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    Depressed Diane-Case Study On Depression

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    Farhath Jabien
    This presentation is based on analysis of case study of a girl named Diane and her problem of Depression. There are few theories that explains the causes of symptoms. Various therapeutic drugs have been discussed.

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    Download as PPTX, PDF, TXT or read online from Scribd

    Depressed Diane-Case Study On Depression

    Uploaded by

    Farhath Jabien
    716 views27 pages
    This presentation is based on analysis of case study of a girl named Diane and her problem of Depression. There are few theories that explains the causes of symptoms. Various therapeutic drugs have been discussed.

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    Depressed Diane-Case Study on Depression

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    This presentation is based on analysis of case study of a girl named Diane and her problem of Depression. There are few theories that explains the causes of symptoms. Various therapeutic drugs have been discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    716 views27 pages

    Depressed Diane-Case Study On Depression

    Uploaded by

    Farhath Jabien
    This presentation is based on analysis of case study of a girl named Diane and her problem of Depression. There are few theories that explains the causes of symptoms. Various therapeutic drugs have been discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27
    At a glance
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    The key takeaways are that depression has various biological, psychological and environmental causes. Some of the symptoms include low mood, lack of motivation and fatigue. Treatment options include antidepressant medications like SSRIs and tricyclics as well as exercise and psychotherapy.

    Some of the symptoms of depression discussed include poor attendance, lack of motivation, fatigue, avoiding eye contact, struggling to make friends and having a negative outlook.

    Theories discussed around the biochemical causes of depression include the monoamine theory about low levels of neurotransmitters like serotonin, norepinephrine and dopamine. The biogenic amine theory specifically focuses on low serotonin levels.

    Case 3: Depressed Diane

    Group 3 Members:
    Ensy Caroline Farhath Jabien Felicia Lim Shang Fei Khin Nyein Kyi Ng Miow Ling Thushara Ansari

    DIANES SITUATIONS
    21 year old University student
    Living alone for last 6 months Struggle to make friends and homesick

    Poor attendance, negative view of the course


    Less groomed, no eye contact and tired

    LEARNING OBJECTIVES

    Review symptoms of depression Consider drug treatments for depressive disorders & their mechanism of action and adverse effects Discuss alternative to pharmacological treatment

    Review the underlying pathophysiology of depression

    WHAT IS DEPRESSION?

    State of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical wellbeing Types Causes

    Exogenous/ Major Depression (75%)

    Hereditary

    Endogenous Depression (25%)

    Environment

    SYMPTOMS OF DEPRESSION
    Emotional
    Low self-esteem, miserable, pessimism, feelings of guilt, loss of interest/ pleasure/ motivation, anti-social, agitated, anxiety, suicidal

    Physical
    Fatigue, weight loss/gain

    Biological
    insomnia, loss of appetite, retardation of thought and action, hallucination/delusions (if severe)

    DIANES SYMPTOMS
    Lack of motivation Fatigue Anxiety/ Miserable Pessimistic
    Poor attendance and punctuality

    Sounds lethargic Lacks of grooming

    Avoids eye contact Struggled to make friends Home sick

    Negative view towards course, abilities, and future

    THEORIES OF BIOCHEMICAL ABNORMALITY

    THE MONOAMINE THEORY (BIOGENIC AMINE THEORY)

    proposed by Schildkraut in 1960s Low level of biogenic amine function leads to depressive symptoms Antidepressants play a role by elevating serotonin / NA level by:
    Inhibiting the reuptake mechanism Inhibiting enzymes that breakdown Enhance release of neurotransmitters from nerve terminals

    BIOGENIC AMINE THEORY (SEROTONIN HYPOTHESIS)

    Born from 1st theory in 1980s Decreased serotonin level generates depressive symptoms

    Secondary down-regulation of NA & dopamine influence

    Explains why certain symptoms are tied with specific neurotransmitters


    NA lack of alertness and interest DA lack of attention and motivation

    Serotonin anxiety obsession compulsion

    WHY HYPOTHESIS REMAINS


    Neurotransmitters level low, drugs restore

    Effect is quicker than time taken by antidepressants to be effective

    Adaptive responses in brain occurs Reduced receptor function Clinical benefit due to such response, not due to monoamine influence

    WHY HYPOTHESIS REMAINS


    Some antidepressants do not enhance neurotransmitters activity Eg: Tianeptine enhance serotonin re uptake Some drugs lower serotonin & NA influence without creating depression

    Currently, biogenic amines are involved in therapeutic response to drugs Unclear what this tells about nature of depression

    FORMAL DIAGNOSIS
    The International Criteria for Disease (ICD-10) of WHO & Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

    Medical history & current medication

    Depression test (e.g. Becks Depression Inventory Test)

    Laboratory Tests: blood test, basic electrolyte serum test, etc

    TREATMENT: PSYCHOTHERAPY
    Interpersonal Therapy
    Focus on behaviours and interactions between the patients with family and friends. Improve communication skills and increase selfesteem.

