This document summarizes unipolar major depression. It defines unipolar major depression as a mental disorder characterized by persistent low mood and loss of interest in activities. It discusses the manifestations, risk factors, symptoms, epidemiology, global burden, history of classification, shortcomings of treatment programs, and recommendations to strengthen mental health resources and programming.

1. UNIPOLAR
MAJOR
DEPRESSION
SIR MICHAEL MARMOT GROUP
1

2. GROUP CONTRIBUTIONS
SHIRISH TIWARI
Slide Preparation and
Presentation
DR NEYANG NITIK
Data Collection from
Books
DR MEENAKSHI
MALIK
Data collection for
Global Burden
DR ISHA SHARMA
Data Collection for
NMHP
MRS SHALINI
KUMARI
Data Compilation for
NMHP
HEEYA MAITY
WHO and Data
Compilation
SIR MICHAEL MARMOT GROUP 2

3. ABRAHAM LINCOLN
SIR MICHAEL MARMOT GROUP 3

4. WHAT IS UNIPOLAR MAJOR DEPRESSION ?
Unipolar Major Depression is a mental
disorder characterized by pervasive
and persistent low mood that is
accompanied by low self esteem and by
a loss of interest of pleasure in
enjoyable activities. (3)
MANIFESTATIONS
 Affects daily life for weeks or longer
 Interferes with social life
- Family and relationships
- work and school life
- Sleeping and eating habits
 Implications on general health
SIR MICHAEL MARMOT GROUP 4

5. SIR MICHAEL MARMOT GROUP 5
HISTORY
• Hippocrates – described
Melancholia with mental and
physical symptoms. (3)
• Sigmund Freud – Mourning and
Melancholy
CLASSIFICATION
• DSM-I, 1952 AND DSM-II, 1968. (3)
• ICD – 10 By WHO

6. SIR MICHAEL MARMOT GROUP 6
RISK FACTORS
• Anemia, Epilepsy
• Metabolic
• Neurological and Metabolic
PHYSIOLOGICAL
FACTORS
• Anxiety
• Poverty
• Family Pressure
SOCIAL FACTORS
SYMPTOMS
Restlessness and Irritation
Loss of Interest
Abnormal Appetite
Insomnia and Hypersomnia

7. EPIDEMIOLOGYOF
DEPRESSION
Approx. 298 MN people affected as of 2010
(4.3%) of global population. (3)
Lifetime Incidence – 3% in Japan to 17% in
USA.
Population Studies – UMD twice in women
compared to men. (3)
SIR MICHAEL MARMOT GROUP 7
More common in urban than rural population. (3)
8.2% - global YLDs in 2010, making it the 2nd
leading cause of global disability.
11th leading cause of global burden (or DALYs) in
2010.(6)

8. SIR MICHAEL MARMOT GROUP 8
GOLBAL BURDEN OF UNIPOLAR DEPRESSION
Global Rank of MDD (Acc. To WHO)(5)
Year Rank Cause DALYs
(000s)
% DALYs DALYs per
100,000
population
2000 11 Unipolar depressive disorders
64,300 2.2 1050
2010 9 Unipolar depressive disorders 76,500 2.8 1081
 GHE Estimates 2014 : DALYs by Age and Sex (Acc. To
WHO)(5)
Age group
Sex
0-27
days
1-59
months 5-14 years 15-29 years
30-49
years
50-59
years
60-69
years 70+ years Total
Male 0 1,731 3,084,015 8,598,453 10,379,302 3,783,804 2,012,581 1,288,466 29,148,352
Female 0 2,759 4,796,559 13,222,569 16,511,919 6,321,185 3,600,032 2,896,867 47,351,890

9. SIR MICHAEL MARMOT GROUP 9
COMPARISON OF DALYs
 Globally, Prevalence of MDD more in women than men
(2012)
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
40,000,000
45,000,000
50,000,000
0-27 days 1-59
months
5-14 years 15-29
years
30-49
years
50-59
years
60-69
years
70+ years Total
Male
Female

10. SIR MICHAEL MARMOT GROUP 10
Unipolar Depressive Disorders World Map(6)

11. SIR MICHAEL MARMOT GROUP 11
GBD OF DEPRESSION IN INDIA
 Global Health Estimates – DALYs – By sex and age groups
(2012).(5)
0
1000
2000
3000
4000
5000
6000
7000
8000
DALYs 0-4
years
DALYs 5-14
years
DALYs 15-29
years
DALYs 30-59
years
DALYs 60-69
years
DALYs 70+
years
All Ages
MALE 0.3 587.6 1543.5 2282.9 267 134 4815.3
FEMALE 0.4 876.9 2288.9 3474.2 458.1 269.2 7367.7
Population('000)

12. SIR MICHAEL MARMOT GROUP 12
GBD OF DEPRESSION IN INDIA
Global Health Estimates – DALYs in year 2000 and 2012.(5)
18% increase from year 2000 to 2012 of depressive disorder.
YEAR AGE
GROUP
DALYs 0-4
years
DALYs 5-14
years
DALYs 15-29
years
DALYs 30-59
years
DALYs 60-69
years
DALYs 70+
years
All Ages
2000 2000 0.7 1400.8 3278.7 4393.1 547.7 271.6 9892
2012 2012 0.7 1464.5 3832.4 5757 725.1 403.3 12183
0
2000
4000
6000
8000
10000
12000
14000
Population('000)

