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DEPRESSION

As per DSM V criteria depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. Mood represents a change from the person's baseline. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1 depressed mood or 2 loss of interest or pleasure.

  • Depressed mood or irritable: Most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
  • Decreased interest or pleasure: In most activities, most of each day
  • Significant weight change (5%) or change in appetite
  • Change in sleep: Insomnia or hypersomnia
  • Change in activity: Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
  • Concentration: Diminished ability to think or concentrate, or more indecisiveness
  • Suicidal: Thoughts of death or suicide, or has suicide plan
Pathophysiology:

Depression is commonly phrased as neurochemical imbalance. Neurotransmitters that mediate depression are Serotonin, GABA, Dopamine and norepinephrine. Serotonin is hypothesized to regulate other neurotransmitter systems; decreased serotonin activity may allow these systems to act in unusual and erratic ways.

Symptoms:
  • Very low mood
  • Poor concentration
  • Inability to experience pleasure

Very low mood, poor concentration, inability to experience pleasure, feeling of worthless, helpless, guilt, self hatred, weight loss or gain, hopeless, loss of interest, withdrawal, reduced sex drive, poor sleep, or over sleep, fatigue, headache, digestive issues, agitated or lethargic. Some may experience memory loss, slowing of movements, suicidal thoughts or plan, harming others.

Types:
  • Mild depression: Mild in severity and functional impairment
  • Moderate Depression: Moderate severity and functional impairment, may have suicidal thoughts and hurting others
  • Severe depression: Severe functional impairment, clear suicidal plan or recent attempt or specific intent of hurting own or other.
Subtypes:

5 subtypes are there.

  • Melancholic depression
  • Atypical depression
  • Catatonic depression
  • Postpartum depression
  • Seasonal affective disorder
Causes:
  • Genetic: Familial, runs in family
  • Social: Childhood abuse (physical, emotional or sexual), poverty, isolation
  • Psychological: Chronic diseases, fears, anxiety, phobias, low self esteem, loss of loved ones, trauma
  • Drugs: Adverse effect of some medication, drug abuse, and drug or alcohol withdrawal symptoms
Diagnosis:

Psychiatrist or a psychologist will come to a diagnosis based on the mental health examination. That may include the use of rating scale such as Hamilton Rating Scale for depression or the Beck Depression Inventory or the Suicide Behaviors questionnaire-Revised. Clinician comes to the diagnosis of depression after thorough examination and symptoms of the person satisfy the DSM-criteria or ICD. Before finalizing the diagnosis clinician rules out other medical conditions that mimic depression that are hypothyroidism, basic electrolyte disturbance, metabolic disturbance, and other systemic conditions. In males hypogonadism has to be ruled out before diagnosing depression.

Management:
  1. Psychotherapy
  2. Cognitive behavioral therapy
  3. Psychodynamic therapy
  4. Alternative approaches: Meditation, Yoga, Massage, Reiki, Hypnotherapy, Acupuncture, Exercis
    • SSRIs (Fluoxetine ”Prozac”, Sertraline “Zoloft”, Paroxetine “Paxil”, Citalopram “celexa”)
    • SNRIs (Venlafaxine “Effexor” Desvenlafaxine “Pristiq”, Duloxetine “Cymbalta”
    • NDRIs (Bupropion “Wellbutrin”)
    • Mirtazapine “Remeron”
    • Second generation antipsychotics: Aripiparazole “Abilify”, Quetiapine “Seroquel”
    • Tricyclic antidepressants (Amitriptyline “Elavil”, Desipramine “Norpramin”, Doxepin “Sinequan”, Imipramine “Tofranil”, Nortryptyline “Pamelor,Avantyl)
    • MAOIs (Phenelzine “nardil”, Isocarboxazid “Marplan”, Tranylcypromine Sulfate “Parnate”, Selegiline patch “Emsam”
  5. Repetitive Transcranial Magnetic Stimulation (RTMS)
  6. Electro Convulsive Therapy (ECT)
  7. Alternative approaches: Meditation, Yoga, Massage, Reiki, Hypnotherapy, Acupuncture, Exercise