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Learn about various types of depressive disorders, including major depressive disorder and dysthymia. Understand the epidemiology, etiopathogenesis, and general treatment approach to help individuals suffering from depression. Early intervention is crucial for prevention and relief of symptoms.
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Depressive Disorders Dr RohanMendonsa, Professor, Dept of Psychiatry.
Depression is a mood disorder • What is mood? • It is an emotional experience, sustained in time, that influences his/her behaviour and perception of the world.
Different types of depressive disorders • Major depressive disorder • Dysthymia • Minor depressive disorder • Mixed anxiety deoressive disorder
Epidemiology • 20-25% of population will suffer at some point of their lifetime. • Higher in women • Higher- poor interpersonal relationships.
Etiopathogenesis • Interaction of Biological, Psychological and Social factors. • Biological- genetics, decreased catecholamines, increased activity of HPA axis • Psychological- worrying, pessimistic • Social- life events/adversities
Major depressive disorder • Depressive episodes lasting more than 2 weeks, last for 6 months to 1 year if not treated • Depressed mood most of the day • Loss of interest • Decreased energy • Feelings of worthlessness, hopelessness, wish to die, suicidal thoughts • Insomnia, decreased appetite, Weight loss • Decreased ability to think/concentrate
Dysthymia • Mild chronic disorder affecting 3-6% • Low self esteem, low mood,pessimistic thinking- less severe • Duration more than 2 years • Some recover, others may experience concmitant depressive episodes- Double depression.
Other types • Premenstrual dysphoric disorder- irritability, increased rejection sensitivity, crying spells,headache, breast tenderness, fatigue etc begin about 1 week prior to menses and remit with onset of menses. • Post partum depression: one in ten women, different from ‘baby blues’ • Seasonal affective disorder (winter depression)
Diagnosis • Clinical one. • O/E – Stooped posture, downcast gaze, decreased rate and volume of speech,long pauses, negative content of thinking- guilt, suicidal ideas • Rule out manic/ hypomanic, substance use, medical disorders like hypothyroidism
Differential diagnosis • Endocrine disorders • Infections- infectious mononucleosis • Neurological- Parkinsons, Alzheimer’s • Cerebrovasular • Adjustment disorder • Bipolar depression/Psychotic disorder/Anxiety disorder
General Treatment Approach • Short term goal is remission of symptoms • Long term goal- preventing recurrences, improving functioning • Good doctor patient relationship is a must. • Psycho education. • Compliance
Different treatment modalities • Psychotherapy: Cognitive, Interpersonal • Pharmacotherapy: Antidepressants- after remission, at least 4 months (for single episode) and longer for prophylaxis. • ECT • Others: Exercise, Meditation are useful as adjuvants. • Best approach is to combine various modalities
Take Home Message………. • Depressive disorders are very common. • Biopsychosocial factors interact to cause these disorders • Correct diagnosis depends on good history and mental state examination. • Early intervention is important to prevent complications and also to relieve suffering • Multimodal approach is the best approach.