Nuno Sousa, Christer Löfkrantz and Millie Ottesen Depression Nuno Sousa, Christer Löfkrantz and Millie Ottesen

Depression Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.

Depression Long-lasting or recurrent, substantially impairing an individual’s ability to function at work or school or cope with daily life. At its most severe, depression can lead to suicide. When mild, people can be treated without medicines but when depression is moderate or severe they may need medication and professional talking treatments.

Etiology Abuse. Certain medications. (ex: isotretinoin). Conflict. Death or a loss.  Genetics (family history of depression may increase the risk) Major events.  Other personal problems.  Serious illnesses.  Substance abuse. (nearly 30% of people with substance abuse problems also have major or clinical depression.) Abuse. physical, sexual, or emotional abuse can increase the vulnerability to clinical depression later in life. Certain medications. Some drugs, such as isotretinoin (used to treat acne), the antiviral drug interferon-alpha, and corticosteroids, can increase your risk of depression. Conflict. Depression in someone who has the biological vulnerability to develop depression may result from personal conflicts or disputes with family members or friends. Death or a loss. Sadness or grief from the death or loss of a loved one, though natural, may increase the risk of depression. Genetics. A family history of depression may increase the risk. It's thought that depression is a complex trait, meaning that there are probably many different genes that each exert small effects, rather than a single gene that contributes to disease risk. The genetics of depression, like most psychiatric disorders, are not as simple or straightforward as in purely genetic diseases such as Huntington's chorea or cystic fibrosis. Major events. Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring. However, the syndrome of clinical depression is never just a "normal" response to stressful life events. Other personal problems. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can contribute to the risk of developing clinical depression. Serious illnesses. Sometimes depression co-exists with a major illness or may be triggered by another medical condition. Substance abuse. Nearly 30% of people with substance abuse problems also have major or clinical depression.

Symptoms Slow wave pattern left frontal area Right frontal area domination Sleep Appetite Dysphoria Fatigue Anhedonia Concentration Esteem Suicidal thoughts

Diagnosis 5 of SADFACES present for 2W GP – psychiatrist – psychologist 2/3 misdiagnosed in rural areas MSE – standard No lab-test Differential – hypothyroidism, sepsis

Treatment Drugs Psychotherapy Electric shock treatment Interpersonal therapy Psychodynamic therapy Cognitive behavioral therapy

Drugs Only about 30% of people with depression go into full remission after taking their first course of antidepressants. Some people need more than one medicine for treatment. Some antidepressants work better for certain individuals than others. Selective serotonin reuptake inhibitors – SSRI’s Tricyclic antidepressants – TCA’s Monoamine oxidase inhibitors – MAO’s Side effects? Drugs affecting neurogenesis

Psychotherapy Is an effective therapy, but may not be enough on its own. It is often combined with other treatments as for example medications. It's used to help the person find ways to deal with everyday stressors. What Are The Benefits? It can help ease stress. It can give you a new perspective on problems. It can make it easier to stick to your treatment. You can use it to learn how to deal with side effects from your medicine You learn ways to talk to other people about your condition. It helps catch early signs that your depression is getting worse.

Electroshock therapy Electroconvulsive therapy (ECT), can be used to treat major depression that hasn't responded to standard treatments. It is among the safest and most effective treatments available for depression. With ECT, electrodes are placed on the patient's scalp and a finely controlled electric current is applied while the patient is under general anesthesia. The current causes a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients. It's also very effective for patients who suffer from mania or other mental illnesses.

Interpersonal therapy Interpersonal therapy, or IPT, is a short-term, limited-focus treatment for depression. Studies have shown that IPT, which addresses interpersonal issues, may be as effective as short-term treatment with antidepressants for mild to moderate forms of clinical depression. By addressing interpersonal issues, interpersonal therapy for depression puts emphasis on the way symptoms are related to a person's relationships, including family and peers. The immediate goals of treatment are rapid symptom reduction and improved social adjustment. The long-term goal is to enable people with depression to make their own needed adjustments. 

Pshychodynamic therapy Psychodynamic therapy is designed to help patients explore the full range of their emotions, including feelings they may not be aware of. By making the unconscious elements of their life a part of their present experience, psychodynamic therapy helps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings.

Cognitive behavioural therapy CBT aim to help their patients change patterns of behavior that come from dysfunctional thinking. Negative thoughts and behavior predispose an individual to depression and make it nearly impossible to escape its downward spiral. When patterns of thought and behavior are changed, so is mood.

Sources http://www.who.int/topics/depression/en/ http://www.webmd.com/depression/guide/causes-depression#1 http://www.thebrainperformancecenter.com/conditions-and-symptoms/depression/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/ http://www.webmd.com/depression/guide/interpersonal-therapy-for-depression#1 http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for- depression#1 http://www.webmd.com/depression/guide/psychodynamic-therapy-for-depression#1 http://www.webmd.com/depression/guide/electroconvulsive-therapy#1 http://www.webmd.com/depression/guide/treatment-resistant-depression- psychotherapy#1 http://www.webmd.com/depression/guide/optimizing-depression-medicines#2