Monday, March 26, 2018

Depression: A Summary

Hey guys! Here’s a review of Major Depressive Disorder using a whiteboard as help.

Depression is a type of mood disorder with primary disturbance in internal emotional state causing subjective distress and socio-occupational dysfunction.



Learned helplessness is when the individual learns that he/she is helpless in situations where there is a presence of aversive stimuli, has accepted that there’s no control over it, and thus gives up trying.

CLINICAL FEATURES:
The classic mnemonic goes as-
  • Depressed mood: Can show diurnal variation. Patient reported. Essential for diagnosis.
  • Sleep disturbance: Patients have decreased slow wave sleep duration and R.E.M. latency while having increased total R.E.M. duration with early R.E.M. onset in sleep cycle.
  • Interest loss or anhedonia: Inability to attain pleasure from almost any activity. Patient reported. Essential for diagnosis.
  • Guilty: Patients have feelings of worthlessness or sin for events they have little or no role in/ control of.
  • Energy loss or fatigue
  • Concentration difficulties: Usually accompanied with indecisiveness.
  • Appetite and weight changes: Can increases or decrease. Usually, there’s a loss of body weight by 5% or more, associated with GI complaints of constipation, dyspepsia etc.
  • Psychomotor changes: Retardation or agitation.
  • Suicidal ideations: Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

MANAGEMENT:

1st line-
Psychotherapy: Cognitive Behavioural Therapy, Problem Solving Therapy, Emotions Focused Therapy and Behavioural Activation etc.

Selective Serotonin Reuptake Inhibitors: Fluoxetine, Paroxetine, Fluvoxamine, Escitalopram and Sertraline.

2nd line-
Serotonin/ Norepinephrine Reuptake Inhibitors: Duloxetine, Venlafaxine, Desvenlafaxine.

Tricyclic Antidepressants: Amitriptyline, Nortriptyline, Clomipramine, Desipramine and Imipramine.

Monoamine Oxidase Inhibitors: Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline.

Atypical antidepressants: Bupropion, Trazodone, Mirtazapine.

Last line-
Electroconvulsive therapy is reserved for:
-Need for a rapid antidepressant reponse
-Failure of drug therapies
-History of good response to ECT
-High risk of suicide
-High risk of medical morbidity and mortality

Further reading:
Normal vs. abnormal grief reaction
Cyclothymia vs Dysthymia
Types of psychotherapy


Hope this helps. Happy studying!
--Ashish Singh

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