Yosi Febrianti, M.Sc.

,Apt
Pernah merasa depresi ?
What did you feel ?
Definition of Depression
Gangguan mental/mood yg bersifat searah
(unipolar), berupa suatu emosi yang meresap dan
menetap (perasaan tertekan) yang dapat
mempengaruhi persepsi seseorang
Epidemiologi
In the U.S., about 14.8 million adults suffer from major
depression, according to the National Institute of Mental
Health. For people between the ages of 10 and 24, suicide is
the third leading cause of death. Unfortunately, most people
with clinical depression never seek treatment. Left undiagnosed
and untreated, depression can worsen, lasting for years and
causing untold suffering, and possibly suicide.
Klasifikasi
1) Depresi mayor
2) Depresi atipikal
3) Dysthimia
4) Depresi psikotik
Depresi mayor
Gangguan mood yang ditandai dgn suasana hati
yg tertekan, hilangnya minat terhadap aktivitas yg
disukai, perubahan BB dan pola tidur,kelelahan,
perasaan tidak dihargai dan bersalah.
Periode > 2minggu
Depresi atipikal
Hampir sama dengan depresi mayor, namun
penderita kadang2 dpt mengalami
kebahagian/saat yg menggembirakan
Dpt berlangsung berbulan2/selamanya
Dysthimia
Depresi ringan-sedang, namun kronis
Tertekan, sedih/melankolis
Berlangsung hampir seumur hidup dan tidak
disadari
Depresi psikotik
Depresi yg disertai dengan gejala psikotik
Gejala psikotik : halusinasi dan atau delusi
Waktu terjadinya
1) Depresi postpartum /blue baby sydrome : depresi
pasca melahirkan, ringan-berat
2) Premenstrual Dysphoric Disorders : depresi
menjelang menstruasi
3) Depresi musiman (seasonal affective disorder):
biasanya terjadi pada negara 4 musim (depresi
kambuh pd musim dingin, dan membaik musism
semi/panas
Etiology
The etiology of depressive disorders is too complex
to be totally explained by a single social,
developmental, or biologic theory.
Several factors appear to work together to cause
or precipitate depressive disorders.
The symptoms reported by patients with major
depression consistently reflect changes in brain
monoamine neurotransmitters, specifically
norepinephrine (NE), serotonin (5-
hydroxytryptamine [5-HT]), and dopamine (DA).
Cont
Genetik
Kepribadian : berfikir negatif, pesimisme, rendah
diri, kekhawatiran berlebihan, tergantung pd orng
lain
Situasi/lingkungan: kehilangan,kesulitan hidup, stres
trs menerus NT tidak seimbang
Kondisi medik : penyakit kronis (DM, CVD, kanker)
Penggunaan obat (prednison, penurun TD)
Penyalahgunaan zat (alkohol, obat-obatan)
PATHOPHYSIOLOGY
HIPOTESIS AMIN BIOGENIK
HIPOTESIS PERMISIF
HIPOTESIS SENSITIVITAS RESEPTOR
ATROFI HIPPOCAMPUS
HIPOTESIS AMIN BIOGENIK

Depresi kekurangan senyawa katekolamin (NE

dan 5-HT)
Pemberian antidepresan meningkatkan
ketersediaan monoaminmemperbaiki gejala
Dapat menjelaskan keterkaitan depresi dengan
genetik
HIPOTESIS PERMISIF
Berfokus pada 5HT
Berkurangnya 5HT menyebabkan depresi
turunnya kadar NE
HIPOTESIS SENSITIVITAS RESEPTOR

Onset terapi antidepresan 6-8 minggu

Reseptor pada syaraf pasca sinaptik dpt
mengalami supersensitivitas
Supersensitivitas respon kompensasi dari syaraf
pasca sinaptikkrn stimulasi yg terlalu
sedikitpeningkatan responsivitas syaraf
Normalisasi sensitivitas reseptor perbaikan
gejala depresi
Obat antidepresan bekerja me(-) supersensitivitas
reseptor
ATROFI HIPPOCAMPUS

Penderita depresi penurunan volume

hippocampus (bagian dari otak dimana terdapat
sel syaraf baru yang terus membelah dan
membentuk sel syaraf yang baru) penelitian lebih
lanjut
Sign & Symptoms
DSM-IV-TR (Diagnostics and Statistical Manual of
Mental Disorders), didiagnosa depresi jika ada
5/lebih gejala dan muncul dlm suatu periode (2
minggu) dan menunjukkan adanya perubahan dari
fungsi sebelumnya
Gejala : rasa tekan/sedih sepanjang hari, lack of
interest, penurunan/peningkatan BB signifikan,
insomnia/hipersomnia, persaan tidak
berharga/bersalah, keletihan, penurunan
kemampuan berfikir, Gangguan pada sosialisasi/
pekerjaan/atau fungsi lain
Tujuan Terapi
Menurunkan gejala depresi dan memfasilitasi pasien
untuk kembali ke kondisi normal
Strategi terapi : antidepresan yg dapat memodulasi
kadar 5-HT dan NE
Tatalaksana Terapi
Non-Farmakologi
Psikoterapi
Terapi elektrokonvulsif
Psikoterapi

