Typical Features of Depression
i. Mood: Persistent low mood or sadness.
ii. Energy Levels: Marked lack of energy and fatigue.
iii. Loss of Interest: Reduced interest or pleasure in daily activities and hobbies.
iv. Sleep Disturbance: Insomnia, often characterized by difficulty falling or staying asleep.
v. Appetite and Weight Changes: Anorexia (loss of appetite) leading to weight loss.
vi. Concentration: Difficulty focusing or making decisions.
vii. Behaviour: Avoidance of eye contact and social withdrawal.
These features collectively describe typical depression, often experienced as low mood, reduced activity levels, and insomnia.
Atypical Depression
i. Sleep: Sleeps more than usual (hypersomnia).
ii. Appetite: Increased appetite with potential weight gain.
iii. Mood Reactivity: Mood may temporarily improve in response to positive events.
Management of Depression
i. First-Line Management:
Psychotherapy:
i. Cognitive Behavioural Therapy (CBT):
ii. Focus: Aims to change negative patterns of thinking, emotions, and behaviours.
iii. Approach: More directive and structured.
Counselling
i. Focus: Involves active listening, empathy, and encouragement.
ii. Approach: Less directive, more supportive.
iii. Referral Pathway: Start with CBT; if there’s no improvement, refer to counselling.
Pharmacological Treatment
i. Selective Serotonin Reuptake Inhibitors (SSRIs):
ii. Common SSRIs: Fluoxetine, Sertraline, Citalopram.
iii. Onset of Action: Takes 2-4 weeks to show effect.
Steps in Medication Management
Start with SSRIs.
i. If no response after 2-4 weeks, verify medication adherence.
ii. If adherent but still no response, either increase the SSRI dose or switch to another SSRI.
iii. Consider switching to a different class of antidepressants, such as Mirtazapine (a tetracyclic antidepressant) if SSRIs are ineffective.
Important Considerations
i. Warfarin Interaction: Mirtazapine is preferred over SSRIs due to a lower risk of gastrointestinal bleeding.
ii. Cardiac History: In patients with a history of myocardial infarction (MI), first-line SSRIs include Sertraline, followed by Citalopram.
iii. Breastfeeding: Sertraline is the preferred SSRI.
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