DEPRESSION:

Dr. Zoobia Ramzan

MBBS, FCPS (PSY)
Assistant Professor & Consultant Psychiatrist
Dr. A. Q. Khan Centre, Institute of Behavioral Sciences

Clinical features
Depressive disorder
1.

Depressed mood

2.

Loss of interest in environment or previously enjoyable activities

3.

Reduced energy leading to increased

4.

Fatigability & diminished activity

5.

Reduced concentration & attention

6.

Reduced self-esteem & self-confidence

7.

Ideas of guilt & unworthiness (even in a mild type of episode)

8.

Bleak & pessimistic views of the future

9.

Ideas or acts of self-harm or suicide

10.

Disturbed sleep

11.

Diminished appetite

12.

Psychotic symptoms may or may not be present

13.

Minimum duration of at least 2 weeks is required for an episode

Classification
3. Depressive episode
i.

Mild depressive episode

ii.

Moderate depressive episode

iii.

Severe depressive episode without psychotic features

iv.

Severe depressive episode with psychotic features

Epidemiology of Depression:

Prevalence: 2-5% in general population.

Male to Female ratio:1:2.

Risk Factors: A) Genetic:

B) Childhood Experiences:
C) Personality Traits:
D) Social circumstances:
E) Physical illness:

Neurotransmitter abnormalities:

Reduced monoamine function cause depression (5HT,NA,DA).

Therefore role of Antidepressants to increase monoamine release & reduce

their reuptake in the synaptic cleft.

Differential Diagnosis:

Normal Sadness

Anxiety d/o

OCD

Psychotic d/o

Substance misuse

Medical illness

Medication/drug related

Management:

Initial assessment A) History

B) Examination (Physical & MSE)
C) Investigations
Initiating Treatment A) Use of psychological therapies(mild depression)
B) Pharmacological treatment

(moderate/severe)

Psychological Approach:

Self-help

Exercise

Breathing/relaxation techniques

CBT

Behavioral therapy

Interpersonal therapy

Couple therapy

Pharmacological Approach:

Antidepressants A) SSRI (Selective serotonin reuptake inhibitor)

B) TCA (Tricyclic antidepressant)
Only prescribed in moderate/severe depression along with psychotherapy for
at least 6-9months.
Hospital admission: only in severe depression with suicidal attempt/psychotic
features.

Classification
2. Bipolar affective disorder
i.

Bipolar affective disorder, current episode hypomanic

ii.

Bipolar affective disorder, current episode manic without psychotic features

iii.

Bipolar affective disorder, current episode manic with psychotic features

iv.

Bipolar affective disorder, current episode mild-moderate depression

v.

Bipolar affective disorder, current episode severe depression without psychotic

features

vi.

Bipolar affective disorder, current episode severe depression with psychotic

features

vii.

Bipolar affective disorder, current episode mixed

viii.

Bipolar affective disorder, currently in remission

Classification
4. Recurrent depressive disorder
i.

Recurrent depressive disorder, current episode mild

ii.

Recurrent depressive disorder, current episode moderate

iii.

Recurrent depressive disorder, current episode severe without psychotic features

iv.

Recurrent depressive disorder, current episode severe with psychotic features

v.

Recurrent depressive disorder, currently in remission

5. Persistent mood disorders

vi.

Dysthymia

vii.

Cyclothymia

Clinical features
Mania
1.

Mood elevation which is out of keeping with the individuals circumstances, & may vary from
carefree joviality to uncontrollable excitement.

2.

Increased energy resulting in overactivity.

3.

Reduced need for sleep.

4.

Pressure of speech.

5.

Loss of normal social inhibitions.

6.

Marked distractibility.

7.

Inflated self-esteem.

8.

Grandiose & over-optimistic ideas.

9.

Duration of at least one week, & severity enough to disrupt everyday work & social activities almost
completely.

10.

Psychotic features (hallucinations, delusions, or catatonia) may or may not be present.

Management
Mania/Hypomania
1.

Physical treatments Antipsychotics, mood-stabilizers, sedative/hypnotics,

ECT.

2.

Psychological treatments Relapse prevention, stress & anger management.

3.

Hospital admission.