    Psychodinamic Therapy

    Causes are assumed to be unresolved conflicts, often stemming from childhood

    understand and cope better with these feelings by talking about the experiences

    TREATMENT: PSYCHOTHERAPY
    Focus on how thinking affects the way a person feels and acts feel better, remain calm, even when the situation stays the same Most suitable for Diane

    Cognitive Behavioural Therapy

    DIANES CONDITION
    Insomnia Loss of appetite & weight Score moderately to severely depressed on Beck Depression Inventory test

    GPs advise
    Increase exercise level of

    Paroxetine (20mg/d)

    Problems

    GENERAL MECHANISM OF ANTIDEPRESSANT DRUGS

    Increase availability of target monoamine neurotransmitter by:


    a) inhibiting neurotransmitters removal by uptake b) inhibiting breakdown by enzymes

    Alternative Mechanism:

    Reducing monoamine breakdown by MAOIs

    Types:
    SSRIs TCAs SNRIs NARIs NASSAs MAOIs

    MECHANISM OF ACTION OF PAROXETINE

    Belongs to SSRI (Selective Serotonin Reuptake Inhibitor)

    Potently & selectively inhibit neuronal serotonin reuptake through antagonism of the serotonin transporter in membrane
    Location of the reuptake of 5-HT and/or NA (weak inhibition)

    monoaminergic nerve terminal.

    SIDE EFFECTS OF PAROXETINE


    Dianes side effects
    Typical headaches, nausea, diarrhoea, weight loss, complete loss of appetite, insomnia

    Other side effects


    Agitation, anorgasmia, inhibit metabolism of other drugs, tremor, muscle weakness/spasm, seizures

    ANOTHER APPOINTMENT WITH THE GP

    *Change medication to Amitriptyline

    TRY EXERCISE MORE ???

    Gain confidence Reduce stress Active and get more interaction Release endorphine

    MECHANISM OF ACTION OF AMITRIPTYLINE

    Inhibits the reuptake of NA

    Inhibits the membrane pump mechanism responsible for uptake of NA and 5-HT in adrenergic and serotonergic neurons.
    Prolong neuronal activity by increasing neurotransmitters
    Class of antidepressants: Tricyclic Antidepressants (TCAs) Non-selective receptor blocking action
    (Due to the tricyclic chemical structure)

    SIDE EFFECTS OF AMITRIPTYLINE


    Sedation (H1 block) Postural hypotension (-adrenoceptor block) Constipation (Muscarinic block)

    Blurred vision

    Dry mouth

    Urinary retention

    Epilepsy

    Weight gain

    Skin rash

    Nausea

    Vomiting

    COMMON TO TRY MORE THAN ONE MEDICATION?


    *Yes, if there is low or no response to the amount of drug given

    Increase dosage

    Change anti-depression drugs with consideration

    Takes time to prescribe right dosage & type of antidepressant

    COMMON TO TRY MORE THAN ONE MEDICATION?


    . Combination of antidepressants (Eg. Tricyclic along with MAOI or lithium or SSRI with mianserin or lithium)

    Combine medicine with psychotherapy


    .

    Electroconvulsive Therapy (ECT) .

    CONCLUSION
    What defines a best suited treatment?

    Efficacy

    Adverse side effects


    Psychoterapy

    Anti-Depressant Drug

    REFERENCES

    A.C.Shaw, 2001.Counselling and Psychotherapy today. Singapore: Mcgraw hill. American Psychiatric Association.Diagnostic and statistical manual of mental disorders, 2010. 4th edition.USA . D.Healy,1997. Psychiatric drugs explained.4th edition.UK: Elsevier church hill livingstone. Boarder,M.,Newby,D.,Navti,P., 2010. Pharmacology for pharmacy and the health sciences. USA: Oxford University Press Inc Seligman,L. Richenberg,L.W., 2010.Theories of Counselling and Psychotherapy. Internation edition. USA: Pearson Education,Inc WebMD,2011,WebMD. Better information.Better health. [online] available from: http://www.webmd.com/depression/tc/depression-topic-overview [accessed on]: 27th January 12.

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