Depression
Topic Highlights
● Depression is a common mental disorder which occurs as a result of chemical imbalances in the brain.
● Depression results in problems adjusting to social and family life.
● Depression increases the risk of suicide.
● This animation provides information on the types of depressive disorders, their causes, consequences, diagnosis, and treatment such as psychotherapy and drug therapy.
● The animation also provides guidelines to coping with the disorder.
Transcript
This presentation focuses on depression and provides an overview about mental health, pathophysiology of depression, diagnosis and various treatment options.
Depression is a leading cause of disability affecting millions of people worldwide. According to the World Health Organization, nearly 121 million people in the world suffer from depression. Depression occurs in men and women of all ages and backgrounds. However, it is more common in women than in men. Overall prevalence for depression is 17%. 43% of sufferers of depression fail to seek treatment for their symptoms. Of those diagnosed, two thirds were not prescribed medications for their symptoms.
Depression is a common mental disorder, which presents feelings of sadness or loss of interest lasting at least 2 weeks. Depression interferes with daily life, and can last for months or years. Those who suffer from depression experience a range of symptoms such as sadness, lack of interest, guilt, disturbances in sleep, loss of appetite, weight loss, retardation or agitation, low energy levels, poor concentration and recurrent suicidal thoughts.
These problems almost always become recurrent or chronic and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. Depression always causes problems with work, social or family adjustment. It causes pain and suffering not only to those who have the disorder, but also to those who care for them. Depression can lead to suicide.
It is believed that certain factors predispose a person toward developing depression. The most common factors are biological, psychological and environmental. Women are more prone to depression than men. Depression is found to be common in the elderly.
Environmental factors include significant events in a person's life which may trigger a depressive episode such as the death of a loved one, divorce or physical illness. Long-term use of certain medications, such as drugs used to control high blood pressure, sleeping pills or birth control pills may cause symptoms of depression in some people.
Depression can be of different types. Major depression is the most common and affects daily life, work and social activities. Also known as clinical depression or unipolar depression, MDD is characterized by a severely depressed mood for at least two weeks. The patient may experience despair and low energy levels. They may lose interest in activities which they previously enjoyed. Major depression can also cause sleep disturbances, change in appetite and poor concentration. Depression raises thoughts of pessimism and guilt and increases the risk of suicide.
Bipolar disorder is most frequently a depressive disorder with the same range of depressive symptoms as major depression. The patient, however, must have had an episode of mania or something close to mania called hypomania. The manic phase is characterized by elated mood and may result in exaggerated feelings of well being, racing thoughts, pressure to talk and a decreased need for sleep. Dysthymia is a chronic, long-term disease lasting for at least two years. During the depressive phase, the person may experience an extremely low mood, feel desperate and even consider suicide. Postnatal depression is the depression experienced by new mothers following the birth of a child. Seasonal Affective Disorder or SAD, also known as winter depression, has similar symptoms to a major depressive disorder.
Depression is a result of chemical imbalances in the brain. Neurons or brain cells conduct and transmit electrical signals. Several millions of neurons are arranged end-to-end to form circuits in the brain. These circuits control all types of activities of the body such as seeing, hearing, eating and walking. These circuits also control our thoughts and emotions. The area where two neurons join together is called a synapse. Electrical impulses generated within the neuronal cells jump across the synapse with the help of chemicals known as neurotransmitters.
These neurotransmitters allow the electrical impulses to jump from one neuron to another and hence complete the circuits. Important neurotransmitters include serotonin, dopamine, and noradrenaline, also known as norepinephrine. Reduction in the levels of the neurotransmitters in the synaptic gap leads to depression.
There is no lab test to diagnose depression. A careful psychiatric evaluation is essential. This includes medical history and a physical and mental status exam. Sometimes depression may be caused or worsened by other medical conditions. It is important to inform the doctor about the symptoms as experienced by the patient or noticed by the family.
Depression can be treated and the choice of treatment will depend on the outcome of the evaluation. Depending on the complexity and responsiveness of depression to treatment, patients may require different combinations of treatment methods to meet their individual needs. Drug therapy, which is usually used first, may sometimes be combined with psychotherapy. Psychotherapy, like cognitive behavioral therapy and interpersonal psychotherapy, where the therapist talks to the patient have been shown to be useful.
The drugs used for treating depression are called antidepressants. Different types of antidepressants are available. Almost all antidepressants work by increasing the levels of neurotransmitters in the synaptic gaps, though the mechanism of action is different for each type of drug. Beginning with selective serotonin reuptake inhibitors or SSRIs is usually recommended. Their mode of action is to act by blocking the reuptake of serotonin at the synapse. This increases the serotonin levels enhancing neurotransmission. The SSRIs include sertraline, citalopram, escitalopram, fluoxetine and paroxetine. SSRIs may cause nausea, nervousness and sexual problems.
Serotonin and noradrenaline reuptake inhibitors or SNRIs increase the levels of both serotonin and noradrenaline in the synapse by inhibiting their reuptake. They are also called dual reuptake inhibitors. SNRIs may cause nausea, nervousness and sexual problems via their action on serotonin as well as anxiety, dry mouth and constipation via noradrenaline. SNRIs include duloxetine and venlafaxine, which may raise the blood pressure. Venlafaxine is also found to increase the cholesterol levels. This medication should be used with caution in patients suffering from related problems.
Tricyclic antidepressants or TCAs inhibit the reuptake of serotonin and noradrenaline, as well as block a number of other receptors which add to the burden of side effects. Some of the TCAs are amitriptyline, imipramine, nortriptyline, desipramine and doxepin. Since TCAs are less selective in their action they tend to have more side effects than other antidepressants. Common side effects include nausea, dry mouth, blurred vision, constipation, confusion and tiredness. TCAs are found to increase the risk of heart attacks. They may also affect blood sugar levels.
Abruptly stopping or missing several doses of SSRIs, SNRIs and TCAs may cause withdrawal-like symptoms such as nausea, headache and dizziness. Stopping the medication gradually helps prevent this. Patients should be monitored for any changes in symptoms especially during early treatment or change in treatment.
Monoamine oxidase inhibitors or MAOIs are the earliest type of antidepressants. Examples are phenelzine, tranylcypromine, isocarboxazid. MAOIs may cause serious side effects, particularly when taken with certain foods or medicines, and are advised only for those who do not respond to other antidepressants. Electroconvulsive therapy or ECT is rarely used and only considered in very severe or resistant cases under strictly controlled conditions.
It is important for the patient to visit a doctor regularly to monitor progress and to discuss the side effects of medications. Take medication as instructed by the doctor. A person with depression should try to socialize and be involved in daily activities, as well being part of a caring atmosphere. Patients should ignore the possible stigma that might discourage them from seeking help. They should also maintain a healthy lifestyle ' including exercise and a healthy diet. Physical activity and exercise has been found to help patients cope better. Walking is a good form of exercise. Avoid drugs and alcohol abuse as these may have adverse effects.