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Depression or ‘mood disorder’ or Major Depression encompass a large group of psychiatric disorders in which pathological mood and mood-related disturbances dominate the clinical picture. The mood can be affected by bipolar disorder (elated or depressed) or unipolar depression (depressed). The depressed mood in major depressive disorders is persistent for at least 15 days for the diagnosis of depression.
MDD is a common disorder with a lifetime prevalence of 15 % ( 25% in the female population) i.e. the female population is affected more as compared to males. Hormonal differences, psychosocial stress are factors for such high incidence among the female population. Social economic, cultural, marital status are also considered as some important epidemiological factors.
Abnormalities in biogenic amines metabolites, neurotransmitters like norepinephrine and serotonin are implicated in the pathophysiology of depression.
Diagnostic criteria for Major depression / Signs and Symptoms
(1) persistent depressed mood, most of the day, nearly every day; can be subjective (noticed by the patient) or can be objective (observed by family members. In children and adolescent, the mood can be irritable.
(2) loss of interest and pleasure. Markedly diminished interest in pleasure in all, or almost all activities throughout the day.
(3) Significant weight loss or weight gain (change of more than 5% of body weight in a month) or change in appetite (either increase or decrease).
(4) excess sleep (hypersomnia) or no sleep (insomnia).
(5) Increased or decreased body activity (psychomotor agitation or retardation)
(6) fatigue or loss of energy
(7) feeling of worthlessness, excessive or inappropriate guilt
(8) Inability to think and concentrate properly or indecisiveness.
(9) Recurrent thoughts of death, recurrent suicidal ideation.
The diagnosis of depression is based on clinical presentation, psychiatry history, psychiatric interview and examination. Sometimes psychological tests and different diagnostic scales are used for diagnosis.
Another variant of illness like the manic or hypomanic episode, major depression single episode or mixed episode has to be differentiated from MDD. There are other varieties of a severe form of depression like psychotic depression, mood-congruent and mood-incongruent and one with partial remission. Major depressive disorder with catatonic features, melancholic features, atypical features, the postpartum onset is further subtypes of MDD, single episode. Seasonal pattern of depression i.e. depressive episode during a particular season, most commonly winter is also seen in some patients.
Risk of Suicide –
Approximately two- thirds of all depressed patients contemplate suicide, and 10 to 15 per cent commit suicide. Those who have a recent attempt or hospitalized patient who have suicidal ideation have a higher risk of suicide. Withdrawal from family, friends and activities, reduced energy, impaired work performance, lack of motivation are some of the symptoms to identify suicidal behaviour.
Anxiety, Alcohol dependence, other substance-related disorder (addiction), medical complications are also associated with depressive episodes.
Course and prognosis –
The depressive disorder tends to have long courses and frequent relapses. Therefore they require proper care and treatment by a trained psychiatrist. Early identification and treatment of early symptoms may prevent the development of a full-blown depressive episode.
The treatment plan for depressive disorder is directed towards several goals. Patient’s safety, complete psychiatric evaluation, designing of the appropriate treatment plan are the three main important strategies for a better outcome. Hospitalisation for severely depressed patients, psychotherapy and pharmacotherapy are effective modes of treatment.
Recently Ketamine Infusion Therapy is gaining a lot of popularity across the globe for its rapid onset of action and reversal of depressive symptomatology in as early as possible may be within 24 hours. All other treatment modality takes at least two to three weeks of time for the therapeutic effect as down-regulation of receptors in the brain requires a longer time. However, there are a lot of studies available which shows Ketamine therapy can revert back depressive mood within 24 hours. The subsequent therapy session spread over two to three weeks period can give maximum recovery to depressed patients along with judicial use of pharmacotherapy.
Thus Ketamine Infusion makes depression a safe, quick and effective treatment option.