Lecture on Depression

Overview

• Depression is a significant global health issue, contributing to 10% of all death and disability worldwide.
• Focus of the lecture is on recognizing and treating depression using evidence-based practices.

Understanding Depression

• Depression is considered to be many different conditions; focus here on episodic unipolar major depressive disorder and its subtypes.
• Key features include depressed mood and anhedonia.

Diagnosis of Depression

• Key Features: Depressed mood and anhedonia.
• Mnemonic "SIG-E-CAPS":
  • S: Sleep disturbances
  • I: Interest (reduced)
  • G: Guilt or hopelessness
  • E: Energy (depleted)
  • C: Concentration difficulties
  • A: Appetite changes
  • P: Psychomotor retardation
  • S: Suicidal thoughts
• Diagnosis requires at least 5 of these symptoms for 2 or more weeks.
• Depression is common, affecting 20% of people at some point.

Epidemiology

• Most common psychiatric disorder.
• Median onset age is 32, but can occur at any age.
• Women diagnosed twice as often as men.
• Episodes last 6-12 months if untreated.

Prognosis

• 50% risk of recurrence after first episode.
• Life events can trigger depression but are not always the cause.
• Depression can exacerbate other medical conditions.

Treatment Options

• Combination of psychotherapy and medications is most effective.
• Psychotherapy: Cognitive Behavioral Therapy (CBT) is most studied.
• Medications: Antidepressants increase neurotransmitters.
• Rule of thirds: One-third fully recover, one-third improve, one-third do not respond.
• Treatment-resistant cases may consider Electroconvulsive Therapy (ECT).

Subtypes of Depression

• Melancholic Depression: Severe, often non-reactive, neuro-vegetative symptoms.
• Atypical Depression: Mood reactivity, increased appetite, weight gain.
• Postpartum Depression: Affects 15% of new mothers.
• Seasonal Affective Disorder (SAD): Linked to winter months, treated with light therapy.
• Psychotic Depression: Includes paranoia, hallucinations.

Related Disorders

• Dysthymia (Persistent Depressive Disorder):
  • Chronic, lasting at least 2 years.
  • Sub-syndromal symptoms.
  • Treated similarly to major depression.
• Double Depression: Combination of dysthymia and major depressive episodes.

Further Reading

• Suggested book: "Memorable Psychiatry" for deeper insights and practice questions.

Conclusion

• Overview of major depressive disorder's diagnosis and treatment.
• Next topic: Bipolar Disorder.