Monday, May 13, 2013


We all feel sad some or the other time but this does not mean that we are suffering from depression. So what is depression? 

Depression is a mood disorder characterized by persistent and pervasive low mood usually lasting for more than two weeks. 

Other symptoms of depression are-
Major symptoms- these are apart from depressed mood
      1.      Lack of interest in once pleasurable activities.
      2.      Decreased energy
Minor symptoms-
      1.      Decreased sleep
      2.      Decreased appetite
      3.      Lack of confidence
      4.      Lack of concentration
      5.      Suicidal ideas
      6.      Decreased activity
      7.      Guilt

Depression can be with or without psychotic symptoms.
Depression is mild if it has 2 from major and 2 from minor, moderate if there are 2 from major and 3 from minor criteria and severe if there are 3 from major and at-least 4 from minor criteria present.
Depression has a life time prevalence of around 10%.
Risk factors for depression
Women are affected two times more than men.
Depression commonly occurs in middle 40’s.
Genetic factors- family history

Causes of depression

       1.      Certain neuro-chemicals like serotonin, norepinephrine, dopamine and acetylcholine.
       2.      Hormonal alterations like thyroid, growth hormone and prolactin.
       3.      Minute abnormalities in brain
Average length of depression episode can be from 6-9 months
There are various scales to measure the severity of depression. These are
        A.      Hamilton
        B.      Beck
        C.      MADRS
        D.     Zung

Treatment of depression

Treatment by medicines
          A.      SSRI’S fluoxetine, sertraline, fluvoxamine, paroxetine, escitalopram and citalopram
          B.      SNRI’S venlafaxine, duloxetine, milnacipran and desvenlafaxine.
          C.      NDRI- Bupropion 
          D.     Mirtazapine, trazadone, raboxetine, tianaptine,
          E.      TCA’S- Amitriptyline, imipramine, amoxapine
          F.       MAOI inhibitors
Medicines for augmentation of anti-depressants are
          A.      Lithium
          B.      Anti-psychotics
          C.      Modafenil
          D.     Thyroxine
          E.      Pindolol
          F.       buspirone
Treatment resistant cases can be treated with electro convulsive therapy. Average no of ECT required for depression is around 6-8 in number.

Wishing for your healthy life
Dr Hitesh Sharma
MBBS, MD (Psychiatry)
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