Download major depressive disorder - Sukhdeep`s e

MAJOR DEPRESSIVE DISORDER
• PRESENTORS: • HARWINDER DHILLON
• KARAMVEER KAUR
KINGRA
• SUKHDEEP KAUR
CHAHAL
• MANPREET KAUR
• PARMINDER PAL SINGH
SAINI
OUTLINE
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Case study overview
What is depression
Symptoms
Causes
Types
Risk Factors
Treatment
CASE STUDY OVERVIEW
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Janet is 30 year old lady.
Divorced for more than 1 year.
Has 3 children
Part time student but withdrawn.
Following after divorce financial problems occurred.
In childhood she was reserved socially, hesitant, lack of
assertiveness.
• She broke up with her first boyfriend in college and
then she met with David and rushed into marriage and
her relationship with her husband was not good.
DEPRESSION
• A very common, highly treatable, medical illness.
• Affects physical, mental and emotional well-being.
• Affects basic, everyday activities like eating and sleeping.
• Affects how people think about things and feel about
themselves. In contrast to the normal emotional
experiences of sadness, loss, or passing mood states,
clinical depression is persistent and can interfere
• significantly with an individual's ability to function.
• People with depressive illness cannot just “pull themselves
together” and “get over it.”
• Depression often takes on a life of its own – without
treatment, symptoms can last months or even years.
DEFINITION
• Depression is the feeling of
sadness, grief,
hopelessness,
helplessness, and guilt
• The Disorder is extremely
intense and prolonged
• The Illness has serious
affects on the mental and
physical well being of a
person.
• http://www.youtube.com/
watch?v=lb-TisO17HE
PREVALENCE
• INCIDENCE OF DEPRESSION IN CANADA:- 7.9% to 8.6%
of adults over 18 years of age.
• According to national population health survey in
1994-95:- 6% of Canadian population of age 12 years
and over has symptoms of depression.
• Average age of depression:- early 20’s to early 30’s.
• Sex: - more in women than men
• In Ontario:- 2% of men and 3% of women have mood
disorder
• Genetic factors:- it runs in families 1.5-3 times more
common among first degree biological relatives.
CAUSES
However, causes are not known, but current
theories include: • Genetic
• Runs in families
• However, depression can also occur in
people who have no family history.
• Environmental
• A serious loss, difficult relationship, financial
problem, or any stressful (unwelcome or
even desired) change in life patterns can
trigger a depressive episode.
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CONTD…
• Personality Characteristics
– low self-esteem, pessimistic world view, low
stress tolerance
– Whether this represents a psychological
predisposition or an early form of the illness is
not clear.
• Biological
Medical model explores problems in brain
functioning in the following areas: Limbic
system, neurotransmitters and neurons,
hormones and the endocrine system
CONTD…
• Combination
• a combination of genetic, psychological,
environmental, and/ or biological factors
may contribute to the onset of a depressive
disorder
CAUSES IN JANET’S CASE
• Janet’s depression was clearly precipitated by her
divorce which has affected her life.
– Increased financial burden and disturbed
interpersonal relationship imbalanced her life.
– She lost her role as a wife.
– Stressful events can cause depression and vice
versa.
• Major Life Changes
– Positive or negative events can trigger
depression. Here , Janet's divorce is a major
life change.
TRIGRRING FACTORS
• There are many other factors which contribute to
depression: • Reserve social behavior in childhood.
• Hesitant in expression.
• Lack of assertiveness.
• Unable to make many friends.
• Dependent relationship and personality.
• Separation from mother at the age of 11.
• Financial burden, education and children responsibility.
• Lack of social support.
• Hopelessness and helplessness.
SYMPTOMS ACCORDING TO DSM• Depressed mood most of the day, feel sad, empty, and
appears tearful.
• Diminished interest in all the activities
• Weight loss or weight gain, decrease or increase in appetite.
• Insomnia or hypersomnia.
• Psychomotor agitation or retardation.
• Fatigue or loss of energy.
• Feeling of worthlessness or excessive or inappropriate guilt.
• Diminished ability to think or concentrate or decisiveness.
• Recurrent thoughts of death or suicidal ideation.
SYMPTOMS IN JANET
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First 2 symptoms must be present at least for two weeks.
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Feeling sad, blue, or down in the dumps.
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Loss of interest in things you usually enjoy.
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Feeling slowed down or restless.
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Having trouble sleeping or sleeping too much Loss of energy or
feeling tired all the time.
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Having an increase or decrease in appetite or weight.
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Having problems concentrating, thinking, remembering or making
decisions.
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Feeling worthless or guilty.
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Having thoughts of death or suicide.
ADDITIONAL SIGNS
• Changes in feelings which may include:
– Feeling empty
– Inability to enjoy anything
– Hopelessness
– Loss of sexual desire
– Loss of warm feelings for family or friends
– Feelings of self blame or guilt
– Loss of self esteem
– Inexplicable crying spells, sadness or irritability
TREATMENT
In general, treatment for
depression include:
• Medications
• Psychotherapies.
