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.
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.
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
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 ?
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 ?
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.
