DEPRESSION DISEASE

Represented by:

Anisyah Achmad, S.Si., Apt., Sp.FRS

Department of Clinical Pharmacy
Brawijaya University

Dr. Sarma R V S N
Consultant Physician
visit: www.drsarma.in

http://www.hcc.bcu.ac.uk/craig_jackson/
psychopharmacology%20and%20serotonin.ppt
 What is Depression?
A Continuum
Normal Mood Lowering

Abnormal Mood Lowering

Abnormal mood lowering and loss of function

Association of Psychiatric
Disorders
ETIOLOGY

Depression more common in those with:

Life threatened / limited / chronic physical

illness

Unpleasant / demanding treatment

Low social support

Adverse social circumstances

Personal / family history of depression /

psychological vulnerability

Substance misuse

Anti-hypertensive / Corticosteroid /
Chemotherapy use
Depressive Illness
Usually treatable

Common
Marked disability
Reduced survival
Increased costs

Depression may be
Coincidental association
Complication of physical illness
Cause of / Exacerbation of somatic symptoms
Major depression (DSM IV-TR)
5 or more..
decreased interest / pleasure *
depressed mood *
reduced energy
weight gain / loss
insomnia / hypersomnia
feeling worthless
guilt
recurrent morbid thought
psychomotor changes
fatigue
poor concentration
pessimism / bleak views
self harm ideas / actions
suicide ideation
Somatization Syndrome (DSM IV)
4 or more..
Anhedonia (inability experience pleasure)

Loss of emotional reactivity

Early waking (>2 hours early)

Psychomotor retardation or agitation

Marked loss of appetite

Weight loss >5% of body mass in one month

Loss of libido (important and often ignored)

 Explanations

Anti-depressants are
not addictive or habit
forming.
Anti-depressants take
2-3 weeks to begin to
work and need to be
taken for 4-6 months
after the full benefit is
obtained to prevent
relapse.
 Explanations

Depression benefits
from both drug and
non-drug
approaches.
Pills for symptoms.
Talking for
problems.
 What Is Depression? - Various Criteria.
ICD 10 Mild.
Patient has low mood: Two criteria from 1-3 and 2 others.
Moderate.
1) How bad is it and how long has it been Two criteria from 1-3 and 3-4 others
going on? or a yes to question 5.
2) Have you lost interest in things? Severe.
3) Are you more tired than usual? Most of the criteria in severe form
especially questions 5 & 9.
If the answer is yes to these, then:
4) Have you lost confidence in yourself?
5) Do you feel guilty about things?
6) Concentration difficulties?
7) Sleeping problems?
8) Change in appetite or weight?
9) Do you feel that life is not worth living
any more?
 Pathophysiologic

Depression is thought
To be connected with decreased(relative
orab-solute) availability of norepinephrine
and/or serotonin in the brain
Drug Treatment
Selective Serotonin Re-uptake Inhibitors (SSRIs) - Newer
Sertraline lack sedation - no anticholinergic effects
improved compliance favourable on glucose metabolism
Platelet SSRI Decreased and favourable of CHD
patients
Remission Prolonged remission with Sertraline
safe in overdose single or narrow range of doses works
Dual Norepinephrine and Serotonin Re-uptake Inhibitors (SSRIs)
Newer
Similar in action and benefits as SSRIs but also inhibit the
noradrenaline pathways
Problem in hypertensive patients
Cognitive Behavioural Therapy - CBT
Electroconvulsive Threrapy - ECT
Antidepressant
Antidepressant: TCA
(Imipramine)
block the amines (NE and 5-HT) a
nondepressed person experiences
MoA sleeping. In the depressed patient,
an elevation of mood occurs 2-3
weeks after administration begins

Treatment of severe endogenous

depression (characterized by
regression and inactivity).
Therapeutic Treatment of enuresis.
uses Treatment of obsessive-compulsive
neurosis accompanied by depression,
and phobic-anxiety syndromes,
chronic pain and neuralgia

blurred vision, dry mouth,

ADR
constipation, urinary retention
Antidepressant: SSRI
(Fluoxetine)
Antidepressant: SNRIs (Venlafaxine &
Duloxetine)
SNRIs treat cases of depression which are resistant to
SSRIs.

Treat depression accompanied neuropathic pain.

No activity at adrenergic, muscarinic, or histamine

receptors fewer adverse effects than TCA.

Duloxetine is contraindicated in hepatic insufficiency &

end-stage renal disease.
 Antidepressant: Atypical
Antidepressants
Bupropion:

Nefazodone & trazodone:

Mirtazapine:
It inhibits It blocks They are weak
noradrenaline presynaptic serotonin re-
and dopamine alpha2- uptake
reuptake. receptors inhibitors.
It decreases increases NA & They block
craving for serotonin. postsynaptic 5-
nicotine in It also blocks HT2 receptors.
tobacco 5HT2 receptors Both agents
abusers. It may cause block H1-
S/E: dry mouth, sedation & receptor
sweating, weight gain sedation
tremor, and
seizures at high
doses
Management
The main aims of treatment:
improve mood and quality of life
reduce the risk of medical complications
improve compliance with and outcome of
physical treatment
facilitate the "appropriate" use of healthcare
resources

Primary care staff should be familiar with

properties and use of:
1) common antidepressant drugs & brief
psychological treatments
2) assessment of suicidal thinking and risk
 Explanations

Anti-depressants are
not addictive or habit
forming.
Anti-depressants take
2-3 weeks to begin to
work and need to be
taken for 4-6 months
after the full benefit is
obtained to prevent
relapse.
Explanations

Side effects occur and

are expected explain.
Drugs enable talking
therapy to work better.
Regular review is
important and needs to
continue for at least 6
months.
THANK YOU