This presentation was done to raise awareness about depression in nurses and paramedic staff.

1. DEPRESSION
Dr Kapil Kulkarni
Psychiatrist
Kulhudhuffushi Regional Hospital, Kulhudhuffushi,
Republic of Maldives

2. Overview
1. Misconceptions
2. Cases
3. Introduction
4. How common is it?
5. Clinical presentation
6. Causes
7. Diagnosis
8. Treatment
9. Take home message

3. Misconceptions

4. • Depression is synonymous with only sadness.
• Depression is a sign of mental weakness.
• Depression is always situational.
• Depression symptoms are all in your head.
• Once you are diagnosed with depression,
you’ll be on antidepressants the rest of your
life.

5. Cases

6. Case 1: Childhood Depression
• 10 yrs old boy brought by mother
• Complaints of headache, occasional non specific abdominal
pain, increased eating - 3 months
• Also loss of interest in watching television and social plays,
started remaining alone with minimal talk.
• Teacher c/o poor attention in class with decreasing academic
performance.
• History of parental separation when he was 4 yrs old.

7. Case 2: Classical Depression
• 26 yrs old teacher lady came herself
• C/o sadness of mood, decreased sleep, loss of interest in daily
activities, unable to focus on work since 2 months
• Also c/o loss of appetite and feels worthless and helpless
• Feels suicidal and attempted by cutting wrist
• Denies any stressor

8. Case 3: Depression due to
hypothyroidism
• 41 yrs old housewife referred by physician
• C/o loss of energy and easy fatigability, also
feeling of low without any reason
• Now a days accepts disturbed sleep, slow in
her routine work and gaining excess weight
• She says she is k/c/o hypothyroidism poor
compliant to medication

9. Case 4: Depression in Stroke and DM
• 68 yrs old retired policeman with DM and HTN
• Complained loss of memory, tearfulness, poor appetite
• He is thinking excessively now a days in spite of the fact that
everything is in place in family
• Daughter also informed decreased social interaction and has
minimal talk at home
• History of stroke 1 yr back.

10. Case 4: Baby blues & Postpartum
depression
• 32 yr old lady who delivered baby 6 days before
• Complaints- tearfulness, mood swings, sleep disturbances.
• She neglects baby care and keeps thinking all the time with
minimal talk to people coming to meet her.

11. Introduction

12.  What we usually know?
• It is a disorder of mood characterized by
Feeling of sadness
Crying spells
Suicide ideas or attempts

13. × What we usually miss ?
• Loss of interest or pleasure
• Changes in appetite or weight
• Sleep disturbances, usually insomnia
• Psychomotor retardation/agitation
• Easy fatigability or loss of energy
• Worthlessness, hopelessness & helplessness, guilt
• Poor concentration
• Somatic/ physical symptoms

14. How common it is ?

15. • Its very common
• Its increasing nowadays all over world
• Common in young people now a days
• High suicide rates worldwide are due to depression
 What we usually know?

16. • On average, 1 in 6 people – 1 in 5 women and 1 in 8
men – will experience depression at some stage of
their lives.
• Major depressive disorder is more prevalent in
women than in men.
• People with depression are four times as likely to
develop a heart attack than those without a history
of the illness. After a heart attack, they are at a
significantly increased risk of death or second heart
attack.
×What are we usually unaware of ?

17. • WHO estimates it to be one of the medical challenge
of 21st century.
• Less than 80% of the patients seek psychiatric help.
×What are we usually unaware of ?

18. • Considering all age groups rate of suicide in the
world is fairly constant in over 20 and 21 century.
• However in age group 15-44, suicide rate is 3 time
increased.
×What are we usually unaware of ?

19. Clinical presentation

20. • Middle/old aged male/female
• Sadness of mood, crying spells, disturbed sleep
usually associated with some stressors
 What we usually know?

21. ×What do we usually miss?
Atypical depression
• Middle/old aged male/female
• Irritability, increased sleep, increased appetite and
weight, usually associated with or without some
stressors

22. Bipolar depression
• Asking history of elated or happy mood, decreased
need for sleep, excess talking, big talks, increased
energy and grandiosity.
×What do we usually miss ?

23. Psychotic depression
• All depressive features with bizarre behavior,
delusions or hallucinations or both.
×What do we usually miss ?

24. Depression with predominant somatic features
• Headache, backache, neck pain, giddiness,
generalized weakness
×What do we usually miss ?

25. Mood swings in personality disorder patients
• Borderline and histrionic PD coming to OBR with
suicide attempts.
×What do we usually miss ?

26. Mixed anxiety depression
• Depressive features combined with anxiety features
like excessive worry, palpitation, breathlessness,
sweating, tremors etc.
×What do we usually miss?

27. Depression in Mentally Retarded patients
• Usually presents with aggression, behavioral
disturbances and decreased social interactions.
×What do we usually miss ?

28. Etiology

29. • Stressful life events (Psychosocial factors)
• Some neurochemical changes
1. Serotonin system
2. Noradrenaline system
 What we usually know?

30. • Hormonal disorders
• Associated comorbid medical condition
• Premenstrual tension syndrome
• Grief reaction
×What do we usually miss ?

31. Diagnosis

32. • All typical symptoms of depression are met the its
depression.
• Stressful factor noted in history.
 What do we usually do?

33. • DSM IV TR Criteria
• ICD 10 Criteria
×What do we usually neglect?

34. Rating scales for depression
• HDRS- Hamilton Depression Rating Scale
• MADRS- Montgomery Asperger’s Depression Rating
Scale
• BDI- Beck’s Depression Inventory
• EPDS- Edinburgh Postnatal Depression Scale
×What are we usually unaware
of ?

35. Treatment

36. • Pharmacological management
1. SSRI- Fluoxetine, Sertraline, Paroxetine
2. SNRI- Venlafaxine
3. TCA- Imipramine, Amitriptyline
4. NaSSA- Mirtazepine
5. MAOI- Meclobomide
• Counselling
• Electroconvulsive therapy
 What we usually know?

37. • Cognitive behavioral therapy
• Interpersonal therapy
• Psychotherapy
• Family therapy
• Deep brain stimulation
×What can we do more ?

38. • Duration of treatment
• Safety of treatment
• Final outcome of treatment
×What are we usually unaware
of ?

39. Take home message
• While assessing patient, one should keep in
mind that depression has many causes and
different presentation.
• It is a fully treatable condition provided we
should make accurate diagnosis and prompt
management.

40. Thank you