|
REVIEW OF LITRATURE:
INTRODUCTION
Depression
is characterized by persistent sadness and a lack of interest or pleasure in
previously rewarding or enjoyable activities. (5)
Globally,
the total number of people with depression was estimated to exceed 300
million in 2015, equivalent to 4.3% of the world’s population. (1)
The National Mental Health Survey of India (NMHS), 2015-16 has
reported that India is home to an estimated 57 million people suffering from
depression which is 18% of the global estimate. Nearly 15% Indian adults need
active intervention for one or more mental health issues and one in 20
Indians suffers from depression. (6)
There
are more prevalence of depression in people younger than 45 years of age. (7)
CLINICAL PRESENTATION :
A
depressed mood and a loss of interest or pleasure are the key symptoms of
depression. Patients may say that they feel blue, hopeless, in the dumps, or
worthless.
The
most typical somatic symptoms of depression are called the neurovegetative
symptoms of depression and typically include a variety of physical symptoms.
Decreased energy, tiredness, and fatigue are common.
Many
individuals report impaired ability to think, concentrate, or make even minor
decisions. (8) They may appear
easily distracted or complain of memory difficulties. Thoughts of death,
suicidal ideation, or suicide attempts
are common. Psychomotor agitation may occur, including such
behaviours as hand wringing and hair pulling. Many depressed patients have a
decreased rate and volume of speech; they respond to questions with single
words and exhibit delayed responses to questions. (8)
TYPES OF DEPRESSIVE DISORDERS:
· Major Depressive Disorder:
The
primary features of major depressive disorder is the occurrence of at least
one episode of major depression, which is significant depressive symptoms
that last for significant time (>2weeks)
Diagnostic criteria of MDD is given in DSM-5.
Common Symptoms of major
depressive disorder is following (8)
- Dysphoria
or feeling depressed
- Anhedonia
- Increased
or decreased weight or appetite
- Increase
or decrease sleep
- Increase
or decrease activity
- Decreased
energy
- Depressing
thoughts: worthlessness, guilt
- Decreased
concentration
- Suicidal
ideation/plan
Major
depressive disorder may presented with psychotic symptoms, with melancholic
symptoms, with Atypical features with catatonic features.
· Dysthymic disorder:
Dysthymia
is not severe than a major depressive disorder, it is often more chronic. The
most typical feature of dysthymia, also known as persistent depressive
disorder, is the presence of a depressed mood that lasts most of the day and
is present almost continuously. There are associated feelings of inadequacy,
guilt, irritability, and anger; withdrawal from society; loss of interest;
and inactivity and lack of productivity.
Other
Diagnoses:
· Minor Depressive Disorder.
Minor depressive disorder consists of episodes of depressive symptoms that
are less severe than those seen in major depressive disorder. The difference
between dysthymia and minor depressive disorder is primarily the episodic
nature of the symptoms in the latter.
· Recurrent Brief Depressive Disorder:
Recurrent brief depressive disorder consists of brief periods (less than 2
weeks) during which depressive episodes are present.
· Double Depression: An
estimated 40% of patients with major depressive disorder also meet the
criteria for dysthymia, a combination often referred to as a double
depression.
o Neurotransmitter
Deficits Are Involved. (5)
Norepinephrine
Serotonin
Dopamine
Acetylcholine
Stress is usually defined as a state of
disturbed homeostasis inducing somatic and mental adaptive reactions,
globally defined as “stress response,†aiming to reconstitute the initial
homeostasis or a new level of homeostasis after successful adaptation, i.e.,
allostasis. There is wide consensus and support from preclinical and clinical
data that stress exposure conceivably plays a causal role in the etiology of
MD and depression-like disorders. (9)
o Objective
Rating Scales for Depression:
Clinician
Administered Scales: The Hamilton Rating Scale
Self-Administered
Scales: The Zung Self-Rating Depression Scale.
DIFFERENTIAL
DIAGNOSIS
Schizophrenia
Manic episode with irritable mood or mixed
features
Uncomplicated bereavement
Bipolar disorder
Substance use disorder
THE PSYCHOLOGY OF DEPRESSION
Stress
and Depression : Some clinicians believe that life events play the primary or
principal role in depression; others suggest that life events have only a
limited role in the onset and timing of depression. (5)
If
stressors are maintained, long-term emotional effect occur which leads to
emotional disorders like chronic depression and anxiety, phobias, personality
changes, and other mental illness which causes decreased productivity,
decreased enjoyment and decreased intimacy. (10)
Relationship between stress and depression
is to focus not on specific life events, per se, but rather on the effects of
chronic stress. Studies in this genre are few, but those that do exist tend
to support a relationship between chronic stress and the propensity for major
depression. (10)
HOMOEOPATHIC APPROACH
Mental diseases of
Psychosomatic type (§225): Mental diseases that arise as a result of prolonged
emotional disturbances and different psychological depressions like continued
anxiety, worry, vexation, wrongs and frequent occurrence of greater fear and
fright. Such diseases may be of recent origin and may not have developed
fully into corporeal diseases. But if left untreated they may damage the
body. (4)
According to aphorism 215-216 Hahnemann
considers mental disease as one sided diseases of the chronic type affecting
the whole psychosomatic entity.
Common suitable homeopathic drugs for
depression: (11)
Avena sativa
Causticum
Cimicifuga racemosa
Ignatia
Kali phosphoricum
Natrum muriaticum
Pulsatilla
Sepia
Aurum metallicum
|