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Depression - Symptoms, Causes, and Treatment - NEET PG Psychiatry

Feb 09, 2023

Depression - Symptoms, Causes, and Treatment - Medical PG Psychiatry

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.

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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: 

  • Mnemonic: SIGECAPSS
    • 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.

Important information

Significant weight gain/loss

If there is a change in weight of > 5% in one month

Specific symptoms with depression: Specifiers

  • Psychotic features
    • Delusions/Hallucinations: If present along with depression, then in management antipsychotics are added
  • Atypical features
    • 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.
  • Important Information
    • 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
  • Important Information
  • There are higher chances of developing psychotic features and possibility of suicide attempts and completed suicides are more in melancholic depression.

Also Read: Narcissistic Personality Disorder: Causes, Symptoms, Diagnosis, Treatment, Prevention and Complications

Etiology of depression

  1. Neurotransmitter disturbances
    • Serotonin deficiency 
    • Serotonin, Norepinephrine and dopamine deficiency
  2. Psychological theory (Cognitive theory)
    • Given by Aaron Beck: i.e. negative thought in depression sustains the depression itself.

Beck’s cognitive Triad

  • Negative view of self (Ideas of worthlessness)
  • Negative view of environment (Ideas of helplessness)
  • Negative view of future (Ideas of hopelessness) - this is more important because it is associated with increased risk of suicide.


Treatment of depression is as follows: 


  • SSRIs, SNRIs, TCAs, MAOIs, Atypical antidepressants.
  • The first antidepressants and M/C used antidepressants are SSRI (Escitalopram) because side effect profile of SSRI is better as compared to other antidepressants
  • Antidepressants are chosen on the basis of side effect profile
Important information 

SSRIs: Selective Serotonin Reuptake Inhibitors 

SNRIs: Serotonin Norepinephrine Reuptake Inhibitors

TCAs: Tricyclic Antidepressants

MAOIs: Monoamine Oxidase Inhibitors

TCA toxicity

  1. Problem with TCAs
    • Side effect: Anticholinergic action, antiadrenergic action, antihistamine action 
      • Avoided in certain disease like Angle closure glaucoma
    • Safety: If excessive, leads to Toxicity
  2. Action of TCAs: It blocks sodium channels
  3. TCA toxicity
    • Hypotension, tachycardia, altered sensorium, respiratory depression & seizures (CVS and CNS manifestation)  
    • Dry mouth, blurred vision (Anticholinergic action) 
    • Metabolic acidosis (Due to hypoxia)
    • 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
    • Erectile dysfunction
    • Delayed ejaculation
      • 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)
  • Weight gain
  • Discontinuation symptoms of antidepressants.
  • M/C associated with venlafaxine (SNRI), short acting SSRIs (paroxetine, fluvoxamine)
  • Flu like symptoms, nausea, agitation, anxiety and insomnia
  • Important Information
  • Tapering of antidepressants is to be done before discontinuation, never be abruptly stopped.
  • Electroconvulsive therapy 
    • Immediately starts working
      • Depression with suicide risk
      • Depression with stupor 
  1. Cognitive behavioral therapy (psychotherapy)
    • Try to fix the negative thoughts

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