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