Depression - Symptoms, Causes, and Treatment - NEET PG Psychiatry
Feb 09, 2023
Depression is considered an important topic for NEET PG exam preparation because it is a prevalent mental health disorder and requires a comprehensive understanding for the effective management and treatment of patients. Furthermore, topics related to depression, such as pharmacotherapy and psychotherapy, are commonly tested in the NEET PG exam.
According to NMHS depression is the most common psychiatric disorder in India. Most common psychiatric disorder in the world is Anxiety disorder.
Female: Male= 2:1 (Multiple factor: Biological or Social)
Mean age of onset: Middle age
Most common cause of DALYs amongst all psychiatric disorders (Disability Adjusted Life Years)
Listed below are the primary symptoms of depression:
S - Sadness of mood/Depressed mood (Persistent and Pervasive)
I - Interest (Loss)/Loss of pleasure (Anhedonia)
G - Guilt/Feeling of worthlessness
E - Energy (Loss)/Fatigue
C - Concentration (loss)
P - Psychomotor agitation/retardation
A - Appetite (Loss) with weight changes
S - Suicidal thought
S - Sleep disturbances (Decreased/Increased) - Early morning insomnia is specific for depression - waking early and time shifts up to 2 hours before.
If symptoms are present for > 2 weeks, diagnosis of depression is made.
Significant weight gain/loss
If there is a change in weight of > 5% in one month
Specific symptoms with depression: Specifiers
Delusions/Hallucinations: If present along with depression, then in management antipsychotics are added
Reversed biological feature (increased appetite, weight and sleep)
Mood Reactivity present (Mood improves with positive events)
Leaden paralysis: Subjective feeling of heaviness of limbs
Extreme sensitivity To Interpersonal Rejection.
Sensitivity to even slight things
E.g.: Person feels disturbed if someone rejects him or criticize him.
Patient with atypical depression respond better to SSRIs, and MAOIs better than TCAs.
Melancholic features (Involutional melancholia)
Significant biological symptoms (significant anorexia, weight loss, early morning awakening)
Lack of mood reactivity and Anhedonia
Depression worse in morning, distinct quality of mood (feeling of misery)
Excessive guilt and marked psychomotor aviation and retardation
There are higher chances of developing psychotic features and possibility of suicide attempts and completed suicides are more in melancholic depression.
ECG: Prolonged PR, QRS and QT interval, right axis deviation
Use I.V. sodium bicarbonate (if QRS more than 100 milliseconds)
SSRI Side Effects
GI side effects (Most common)
Sexual dysfunction (Most common long-term effect)
Loss of libido
T/t of premature ejaculation- give SSRIs
To avoid sexual dysfunction give other antidepressants like Mirtazapine, Bupropion
Sweating, vivid dreams (Dreams in the night and don’t feel fresh in the morning)
Discontinuation symptoms of antidepressants.
M/C associated with venlafaxine (SNRI), short acting SSRIs (paroxetine, fluvoxamine)
Flu like symptoms, nausea, agitation, anxiety and insomnia
Tapering of antidepressants is to be done before discontinuation, never be abruptly stopped.
Immediately starts working
Depression with suicide risk
Depression with stupor
Cognitive behavioral therapy (psychotherapy)
Try to fix the negative thoughts
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