| Introduction
Depression is one of the common problems in clinical practice, which causes social , occupational, financial and interpersonal difficulties.
- Epidemiology of depression :
- Clinic-based studies on depression in India have noted rates
of 6% to 35%.
- Depression is more common in women then in men, at a ratio
of approximately 2 to 1.
- Although there are indications that the incidence of
depression is highest at middle age, it occurs at all ages.
- There are indications of higher rates of depression in North
India compared to South India.
- Risk factors for depression are :
- Persons within the age group 35-55 years
- Females; more common in females of lower socio-economic back-ground
- Persons engaged in business
- Males living in joint families
- Causes of depression.
No single factor can possibly explain the complex human experience of depression. The various factors identified to be involved are:
- Genetic factors -- hereditary factors predispose some individuals to the development of depression
- Enviornmental factors
- Life events
- Other factors such as biological reaction of an individual
- Clinical features of depression :
Sadness of mood is likely to be the key symptom of depression; when severe may be accompanied by a desire to weep or by crying spells.
- Inability to enjoy or drive pleasure from usual activities which gave pleasure earlier
- Lack of interest in day to day activities
- Bad thoughts about self, family and also about future
- Self blame, self-criticism and guilt
- Clinical assessment of depression.
This can include :
- Symptomatic assessment
- Physical examination
- Social assessment
- Screening for depression
- Types of depression :
- Primary depressions are those which arise in and of themselves.
- Secondary depressions follow in the train of some other illness or event.
- Other classifications are endogenous or reactive and psychotic or neurotic.
- Symptomatic depressive disorders often occur in people who are unaware that they are physically ill.
- Mood disorders should be suspected of being symptomatic of an underlying physical illness in certain circumstances.
- Depression due to illness, viz. endocrine disorders, cancer, collagen disease is also fairly common.
- Drug treatment of depression :
- Choice of antidepressant requires a thorough evaluation of patient and his depressive disorder
- Tricyclic anti-depressants for adult be given preferably in a single dose
- Starting daily dose of 50-750 mg and dose can be increased to 100-150 mg daily after a week
- A single bed-time (late evening 7-8 pm) dosage is advantageous.
- Explain to family members and patients that most side effects would wear off in due course of time.
|
