Major depressive disorder (MDD) presentation

Subtopics: introduction, clinical feature, DSM 5, Differential diagnosis, treatment, etiology.
presented in American University of Barbados.

1. Major Depressive disorder.

2. Outline Introduction Etiology Clinical features Diagnostic criteria Differential diagnosis Treatment .

3. INTRODUCTION

4. What is major depressive disorder? Major depressive disorder is also known as Clinical depression Common mental health disorder Estimated to affect 15% of the adult population

5. What is major depressive disorder? Major depressive disorder impacts a person’s Mood Cognition Behavior

6. Types of Major depressive disorder. There are several types of Major depressive disorder; Seasonal affective disorder Psychotic depression Postpartum depression Melancholic depression Catatonic depression Bipolar disorder Persistent depressive disorder

7. Types of Major depressive disorder. Seasonal affective disorder - Occurs mostly in the winter months and generally lifts during spring and summer.

8. Types of Major depressive disorder Postpartum depression Present in new mothers and is much more than “baby blues”. Involves major depression consisting of feelings of sadness and anxiety.

9. Types of Major depressive disorder. Catatonic depression - This is characterized by muscular rigidity or motor difficulties or stupor. Bipolar disorder - Although different from depression, the individual experiences episodes of extremely low moods Known as Bipolar depression. https://www.youtube.com/watch?v=_s1lzxHRO4U

10. Types of Major depressive disorder. Persistent depressive disorder- This is also known as Dysthymia . Episodes of major depression accompanied with periods of less serious symptoms. MUST last for 2 years.

11. etiology

12. Etiology Causes of Major depressive disorder is generally a combination of factors; Genetics Biological factors Environmental factors Psychological factors

13. Genetic factors Risk is increased in individuals with family members that have had a history of depression .

14. Environmental factors Specific events surrounding an individual like Death of a loved one Sexual abuse Physical abuse

15. Clinical features

16. “ SIG-E-CAPS” S   leep changes I   nterest (loss) G   uilt (worthless) E   nergy (lack) C   ognition / C   oncentration A   ppetite disturbance P   sychomotor S   uicide

17. Depression symptoms in children Sadness Irritability Clinginess Refusing to go to school Being underweight

18. Depression symptoms in teens Anger Feeling negative and worthless Poor performance or poor attendance at school Feeling misunderstood and extremely sensitive

19. Depression symptoms in teens

20. Depression symptoms in older adults Memory difficulties Physical aches or pain Sleep problems or loss of interest in sex — not caused by a medical condition or medication Loss of interest in socializing or in activities Suicidal thinking or feelings, especially in older men

21. Differential Diagnosis of MDD

22. Diagnosis of MDD is also related with other condition. Major Depressive Disorder has relation with a few medical conditions, psychiatric conditions and other conditions. It is most commonly confused with Bipolar Disorders and other types of Depressive disorders previously mentioned.

23. Medical Conditions Neurological abnormality (e.g., Parkinson’s disease, Huntington disease, Multiple sclerosis, Dementia). Renal or Cardiopulmonary disease. Cancer (pancreatic) and gastrointestinal tumors. Viral illness (e.g., pneumonia, influenza, AIDS) Nutritional deficiency (e.g., Folic acid, B12).

24. Psychiatric and related conditions Anxiety disorder, Schizophrenia, Eating disorder, Somatic symptom disorder. Normal reaction to a life loss . Drug and alcohol use (Particularly use of Sedatives and withdrawal from stimulants). Prescription drug use (like steroids, antihypertensives, antineoplastics .

25. MDD DSM 5

26. MDD DSM5 A. Five or more of the following symptoms either (1)depressed mood or (2)loss of interest or pleasure)have been present during the same 2-week period.

27. Depressed mood: For children and adolescents, this can also be an irritable mood.

28. Anhedonia: Loss of interest or pleasure in almost all activities.

29. Weight loss or gain. Appetite disturbance

30. Insomnia or Hypersomnia:

31. Psychomotor agitation or retardation:

32. Fatigue:

33. Feelings of worthlessness

34. Decreased concentration :

35. Thoughts of death/suicide:

36. MDD DSM5 The symptoms cause clinically significant distress or impairment in social, occupational or other important area. The episode is not attributable to the physiological effects of a substance or to another medical condition.

37. MDD DSM5 The occurrence of major depressive episode is not better explained by other disorders. There has never been a manic episode or hypomanic episode.

38. TREATMENT

39. Psychotherapy Psychotherapy or talk therapy is a common term for treating depression by talking about your condition and related issues with a mental health professional.

40. Cognitive behavioral therapy or Interpersonal therapy are forms that are also used. Psychotherapy can help you: Identify and replace negative habits with healthy, positive ones Develop positive interactions with others

41. CONT’D Regain a sense control in life. Adjust to a crisis or other current difficulty

42. Selective serotonin reuptake inhibitors (SSRIs) SSRIs are generally used. SSRIs include citalopram, fluoxetine, sertraline and vilazodone

43. Serotonin-norepinephrine reuptake inhibitors (SNRIs) SNRIs include desvenlafaxine, levomilnacipran and duloxetine

44. Atypical antidepressants They include bupropion, mirtazapine , nefazodone, trazodone and vortioxetine

45. Tricyclic antidepressants Drugs such as imipramine, doxepine , nortriptyline, trimipramine are effective but have severe side effects than recent antidepressants..

46. Monoamine oxidase inhibitors   MAOIs such as tranylcypromine, phenelzine and isocarboxazid are used as a later option. However dangerous interactions may occur with foods such as certain cheeses, pickles and wines and other herbal supplements.

47. Selegiline, a recent MAOI has fewer side effects than other MAOIs do. These medications can't be combined with SSRIs

48. Other medications     Other medications may be used to enhance antidepressant effects. Short term use of Anti-anxiety medications and stimulants.

49. Other treatment options Electroconvulsive therapy (ECT) is used in depression to impact the function and effect of neurotransmitters in the brain.

50. CONT’D Transcranial magnetic stimulation (TMS) uses magnetic pulses to stimulate nerve cells in the brain that are involved in regulation of mood.

51. Lifestyle and home remedies In addition to professional treatment Stick to treatment plan Learn to pay attention to warning signs Avoid taking alcohol and recreational drugs.

52. Mind-body connections Acupuncture Relaxation techniques e.g Yoga Meditation session and guided imagery

53. CONT’D Massage therapy Art or music therapy Aerobic exercises

54. Reference https://www.nimh.nih.gov/health/topics/depression/index.shtml https://www.healthline.com/health/clinical-depression https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-2035600 https://www.webmd.com/depression/guide/major-depression#1

55. Reference DSM-5 Criteria for Major Depressive Disorder. (n.d.). Retrieved from https://www.mdcalc.com/dsm-5-criteria-major-depressive-disorder#use-cases Depression Clinical Presentation: History, Physical Examination, Major Depressive Disorder. (2019, April 23). Retrieved from https://emedicine.medscape.com/article/286759-clinical#b4 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

56. Reference Depression. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml Major Depressive Disorder. (2019, April 01). Retrieved from https://www.therecoveryvillage.com/mental-health/major-depressive-disorder/