| Disease |
DEPRESSION |
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| Quotation |
“The patient has been depressed since he began seeing me in 1994” |
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| Definition |
A mood disorder characterized by disturbance in mood, behavior, and affect.
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| Prognosis |
Excellent for most. If the right dose of the appropriate drug is found for a given patient but about 15% run a chronic course, and about 45% run a recurrent course.
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| General Measures |
Electro-convulsive therapy (ECT) administered by psychiatrist for indications including depressive stupor, cases with high risk of suicide, presence of psychotic symptoms, and failure to respond to several adequate doses of medication.
Congnitive therapy, problem-solving therapy, and inter-personal psychotherapy are effective treatments for major depression and will be offered by Psychiatric consultants.
It is important to listen to patients describing their symptoms with empathy, and often this is very therapeutic.
Emphasis on personal hygiene, personal safety, and nutrition
Support and education of family.
Promoting full activity.
It is best not to prescribe more than a month’s requirement of medication, in view of the potential for overdose in these patients. |
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| Advice to Patient |
To counsel patients on nature of depression, and the nature and effects of medications being prescribed
Persuaded to confide to doctor thoughts on suicide (“life has no charm”, “I wish I could go to sleep and not get up in the morning”).
Should be told about the lag before response, the side effects of drugs and cautious use of alcohol.
Not to discontinue a drug suddenly.
Not to drive a vehicle or operate machinery, when on sedating drugs.
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| Follow Up |
Every 2 weeks after starting therapy, (appreciable effect usually by the second visit)
To be followed up every month subsequently.
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| Inadequate Response |
Could be due to poor compliance.
Might be needing a higher dose of the same drug.
Often one drug fails to help and another of the same class or different class of drug might work.
For some lithium or thyroid hormone might be required, and the decision should be Psyciatrist’s
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| Reference From |
Gabard GO (Ed). Treatment of Psychiatric Disorders2n Ed., Vol.1 1999b, Jaypee Brothers (India) pp 1330-1348
www.psyhologyinfo.com/depression |
