You are on page 1of 5

DEPRESI

ETIOLOGY AND PATHOGENESIS


Neurotransmitter and Neuroendocrine
Decreased activity of serotonin, norepinephrine, dopamine, GABA
Increased hypothalamus-pituitary axis activity Hypercortisolemia
Blunted TSH response to TRH, blunted growth hormone secretion during sleep

Disturbances of Sleep
Increase in nocturnal awakening
Reduction in total sleep time
Increased phasic rapid eye movement sleep
Increased core body temperature

Life Events and Environmental Stress


Loss of parent before the age of 11 years, poor parent-child interaction, low
paternal involvement and high maternal overprotection during childhood,
Troubled relationship with parents, siblings, and peers
Chronic pain, medical illness, increased disability and dependence
Unemployment, out of work, caregiver burden
Loneliness, bereavement, negative life events
Personality disorders : Obsessive-compulsive disorder, histrionic, borderline

Psychodynamic Factors
Disruption of caregiving relationship with primary object Feelings of
helplessness and weakness
Fails to meet their own standards due to highly critical superego Feelings of
worthlessness, guilt, and sense of having failure
Introjection of ambivalently lost objects toward the self Inner sense of guilt,
rage, pain, and loathing

Cognitive Triad Theory


1. Negative-self Schema
Negative view of the self : Helpless, worthless, inadequate
Negative view of the world : Experience the world as hostile, demanding, and
posing obstacles that cannot be handled
Negative view of the future : Totally hopeless because their worthlessness will
prevent their situation improving
2. Illogical Thought Patterns
Arbitrary inference : Drawing negative conclusion without supporting data
Spesific abstraction : Focusing on the worst aspects of any situation
Overgeneralization : If they have problem, they make it appear bigger than it
is. If they have solution, they make it smaller
Personalization : Negative events are interpreted as their fault
Dichotomous thinking : Every thought or situation breaks down to black or
white, good or bad and all or nothing

Medical Illness

Substances Abuse
GEJALA KLINIS
F32 Pedoman Diagnostik Depresi (PPDGJ III)
a. Gejala Utama
Afek depresi
Anhedonia : Kehilangan minat dan kegembiraan
Anergia : Kekurangan energi, mudah lelah, aktivitas menurun
b. Gejala Lainnya
Konsentrasi dan perhatian berkurang
Harga diri dan kepercayaan diri berkurang
Gagasan tentang rasa bersalah dan tidak berguna
Pandangan tentang masa depan yang suram dan pesimistis
Gagasan atau perbuatan membahayakan diri atau bunuh diri
Tidur terganggu
Nafsu makan berkurang
c. Gejala tersebut berlangsung selama minimal 2 minggu. Tetapi,
periode lebih pendek dapat dibenarkan jika gejala sangat berat dan
berlangsung cepat

Tingkat Gejala Utama Gejala Lain Aktivitas Sosial


Ringan 2 2 Sedikit kesulitan
Sedang 2 34 Kesulitan
Berat 3 Minimal 4 Tidak dapat melakukan

Depresi pada lansia lebih sulit dideteksi karena


Penyakit fisik sering menutupi gejala depresi, misalnya mudah lelah dan berat
badan turun
Tampak lebih aktif untuk menutupi rasa sedih
Kecemasan, histeria, dan hipokondriasis sering menutupi gejala depresi
Masalah sosial dapat memperberat depresi

TERAPI
Terapi Farmakologi
First line : SSRI Second line : Trisiklik
Mekanisme Contoh Obat
Blokade reseptor muskarinik :
Pandangan kabur, mulut
Trisiklik
Menghambat reuptake kering, retensi urine,
Amitriptilin
Imipramin katekolamine pada takikardia, konstipasi,
Klomipramin celah sinapsis glaukoma akut
Tianeptine Blokade reseptor alfa-1 :
Hipotensi ortostatik, pusing
Blokade reseptor H1 : Sedasi
Monoamine Menghambat Sedasi, hipotensi ortostatik,
oxidase inhibitor pemecahan pandangan kabur, mulut
(MAO-I) neurotransmitter oleh kering, konstipasi
Krisis hipertensi jika
Moclobemide monoamine oksidase dikonsumsi bersama makanan
yang mengandung tiramin
Disfungsi seksual,
berkeringat, tremor, berat
Selective badan naik
serotonin Gejala SSP : Nyeri kepala,
reuptake Menghambat reuptake insomnia, sedasi, mimpi buruk
inhibitor (SSRI) serotonin pada celah Gejala GIT : Mual, muntah,
Sertraline sinapsis diare, dispepsia, anoreksia
Paroxetine Sindrom serotonin :
Fluoxetine Hipertermi, hipertensi,
berkeringat, agitasi, diare,
inkoordinasi otot, koma

Indikasi Electroconvulsive Therapy


Depresi berat dengan risiko bunuh diri
Depresi berat dengan stupor, retardasi, atau gejala somatik
Depresi refractory yang parah
Terdapat efek samping antidepresan yang berat atau intoleransi terhadap obat

Psychotherapy
1. Cognitive Behavior Therapy
Correcting negative ideations and replacing them by new positive ideations and
behavioral responses
2. Interpersonal Therapy
Attempts to recognise and explore interpersonal stressors, role disputes and
transitions, social isolation, or social skills deficits
3. Psychoanalytic Therapy
Change in personality structure or character, not simply to alleviate
symptoms.
Improve interpersonal trust, capacity for intimacy, coping mechanism,
capacity to grieve, and ability to express the emotions
4. Behavior Therapy
Social skills training, problem solving, assertiveness training, self-control
therapy, activity scheduling, decision-making techniques
5. Group Therapy
Decrease intrafamilial and interpersonal difficulties and to reduce of modify
stressors