Depressive disorder (Depression Made Easy!)

A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression

1. Covered by: Arwa H. Al- Onayzan .

2. Depressive disorders

3. Definition: De pressive disorders: Are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities.

4. Types: Classification according to DSM-5 by spe c ific symptoms: Major depressive disorder (often called major depression ). Persistent depressive disorder (dysthymia ). Other specified or unspecified depressive disorder. Others are classified by etiology: Premenstrual dysphoric disorder. Depressive disorder due to another medical condition. Substance/medication-induced depressive disorder.

5. Causes: Heredity accounts for about half of the etiology. Thus , depression is more common among 1st-degree relatives of depressed patients. Other theories focus on changes in neurotransmitter levels, including abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), and serotonergic (5-hydroxytryptamine) neurotransmission.  Psychosocial factors also seem to be involved. Major life stresses, especially separations and losses. Depressive symptoms or disorders may accompany various physical disorders, including thyroid disorders, adrenal gland disorders, benign and malignant brain tumors , stroke, AIDS, Parkinson disease, and MS. Certain drugs, such as corticosteroids, some beta-blockers, interferon, and  reserpine, can also result in depressive disorders . Also, drug abuse.

6. Pathophysiology: The underlying pathophysiology has not been clearly defined . Clinical and preclinical trials suggest a disturbance (reduced) in central nervous system serotonin (5-HT) activity as an important factor. It suggested that selective serotonin reuptake inhibitors ( SSRIs) plays a role in reduced the depression. Vascular lesions may contribute to depression by disrupting the neural networks involved in emotion regulation—in particular, frontostriatal pathways. Functional neuroimaging studies support the hypothesis that the depressed state is associated with decreased metabolic activity in neocortical structures and increased metabolic activity in limbic structures.  

7. Signs and symptoms:

8. How to Diagnose: Clinical criteria (DSM-5 )  See previous slide. CBC, electrolytes, and TSH, vitamin B 12 , and folate levels to rule out physical disorders that can cause depression. Several brief questionnaires are available for screening. They help elicit some depressive symptoms but cannot be used alone for diagnosis. 

9. Treatment: Support ( a physician need to see patients weekly or biweekly to provide support and education- doctor should encourage patients to gradually increase simple activities ( eg , taking walks, exercising regularly ).   Psychotherapy ( particularly cognitive-behavioral therapy and interpersonal therapy, is effective, both to treat acute symptoms and to decrease the likelihood of relapse). Drugs (SSRIs, Serotonin modulators (5-HT 2   blockers), Serotonin-norepinephrine  reuptake inhibitors, Norepinephrine-dopamine  reuptake inhibitor, Heterocyclic antidepressants, Monoamine oxidase inhibitors ( MAOIs)). Best choice is SSRI  has less side effects. Electroconvulsive therapy (ECT )  used if drug not affected.

10. Prognosis: Major depressive disorder has significant potential morbidity and mortality, contributing as it does to suicide. With appropriate treatment, 70-80% of individuals with major depressive disorder can achieve a significant reduction in symptoms, although as many as 50% of patients may not respond to the initial treatment trial . Pretreatment irritability and psychotic symptoms may be associated with poorer outcomes. 

11. Prevention:

12. References: Merk manual (nineteenth edition, page 1538-1548). Medscape: http:// emedicine.medscape.com/article/286759-overview#a7 Goegle images.