Depression – Introduction & Symptoms

DEPRESSION – INTRODUCTION & SYMPTOMS

INTRODUCTION:

• One of commonest psychiatric disorder.
• Responsible for maximum DALYs (disability-adjusted life years) amongst all psychiatric disorders.
• Most common cause of suicide.
• Characterized by major depressive episodes in absence of any manic, mixed or hypomanic episodes.

EPIDEMIOLOGY:

• Lifetime prevalence = 17%
• More prevalent in women (Middle-aged)
  • Mean onset age – 40 years.
• More commonly in divorced & separated persons.

CAUSES:

Biological factors – 

• Neurotransmitters disturbance (Decreased levels of serotonin & norepinephrine).
• Hormonal disturbance (Elevated HPA activity (hypothalamic-pituitary-adrenal axis activity) & hypothyroidism).
• Neuroanatomical consideration – Decreased activity in dorsolateral prefrontal cortex & increased activity in amygdala).
• Genetic factors – Element binding protein (CREB 1)on chromosome 2.

Psychological theories –

• Cognitive theory – 
• Cognitive triad of depression – Negative view of self (ideas of worthlessness), negative views about environment (ideas of helplessness) & negative view about future (ideas of hopelessness).
• Learned helplessness.

SYMPTOMS:

• Pneumonics = SIGECAPS.

1. Sleep disturbances:

• Insomnia & sometimes hypersomnia.
• Characteristic sleep pattern – Early morning awakening & reduced latency of REM sleep.

2. Interest (Loss)/anhedonia:

• Loss of interest in activities which interests patient before.

3. Guilt: 

• Excessive guilt feelings.
• Blaming himself for trivial matters.

4. Energy (lack): 

• Decreased energy levels.
• Ea
• sy fatigability.

5. Cognition/Concentration:

• Negative cognitions (thoughts).
• Poor concentration.

6. Appetite:

• Loss of appetite & weight loss (usually).
• Sometimes weight gain also.

7. Psychomotor agitation or retardation:

• Psychomotor – Changes in motor activity secondary to psychological causes.
• Increased activities (restlessness) or decreased (dormant activities).

8. Suicidal thoughts.

9. Sadness of mood (depressed mood).

SPECIAL FEATURES IN DEPRESSION:

Psychotic features –

• Severe depression patients present with psychotic symptoms (delusions & hallucinations) – Referred as “psychotic depression”.
• Psychotic symptoms are mood congruent (content of delusion) or nihilistic delusion.

Atypical features:

• Presents reverse biological symptoms (hypersomnia, overeating & weight gain).

Melancholic features:

• Depression with melancholic features referred to “involutional melancholia”.
• Seen in old age.
• Characterized by severe anhedonia, profound guilt feelings, early morning awakening, eight loss, agitation & high suicide risk.

Catatonic features:

• Catatonic symptoms like stupor & negativism.

DIAGNOSTIC CRITERIA:

• All symptoms must last for > 2 weeks.
• SWAG (suicidality, weight loss, anhedonia and guilt feelings) – Suggestive of depression.