1. DEPRESSION

2. What causes depression?
combination of genetic, biological, environmental,
and psychological factors.

3. “saya berasa amat sukar untuk bangun pagi ,
saya hanya mahu berada disebalik cadar dan
tidak mahu bercakap dengan siapa-siapa”
“saya kurang selera makan dan telah hilang
banyak berat badan”
“saya selalu penat dan tidur malam tidak lena”
“+saya sudah berkeluarga dan kerjaya tetapi saya
selalu rase tidak sempurna atau bertambah baik”

4. Validated Screening Instrument
THE PHQ-9
Scores the frequency during the last 2 weeks of the 9 symptom domains that constitute the
DSM criteria for MDD, using Likert scales. The domains include:
Little interest or pleasure in doing things;
Feeling down, depressed, or hopeless;
Trouble falling or staying asleep or sleeping too much;
Feeling tired and having little energy;
Poor appetite or overeating;
Feeling bad about yourself (eg, failure);
Difficulty concentrating;
Moving slowly or fidgety; and
Thoughts that you would be better off dead.
The tenth question evaluates level of impairment related to any of the 9 symptom domains
endorsed by the patient

5. Signs and symptoms
-Persistent sad, anxious, or "empty" feelings
-Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Irritability, restlessness
-Loss of interest in activities or hobbies once pleasurable,
including sex
-Fatigue and decreased energy
-Difficulty concentrating, remembering details, and making
decisions
- Insomnia, early-morning wakefulness, or excessive sleeping
-Overeating, or appetite loss
-Thoughts of suicide, suicide attempts
-Aches or pains, headaches, cramps, or digestive problems that
do not ease even with treatment.

6. Tr1)emaedticmatioensnt
2) behavior therapy
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*antidepressants : to regulate hormonal chemical –
dopamine , serotonin, norepinephrine
1) SSRIs – Fluoxetine (Prozac), sertraline (Zoloft),
escitalopram (Lexapro)
2) SNRIs - venlafaxine (Effexor) and duloxetine
(Cymbalta)
3) Dopamine receptors :bupropion (Wellbutrin) less likely
to cause sexual side effects. However, it can increase a
person's risk for ^seizures.
*SE : tricyclic ^drymouth ^constipation ; headaches,
nausea, jitters, or insomnia

7. Other drug groups
2) tricyclic : imipramine and nortriptyline.
SE : affect the heart in people with heart
conditions. ^diarrhea/ ^ insomnia They sometimes
cause dizziness, especially in older adults. They
also may cause drowsiness, dry mouth, and
weight gain
3) Monoamine oxidase inhibitors (MAOIs) :
"atypical" depression, such as when a person
experiences increased appetite and the need for
more sleep rather than decreased appetite and
sleep. They also may help with anxious feelings or
panic and other specific symptoms

8. HOW TO?
All antidepressants must be taken for at least 4 to 6 weeks before they have a
full effect. You should continue to take the medication, even if you are feeling
better, to prevent the depression from returning.
Medication should be stopped only under a doctor's supervision. Some
medications need to be gradually stopped to give the body time to adjust.
Although antidepressants are not habit-forming or addictive, suddenly ending an
antidepressant can cause withdrawal symptoms or lead to a relapse of the
depression. Some individuals, such as those with chronic or recurrent
depression, may need to stay on the medication indefinitely.
In addition, if one medication does not work, you should consider trying another.
NIMH-funded research has shown that people who did not get well after taking a
first medication increased their chances of beating the depression after they
switched to a different medication or added another medication to their existing
one.

9. Pychotherapy
1)cognitive-behavioral therapy (CBT)
2)interpersonal therapy (IPT)
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**CBT helps people with depression restructure negative thought patterns.
Doing so helps people interpret their environment and interactions with others in
a positive and realistic way. It may also help you recognize things that may be
contributing to the depression and help you change behaviors that may be
making the depression worse
**IPT helps people understand and work through troubled relationships that may
cause their depression or make it worse.

10. How you can help
-Offer emotional support, understanding, patience, and
encouragement.
-Talk to him or her, and listen carefully.
-Never dismiss feelings, but point out realities and offer
hope.
-Never ignore comments about suicide, and report them
to your loved one's therapist or doctor.
-Invite your loved one out for walks, outings and other
activities. Keep trying if he or she declines, but don't push
him or her to take on too much too soon.
-Provide assistance in getting to the doctor's
appointments.
-Remind your loved one that with time and treatment, the
depression will lift

11. Other drug groups
2) tricyclic : imipramine and nortriptyline.
SE : affect the heart in people with heart
conditions. They sometimes cause dizziness,
especially in older adults. They also may cause
drowsiness, dry mouth, and weight gain
3) Monoamine oxidase inhibitors (MAOIs) :
"atypical" depression, such as when a person
experiences increased appetite and the need for
more sleep rather than decreased appetite and
sleep. They also may help with anxious feelings or
panic and other specific symptoms