Depression: “Let’s Talk”

Management And
Prevention Of
DepressionPresented By,
Syed Mohammad Moosi Raza Ali
Khan
Roll No: 88
Guidance, Support and Inputs:
Dr Deeksha Elwadhi (Dept. of Psychiatry)
Dr Rashmi Agarwala (Dept. of Community Med.)
Fatima Bv (MBBS 2014)
PHARMACOLOGICAL
TREATMENT:

ANTIDEPRESSANTS
 NDRIs : Imipramine,
Bupropion Clomipramine
Tricyclic
Antidepressa Paroxetine,
Atomoxetine, nts Dapoxetine
Reboxetine

St Jone’s NARIs SSRIs

Wort
(Hypericum
perforatum) Classification
NaSSA of Anti- Venlafaxine,
Depressants
Duloxetine

SARIs :
Phenylpipera SNRIs
zine

MAO-A
Mianserin, Inhibitors:
Mirtazapin Moclobemide
Basic Pathology
&
Antidepressants:
How They Act
• Safety
STEPS to selection
-Therapeutic index
-Drug-drug interactions- Pharmacodynamics,
Pharmacokinetics
• Tolerability
• Efficacy
-Overall
-Unique spectrum of activity
-Rate of response
-Maintenance and prophylaxis
• Payment
• Simplicity - Ease of administration
[ Preskorn SH, J Clin Psychiatry, 1994]
 Non-
Pharmacological
Treatment
 Electroconvulsive Therapy
Modulation of monoamines
Definition:
Electricity applied
transcranially via
electrode placed Change in neurotrophic
on the scalp to Mechanism
factors
induce seizure of action
under surgical
anesthesia Anticonvulsant factors

Neurophysiological factors
 INDICATIONS:
‽Severe depressive illness (with suicidal
symptoms)
‽Psychotic Depression as in prolonged or
severe mania
‽Resistant to Anti-depressant drug treatment
‽Refuses to eat dangerous malnutrition.
‽Accompanied by psychotic symptoms,
catatonia symptoms
 CONTRAINDICATIONS
No absolute contraindication to ECT, however it is best
avoided in the following conditions

? Uncontrolled cardiac failure

? DVT – until anticoagulated
? Acute respiratory infection
? Recent myocardial infarction etc
 ADVERSE EFFECTS OF
ECT
• Mortality rate: 1/1000 patients
• Prolonged seizure (>3 minutes by APA)
• Common side effects: headache, nausea,
muscle pain
• Cognitive side effects
 Light Therapy

• Used for seasonal affective disorder

• Usual dose-
2,500 lux for at least 1 to 2 hours per day
or
10,000 lux for 30 minutes
• White light
• Response rate – 60 to 90 %
 Interpersonal Therapy

Focuses on current conflicts

and interpersonal problems.

PSYCHOTHERA
PY Behavioral & Cognitive
Behavioral Therapy
Concentrate on defining how a
person’s behavior affect
problems that contribute to
depression.

Changing those behavior

 INTERPERSONAL THERAPY
Short-term treatment -12 to 16 one-hour
weekly sessions.
focus on problems in how an individual
interacts with or doesn't interact with others.
Goal
to enable people with depression to make
their own needed adjustments to cope with
and reduce depressive symptoms.
 Cognitive Behavioral Therapy
• An effective treatment for mild depression
• CBT is an assumption that a person's mood is
directly related to his or her patterns of
thought.
• Goal : to help a person learn to recognize
negative patterns of thought, evaluate their
validity, and replace them with healthier ways
of thinking.
 Transcranial Magnetic Stimulation
• Non-invasive procedure
• uses magnetic fields to
stimulate nerve cells in the
brain
• used when other depression
treatments haven't been
effective.
STEPPED CARE MODEL
FOR TREATING
DEPRESSION
ACCORDING TO THE
NICE CLINICAL
GUIDELINES-CG91
of
 Preventive Psychiatry
• Use of theoretic knowledge
and skills to plan and
implement programs designed
to achieve primary, secondary,
and tertiary prevention of
onset of psychiatric disorders
(Mosby's Medical Dictionary,
8th edition)
 Levels Of Prevention

Seconda
ry

Primary
 Primary Prevention
· Reduce individual vulnerability

 Improve parent-child interactions

 Offer event-centered interventions

 Secondary Prevention
Early case detection

Early intervention
Tertiary Prevention
Reduce relapse and recurrence

Provide vocational rehabilitation

Develop support programmes

 Universal Selective Indicated
prevention prevention prevention
Target general public Targets individuals or Targets high-risk
or to a whole subgroups of people who have
population group that population whose risk minimal but
has not been of developing a detectable signs or
identified one basis of mental disorder is symptoms
increased risk significantly higher foreshadowing
than average, as mental disorder or
evidenced by biological markers
biological, indicating
psychological or predisposition for
social risk factors mental disorder but
who do not meet
diagnostic criteria for
disorder at that time

(Mrazek & Haggerty, 1994)

 DEPRESSION BASED
INTERVENTIONS
• Depression-specific risk factors , generic risk factors
and protective factors have been identified
• Controlled studies show a significant but small effect
of 11% reduction in depressive symptomatology after
intervention (Jané-Llopis et al 2003)
• Universal interventions
– Strengthening protective factors among general population
– School-based programmes targeting cognitive, problem-
solving and social skills of children and adolescents and
exercise programmes for elderly
– Programmes have been found effective in reducing
depressive symptoms to extent of 50% or more in one year
(Shochet et al., 2001)
• Selective Intervention
– Parents of children with conduct problems - providing information and
training in childrearing strategies
– Coping with major life events like programmes for children with parental
death or divorce unemployment and chronically ill elderly
• Indicated Intervention
– Educate people at risk in positive thinking, challenge negative thinking
styles and improve problem-solving skills
– New projects investigating possibility of reaching larger populations at risk
through use of written self-help materials, mass media and Internet
– Additional exposure to light therapy for winter depression in people with
subsyndromal depressive symptoms (Avery et al 2001)