TREATMENT
• MedicationAntidepressants
• Psychotherapy
• Interpersonal
Psychotherapy
• Cognitive behavior
therapy
• Psychodynamic therapy
MEDICATION
• Drugs used to treat depression are
called antidepressants. Common types
of antidepressants include:
• Selective serotonin re-uptake
inhibitors (SSRIs), including fluoxetine
(Prozac), sertraline (Zoloft), paroxetine
(Paxil), fluvoxamine (Luvox), citalopram
(Celexa), and escitalopram (Lexapro).
• Serotonin norepinephrine reuptake
inhibitors (SNRIs), including
desvenlafaxine (Pristiq), venlafaxine
(Effexor), and duloxetine (Cymbalta).
Other medicines used to treat
depression include:
• Tricyclic antidepressants
• Bupropion (Wellbutrin)
• Monoamine oxidase inhibitors
ANTIDEPRESSENT FOR JANET
Janet’s depression can be tackled from
antidepressant medication as her morbid
ruminations marked a clear deterioration in her
condition. Janet can respond to fluoxetine (Prozac).
Selective serotonin reuptake inhibitors (SSRIs) are
most effective prescriptions written for
antidepressant medication. The SSRIs inhibit the
reuptake of serotonin into the presynaptic nerve
ending and therefore increase the amount of
serotonin available in the synaptic clef.
PSYCHOTHERAPY
• Psychotherapy is often the first form of treatment
recommended for depression. Called "therapy" for
short, the word psychotherapy actually involves a
variety of treatment techniques. During psychotherapy,
a person with depression talks to a licensed and
trained mental health care professional who helps the
person identify and work through the factors that may
be triggering the depression.
• Sometimes these factors work in combination with
heredity or chemical imbalances in the brain to trigger
depression. Taking care of the psychological and
psychosocial aspects of depression are just as
important as treating its medical cause.
PSYCHOTHERAPY CAN HELP JANET TO• Understand the behaviors, emotions, and ideas that
contribute to her depression
• Understand and identify the life problems or events—
like a major separation issue, finances, a loss of a job
and divorce—that contribute to her depression and
help her understand which aspects of those problems
may be able to solve or improve
• Regain a sense of control and pleasure in life
Learn coping techniques and problem-solving skills
TYPES OF PSYCHOTHERAPY
• Individual psychotherapy
• Group psychotherapy
• Couple psychotherapy
Janet can attend individual or group therapy.
Couple therapy may not be appropriate for her
at this stage.
INTERPERSONAL PSYCHOTHERAPY
• Interpersonal therapy focuses on the behaviors and
interactions a depressed patient has with family and
friends. The primary goal of this therapy is to improve
communication skills and increase self esteem during a
short period of time. Therapy usually lasts three to four
months and works well for depression caused by mourning,
relationship conflicts, major life events, and social isolation.
• Psychodynamic and interpersonal therapies help patients
resolve depression caused by:
• Loss (grief)
• Relationship conflicts
• Role transitions (such as becoming a mother or a caregiver)
COGNATIVE BEHAVIOUR THERAPY
• Cognitive behavioral therapy helps people with depression to
identify and change inaccurate perceptions that they may have of
themselves and the world around them. The therapist helps
patients establish new ways of thinking by directing attention to
both the "wrong" and "right" assumptions they make about
themselves and others.
• Cognitive-behavioral therapy is recommended for patients: - Who
think and behave in ways that trigger and perpetuate depression
With mild-to-moderate depression as the only treatment or in
addition to treatment with antidepressant medication
Who refuse or are unable to take antidepressant medication
Of all ages who have depression that causes suffering, disability, or
interpersonal problems
• In Janet's case this is an appropriate therapy.
REFRENCES
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Bennett, P. (2003). Abnormal and Clinical Psychology: An introductory textbook. (1stEd.).
Maidenhead: Open University Press.
Dubovsky, S.L., & Dubovsky, A.N. (2005) Mood Disorders. New York: American Psychiatric
Publishing Inc.
Firestone, P., & Marshall, W.L. (Eds). (2003). Abnormal Psychology: Perspectives. Toronto,
Ontario, Pearson Ed.
Long, P. W. (1998). Major Depressive Disorder: Treatment. Internet Mental Health.
Retrieved,from http://www.mentalhealth.com/rx/p23-md01.html
Nevid, J., Greeve, B., Johnson, P., Taylor, S., & Macnab, M. (2013). Essentials of Abnormal
Psychology (3rd Ed.).Toronto, Ontario: Pearson Ed.
Public Health Agency of Canada. (2002). A report on Mental Illnesses in Canada.
Retrieved from http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_2-eng.php
Sadock, B. J., & Sadock, V.A. (2007). Synopsis of Psychiatry Behavioral Science/ Clinical
Psychiatry (10th Ed.). New York: Wolters Kluwer/Lippincott Williams& Wilkins.
Tracy, N.,(2012). Major Depression (Major Depressive Disorder) Symptoms, Causes, Treatments,
HealthyPlace.com .
Retrieved fromhttp://www.healthyplace.com/depression/major-depression/major-depressionmajor-depressive-disorder-symptoms-causes-treatments/