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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
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