Consultant Psychiatrist

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DR. K.Krishna Murthy

• Consultant Psychiatrist
• Royal Hospital . Chesterfield

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What is Depression?

• Depression is a persistent exaggeration
• of everyday feelings that accompany sadness.
• A) Variable severity and duration
• B) Frequently recurrent
• C) Accompanied by Physical/mental symp.
• D) Involves thinking, drive, judgement.

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Demographics- Dep.

• Women twice as likely as men.
• Incidence max. 35-45 yrs age grp.
• Rates increase with age in men.
• More in upper and lower social classes..
• More in single people.
• Seasonal affective disorders/small no. recurrent
  summer depression.
• Unemployed/ immigrants.

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Symptoms/signs

• Low mood persistent.
• Sleep disturbance.
• Lack of enjoyment.
• Reduced energy.
• Loss of appetite/weight
• Self reproach /guilt.
• Poor concentration.

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Severe Depression

• Symptoms with greater intensity
• Retardation and agitation..
• Failure to eat or drink
• Suicidal ideas,plans or acts.
• Delusions and /or hallucinations

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Acute Presentation

• Normal activities disrupted-work ,ADL.
• Physical symptoms-loss of appetite, libido,
  tiredness, insomnia.
• Difficulty coping-alcohol/drug abuse, violent
  impulses or behaviour.
• Suicide-thoughts, plans, attempts.
• Worried family and friends.

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Causes of depression

• Genetic factors-Family history
• (Family,twin and adoption studies)
• Life events- Death of loved person,
• Divorce/separation/ loss of job,moving
  house,physical illness,retirement.
• Psycho-social transition migration,
• Change in occupation. Habits alcoh./drug.
• Post natal depression.

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Failure to detect- dep.

• Masked by somatic symptoms
• Judged as demoralization reaction to medical
  problems.
• Incomplete diagnostic work-up.
• Minimised relative to physical disease.
• Misdiagnosed as dementia in elderly
• Misinterpreted as a negative attitude.

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Cues for recognition- dep

• Patient volunteers-I am depressed.
• Physical symptoms without physical cause.
• Recurrent presentation of children by pt.
• Doctor feels depressed/ Fat case record.
• Patient unduly troubled by symptoms.
• Pt. consults without change in cl.status.
• Pt. seemingly dissatisfied with their care.

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Course of Depression

• Natural remission usually in younger pt.
• 50 have single episode of depression.
• Single episode- treat for 6 mo.after rec.
• 2 or more episodes-tr.for 2 yr.after rec.
• Multiple episodes- several years.
• Complex /co-morbid cond. Several years.
• Maintenance at same dosage.

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Treatment

• First line drugs
• SSRI - Fluoxetine,Citalopram,Paroxetine,
  Sertraline.Escitalopram,
• Second line- Dual action Mirtazepine,
  Venlafaxine,Duloxetine
• Tricyclics- Amitriptyline,Imipramine,
  Lofepramine. Trazodone.
• MAO Inhibitors Phenelezine
• Tranylcypromine

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Other Drugs

• Mood stabilizers- Lithium, Lamotrigine
• Sodium Valproate, Carbamazepine.
• Combination of drugs- Fluo./ Olanz.
• Mirtaz./SSRI/ Venlafaxine.
• Other drugs- Typtophan. Quetiapine .
• Very severe depression- ECT.

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Side effects of Anti-Dep.

• Tricyclics (older drugs) Dry mouth,blurring
• of vision,post.hypotension,ECG changes,
• Palpition,sweating,consitation,headache,
• difficulty in passing urine,sedation.
• MAO inhibitors- dietary restrictions,
• Hyper tensive crisis

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Side-effects- cont.

• Venlafax/Dulox..- Blood pr., ECG changes
• Mirtazepine- weight gain,sedation,
• increased appetite.
• Lithium fine tremor,renal impairment, weight
  gain, hypo-thyroidism, thirst, freq. of
  urination, ECG changes.

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Psychological Therapies.

• Cognitive behaviour therapy
• Working through depressive cognitions
• of thoughts,expectations,Distortions.
• Coping strategies group-CMHT
• Depresion group/walking gr/craft/SHE grp.
• Counselling.
• Psycho-analytical therapy.

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• Thank You