Depressed Diane-Case Study on Depression
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8/13/2019 Depressed Diane-Case Study on Depression
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Group 3 Members:
Ensy CarolineFarhath JabienFelicia Lim Shang FeiKhin Nyein KyiNg Miow LingThushara Ansari
Case 3: DepressedDiane
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D IANE ’ S S ITUATIONS
21 year old University student
Living alone for last 6 months
Struggle to make friends and homesick
Poor attendance, negative view of the course
Less groomed, no eye contact and tired
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L EARNING O BJECTIVES
Review symptoms of depression
Consider drug treatments for depressive disorders &their mechanism of action and adverse effects
Discuss alternative to pharmacological treatment
Review the underlying pathophysiology of depression
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W HAT IS D EPRESSION ?
State of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well- being
Types
Exogenous/ MajorDepression (75%)
EndogenousDepression (25%)
Causes
Hereditary
Environment
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SYMPTOMS OF DEPRESSION
• Low self-esteem, miserable, pessimism, feelings of guilt, loss ofinterest/ pleasure/ motivation, anti-social, agitated, anxiety,suicidal
Emotional
• Fatigue, weight loss/gain
Physical
• insomnia, loss of appetite, retardation of thought and action,
hallucination/delusions (if severe)
Biological
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D IANE ’ S SYMPTOMS
• Poor attendance and punctualityLack ofmotivation
• Sounds lethargic• Lacks of groomingFatigue
• Avoids eye contact• Struggled to make friends• Home sick
Anxiety/Miserable
• Negative view towards course, abilities, andfuturePessimistic
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T HEORIES OF B IOCHEMICAL ABNORMALITY
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T HE M ONOAMINE T HEORY (BIOGENIC AMINE THEORY )
proposed by Schildkraut in 1960s
Low level of biogenic amine function leads todepressive symptoms
Antidepressants play a role by elevating serotonin / NA
level by:Inhibiting the reuptake mechanismInhibiting enzymes that breakdownEnhance release of neurotransmitters from nerve terminals
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BIOGENIC AMINE T HEORY (SEROTONIN HYPOTHESIS )
Born from 1 st theory in 1980s
Decreased serotonin level generates depressive symptomsSecondary down-regulation of NA & dopamine influence
Explains why certain symptoms are tied with specificneurotransmitters
Serotonin
• anxiety • obsession
• compulsion
NA
• lack of alertness
and interest
DA
• lack of attention
and motivation
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W HY H YPOTHESIS R EMAINS
Neurotransmitters level low, drugs restore
Effect is quicker than time taken by antidepressants to be effective
• Reduced receptor function• Clinical benefit due to such response, not due to monoamine
influence
Adaptive responses in brain occurs
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• Eg: Tianeptine enhance serotonin re uptake
Some antidepressants do not enhance neurotransmittersactivity
Some drugs lower serotonin & NA influence withoutcreating depression
• Unclear what this tells about nature of depression
Currently, biogenic amines are involved in therapeuticresponse to drugs
W HY H YPOTHESIS R EMAINS
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The International Criteria for Disease (ICD-10) ofWHO & Diagnostic and Statistical Manual ofMental Disorders (DSM-IV)
Medical history & current medication
Depression test (e.g. Beck’s Depression InventoryTest)
Laboratory Tests: blood test, basic electrolyteserum test, etc
F ORMAL D IAGNOSIS
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T REATMENT : P SYCHOTHERAPY
• Focus on behaviours and interactions between the patients with family and friends.
• Improve communication skills and increase self-esteem.
InterpersonalTherapy
• Causes are assumed to be unresolved conflicts ,often stemming from childhood
• understand and cope better with these feelings bytalking about the experiences
PsychodinamicTherapy
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T REATMENT : P SYCHOTHERAPY
• Focus on how thinking affects the way a personfeels and acts
• feel better, remain calm , even when the situationstays the same
• Most suitable for Diane
CognitiveBehavioural
Therapy
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D IANE ’ S C ONDITION
• Insomnia
• Loss of appetite &weight
• Score ‘moderately toseverely depressed’ on Beck DepressionInventory test
Problems
• Increase level ofexercise
• Paroxetine (20mg/d)
GP’s advise
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G ENERAL M ECHANISM OF ANTIDEPRESSANT D RUGS
Increase availability of target monoamine neurotransmitter by:a) inhibiting neurotransmitters removal by uptake
b) inhibiting breakdown by enzymes
Alternative Mechanism:Reducing monoamine breakdown by MAOIs
Types:
SSRIs TCAs SNRIs NARIs NASSAs MAOIs
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M ECHANISM OF A CTION OF PAROXETINE
Belongs to SSRI (Selective Serotonin Reuptake Inhibitor)
Potently & selectively inhibit neuronal serotonin reuptakethrough antagonism of the serotonin transporter inmembrane
Location of the reuptake of 5-HTand/or NA (weak inhibition)
monoaminergic nerve terminal.
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SIDE E FFECTS OF PAROXETINE
• Typical headaches, nausea, diarrhoea, weight loss, completeloss of appetite, insomnia
Diane’s side effects
• Agitation, anorgasmia, inhibit metabolism of other drugs,tremor, muscle weakness/spasm, seizures
Other side effects
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ANOTHER APPOINTMENT WITH THE GP
*Change medication to Amitriptyline
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TRY E XERCISE MORE ???
Gain confidence
Reduce stress
Active and get moreinteraction
Release endorphine
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M ECHANISM OF ACTION OF AMITRIPTYLINE
Inhibits the reuptake of NA
Inhibits the membrane pump mechanism responsible foruptake of NA and 5-HT in adrenergic and serotonergicneurons.
Prolong neuronal activity by increasing neurotransmitters
Class of antidepressants:
Tricyclic Antidepressants (TCAs) Non-selective receptor blocking action
( Due to the tricyclic chemical structure)
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SIDE E FFECTS OF AMITRIPTYLINE
Sedation(H1 block)
Posturalhypotension
(α -adrenoceptorblock)
Constipation(Muscarinic
block)Blurred vision
Dry mouth Urinaryretention Epilepsy Weight gain
Skin rash Nausea Vomiting
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C OMMON TO T RY M ORE T HAN O NE M EDICATION ?
*Yes, if there is low or no response to the amount of drug given
Change anti-depression drugs with consideration
Increase dosage
Takes time to prescribe right dosage & type of antidepressant
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.
• Combination of antidepressants (Eg. Tricyclic alongwith MAOI or lithium or SSRI with mianserin orlithium)
.• Combine medicine with psychotherapy
.• Electroconvulsive Therapy (ECT)
C OMMON TO T RY M ORE T HAN O NE M EDICATION ?
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C ONCLUSION
What defines a best suited treatment?
Efficacy
Adverse side effects
Psychoterapy
Anti-DepressantDrug
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R EFERENCES A.C.Shaw, 2001.Counselling and Psychotherapy today. Singapore: Mcgraw hill.
American Psychiatric Association.Diagnostic and statistical manual of mentaldisorders, 2010. 4 th edition.USA .
D.Healy,1997. Psychiatric drugs explained.4 th edition.UK: Elsevier church hill
livingstone.
Boarder,M.,Newby,D.,Navti,P., 2010. Pharmacology for pharmacy and the healthsciences. USA: Oxford University Press Inc
Seligman,L. Richenberg,L.W., 2010.Theories of Counselling and Psychotherapy.Internation edition. USA: Pearson Education,Inc
WebMD,2011,WebMD. Better information.Better health. [online] available from:http://www.webmd.com/depression/tc/depression-topic-overview [accessed on]: 27 th January 12.
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