| ID | 126 |
|---|---|
| Name | UNIPOLAR DEPRESSION (MAJOR DEPRESSIVE DISORDER) |
| Cause | Predisposing causes: 1. Heridity is an important factor. 2. Constitution: These patients are of pyknic built, obese and muscular development is poor. 3. Exposure to stress is important. 4. Organic diseases depressing the vital powers may play some role e.g various viral diseases, cardiovascular diseases, anemia, myxoedema, carcinoma etc. 5. Biochemical factors: There may be marked deficiency of brain monoamines, noradrenaline, serotonin (5-HT) and dopamine. |
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| Introduction | Depression as defined above, is a unipolar depression also called ‘major depressive disorder’. It, like anxiety (with which it is associated), is ubiquitous and is a reality of everyday life. It frequently presents in the form of somatic complaints with negative medical workup. It can be a normal reaction to a wide variety of events and must be evaluated as such. Depression may occur alone or combind or in cycle with mania. Depression usually presents with misery and malaise associated with poor self consciousness and self abnegation without hope. |
| History | |
| Etiology | Etiology: Not clearly known. |
| Clinical Features | Clinical features: A. Psychological symptoms: 1. Depressed mood (feeling of unhappiness, sadness). 2. Loss of interest and enjoyment. 3. Reduced energy and decreased activity. 4. Reduced concentration. 5. Reduced self-esteem and confidence. 6. Ideas of guilt and unworthiness. 7. Pessimistic thoughts about past, present and future. 8. Helplessness. 10. Hopelessness. 11. Forgetfulness. 12. Hallucinations e.g auditory hallucination. 13. Delusions e.g delusion of persecution, delusion of reference, delusion of guilt, nihilistic delusion. 14. Ideas of self harm (suicidal idea, threat, attempt). B. Vegetative or biological symptoms: 1. Sleep disturbance (early morning waking). 2. Diurnal variation of mood (feeling of worse at morning). 3. Loss of appetite. 4. Loss of weight. 5. Pressure headache. 6. Backache. 7. Retardation of physical activity. 8. Constipation. 9. Loss of libido. 10. Arnenorrhoea. C. Other associated features: 1. Tension. 2. Phobia. 3. Obsession. |
| Preventions | |
| Treatment | Treatment: Mild and moderate cases- can be managed as an out patient. Severe cases with psychotic symptoms- should be hospitalized. A. General measures: 1. Maintenance of nutrition. 2. Correction of vitamin and iron deficiency. 3. Care of personal hygiene. 4. Correction of sleep disturbance. 5. Protection of the patient from self-harm and harm to others. B. Specific drug treatment: 1. Antidepressant therapy: a. Tricyclic antidepressants (TCAs): e.g- Imipramine or Amitriptyline 50-75mg 3 times daily for a period of 3-6 months. Maprotiline 75-150mg daily, starting dose 25mg daily, b. Monoamine oxidase inhibitor drugs (MAOIs): e.g- Iproniazid 150-300mg daily. Phenelzine 34-90mg daily. Nialamide 50-150mg daily, c. Selective serotonin reuptake inhibitors (SSRIs): e.g- Fluoxetine 20-40mg daily, starting dose 20mg daily. Sertraline 50-150mg daily, starting dose 20mg daily. Paroxetine 20-40mg daily, starting dose 20mg daily. Citalopram 10-40mg daily, starting dose 10mg daily. Escitalopram 5-10mg daily, starting dose 5mg daily. Fluvoxamine 50-150mg daily, starting dose 50mg daily, d. Other newer antidepressants: e.g- Duloxetine 40-60mg daily, starting dose 20mg daily. Mirtazepine 15-45mg daily, starting dose 15mg daily. Venlafaxine 75-150mg daily, starting dose 75mg daily. 2. Electroconvulsive therapy (ECT): This is also helpful in some cases, particularly when there is high risk of suicide. 3. Social treatment: Support and sympathetic attitude from the family members for the patient. Mental support for the family members. 4. Psychological treatment: Psychotherapy (encouragement & reassurance). |
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