1. DEPRESSIVE DISORDERS IN OTHER SELECTED MEDICAL CONDITIONS FRANCIS CREED & SANTOSH K CHATURVEDI Copyright © 2012. World Psychiatric Association

2. Feeling helpless and hopeless Inability to work Insomnia Lack of energy General poor health Copyright © 2012. World Psychiatric Association2 SYMPTOMS SHARED BY RHEUMATOID ARTHRITIS AND DEPRESSIVE DISORDER

3. HEPATOTOXICITY & ANTIDEPRESSANTS Most antidepressants undergo extensive hepatic oxidative metabolism and should be dosed cautiously Antidepressants can cause hepatitis, at times Most antidepressant agents have the potential to produce idiopathic liver injury. Possible drug discontinuation syndromes can occur if antidepressants are stopped due to hepatotoxicity. Consider early discontinuation of an antidepressant if hepatotoxicity is suspected. Idiopathic drug-induced liver injury cannot be prevented, but the severity of the reaction may be minimized with prompt recognition and early withdrawal of the agent. Ongoing therapy of the underlying depressive disorder should be provided using psychological or safe pharmacological methods 3Copyright © 2012. World Psychiatric Association

4. ETIOLOGY OF DEPRESSION IN RENAL DISEASE: Metabolic changes, including sedative accumulation Other drug-induced metabolic disturbances, Psychosocial aspects of chronic renal failure, such as restrictions imposed by the need for lifelong dialysis. Stressful life events and dependence on family or others for help Electrolyte disturbances involving sodium, potassium, calcium, chloride, phosphate, and acid-base balance. Related to treatment – steroids, immunosuppressants, dialysis, or transplantation 4Copyright © 2012. World Psychiatric Association

5. Depression can present with chronic pain Chronic pain can cause depression Aches and pains may be symptoms of Depression Chronic pain may be a variant of depression Depression can worsen chronic pain 5Copyright © 2012. World Psychiatric Association Inter relationship between Chronic Pain & Depression

6. Appropriate use of antidepressants Explaining the relationship between pain and depression Reattribution of pain to mood and depression Rehabilitation and Living with pain 6Copyright © 2012. World Psychiatric Association Psychiatric Management of Chronic pain & Depression

7. Use of Antidepressants for Chronic Pain 1.Elevation of Mood 2.Reduction of Anxiety 3.Potentiation Of Analgesics 4.Primary Analgesic Effect 5.Relief From Non-Organic Causes of pain 6.Reduces psychological symptoms as restlessness, agitation, sleep disturbance 7Copyright © 2012. World Psychiatric Association