Depression

Introduction

A depressive person experiences sadness of varying degree. Definite disturbance of physiological functions like very poor appetite, disturbed sleep, extreme dryness of mouth, loss of libido and diurnal variation of mood are important diagnostic features. There may be multiple bodily symptoms and at times somatic symptoms may be the only presenting feature. The patient may do considerable doctor–shopping, undergoing a series of investigations in search of causes without any relief. Some of the depressives may be severely retarded. Depressive pose high-risk of suicides and some are severely agitated.

Treatment

• SSRI Citanew(Citalopram)10mg PO OD, Fluoxetine, Sertraline) are the mainstay of treatment due to their better side effect profile. To a large extent, these have replaced the tricyclic antidepressants.
• By and large all the tricyclic antidepressants have anticholinergic side effects and hence not desirable in the elderly.
• ECT: The definite indication for ECT is in depression with high suicidal risk. In stupors also ECT can be lifesaving. Ever so many misconceptions prevail regarding ECT even among the professionals. ECT when used with caution and care in right setting is an extremely helpful tool in the armamentarium of Psychiatrists.

Mild Depressive Disorder

May present with symptoms of major depressive disorder of lesser severity. In addition, there may be other symptoms which are less prominent as in MDP depression. These symptoms have been characterized as “neurotic” and they include anxiety, phobias, obsessional symptoms, etc. Some patients may present with varieties of somatic symptoms, these are very common in general practice. The treatment consists essentially of counselling, reassurance and anxiolytics, if the anxiety is severe. Give antidepressants if the depressive symptoms predominate.