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Depression

NIKOLA ROGINA,
4TH YEAR, 2014/2015

Definition

Depression is a state of low mood and aversion to activity that


can affect a person's thoughts, behavior, feelings and sense of
well-being

Depressed mood persists for at least two weeks

Many people with a depressive illness never seek treatment. But


the majority, even those with the most severe depression, can
get better with treatment

Epidemiology & Types

Affects approximately 298million people (4.3% of the global population)

Major depression

Persistent depressive disorder

Psychotic depression

Postpartum depression

Seasonal affective disorder

Causes & Symptoms

Combination of genetic, biological, environmental, and psychological


factors

Symptoms (min. 5):

Depressed mood

Loss of interest or pleasure

Change in appetite or weight

Insomnia or hypersomnia

Fatigue or loss of energy

Psychomotor agitation or retardation

Feelings of worthlessness or inappropriate guilt

Decreased ability to concentrate and make decisions

Suicide

Approximately 45% of all depressed pts will commit suicide, and


most will have sought help from a physician within 1 month of their
death

Depression with Medical Illness

Virtually every class of medication can potentially induce or worsen depression

Between 2030% of cardiac patients manifest a depressive disorder

In cancer, the prevalence of depression is 25%

Diabetes mellitus - the severity of the mood state correlates with the level of
hyperglycemia and the presence of diabetic complications

Depression may also occur with hypothyroidism or hyperthyroidism or in


neurologic disorders

Biological theories

Monoamine hypothesis

Dysregulation inoverall balance of three neurotransmitters:


serotonin,norepinephrine, anddopamine

Antidepressants increase the levels of one or


more monoamine neurotransmitters

Differential diagnoses

Wide variety of medical disorders:

CNS diseases (e.g., Parkinson disease, dementia)

Endocrine disorders (e.g., hyperthyroidism, hypothyroidism)

Drug-related conditions (e.g., cocaine abuse)

Sleep-related disorders

Related psychiatric disorders:

Dysthymia

Posttraumatic stress disorder

Bipolar disorder

Treatment

Antidepressant medications are the basis of treatment

SSRIs, SNRIs, TCAs, MAOIs

Symptoms are ameliorated after 68 weeks at a therapeutic dose in 6070%


of patients

Once remission is achieved, antidepressants should be continued for 69


months

Electroconvulsive therapy is generally reserved for treatmentresistant depression

Transcranial magnetic stimulation (TMS)

Vagus nerve stimulation (VNS)

References

http://emedicine.medscape.com/article/286759

https://en.wikipedia.org/wiki/Major_depressive_disorder

https://en.wikipedia.org/wiki/Biology_of_depression

http://www.nimh.nih.gov/health/topics/depression/index.shtml

Reus VI: Mental Disorders, Chap. 391, p. 3529, in HPIM-18