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Depression
·
Depression is a mood disorder that causes a persistent feeling
of sadness and loss of interest.
·
It is also called major depressive disorder (MDD) or clinical
depression.
·
It affects how a person feels, thinks and behave and can lead to
a variety of emotional and physical problems.
Epidemiology
Lifetime prevalence
·
16.4%
MDD
·
2.5%
Dysthymia
Etiology of Mood Disorders:
·
Neurobiological
Factors
·
Genetic
factors
·
Heritability
estimates 93% Bipolar Disorder &37% MDD
·
Heritability
estimates higher for women than men
·
Neurotransmitters
§ Low levels of norepinephrine, dopamine, and
serotonin
·
Neuroendocrine theories
§ Over activity of HPA axis triggers release of
cortisol - stress hormone.
§ Findings that link depression to high cortisol
levels are Cushing’s syndrome which causes over secretion of cortisol.
§ Symptoms include those of depression.
§ Injecting cortisol in animals produce
depressive symptoms.
§ Dexamethasone suppression test.
§ Lack of cortisol suppression in people with
history of depression.
Psychological theories
Freud’s theory
·
Oral
fixation leads to excessive dependency, depression, anger towards loved ones
who reject us is turned inward.
·
Affect
·
High
negative affect
·
Low
positive affect
In response to positive stimuli, depressed
individuals experience:
·
Fewer
positive facial expressions
·
Report
less pleasant emotion
·
Show
less motivation
·
Demonstrate
less psychophysiological activity
·
Neuroticism
·
Tendency
to react with higher levels of negative affect
·
Predicts
onset of depression
·
Extraversion
·
Associated
with high levels of positive affect
·
Low
extraversion does not always precede depression
Cognitive theories
Beck’s theory: Negative triad
Negative view of:
·
Self,
world, future
·
Negative
schemata
·
Underlying
tendency to see the world negatively
·
Negative
schemata cause cognitive biases
·
Tendency
to process information in negative ways
DSM 5 criteria
·
5 or more symptoms
present in same 2-week period,
where at least one symptom is (1) depressed
mood or(2) loss of interest or
pleasure. Depressed mood most of
the day nearly every day.
·
In
children/adolescents can be irritable mood
·
Diminished
interest/pleasure in all or almost all activities most of the day nearly every
day
·
Weight
loss, weight gain, decrease/increase in appetite
·
In
children, failure to make expected weight gain
·
Insomnia/hypersomnia
·
Psychomotor
agitation/retardation
·
Fatigue
or loss of energy and worthlessness or excessive or inappropriate guilt
·
Diminished
ability to think or concentrate, or indecisiveness.
·
Recurrent
thoughts of death, recurrent suicidal ideation, suicide attempts, or suicide
plans
Clinical
features
·
Motivation- Apathy, loss of
energy and interest: things seem
pointless, hopeless
·
Emotional- Low mood, emptiness, anger or resentment, anxiety,
shame, guilt
·
Cognitive - Poor concentration,
negative ideas about the self, the world and the future.
·
Behaviour - Lowered activity,
social withdrawal, agitation or retardation.
·
Biological - Sleep disturbance,
loss of appetite, loss of weight, changes in circadian rhythms, hormones and
brain chemicals.
·
Lack
of energy
·
Loss
of appetite
·
Weight
loss or gain
·
Unexplained
headache or backache
·
Stomachaches,
indigestion or changes in bowelhabits.
Objective
Rating Scales for Depression
·
The Zung Self-Rating Depression
Scale is a 20-item report scale.
·
The Raskin Depression Scale
·
The Hamilton Rating Scale for
Depression (HAM-D) is a widely used depression scale with up to 24 items.
Prognosis
·
Major depressive disorder tends to be chronic.
·
Patients who have been hospitalized for a first episode ofmajor
depressive disorder have about a 50 percent chance of recovering in the first
year.
·
About 25 percent of patients experience a recurrence of major
depressive disorder in the first 6 months after release from a hospital, about
30 to 50 percent in the following 2 years and about 50 to 75 percent in 5
years.
Treatment
1. Class of antidepressant drugs used for
depression
·
SSRI-selective
serotonin reuptake inhibitors: Fluoxetine, Escitalopram, Sertraline, Paroxetine
·
TCA-
tricyclic antidepressants:Amitryptilline, Imipramine, Clomipramine
·
MAO
inhibitors
·
SNRI-
serotonin norepinephrine reuptake inhibitors:Venlafaxine, Duloxetine.
·
Others:Mirtazapine,
Bupropion, Trazodone, Vilazodone
2. Electroconvulsive therapy (ECT)
Indications
·
non-responders
Severe depression with high risk of suicide
·
Depression
with psychotic features, melancholic features.