In addition to pharmacologic interventions, psychotherapy

should be employed whenever the patient is able and willing
to participate.
Psychotherapy alone is not recommended for the acute
treatment of patients with severe and/or psychotic major
depressive disorder. However, if the depressive episode is mild
to moderate in severity, psychotherapy can be the first-line
therapy. The effects of psychotherapy and antidepressant
medications are considered to be additive
Terapi elektrokonvulsif

Electroconvulsive therapy (ECT) is a safe and effective

treatment for certain severe mental illnesses, including major
depressive disorder as well as other selected psychiatric
illnesses. Patients with depression are candidates for ECT when
a rapid response is needed, risks of other treatments outweigh
potential benefits, there is a history of poor response to
antidepressants and a history of good response to ECT, and
the patient expresses a preference for ECT.
Cont
ECT administered two to three times weekly for a total of 6 to
12 treatments
A rapid therapeutic response (10 to 14 days) has been
reported.
Risk : These include increased intracranial pressure, cerebral
lesions, recent myocardial infarction, recent intracerebral
hemorrhage, bleeding, or otherwise unstable vascular condition
Adverse effects of ECT include cognitive dysfunction,
cardiovascular dysfunction, prolonged apnea, treatment-
emergent mania, headache, nausea, and muscle aches.
 TERAPI FARMAKOLOGI

FASE AKUT : 6-10 minggu, untuk

menghilangkan gejala

Fase lanjutan : 4-9 bulan, untuk

menghilangkan gejala sisa dan mencegah
kekambuhan (kembalinya gejala dlm 6 bln)

Fase pemeliharaan : 12-36 bulan untuk

mencegah terulangnya episode depresi
 Berdasarkan mekanisme kerja
Golongan Mekanisme Kerja
TCA (Tricyclic Antidepresant) Menghambat reuptake 5HT dan NE
SSRI (Selective Serotonin Reuptake Menghambat reuptake 5HT secara
Inhibitor) selective
Aminoketon Menghambat reuptake NE dan dopamin
Triazolopyridin Antagonis reseptor 5-HT/menghambat
reuptake 5HT
SNRI (Serotonin Norepinefrin Reuptake Menghambat reuptake 5HT dan NE
Inhibitor)
Tetrasiklik Antagonis reseptor alfa 2 adrenergik
MAOI Menghambat enzim monoamin oksidase
Pertimbangan pemilihan obat
Antidepresan empirik Riwayat respon
pengobatan pada pasien, riwayat respon keluarga,
penyakit penyerta, eso, IO, dan biaya
TERAPI FARMAKOLOGI
Penghentian Tx Antidepresan
Kemungkinan kekambuhan
Frekuensi dan tingkat kepararahan
Ada tidaknya gejala depresi pasca pemulihan
Pilihan pasien

Perlu dilakukan tappering dose

Elderly Patients
The SSRIs are usually selected as first-choice
antidepressants in the elderly, and this can enable the
clinician to avoid some of the problematic adverse
effects commonly associated with the TCAs (e.g.,
sedative, anticholinergic, and cardiovascular-related
side effects).
Bupropion and venlafaxine are often selected because
of milder anticholinergic and less frequent
cardiovascular side effects
Pediatric Patients
The treatment of depression in children remains challenging, as
depression can be difficult to diagnose and treat once
identified
Antidepressants are used to treat depressed children and
adolescents because no other definitive effective therapies are
currently available.
However, the TCAs and several of the SSRIs remain viable
treatment options when prescribed and monitored
appropriately.
Pregnant and Lactating Patients
the risks and benefits of drug therapy during
pregnancy must always be weighed, and concerns
about the risks of untreated depression during
pregnancy should be considered
SSRIs, the most commonly used and best-tolerated
treatment for depression, carry a small but significant
risk for a serious medical consequence
Refractory Patients
if patients fail to respond to medication after 6 to 8
weeks, a reappraisal of the treatment regimen
should be considered
Partial responders should consider changing the
dose, augmenting the antidepressant, or adding
psychotherapy or ECT
Monitoring
Several monitoring parameters, in addition to
plasma concentrations, are useful in managing
patients.
Patients must be monitored for:
adverse effects such as sedation, anticholinergic
effects, and sexual dysfunction, and for remission of
previously documented target symptoms.