New Approaches In Screening And Management Of Depression - What New Research Tell You About Depression

 

Depression affected 50% of people worldwide. From studies it is seen that 13%-22% people affected with major depressive disorder from different etiologies that can be either depression secondary to infection, postpartum depression and because of sociological and economic burden.

Due to increment in cases of major depressive disorder. Depression screening done in adult (above 18 years old). For proper treatment accurate diagnosis is important, for this purpose proper systems of screening should be build-in healthcare area. Along with this precautionary measures and awareness decreased the chances or cases of depression.

SCREENING OF DEPRESSION:

As discussed in previous article about THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDER (DSM-5), that according to this criteria at least 5 symptoms must be present in patient for 2 weeks.

If you have these five symptoms for at least 2 week then you are in depression cycle.

Read the symptoms in link

SCREENING INSTRUMENT: 

Screening instruments like:

• 1.       Patient health questionnaire 9 (PHQ-9) that consist of 0-3 range of each question.

Its severity of depression can be measure in 0-27 range.

• 2.       Beck- depression inventory which have another name beck depression inventory II.

Its scale of severity ranges from 0-63.

• 3.       Zung self-rating depression scale: which consists of 20 item survey questionnaire.

4.       Center of epidemiological studies that can also consists of 20 items instruments. It can a analyze patient on basis of their emotions, feelings and behavior of the last week.

These above mentioned scales are self-administer while in contrast some other scales are also need to mention here which are only measured by healthcare professional not by patients.

• 1.       Hamilton rating depression scale: which consists of 17 or 21 items, ranging from 0-2 or 0-4.

Normal range: 0-7

Moderately severely depression: scores of 20 or greater than 20.

• 2.       Geriatric depression scale (GDS): that’s made for older adults but now widely validates for younger adults.

It have two forms short form and long forms which comprises of 15 and 30 items respectively.

MANAGEMENT:

In Major depressive disorder, Medication not give the desire outcome alone. Whereas in combination with psychotherapy it give better outcome.

PHARMACOTHERAPY: major depressive disorder result in decrease level of neurotransmitter and/or alter sensitivity or any changes in receptors.

Serotonin have major role in major depressive disorder, also other neurotransmitters have role in MDD are

• 1.       Nor epinephrine
• 2.       Glutamate
• 3.       Dopamine
• 4.       Brain-derives neurotrophic factor (BDNF).

Some of the drugs use in the treatment of depression are:

• 1.       Selective serotonin reuptake inhibitor (SSRI)
• 2.       Serotonin nor epinephrine reuptake inhibitor (SNRIs)
• 3.       Monoamine oxidase inhibitor (MAOIs)
• 4.       N-methyl-D aspartate (NMDA) receptor antagonist
• 5.       Atypical antidepressant
• 6.       Tricyclic antidepressant.
• 7.       St. John’s wort( Hypericum Perforatum)

PSYCHOTHERAPY: some of the evidence based with strong research support are describe below, along with pharmacotherapy its use can kill depression in effective way. These psycho therapeutic treatments are mentioned below.

• 1.       Cognitive therapy
• 2.       Behavior therapy
• 3.       Interpersonal psychotherapy (IPT)
• 4.       Cognitive behavioral analysis system of psychotherapy.
• 5.       Self-management/ self-control therapy.
• 6.       Problem solving therapy.

These therapies requires Incorporation of family and parents when applied to young and adults.

ELECTROCONVULSIVE THERAPY:  In electroconvulsive therapy controlled electric current passes through the brain under the supervision of professional which can be in certain psychiatric conditions. It basically affects the brain’s activity and relieve severe depressive symptoms and psychiatric symptoms.

When it will use?

• 1.       When you need rapid and fastest antidepressant response.
• 2.  When you didn’t see positive and desire outcomes in patient/ failure of pharmacotherapy.
• 3.       Previously good response to ECT
• 4.       Patient compliance
• 5.       When patient have greatest risk of suicide
• 6.       Greatest risk of medical mortality and morbidity.

What if you failed in all above treatments?

 

If patient doesn’t achieve desire outcome in pharmacotherapy i.e. at least 4 antidepressant medication and ECT then only effective technique approved by FDA is TRANSCRANIAL MAGNETIC STIMULATION(TMS) and VAGUS NERVE STIMULATION (VNS).

This technique work by surgical implantation.

MUST READ POINTS:

Depression affects large number of population worldwide. You didn’t mark patient as depressive until and unless it can pass through the depressive test. Well depression assessment test are not enough for diagnosis. After depression test it can be treated with pharmacotherapy and psychotherapy. But if patient didn’t respond with pharmacotherapy and psychotherapy, FDA approved stimulation therapy namely VNS and TMS. This stimulation technique can be work after implantation.