Depression

Depression

Dr Urmila Aswar

What Is Depression?

A very common, highly treatable, medical illness.

Affects physical, mental and emotional well-being.

Affects basic, everyday activities like eating and sleeping.

Affects how people think about things and feel about themselves.

What is Depression?

In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is persistent and can interfere significantly with an individual's ability to function.

Give up like tendency

Symptoms can last months or even years.

Symptoms of Depression

Feeling sad, blue, or down in the dumps

Loss of interest in things you usually enjoy

Feeling slowed down or restless

Having trouble sleeping or sleeping too much

Symptoms of Depression

Loss of energy or feeling tired all the time

Having an increase or decrease in appetite or weight

Having problems concentrating, thinking, remembering or making decisions

Feeling worthless or guilty

Having thoughts of death or suicide

Symptoms of Depression

People with Major Depression experience at least five of these symptoms all day, nearly every day, for at least 2 weeks.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Causes of Depression

Causes not known, but current theories include:

Genetic

• Runs in families

• However, depression can also occur in people who have no family history.

Environmental

• A serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode.

Causes of Depression

Physical Illness: serious complications

such as cancer, some disorders eg

Cushing’s syndrome etc

Drug induced: eg betablockers and

corticosteroids

Hormonal changes: postmenopausal

depression, post-partum depression

Causes of Depression

Personality Characteristics low self-esteem, pessimistic world view, low

stress tolerance

Biological Current thinking explores problems in brain

functioning in the following areas: Limbic system, neurotransmitters and neurons, hormones and the endocrine system

Serotonin pathway

Causes of Depression

Combination

a combination of genetic, psychological, environmental, and/ or biological factors may contribute to the onset of a depressive disorder.

Forms of Depression

Major Depression

At least 5 of the 9 symptoms of depression present including either loss of interest/pleasure or depressed mood; symptoms interfere with daily functioning

Minor Depression

Fewer symptoms than major depression with significant disability; shorter duration than chronic depression

Forms of Depression

Bipolar Disorder

Cycling mood changes with severe highs (mania) and severe lows (depression)

Dysthymia

Low grade chronic symptoms of depression that last for a minimum of 2 years

Depression and Suicide

Of those with MDD, close to 50% report feelings of wanting to die, 33% consider suicide and 8.8% report a suicide attempt.

More than 90% of those who commit suicide have a diagnosable psychiatric illness at the time of death, usually depression, alcohol abuse or both

Who is at risk for Depression?

Older adults

Young adults

Women, pregnant and post partum women. women report depression about twice as often as men. This may result from a greater likelihood to discuss depression or to seek help.

Depression in Women

Depression is the second leading cause of disease-related disability among women

1 in 4 women will suffer from a Major Depressive Episode during the course of their lives as compared to 1 in 10 men.• Women may be more likely to discuss

depression or to seek help.

Women of childbearing age are at increased risk for major depression• Pregnancy and new motherhood may

increase the risk of depressive episodes

Depression in Older Adults

Of the nearly 35 million Americans age 65 and older, an estimated 2 million have a depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder).

Symptoms of clinical depression can be triggered by other chronic illnesses common in later life, such as Alzheimer’s disease, Parkinson’s disease, heart disease, cancer and arthritis.

Depression is one of the most common conditions associated with suicide in older adults.

Individuals age 65 and older have highest rates of suicide

High suicide rate among older people (85 and older) is largely accounted for by White men.

Depression in Young Adults

10% of college students have been diagnosed with depression, including 13% of college women.

Lifetime prevalence for MDE highest among young adults age 18-25 (10%)

Suicide is the third leading cause of death for those aged 15-24

Additional Risk Factors for Depression

Family or personal history of depression

Current substance abuse problem

A major life stressor or change in life events; i.e.: loss of a loved one or a job

Chronic disease

Diagnosis

Based on alterations in mood

5 symptoms with insomnia or fatigue must

be present every day for more than 2

weeks.

Standarised questionnaires

Lab test: blood test---cortisol

Sleep EEG

Treatment for depression

Psychotherapy

Electroconvulsive therapy

Pharmacotherapy: SSRI: Fluoxetine

Tricyclic antidepressants: amitryptiline,

imipramine

Monoamine oxidase inhibitors:

tranylcypromine