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| Depression |
Depressive disorders are characterized by persistent low
mood, loss of interest and enjoyment and reduced energy. They often impair
day-to-day functioning.
Clinical Features
Typical Symptoms
- Depressed mood – most characteristic feature. It get worst in early morning or in the evening
- Loss of interest and enjoyment
- Reduced energy leading to increased fatigability and diminished activity.
Core Symptoms
- Reduced concentration and attention
- Reduced self-esteem and self-confidence
- Ideas of guilt and unworthiness
- Pessimistic views of future
- Ideas and acts of self-harm or suicide
- Disturbed sleep
- Diminished appetite
Somatic Symptoms
- Diurnal mood variation
- Loss of emotional reactivity
- Anhedonia – inability to feel pleasure in normal pleasurable activities
- Loss of appetite and weight
- Early morning wakening
- Loss of libido
- Psychomotor retardation
Psychotic Symptoms
- Delusion
- Hallucination
- Depressive stupor
Clinically Significant Depressive Episodes (Minimum Criteria)
Presence of at least 2 typical symptoms + at least 2 core
symptoms
- Mild – 2 typical symptoms + 2 core symptoms
- Moderate - 2 typical symptoms + 3 core symptoms
- Severe - 3 typical symptoms + 4 core symptoms
Investigations
- No specific treatment. Exclude other treatable or secondary cause (eg – loss of appetite, alcohol misuse)
- Standard tests such as CBC, ESR, Vit B12 and folate, LFT, TFT, glucose, Calcium
- Others – Thyroid antibody, antinuclear antibody, syphilis serology, EEG, HIV test, Dexamethasone suppression test
Treatment
Pharmacotherapy
- It depends on need of patient, general health status, other medication taking, types of depression illness and side effects of the drugs.
- Cyclic antidepressant – Imipramine, Amitryptyline, Desipramine, Nortriptyline, Mianserin
- Selective Serotonin Reuptake Inhibitors (SSRIs) – Fluoxetine, Paroxetine, Fluvoxamine
Electroconvulsive Therapy (ECT) – Only indicated in selected
situations such as those with high risk of suicide, depression stupor, psychotic
symptoms and when antidepressants are ineffective.
Psychosocial Treatment
- Cognitive behavior therapy
- Interpersonal therapy
- Group therapy
- Family and marital therapy
- Nursing Management
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