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Depressive Disorders

Depressive Disorders. Dr Rohan Mendonsa , Professor, Dept of Psychiatry. Depression is a mood disorder. What is mood? It is an emotional experience, sustained in time, that influences his/her behaviour and perception of the world. Different types of depressive disorders.

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Depressive Disorders

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  1. Depressive Disorders Dr RohanMendonsa, Professor, Dept of Psychiatry.

  2. Depression is a mood disorder • What is mood? • It is an emotional experience, sustained in time, that influences his/her behaviour and perception of the world.

  3. Different types of depressive disorders • Major depressive disorder • Dysthymia • Minor depressive disorder • Mixed anxiety deoressive disorder

  4. Epidemiology • 20-25% of population will suffer at some point of their lifetime. • Higher in women • Higher- poor interpersonal relationships.

  5. Etiopathogenesis • Interaction of Biological, Psychological and Social factors. • Biological- genetics, decreased catecholamines, increased activity of HPA axis • Psychological- worrying, pessimistic • Social- life events/adversities

  6. Major depressive disorder • Depressive episodes lasting more than 2 weeks, last for 6 months to 1 year if not treated • Depressed mood most of the day • Loss of interest • Decreased energy • Feelings of worthlessness, hopelessness, wish to die, suicidal thoughts • Insomnia, decreased appetite, Weight loss • Decreased ability to think/concentrate

  7. Dysthymia • Mild chronic disorder affecting 3-6% • Low self esteem, low mood,pessimistic thinking- less severe • Duration more than 2 years • Some recover, others may experience concmitant depressive episodes- Double depression.

  8. Other types • Premenstrual dysphoric disorder- irritability, increased rejection sensitivity, crying spells,headache, breast tenderness, fatigue etc begin about 1 week prior to menses and remit with onset of menses. • Post partum depression: one in ten women, different from ‘baby blues’ • Seasonal affective disorder (winter depression)

  9. Diagnosis • Clinical one. • O/E – Stooped posture, downcast gaze, decreased rate and volume of speech,long pauses, negative content of thinking- guilt, suicidal ideas • Rule out manic/ hypomanic, substance use, medical disorders like hypothyroidism

  10. Differential diagnosis • Endocrine disorders • Infections- infectious mononucleosis • Neurological- Parkinsons, Alzheimer’s • Cerebrovasular • Adjustment disorder • Bipolar depression/Psychotic disorder/Anxiety disorder

  11. General Treatment Approach • Short term goal is remission of symptoms • Long term goal- preventing recurrences, improving functioning • Good doctor patient relationship is a must. • Psycho education. • Compliance

  12. Different treatment modalities • Psychotherapy: Cognitive, Interpersonal • Pharmacotherapy: Antidepressants- after remission, at least 4 months (for single episode) and longer for prophylaxis. • ECT • Others: Exercise, Meditation are useful as adjuvants. • Best approach is to combine various modalities

  13. Take Home Message………. • Depressive disorders are very common. • Biopsychosocial factors interact to cause these disorders • Correct diagnosis depends on good history and mental state examination. • Early intervention is important to prevent complications and also to relieve suffering • Multimodal approach is the best approach.

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