Depression is a common, yet serious mental disorder that can affect activities of daily living, and how you think and feel in day-to-day life. Depression is associated with persistent low mood associated with other cognitive and behavioral factors that affect a person’s life considerably.
Diagnostic Criteria of Depression
According to ICD-11, depression can be diagnosed as follows. If a person experiences the following symptoms for a minimum duration of 2 weeks.
- Daily depressed mood
- Diminished interest in daily activities
- Increased fatigability associated with other symptoms as difficult concentrating
- Feeling of unworthiness
- Excessive feeling of guilt
- Hopeless feelings
- Recurrent thoughts of death or suicide
- Alterations in sleeping pattern
- Changes in appetite.
Types of Depressive Disorders
There are many types of depression as,
- Single episode depressive disorder
- Recurrent depressive disorder
- Dysthymic disorder
- Depressive episodes in bipolar disorder
Single-episode depressive disorder is characterized by the presence of a single depressive episode and no history of prior depressive episodes. Recurrent depressive disorder is defined as having at least two depressive episodes separated by several months without the presence of significant dysregulation of mood in between. Dysthymic disorder is a persistent depressive mood in most of the day, for two years or more without having sufficient symptoms to meet the diagnostic criteria of depressive episodes. The presence of any prior manic, hypomanic, or mixed episodes would suggest depression in presence of bipolar disorder.
Etiology of Depression
- Biological – genetic predisposition, physical illnesses, endocrine disorders, substance abuse, some medications
- Psychological- some personality factors as increased tendency to worry, lack of self-esteem, increased sensitivity to opinions of society and dependent traits, relationship issues
- Social – financial burdens, marital problems, issues in working place, other social stressors
Management of Depression
Risk Assessment
Depressive patients are at increased risk of harming themselves and at risk of self-neglect. Patients suffering from severe depression can harm others as well due to the psychotic symptoms they experience.
After risk assessment,
- Deciding on the treatment setting whether to treat the patient in inpatient or outpatient setting
- Severe depression, psychotic depression, agitated depression, risk of self- harm, lack of social support and issues in reaching the hospital due to long distance are indications for admission
- After admission, next step is minimizing the harm to the patient and providing a safe environment
- Educating the patient and family
They must be educated that depression is caused by a combination of biological and psychosocial factors, which causes alteration of chemicals in the brain which can be corrected by medications, psychological therapy, and sometimes electroconvulsive therapy. Most antidepressant medications take approximately 2 weeks to produce their therapeutic effects. Hence patients must take medications for a considerable duration of time while being cautious of the side effects to get the benefits of drugs.
Pharmacological Management
Antidepressants are the main class of medication used in the pharmacological management of depression. First-line antidepressants are specific serotonin reuptake inhibitors (SSRIs) such as Sertraline and Fluoxetine. Tricyclic antidepressants such as Amitriptyline and Imipramine are also widely used, but they have many unpleasant side effects and are more toxic in overdose than SSRIs. Serotonin noradrenaline reuptake inhibitors such as Venlafaxin and several other classes of antidepressants are also available as pharmacological treatments.
Patients must be cautious of the side effects of antidepressants such as drowsiness, sexual side effects such as impotence, and serious side effects such as seizures, arrhythmias, and Serotonin syndrome.
Electroconvulsive Therapy (ECT)
ECT gives faster results than medications. Severe depression with risk to the patient’s life, a depressive stupor that makes the patient speechless and motionless for a long period, resistance to pharmacological management, and severe postpartum depression are a few indications for ECT.
Non pharmacological Management
Physical therapy as light therapy, vagus nerve stimulation and deep brain stimulation, psychological therapy as cognitive behavior therapy (CBT) and interpersonal therapy (IPT) can be used to treat depression. Also, supportive psychotherapy as praise, encouragement, and reassurance is effective.
References
- ICD -11, Classification of Mental and Behavioral Disorders- Diagnostic Criteria for Research
- Shorter Oxford Textbook of Psychiatry – 7th Edition – Paul Harrison, Philip Cowen, Tom Burns, Mina Fazel
- Handbook of Clinical Psychiatry – A Practical Guide- Second Edition – Varuni De Silva, Raween Hanwella
