Tag: depression



  • Duration of Illness > 2 week to establish a diagnosis of depression
  • Sleep Disturbances-Usually Insomnia [Early morning Awakening, reduced latency of REM Sleep]
  • Loss of interest-Loses interest in activities which used to interest him earlier [Anhedonia]
  • Guilt-Excessive Guilt Feelings
  • Lack of energy-Decreased energy levels with easy fatigability
  • Cognition / Concentration-Decreased energy levels with easy fatigability
  • Appetite-Usually Decrease Appetite and weight loss
  • Psychomotor-Psychomotor agitation [Restless] or retardation
  • Suicide-Suicide thoughts and sadness of mood

Most critical symptoms of depression: Mnemonic-SWAG







The signs that are seen in depression are:

Omega sign-Seen in Forehead above the root of the nose

Veraguth fold-Triangular shape fold in nasal corner of upper eyelid



Major depressive episode in absence of any manic, mixed or hypomanic episode

One of the commonest psychiatric disorder [Lifetime prevalence 17%]

Twice as prevalent in Women, Mean Age = 40 Years

Responsible for Maximum DALY [Disability Adjusted Life Years]

Most common cause of Suicide

More commonly seen in divorced and separated persons

Endogenous Vs Exogenous [Reactive] Depression

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors

SSSIs are-Fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, paroxetine, vilazodone

  • Act by blocking reuptake of serotonin
  • First Line of T/T for
  1. Depression
  2. OCD
  3. PTSD
  4. Panic disorder
  5. GAD
  6. Phobias

Side Effect – Nausea [M/C], anxiety, diarrhea, delayed ejaculation, ↓ Libido, sedation, sweating, Weight gain, delayed platelet aggregation.

  • Serotonin Syndrome
  1. Concurrent SSRI + MAO Inhibitor, L tryptophan or lithium
  2. Diarrhea, restlessness, hyperreflexia, myoclonus, seizures and even death
  3. T/T – Cyproheptadine & Supportive care
  • Vortioxetine – SSRI + Agonism 5HT1a receptor, Partial antagonist 5HT3, 5HT1D and 5HT7 receptor

Psychotherapy for depression

Psychotherapy for depression

Treatment using psychological techniques

Cognitive Behavior Therapy

  • Aims at correcting cognitive distortions [Faulty ways of thinking] and faulty behaviors
    The most effective psychotherapeutic technique in depression

Interpersonal Therapy

  • Focuses on management of patient’s current interpersonal problems


  • Behavior therapy, Family Therapy and Psychoanalysis oriented therapy

Management of depression

Management of depression


  • Tricyclic Antidepressants (TCAs)
  • SSRIs
  • SNRIs
  • Monoamine Oxidase Inhibitors
  • Atypical Antidepressants


  • Cognitive Behavior Therapy
  • Interpersonal Therapy
  • Behavior Therapy

Somatic Therapy

  • ECT
  • Trans cranial magnetic stimulation
  • Vagal Nerve stimulation
  • Deep brain stimulation
  • Sleep deprivation
  • Phototherapy

Other somatic treatments for depression

Other somatic treatments for depression


  • Severe depression with suicide risk or stupor
  • Can also be used in depression with psychotic symptoms and refractoriness to other treatment

Tran-cranial Magnetic Stimulation:

  • Use of magnetic energy to stimulate neural cells. Non-Convulsive and requires no anesthesia
    Deep brain stimulation -Implantation of leads into specific brain areas used only in chronic and intractable cases

Vagal Nerve Stimulation-Stimulation of vagal nerve using electrode

Sleep deprivation –Transient benefits by sleep deprivation

Phototherapy – Primarily for seasonal affective disorder [Mood Ds with seasonal pattern]

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