Depression

Fa h a d H u s s a i n
This presentation will cover
 What is Depression?
 Prevalence
 Sign and Symptoms
 Ty p e s
 DSM-V Criteria for Depression
 Causes
 Diagnosis
 Treatment
What is Depression
 A common serious mental disorder that is

manifested by combination of symptoms i.e.

low mood, loss of interest or pleasure, feeling

of guilt, disturbed sleep, low energy and poor

concentration.

Occasional sad or down…?

Short lived and pass within couple of days…?
Prevalence
 with more than 300 million people affected

 different from usual mood fluctuations and short-lived

emotional responses

 Close to 800 000 people die due to suicide every year.

 Suicide is the second leading cause of death in 15-29-year-

olds.

 The burden of depression and other mental health conditions

is on the rise globally
The More Depressed
Country and Less
Depressed Country…?
Sign and Symptoms
Pervasive – Persistent – Wide Range of Symptoms

• Worthlessness
• Irritable
• Guilt
• Loss of appetite or …
• Sleep disturbance
• Loss of energy
• Impaired concentration
• Impaired work ability
• Poor social functioning/adjustment
• Thoughts of suicide
• Suicidal attempts
Types
1. Major Depression

 Begin suddenly, possibly triggered by a loss, crisis or stressful

change

 Interfere with normal functioning

 Continue for months or years

 It is possible for a person to have only one episode of major

depression. However, It is more common for episodes to be long
lasting or to recur several times during a person’s life
2. Dysthymia
 People with this illness may be consistently and mildly
depressed for years. They function fairly well on a
daily basis, but their relationships and self esteem
suffer over time.
3. Season Affective Disorder
 This is depression that coincides with changes in the
season. Most cases begin in the fall or winter, when
there is a decrease in sunlight (more common in
regions farther north)

 Less often, depression can occur in late Spring or

summer
4. Bipolar Disorder
 People with this type of illness change back and forth
between periods of depression and mania (an extreme
high, sometimes with agitation or irritability).

 Symptoms of mania may include:

 Less need for sleep

 Overconfidence

 Racing thoughts

 Reckless behavior

 Increased energy

 Mood changes are often gradual, but can be sudden

DSM V Criteria for
Depression
According to DSM-V: Five or more present for 2 weeks and represent a change
from previous functioning, at least one of the symptoms (1) depressed mood or
(2) loss of interest or pleasure.

i. Depressed most of the day nearly every day

ii. Diminished interest or pleasure
iii. Weight loss or gain
iv. Insomnia or hypersomnia
v. Psychomotor agitation or retardation nearly every day
vi. Fatigue or loss of energy
vii. Worthlessness or Guilt
viii. Loss of concentration
ix. Suicidal ideation or attempts
DIPAD (updated for OPCRIT 4.0 DSM IV & ICD-10 algorithms)

A c c o r d i n g t o D I PA D i f D y s p h o r i a & L o s s o f P l e a s u r e i s
present for 1, 2 weeks or 1 month: then proceed for;

1. Loss Of Energy
2. Slowed Activity
3. Impaired Concentration
4. Altered Libido
5. Excessive Self Reproach
6. Suicidality
7. Decreased Or Increased Appetite
8 . We i g h t L o s s O r G a i n
9 . I n i t i a l Te r m i n a l o r M i d d l e I n s o m n i a
10. Excessive Sleep
11 . D i u r n a l Va r i a t i o n
Causes
 Genetic or Hereditary – Family History as it is believed to pass genetically.

 Biological, Biochemical or Medication – beta blockers or reserpine for BP

can increase risk. Serotonin & norepinephrine imbalances. Cortisol hormone controlling
anger, fear and stress.

 Abuse – Physical, emotional or sexual or trauma

 Substance Abuse – 30% of peoples with substance abuse have depression

 Major Events – losing job, getting divorced, death of loved one, social isolation.

 Socio Cultural Factors – conflict or disputes with family or friends

Diagnosis
 History Collection

 Mental Status Examination

 ICD-10 or DSM V criteria

Tr e a t m e n t
 Anti Depressants:

1. S S R I s (Fluoxetine, Sertraline, Escitalopram, Citalopram)

2. Tr i c y c l i c ' s (Imipramine, Nortriptyline)

3. M A O I s

 Psychotherapy

1. C o g n i t i v e B e h a v i o r a l T h e r a p y ( helps people change negative thinking, behavior

patterns and attitudes that affect self esteem and overall sense of well being)

1. I n t e r p e r s o n a l T h e r a p y ( focuses on you and your relationships with other peoples)

2. E l e c t r o c o n v u l s i v e T h e r a p y
Genetics:
 Gene, Stress and Depression (Richard J. Wurtman)
 Degree of heritability is 0.33 (confidence interval 0.26-0.39)

 Biological Psychiatry (Magnus at al)

 FKBP5 is an important target for further studies of depression.

 The Neuronal Transporter Gene SLC6A15 Confers Risk to Major

Depression (Martin A. Kohli at al)
 Neuronal Amino Acid Transporter SLC6A15 act as candidate gene in
pathophysiology of depression.