DEPRESI

DEFINISI

a mood disorder that causes a persistent feeling of sadness and loss of interest.

CLASSIFICATION

Disruptive mood dysregulation disorder

Major depressive disorder

Persistent depressive disorder (dysthymia)

Premenstrual dysphoric disorder

Depressive disorder due to another medical condition

PATHOPHISYOLOGY

Clinical and preclinical trials suggest a disturbance in central nervous system serotonin (5-HT) activity as an important factor. Other neurotransmitters implicated include norepinephrine (NE), dopamine (DA), glutamate, and brain-derived neurotrophic factor (BDNF).

DIAGNOSIS

These are the 9 symptoms listed in the DSM-5. Five must be present to make the diagnosis (one of the symptoms should be depressed mood or loss of interest or pleasure):

Sleep disturbance

Interest/pleasure reduction

Guilt feelings or thoughts of worthlessness

Energy changes/fatigue

Concentration/attention impairment

Appetite/weight changes

Psychomotor disturbances

Suicidal thoughts

Depressed mood

DIFERENTIAL DIAGNOSIS

Schizoaffective disorders

Schizophrenia

Somatic symptom disorders

FARMAKOTHERAPY

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin/norepinephrine reuptake inhibitors (SNRIs)

Atypical antidepressants

Serotonin-Dopamine Activity Modulators (SDAMs)

Tricyclic antidepressants (TCAs)

Monoamine oxidase inhibitors (MAOIs)

Selective serotonin reuptake inhibitors (SSRIs):

PSYOTHERAPY

Cognitive-behavioral therapy (CBT)

Interpersonal Therapy (IPT)

PROGNOSIS

Major depression has very high morbidity and mortality contributing to high rates of suicide. Even though effective drug treatment is available, nearly 50% may not initially respond. Complete remission is not common but at least 40% achieve partial remission in 12 months.

EDUCATION

Avoid solitude by finding a good community.

Make life simpler by making short and long term plans.

Exercise regularly, at least 3-5 times a week with a duration of about 30 minutes.

Eat a balanced diet and a regular diet.

Make life more relaxed and avoid stress.

Avoid consumption of alcoholic beverages and illegal drugs.

KLASSIFICATION ANTI-DEPRESAN DRUG's

ANTI DEPRESAN TRISIKLIK (TCA)

PENGHAMBAT REUPTAKE SEROTONIN SELEKTIF (SSRI)

PENGHAMBAT MAO (MAO-I)

ANTIDEPRESAN ATYPICAL

KOMPLICATION

Being overweight or obese, which can lead to heart disease and diabetes.

Physical illness.

Escape in the form of alcohol or drug abuse.