Major depressive disorder
Introduction
Major depressive disorder is a mood disorder characterised by at least 2 weeks of depressed mood and/or diminished interest and pleasure in activities. It is associated with impairment in level of functioning in different areas including social and occupational.
Risk Factors
Signs and symptoms
Psychological symptoms
• Depressed mood
• Feeling of worthlessness
• Guilt
• Diminished concentration
• Thoughts of death and suicide
Somatic symptoms
• Change in appetite
• Sleep disturbances
• Agitation
• Retardation
• Loss of energy
Diagnostic criteria
Psychological symptoms
• Depressed mood
• Feeling of worthlessness
• Guilt
• Diminished concentration
• Thoughts of death and suicide
Somatic symptoms
• Change in appetite
• Sleep disturbances
• Agitation
• Retardation
• Loss of energy
Investigations
Managemet
-
Non-pharmacological
- Effective psychotherapies include:
• Cognitive Behavioural Therapy
• Interpersonal psychotherapy
• Stress management / coping skills
• Marital and family issues
-
Pharmacological
- Adults:
• Amitriptyline (PO) 50–75 mg daily at night, increase gradually to a maximum of 150 mg daily.
Elderly:
• Initially 25–50 mg. Max. 75mg
OR
• Fluoxetine (PO) 20mg daily (preferably in the morning), may increase up to 60mg/day)
OR
• Fluvoxamine (PO) initially 50–100mg daily
OR
• Citalopram (PO) 20mg daily in the morning or evening increase if necessary to a maximum of 60mg daily (Elderly maximum 40mg daily)
Prevention
Updated on,
20 Novemba 2020, 18:02:48
References
- 1. STG