DEPRESSION

1
DEPRESSION
DISORDERS Major Depression Chronic
Depression Minor Depression Depression Disorder
NOS Adjustment Disorder with depressed mood Mood
Disorders due to general medical
condition Bipolar Disorder

• BARRIERS TO DIAGNOSIS
• PATIENT BARRIERS
• Somatic Presentations - pain, fatigue, GI
  problems
• Stigma - social stigma associated with diagnosis
• CLINICIAN BARRIERS
• Pandoras Box - takes unreasonable amount of
  time
• Financial Discrimination - little or no
  reimbursement

• EPIDEMIOLOGY
• Major Depression
• Men 7-12
• Women 20-25

• DIAGNOSIS
• DSM-IV criteria requires five of nine symptoms
• Depressed mood
• Anhedonia
• Sleep disorder
• Appetite loss, weight loss appetite gain or
  weight gain
• Fatigue or loss of energy
• Psychomotor retardation or agitation
• Trouble concentrating or trouble making decisions
• Low self-esteem or guilt
• Recurrent thoughts of death or suicideal ideation
• Five symptoms from the preceding list, but
  depressed mood or anhedonia is required. The
  symptoms must all have been present most of the
  the day, nearly every day for 2 weeks

• TREATMENTS
• COUNSELING BY THE PHYSICIAN
• SPEAK method - Schedule, Pleasurable Activities,
  Exercise, Assertiveness, Kind thoughts about
  oneself
• FORMAL PSYCHOTHERAPY
• MEDICATION
• Tricyclics - Amitriptyline, Desipramine, Doxepin,
  Imipramine, Nortriptyline
• SSRIs - Citalopram, Fluoxetine, Paroxetine,
  Sertaline
• Others - Buproprion, Mirtazaprine, Nefazodone,
  Venlafaxine
• ELECTROCONVULSIVE THERAPY

• ETIOLOGY
• GENETIC FACTORS
• 50 concordance prevalence in monozygotic twins
• BIOLOGICAL FACTORS
• Elevated cortisol
• Blunted response of thyroid-stimulating hormone
  and thyroglobulin-releasing factor
• Altered CNS levels of norepinephrine and
  serotonin
• Impaired sleep physiology with early induction of
  REM
• SOCIAL PSYCHOLOGICAL FACTORS
• Loss of a parent or spouse
• End of a relationship