Depressive disorders

Depression and mania are both disorders of mood. They are also known as affective disorders. Sometimes both can be found in the same patient at different times. If this happens, then the condition is known as Bipolar mood disorder or Bipolar affective disorder. A few years ago, manic depressive psychosis was the term commonly used.

Frequency:
Depression is one of the commonest psychiatric disorders. Atleast 10% of people experience a depressive episode each year.

Epidemiology:
Age: Can occur at any age
Sex: Depression: twice as common in females as in males
Mania affects both sexes equally.
Marital status: Males-married have lower rates of depression than the single, widowed or divorced, but young married women have high rates
Social class: High among working classes. Creative people such as writers, artists, poets and musicians have more bipolar disorders than other people.
It is found to be more common in urban populations than rural populations.

What causes depression?
Genetics: 10-20% of the first degree relatives of the patients are affected

Neurochemistry: Imbalance of brain chemicals that are used for communication among brain cells can lead to depressive disorders.

Social stress: “Life events” more common in depressed patients, especially loss events, and particularly during the few months preceding the illness.
Chronic social difficulties, lack of confiding relationships and absence of a supportive social network are important mediating factors.

“Learned helplessness” model of depression states that it results from repeated failure to overcome problems by personal effort.

“Cognitive” model by Beck states that depressed mood may result from a habit of interpreting all events in a negative way, and drawing unjustifiably pessimistic and generalised conclusions from minor setbacks ( I can never get it right, and hence I am good for nothing; I don’t look smart so nobody likes me type of comments)

Clinical features:
Feelings of low moods, misery, anxiety, guilt, pessimism, hopelessness, helplessness are very common.
Irritability and hostility are seen.
Impairment in energy, interest, enjoyment, concentration, efficiency and a reduced sexual drive are noted.
In retarded depression patients are mentally and physically slowed down.
In agitated depression patients are anxious and overactive, irritable and short tempered.
Suicide is always a risk, as sometimes patients feel that they are never going to get better, that they have brought shame on the family and that the only way out is to attempt or even complete suicide.
Some patients may develop delusions with depressive thought content and may have paranoid, nihilistic or hypochondriacal themes.
Hallucinations may sometimes be noted consisting usually of voices, criticising the patients or suggesting suicide.

Physical symptoms:
Early morning wakening (some people actually sleep more but are still not refreshed)
Diurnal variations of mood (usually worse in the morning and gradually better by evening
Appetite is reduced (few actually eat more)
Constipation
Impotence (or lack of or reduced sex drive)
Various body pains

Are there any warning signs to predict depression?
It is hard to predict an altogether new episode of depression in a preiously well person. However, a relapse (or a recurrence of illness) may be predicted. There are certains signs (sometimes known as Relapse signatures) which can predict the same. Click here to read more about early warning signs of depression.

MANIA

Mood may swing rapidly between cheerfulness, irritability or aggression. Increased energy with overactivity, disinhibition, and distractibility are seen, along with reduced need for food and sleep. Increased sexual interest and financial extravagance is common. Thought and speech are copious often with rapid loose connection between one topic and another.
Grandiosity is a common feature.

Hypomania is considered to be a milder form of mania without delusions and hallucinations.

Treatment of depression

Pharmacological or Drug treatment:
Antidepressant drugs form the base of treatment in depressive disorders. Some of them are:
TCAs, which include Amitriptyline, Imipramine etc
SSRIs, which include Fluoxetine (Prozac), Citalopram (Citara) etc.

Physical treatment:
ECT
VNS
TMS

Psychological methods:
CBT or cognitive behaviour therapy
IPT or interpersonal therapy

Treatment of mania
Hospitalisation
Antipsychotics
Mood stabilisers

Prognosis:
70-90% of episodes of depression recover within a few months even without treatment.
Even if the first episode is recovered most patients become ill at regular intervals.
10-15% die by suicide.

Are there any warning signs to predict mania?
It is hard to predict an altogether new episode of mania in a preiously well person. However, a relapse (or a recurrence of illness) may be predicted. There are certains signs (sometimes known as Relapse signatures) which can predict the same. Click here to read more about early warning signs of mania.

Further information:
Further information on depression is available from some of these websites:

Personal Tale

All about Depression

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Treatment of Depression

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