Mental health illnesses are common and affect all ages, educational and income levels and cultures. According to the Canadian Mental health Association approximately 8% of adults will experience major depression at some time in their lives. Major Depressive Disorder has a significant morbidity and mortality; that can lead to suicide, disruption in interpersonal relationship, substance abuse and loss of work time. So, early diagnosis is very important. Purpose of this section is unbiased review of leading practise guidelines, explore controversies in guidelines if available and assess risk/benefits of common treatment modalities.
Diagnosis
Proper medical history and relevant physical examination, including mental state exam are essential for …show more content…
Severe depression without psychotic features: Pharmacotherapy, combined pharmacotherapy and psychotherapy. However; American Psychiatrist Association doesn’t recommend Psychotherapy alone for severe Depression.
Severe depression with psychotic features: Antidepressant and Antipsychotic agents should be used, with or without psychotherapy.
According to the American Psychiatrist Association, ECT can be considered any stage of depression as a treatment modality. ECT is a highly effective treatment modality for depression and onset of action often seen after 1 week of treatment compared to other modalities. Often ECT is considered in following circumstances. …show more content…
Adverse Effects Fewer than TCA, therefore increased compliance CNS: restlessness, tremor, insomnia, headache, drowsiness GI: N/V, diarrhea, abdominal cramps, weight loss Sexual dysfunction: impotence, anorgasmia CVS: increased HR, conduction delay, serotonin syndrome, EPS, SIADH Low dose side effects include insomnia (serotonergic) Higher dose side effects include: tremors, tachycardia, sweating, insomnia, dose-dependent increase in diastolic BP (noradrenergic Anticholinergic effects: (Dry mouth, urinary retention, constipation, blurred vision, toxic-confusional states) Noradrenergic effects: tremors, tachycardia, sweating, insomnia, erectile and ejaculation problems -1 adrenergic effects: orthostatic hypotension Antihistamine effects: sedation, weight gain CNS: sedation, stimulation, L seizure threshold CVS: K HR, conduction
Diagnosis
Proper medical history and relevant physical examination, including mental state exam are essential for …show more content…
Severe depression without psychotic features: Pharmacotherapy, combined pharmacotherapy and psychotherapy. However; American Psychiatrist Association doesn’t recommend Psychotherapy alone for severe Depression.
Severe depression with psychotic features: Antidepressant and Antipsychotic agents should be used, with or without psychotherapy.
According to the American Psychiatrist Association, ECT can be considered any stage of depression as a treatment modality. ECT is a highly effective treatment modality for depression and onset of action often seen after 1 week of treatment compared to other modalities. Often ECT is considered in following circumstances. …show more content…
Adverse Effects Fewer than TCA, therefore increased compliance CNS: restlessness, tremor, insomnia, headache, drowsiness GI: N/V, diarrhea, abdominal cramps, weight loss Sexual dysfunction: impotence, anorgasmia CVS: increased HR, conduction delay, serotonin syndrome, EPS, SIADH Low dose side effects include insomnia (serotonergic) Higher dose side effects include: tremors, tachycardia, sweating, insomnia, dose-dependent increase in diastolic BP (noradrenergic Anticholinergic effects: (Dry mouth, urinary retention, constipation, blurred vision, toxic-confusional states) Noradrenergic effects: tremors, tachycardia, sweating, insomnia, erectile and ejaculation problems -1 adrenergic effects: orthostatic hypotension Antihistamine effects: sedation, weight gain CNS: sedation, stimulation, L seizure threshold CVS: K HR, conduction