DEPRESSION

Nasratul ilmi

DEFINITION
Mental disorder characterized by allencompassing low mood accompanied by low self-esteem and a loss of interest / pleasure

Types of depressive disorders : Major depressive disorder Distimik disorders

Major depressive disorder

The most common types of mood disorders is the occurrence of one or more periods / episodes of depression and no history of manic episodes / hipomanik Women = 10% - 25% Male = 5% - 12% Episodes of severe depression (with psychotic features): - Delusions - Hallucinations

Distimik disorders
Milder forms of depression are major depression Chronic (years)

Usually begins in childhood or adolescence

Spirit of poor / deterioration over time, but not very severe depression

ETIOLOGY
Psikoneuroendokrinologi factors: Psychiatric symptoms of hiperkortisolisme (anergia, anhedonia and depressed mood) cortisol in the urine Factors psikoneurimunologi : Ilnes behavior ( appetite, somnolence) changes in function

fatigue, immune

Genetic factors
Changes in neurotransmitters (dopamine, serotonin, norepinephrine)

CLINICAL MANIFESTATIONS
1. Changes in the Emotional condition: Changes in mood (feeling low, depressed, sad or gloomy) Full of tears / crying

Increased irritability (irritability), anxiety or loss of patience

2. Changes in motivation:

CLINICAL MANIFESTATIONS ()
Feelings are not motivated / have a hard time getting started (activity) in the morning, even hard to get up from bed Reduced levels of social participation or interest in social activities

Loss of interest in enjoyable activities

Decreased interest in sex

Can not respond to praise / reward

CLINICAL MANIFESTATIONS ()
3. Changes in Motor Function and Behavior Move or speak more slowly than usual Changes in sleeping habits (sleeping too much or too little, waking up earlier than usual and find it difficult to go back to sleep in the early morning) Changes in appetite Changes in body weight Less effective in performing the activity

CLINICAL MANIFESTATIONS ()
4. Cognitive changes Difficulty concentrating Negative thinking about themselves and the future Feelings of guilt or regret about the mistakes of the past Lack of self-esteem or feel able to live Thinking of death or suicide.

DIAGNOSIS
Characterized by symptoms over a period of 2 weeks: 1. Depressed Mood 2. Loss of interest or pleasure in activities 3. Loss or significant weight gain (5% more than the body weight in a month) 4. Insomnia / hypersomnia 5. Excessive agitation or slowing the movement response 6. Excessive agitation or slowing the movement response 7. Lack of self-esteem or excessive guilt 8. difficulty concentrating 9. Thinking of death or suicide

MANAGEMENT
PHARMACOLOGICA L
GOLONGAN Tricyclic antidepressants MEKANISME KERJA Inhibit the reuptake of 5HT / NE is not selective EXAMPLE Amitriptilin, imipramin, desipramin, nortriptilin, klomipramin Fluoksetin, paroksetin, sertralin, fluvoksamin Trazodon, nefazodon, mirtazapin, bupropion, maprotilin, venlafaksin Phenelzine, tranylcypromine

SSRIs (Selective Serotonin Reuptake Inhibitors) Mixed DA/NE reuptake inhibitor

Selectively inhibits the reuptake of 5-HT Inhibit the reuptake of DA / NE is not selective

MAO inhibitors

Inhibit the enzyme activity of MAO

MANAGEMENT ()

SOMATOTHERAPY : ECT (Electro Convulsive Therapy) CBT (Cognitive Behavior Therapy) IPT (Interpersonal Therapy) TMS (Transcranial Magnetic Stimulation) VNS (Vagus Nerve Stimulation)

PROGNOSIS
Depressive episodes that dealt healed within 3 months. If not treated can be 6-12 months Episode of major depression, although the drug 20-35% of patients had impaired social functioning