Depressed Diane-Case Study on Depression

8/13/2019 Depressed Diane-Case Study on Depression

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Group 3 Members:

Ensy CarolineFarhath JabienFelicia Lim Shang FeiKhin Nyein KyiNg Miow LingThushara Ansari

Case 3: DepressedDiane



D IANE ’ S S ITUATIONS

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



L EARNING O BJECTIVES

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



W HAT IS D EPRESSION ?

State of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well- being

Types

Exogenous/ MajorDepression (75%)

EndogenousDepression (25%)

Causes

Hereditary

Environment



SYMPTOMS OF DEPRESSION

• Low self-esteem, miserable, pessimism, feelings of guilt, loss ofinterest/ pleasure/ motivation, anti-social, agitated, anxiety,suicidal

Emotional

• Fatigue, weight loss/gain

Physical

• insomnia, loss of appetite, retardation of thought and action,

hallucination/delusions (if severe)

Biological



D IANE ’ S SYMPTOMS

• Poor attendance and punctualityLack ofmotivation

• Sounds lethargic• Lacks of groomingFatigue

• Avoids eye contact• Struggled to make friends• Home sick

Anxiety/Miserable

• Negative view towards course, abilities, andfuturePessimistic





T HEORIES OF B IOCHEMICAL ABNORMALITY



T HE M ONOAMINE T HEORY (BIOGENIC AMINE THEORY )

proposed by Schildkraut in 1960s

Low level of biogenic amine function leads todepressive symptoms

Antidepressants play a role by elevating serotonin / NA

level by:Inhibiting the reuptake mechanismInhibiting enzymes that breakdownEnhance release of neurotransmitters from nerve terminals



BIOGENIC AMINE T HEORY (SEROTONIN HYPOTHESIS )

Born from 1 st theory in 1980s

Decreased serotonin level generates depressive symptomsSecondary down-regulation of NA & dopamine influence

Explains why certain symptoms are tied with specificneurotransmitters

Serotonin

• anxiety • obsession

• compulsion

NA

• lack of alertness

and interest

DA

• lack of attention

and motivation



W HY H YPOTHESIS R EMAINS

Neurotransmitters level low, drugs restore

Effect is quicker than time taken by antidepressants to be effective

• Reduced receptor function• Clinical benefit due to such response, not due to monoamine

influence

Adaptive responses in brain occurs



• Eg: Tianeptine enhance serotonin re uptake

Some antidepressants do not enhance neurotransmittersactivity

Some drugs lower serotonin & NA influence withoutcreating depression

• Unclear what this tells about nature of depression

Currently, biogenic amines are involved in therapeuticresponse to drugs

W HY H YPOTHESIS R EMAINS



The International Criteria for Disease (ICD-10) ofWHO & Diagnostic and Statistical Manual ofMental Disorders (DSM-IV)

Medical history & current medication

Depression test (e.g. Beck’s Depression InventoryTest)

Laboratory Tests: blood test, basic electrolyteserum test, etc

F ORMAL D IAGNOSIS



T REATMENT : P SYCHOTHERAPY

• Focus on behaviours and interactions between the patients with family and friends.

• Improve communication skills and increase self-esteem.

InterpersonalTherapy

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

• understand and cope better with these feelings bytalking about the experiences

PsychodinamicTherapy



T REATMENT : P SYCHOTHERAPY

• Focus on how thinking affects the way a personfeels and acts

• feel better, remain calm , even when the situationstays the same

• Most suitable for Diane

CognitiveBehavioural

Therapy



D IANE ’ S C ONDITION

• Insomnia

• Loss of appetite &weight

• Score ‘moderately toseverely depressed’ on Beck DepressionInventory test

Problems

• Increase level ofexercise

• Paroxetine (20mg/d)

GP’s advise



G ENERAL M ECHANISM OF ANTIDEPRESSANT D RUGS

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



M ECHANISM OF A CTION OF PAROXETINE

Belongs to SSRI (Selective Serotonin Reuptake Inhibitor)

Potently & selectively inhibit neuronal serotonin reuptakethrough antagonism of the serotonin transporter inmembrane

Location of the reuptake of 5-HTand/or NA (weak inhibition)

monoaminergic nerve terminal.



SIDE E FFECTS OF PAROXETINE

• Typical headaches, nausea, diarrhoea, weight loss, completeloss of appetite, insomnia

Diane’s side effects

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

Other side effects



ANOTHER APPOINTMENT WITH THE GP

*Change medication to Amitriptyline



TRY E XERCISE MORE ???

Gain confidence

Reduce stress

Active and get moreinteraction

Release endorphine



M ECHANISM OF ACTION OF AMITRIPTYLINE

Inhibits the reuptake of NA

Inhibits the membrane pump mechanism responsible foruptake of NA and 5-HT in adrenergic and serotonergicneurons.

Prolong neuronal activity by increasing neurotransmitters

Class of antidepressants:

Tricyclic Antidepressants (TCAs) Non-selective receptor blocking action

( Due to the tricyclic chemical structure)



SIDE E FFECTS OF AMITRIPTYLINE

Sedation(H1 block)

Posturalhypotension

(α -adrenoceptorblock)

Constipation(Muscarinic

block)Blurred vision

Dry mouth Urinaryretention Epilepsy Weight gain

Skin rash Nausea Vomiting



C OMMON TO T RY M ORE T HAN O NE M EDICATION ?

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

Change anti-depression drugs with consideration

Increase dosage

Takes time to prescribe right dosage & type of antidepressant



.

• Combination of antidepressants (Eg. Tricyclic alongwith MAOI or lithium or SSRI with mianserin orlithium)

.• Combine medicine with psychotherapy

.• Electroconvulsive Therapy (ECT)

C OMMON TO T RY M ORE T HAN O NE M EDICATION ?



C ONCLUSION

What defines a best suited treatment?

Efficacy

Adverse side effects

Psychoterapy

Anti-DepressantDrug



R EFERENCES A.C.Shaw, 2001.Counselling and Psychotherapy today. Singapore: Mcgraw hill.

American Psychiatric Association.Diagnostic and statistical manual of mentaldisorders, 2010. 4 th edition.USA .

D.Healy,1997. Psychiatric drugs explained.4 th edition.UK: Elsevier church hill

livingstone.

Boarder,M.,Newby,D.,Navti,P., 2010. Pharmacology for pharmacy and the healthsciences. 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]: 27 th January 12.

http://www.webmd.com/depression/tc/depression-topic-overview






Documents

Depressed Diane-Case Study on Depression