13. SIR MICHAEL MARMOT GROUP 13
WORLD HEALTH
ORGANISATION
mhGAP – Mental Health Gap Action Plan.(8)
-“Scaling up care for mental, neurological and substance disorder”
- It was endorsed by 55th World Health Assembly in 2002.
- Mental Health : Evidence and Research Team
(MER)
- Mental Health Atlas
- WHO-AIMS (Assessment Instrument for Mental
Health Systems)
- WHO-MIND (Mental Health in Development)

14. SIR MICHAEL MARMOT GROUP 14
Objectives
Ensure Care for
All
Stimulate
Self Help
Promote
Communication
Encourage
Awareness
NATIONAL MENTAL HEALTH PROGRAMME
Started in
1982
Re -
Strategized in
2003

15. SIR MICHAEL MARMOT GROUP 15
NATIONAL MENTAL HEALTH PROGRAMME
HOSPITAL BASED
APPROACH
COMMUNITY
BASED
APPROACH
10th 5 Year plan
(2002-07)
 DMHP-Country
wise
 Strengthening
Central & State
Mental Health
Authorities
 Increased
Psychiatry content
in Medical
curriculum
 Research &
Training
11th 5 Year plan
(2007-12)
 DMHP with
added
components
 Modernization of
state run
hospitals
 Up gradation of
psychiatric wing
 IEC
 Man power
development
12th 5 Year plan
(2012-17)
 Integration of
different
components of
NMHP to that of
NRHM

16. SIR MICHAEL MARMOT GROUP 16
• 0.05% of total Health Budget – For
Mental Health
• The 11th FYP of 2005 had an
allocation of Rs.1000 crore for the
NMHP
• Sum of 70 crore has been made
available for 2008-09 for the further
implementation of NMHP but this only
constitutes 2.5% of the total health
budget.
BUDGET ALLOCATION

17. SIR MICHAEL MARMOT GROUP 17
S. No. Resources Present Status (2011) Required
Status
1 Psychiatrist 3000 11,500
2 Clinical Psychologist 500 17,250
3 Psychiatrist Social
Workers
400 23,000
4 Psychiatrist Nurses 900 9,000
5 Number of Beds 300 30,000
• 7% of population suffers from mental disorders
• Point Prevalence - 10 to 20 per 1000 of the population
• <1 Psychiatrist for every FOUR lakh population.
MANPOWER RESOURCE IN INDIA

18. SIR MICHAEL MARMOT GROUP 18
SHORTCOMINGS OF NMHP
• Lack of manpower resources
• Lack of proper and effective
monitoring and guidelines.
• Inadequate data about Health Status
• Poor feasibility of policies and
implementation.
• No indicators to assess mental health

19. SIR MICHAEL MARMOT GROUP 19
RECOMMENDATIONS FOR NMHP
• Strengthening manpower
• Proactive role of State Government in the
implementation of programmes.
• Preventive measures should be taken
• Manpower should be trained with Public
Mental Health.
• Integrated with NRHM
• NGO works should be encouraged.
• Social Initiatives should be given preference

20. SIR MICHAEL MARMOT GROUP 20
Psychotherapy – Effective at preventing
new onset of depression.
- Interpersonal Therapy
- Cognitive Behavioral Therapy
- Significant in severe cases of disorders.
- Mostly given with psychotherapy.
- E.g.:- SSRIs, Bupropion, Venlafaxine, etc.
- Significant decline in suicide rates.(3)
TREATMENT

21. SIR MICHAEL MARMOT GROUP 21
S. No. Low Resourced Setting High Resourced Setting
1 Routine screening for detection High-risk or routine screening with
confirmation of diagnosis by skilled
clinician
2 Psycho-education Psycho-education
3 Generic antidepressants Choice of antidepressants
4 Problem-solving treatment Choice of brief psychological
treatments
CONCLUSION
• Mass awareness through education and promotion.
• Removal of Social taboos and stigmas (FAITH-HEALERS)
• People with illness should be joined to mainstream.
 PACKAGE CARE FOR DEPRESSION.

22. SIR MICHAEL MARMOT GROUP 22
Sir Isaac Newton John Stuart Mill Abraham Lincoln
Robin Williams Mike Tyson

23. SIR MICHAEL MARMOT GROUP 23
IMPORTANT
FACTS
World Mental Health Day – 10th October
Theme for 2014 – “Living with Schizophrenia”

24. SIR MICHAEL MARMOT GROUP 24
REFERENCES
1) The Hindu Newspaper - http://tinyurl.com/pzby9ow
2) National Crime Records Bureau – Suicides in India, 2013
3) Wikipedia - http://tinyurl.com/lealaug
4) http://obad.ca/information_depression#criteria
5) WHO Data on Global Health Estimates.
6) GBD Data on Depressive Disorder
7) Medscape - http://www.medscape.com/viewarticle/813896
8) WHO - http://www.who.int/mental_health/mhgap/en/
9) WHO - http://www.who.int/mental_health/maternal-child/en/
10)MOHFW - http://tinyurl.com/qgvu6ev

25. SIR MICHAEL MARMOT GROUP 25
“Depression begins with
disappointment. When
disappointment festers in our
soul, it leads to discouragement.”
- Joyce Meyer