1. Depression
Dr Urmila Aswar

2. What Is Depression?
 A very common, highly treatable, medical
illness.
 Affects physical, mental and emotional
well-being.
 Affects basic, everyday activities like eating
and sleeping.
 Affects how people think about things and
feel about themselves.

3. What is Depression?

In contrast to the normal emotional
experiences of sadness, loss, or passing mood
states, clinical depression is persistent and
can interfere significantly with an individual's
ability to function.

Give up like tendency

Symptoms can last months or even years.

4. Symptoms of Depression
 Feeling sad, blue, or down in the dumps
 Loss of interest in things you usually enjoy
 Feeling slowed down or restless
 Having trouble sleeping or sleeping too much

5. Symptoms of Depression
 Loss of energy or feeling tired all the time
 Having an increase or decrease in appetite
or weight
 Having problems concentrating, thinking,
remembering or making decisions
 Feeling worthless or guilty
 Having thoughts of death or suicide

6. Symptoms of Depression
 People with Major Depression experience at
least five of these symptoms all day, nearly
every day, for at least 2 weeks.
 The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.

7. Causes of Depression
Causes not known, but current theories include:
 Genetic
• Runs in families
• However, depression can also occur in
people who have no family history.
 Environmental
• A serious loss, difficult relationship,
financial problem, or any stressful
(unwelcome or even desired) change in life
patterns can trigger a depressive episode.

8. Causes of Depression
 Physical Illness: serious complications
such as cancer, some disorders eg
Cushing’s syndrome etc
 Drug induced: eg betablockers and
corticosteroids
 Hormonal changes: postmenopausal
depression, post-partum depression

9. Causes of Depression
 Personality Characteristics
 low self-esteem, pessimistic world view, low
stress tolerance
 Biological
 Current thinking explores problems in brain
functioning in the following areas: Limbic
system, neurotransmitters and neurons,
hormones and the endocrine system

10. Serotonin pathway

11. Causes of Depression
 Combination
 a combination of genetic, psychological,
environmental, and/ or biological factors
may contribute to the onset of a
depressive disorder.

12. Forms of Depression
 Major Depression
 At least 5 of the 9 symptoms of
depression present including either loss of
interest/pleasure or depressed mood;
symptoms interfere with daily functioning
 Minor Depression
 Fewer symptoms than major depression
with significant disability; shorter
duration than chronic depression

13. Forms of Depression
 Bipolar Disorder
 Cycling mood changes with severe highs
(mania) and severe lows (depression)
 Dysthymia
 Low grade chronic symptoms of
depression that last for a minimum of 2
years

14. Depression and Suicide
 Of those with MDD, close to 50% report
feelings of wanting to die, 33% consider
suicide and 8.8% report a suicide attempt.
 More than 90% of those who commit suicide
have a diagnosable psychiatric illness at the
time of death, usually depression, alcohol
abuse or both

15. Who is at risk for Depression?
 Older adults
 Young adults
 Women, pregnant and post partum women.
women report depression about twice as often
as men. This may result from a greater
likelihood to discuss depression or to seek
help.

16. Depression in Women
 Depression is the second leading cause of
disease-related disability among women
 1 in 4 women will suffer from a Major
Depressive Episode during the course of their
lives as compared to 1 in 10 men.
• Women may be more likely to discuss
depression or to seek help.
 Women of childbearing age are at increased
risk for major depression
• Pregnancy and new motherhood may
increase the risk of depressive episodes

17. Depression in Older Adults

Of the nearly 35 million Americans age 65 and older, an
estimated 2 million have a depressive illness (major depressive
disorder, dysthymic disorder, or bipolar disorder).

Symptoms of clinical depression can be triggered by other
chronic illnesses common in later life, such as Alzheimer’s
disease, Parkinson’s disease, heart disease, cancer and
arthritis.

Depression is one of the most common conditions associated
with suicide in older adults.

Individuals age 65 and older have highest rates of suicide

High suicide rate among older people (85 and older) is largely
accounted for by White men.

18. Depression in Young Adults
 10% of college students have been
diagnosed with depression, including 13%
of college women.
 Lifetime prevalence for MDE highest among
young adults age 18-25 (10%)
 Suicide is the third leading cause of death
for those aged 15-24

19. Additional Risk Factors for
Depression
 Family or personal history of depression
 Current substance abuse problem
 A major life stressor or change in life events;
i.e.: loss of a loved one or a job
 Chronic disease

20. Diagnosis
 Based on alterations in mood
 5 symptoms with insomnia or fatigue must
be present every day for more than 2
weeks.
 Standarised questionnaires
 Lab test: blood test---cortisol
 Sleep EEG

21. Treatment for depression
Psychotherapy
Electroconvulsive therapy
Pharmacotherapy: SSRI: Fluoxetine
Tricyclic antidepressants: amitryptiline,
imipramine
 Monoamine oxidase inhibitors:
tranylcypromine
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