Depression Lecture Notes PDF

D E P R E S S I ON  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors...

D E P R E S S I ON  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  Depression is a brain disorder characterized by persistent low Definition mood and disinterest in things normally enjoyed that affect one’s life. Pathophysiology Theory: reduced level of serotonin and noradrenaline.  Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It's believed that several of these forces interact to bring on depression.  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  Core symptoms: Common symptoms: Persistent sadness or low poor concentration mood feelings of excessive guilt or low self- Marked loss of interest worth Symptoms or pleasure in activities, hopelessness about the future even for activities that thoughts about dying or suicide you normally enjoy disrupted sleep changes in appetite or weight feeling very tired or low in energy Full psychiatric assessment by psychiatrist Diagnosis Diagnostic and Statistical Manual of Mental Disorders fifth version (DSM-5) International Classification of Diseases, eleventh revision (ICD- 11)  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  Stressful events loneliness, personality(lowself alcohol & drugs, esteem/overly self criticism) chronic illness (heart Risk factors genetics diseases, cancer, loss of giving birth (hormonal) libido, other mental health illness etc.) Excess/Lose weight Family conflicts Pain/physical illness Suicide attempts Complications Alcohol/Drug misuse cognitive behavioural therapy Non- interpersonal therapy pharmacological problem-solving therapy treatment behavioural therapy internet-based cognitive behavioural therapy  (CBT): Focuses on identifying and challenging negative thought patterns and behaviors, aiming to change them to improve emotional regulation and coping strategies. (IPT): Aims to improve interpersonal relationships and social functioning to help reduce emotional distress, often focusing on role transitions, grief, or disputes. (PST): Helps individuals develop effective coping strategies to solve the problems contributing to their psychological distress, focusing on practical solutions. Behavioural Therapy: Focuses on changing unhealthy or maladaptive behaviors through techniques like reinforcement and exposure, often used for anxiety and phobias. (iCBT): Provides the same principles of CBT through online platforms, making it accessible and flexible for users who cannot attend in-person sessions.  Even with the help of medications that balance specific neurotransmitters in the brain, depression is a highly complex condition to treat. What proves to be an effective treatment for one person with depression may not work for someone else  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  TCA Atypical MAOi Antidepressants Classification SNRI SSRI MOA – Tricyclic Antidepressants TCA block serotonin & noradrenaline reuptake transporters. TCA also block muscarinic, adrenergic, histamine receptors (side effects) More serotonin & noradrenaline available to generate signal to elevate mood MOA – Monoamine Oxidase Inhibitor MAO degrade serotonin & noradrenaline. MAOi inhibit MAO. More serotonin & noradrenaline available to generate signal to elevate mood MOA – Selective Serotonin Reuptake Inhibitor SSRI block serotonin reuptake transporter More serotonin available to generate signal to elevate mood MOA – Serotonin Noradrenaline Reuptake Inhibitor SNRI block serotonin and noradrenaline reuptake transporter More serotonin/noradrenaline available to generate signal to elevate mood MOA – Atypical Antidepressants Each with different mechanisms depending on individual drugs  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants  TCA MAOi SSRI SNRI Atypical Side decreased alertness, headaches, nausea, sexual problems, Specific to effects tooth decay, diabetes, gastrointestinal bleeding, drug serotonin syndrome, suicidal feelings (esp in younger pt) Nortriptyline Citalopram Venlafaxine Agomelatine Examples Amitriptyline Escitalopram Desvenlafaxine Mirtazapine Clomipramine Phenelzine Fluoxetine Duloxetine Lithium Dothiepin HCl Paroxetine Sertraline Fluvoxamine Bold: Available in KKM formulary  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of depression 2. List the core and common symptoms of depression as well as its diagnosis 3. State the common types of depression 4. Identify the risk factors, complications and non-pharmacological treatment of depression 5. Differentiate the drugs used for depression (classifications, mechanism of actions) 6. List the side-effects, generic and trade names of antidepressants 7. Understand the general information regarding antidepressants General Information Antidepressants are not magic pills! The main goal of antidepressants is to help people with depression feel emotionally stable again and help them to follow a normal daily routine. TCA are also commonly used for neuropathic pain e.g. Amitriptyline, Nortriptyline Drugs interaction SSRI and SNRI – They impair platelet aggregation, bleeding risk ^ when use with aspirin, warfarin, DOACs, NSAIDs General Information Antidepressants generally take 4 - 6 weeks to give full effect: Inhibition of serotonin reuptake transporter initially decrease serotonin level due to activation of serotonin auto receptor that gives negative feedback After some time, the drugs then reduce the number of serotonin auto receptor so more serotonin available to generate signal and elevate symptoms < 4-6 weeks > 4-6 weeks General Information TCA MAOi SSRI SNRI Atypical History of High manic phase, History of Specific to heart tyramine bleeding heart drug diseases, liver food may disorder, diseases, Cautions disease cause Diabetes, uncontrolled hypertensive kidney HPT crisis disease  General Information When to start: Moderate to severe depression, start low, move slow When to stop: Use at least 6 months after symptoms have eased. Stop slowly and gradually to avoid antidepressant discontinuation syndrome esp if have used more than 6w (dizziness, anxiety, agitation, sleep disturbance, flu-like symptoms) – applicable to SSRI and SNRI When to change/^dose: Wait at least 4 weeks. Increasing the dose before 4 weeks will only increase the side effects. Need to wait for antidepressants to give their full effect. applicable to SSRI and SNRI  General Information Serotonin syndrome Life threatening condition associated with increased serotonin level due to overdose or concurrent use of antidepressants (more than two). Symptoms: high fever, seizure, uneven heartbeat (applicable to SSRI and SNRI) Pregnancy/Breastfeeding Not recommended for most pregnant women, especially during the early stages of a pregnancy (Paroxetine can be considered in later pregnancy and breastfeeding) Adherence Educate patients about the importance of adherence to therapy, even if they don’t feel immediate benefits.  For your info only MDD Clinical Practice Guideline 2019