Depression
Definition
MDE = ≥ 5, ≥ 2 weeks
S leep - increased/decreased Note: middle insomnia indicates moderate depression
I nterest- decreased
G uilt
E nergy- decreased
M ood -depressed
C oncentration - decreased
A ppetite - increased/decreased
P sychomotor - agitation/ retardation
S uicidal ideation
Types/Specifiers
Epidemiology
Aetiology
Biological
Risk Factors
Assessment
Treatment
Non pharmacological
Pharmacological
Prognosis
Source
Toronto Notes 2012
www.blackdoginstitute.org.au
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161658/
MDE = ≥ 5, ≥ 2 weeks
S leep - increased/decreased Note: middle insomnia indicates moderate depression
I nterest- decreased
G uilt
E nergy- decreased
M ood -depressed
C oncentration - decreased
A ppetite - increased/decreased
P sychomotor - agitation/ retardation
S uicidal ideation
Types/Specifiers
- Psychotic - with hallucinations or delusions
- Chronic - ≥ 2y
- Catatonic - conscious but unresponsive
- Melancholic - psychomotor retardation (hallmark)
- Atypical- increased sleep, weight gain, leaden paralysis, rejection hypersensitivity
- Postpartum
- Seasonal - pattern of onset at the same time each year (most often in the fall or winter)
Epidemiology
- Prevalence: male 5-12%, female 10-25% (M:F = 1:2)
- Mean age of onset: ≈ 30 yrs
Aetiology
Biological
- Genetic: 65-75% MZ twins; 14-19% DZ twins
- Neurotransmitter dysfunction at level of synapse (decreased activity of serotonin noradrenaline, dopamine)
- Secondary to GMC
- Psychodynamic (e.g. low self-esteem)
- Cognitive (e.g. negative thinking)
- Environmental factors (e.g. job loss, diet, bereavement, history of abuse)
- Co-morbid psychiatric diagnoses (e.g. anxiety, substance abuse, mental retardation, dementia, eating disorder)
Risk Factors
- Childhood experiences: loss of parent before age 11, negative home environment (abuse, neglect)
- Personality: insecure, dependent, obsessional
- Recent stressors: illness, financial, legal
- Postpartum <6 months
- Lack of intimate, confiding relationships or social isolation
Assessment
- K10 anxiety/ depression scale (10 = normal)
- Endinburgh postnatal score
- Geriatric depression scale
- DASS21
Treatment
Non pharmacological
- CBT
- Family therapy
- Group therapy
- Social: vocational rehabilitation, social skills training
- Experimental: deep brain stimulation, transcranial magnetic stimulation, vagal nerve stimulation
Pharmacological
- Biological: antidepressants, lithium, antipsychotics, anxiolytics, ECT
Prognosis
- 1/3 rule: 1/3 full remission, 1/3 responds, 1./3 non responders
Source
Toronto Notes 2012
www.blackdoginstitute.org.au
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161658/