therapy : Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS). Antidepressants include SNRI’s like venlafaxine,levomilnacipran,duloxetine,desvenlafaxine. Atypical antidepressants include mirtazapine,trazadone,nefazodone,vortioxetine. Tricyclic antidepressants include nortriptyline,desipramine,doxepin. MAO inhibitors include nardil,selegiline,marplan,which cannot be combined with SNRI’s. TRANSMAGNETIC STIMULATION may be a option for those who haven’t responded to antidepressants.During TMS a treatment coil placed against your scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.

14. PREVENTION You can’t always prevent depression, but you can help reduce the risk by: Maintaining a healthy sleep routine. Managing stress with healthy coping mechanisms. Practicing regular self-care activities such as exercise, meditation and yoga. If you’ve had depression before, you may be more likely to experience it again. Stay connected to friends and family. Eat healthy foods and drink plenty of water. Avoiding chronic alcohol consumption.

15. REFERENCES https://my.clevelandclinic.org/health/diseases/9290-depression https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007 https://www.healthline.com/health/depression https://www.who.int/news-room/fact-sheets/detail/depression https://www.psychiatry.org/patients-families/depression/what-is-depression