1. MAJOR DEPRESSIVE DISORDER
PRESENTORS: -
HARWINDER DHILLON
KARAMVEER KAUR KINGRA
SUKHDEEP KAUR CHAHAL
MANPREET KAUR
PARMINDER PAL SINGH SAINI

2. OUTLINE Case study overview What is depression Symptoms Causes Types
Risk Factors
Treatment

3. CASE STUDY OVERVIEW Janet is 30 year old lady.
Divorced for more than 1 year.
Has 3 children
Part time student but withdrawn.
Following after divorce financial problems occurred.
In childhood she was reserved socially, hesitant, lack of assertiveness.
She broke up with her first boyfriend in college and then she met with David and rushed into marriage and her relationship with her husband was not good.

4. DEPRESSION A very common, highly treatable, medical illness.
Affects physical, mental and emotional well-being.
Affects basic, everyday activities like eating and sleeping.
Affects how people think about things and feel about themselves. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is persistent and can interfere
significantly with an individual's ability to function.
People with depressive illness cannot just “pull themselves together” and “get over it.”
Depression often takes on a life of its own – without treatment, symptoms can last months or even years.

5. DEFINITION
Depression is the feeling of sadness, grief, hopelessness, helplessness, and guilt
The Disorder is extremely intense and prolonged
The Illness has serious affects on the mental and physical well being of a person.

6. PREVALENCE
INCIDENCE OF DEPRESSION IN CANADA:- 7.9% to 8.6% of adults over 18 years of age.
According to national population health survey in :- 6% of Canadian population of age 12 years and over has symptoms of depression.
Average age of depression:- early 20’s to early 30’s.
Sex: - more in women than men
In Ontario:- 2% of men and 3% of women have mood disorder
Genetic factors:- it runs in families times more common among first degree biological relatives.

7. CAUSES However, causes are not known, but current theories include: -
Genetic
Runs in families
However, depression can also occur in people who have no family history.
Environmental
A serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode.

8. CONTD… Personality Characteristics
low self-esteem, pessimistic world view, low stress tolerance
Whether this represents a psychological predisposition or an early form of the illness is not clear.
Biological
Medical model explores problems in brain functioning in the following areas: Limbic system, neurotransmitters and neurons, hormones and the endocrine system

9. CONTD…
Combination
a combination of genetic, psychological, environmental, and/ or biological factors may contribute to the onset of a depressive disorder

10. CAUSES IN JANET’S CASE Major Life Changes
Janet’s depression was clearly precipitated by her divorce which has affected her life.
Increased financial burden and disturbed interpersonal relationship imbalanced her life.
She lost her role as a wife.
Stressful events can cause depression and vice versa.
Major Life Changes
Positive or negative events can trigger depression. Here , Janet's divorce is a major life change.

11. TRIGRRING FACTORS
There are many other factors which contribute to depression: -
Reserve social behavior in childhood.
Hesitant in expression.
Lack of assertiveness.
Unable to make many friends.
Dependent relationship and personality.
Separation from mother at the age of 11.
Financial burden, education and children responsibility.
Lack of social support.
Hopelessness and helplessness.

12. SYMPTOMS ACCORDING TO DSM-
Depressed mood most of the day, feel sad, empty, and appears tearful.
Diminished interest in all the activities
Weight loss or weight gain, decrease or increase in appetite.
Insomnia or hypersomnia.
Psychomotor agitation or retardation.
Fatigue or loss of energy.
Feeling of worthlessness or excessive or inappropriate guilt.
Diminished ability to think or concentrate or decisiveness.
Recurrent thoughts of death or suicidal ideation.

13. SYMPTOMS IN JANET
First 2 symptoms must be present at least for two weeks.
Feeling sad, blue, or down in the dumps.
Loss of interest in things you usually enjoy.
Feeling slowed down or restless.
Having trouble sleeping or sleeping too much Loss of energy or feeling tired all the time.
Having an increase or decrease in appetite or weight.
Having problems concentrating, thinking, remembering or making decisions.
Feeling worthless or guilty.
Having thoughts of death or suicide.

14. ADDITIONAL SIGNS Changes in feelings which may include: Feeling empty
Inability to enjoy anything
Hopelessness
Loss of sexual desire
Loss of warm feelings for family or friends
Feelings of self blame or guilt
Loss of self esteem
Inexplicable crying spells, sadness or irritability

15. TREATMENT In general, treatment for depression include: Medications
Psychotherapies.

16. TREATMENT Medication- Antidepressants Psychotherapy
Interpersonal Psychotherapy
Cognitive behavior therapy
Psychodynamic therapy

17. MEDICATION
Drugs used to treat depression are called antidepressants. Common types of antidepressants include:
Selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
Serotonin norepinephrine reuptake inhibitors (SNRIs), including desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta). Other medicines used to treat depression include: • Tricyclic antidepressants • Bupropion (Wellbutrin) • Monoamine oxidase inhibitors

18. ANTIDEPRESSENT FOR JANET
Janet’s depression can be tackled from antidepressant medication as her morbid ruminations marked a clear deterioration in her condition. Janet can respond to fluoxetine (Prozac). Selective serotonin reuptake inhibitors (SSRIs) are most effective prescriptions written for antidepressant medication. The SSRIs inhibit the reuptake of serotonin into the presynaptic nerve ending and therefore increase the amount of serotonin available in the synaptic clef.

19. PSYCHOTHERAPY
Psychotherapy is often the first form of treatment recommended for depression. Called "therapy" for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with depression talks to a licensed and trained mental health care professional who helps the person identify and work through the factors that may be triggering the depression.
Sometimes these factors work in combination with heredity or chemical imbalances in the brain to trigger depression. Taking care of the psychological and psychosocial aspects of depression are just as important as treating its medical cause.

20. PSYCHOTHERAPY CAN HELP JANET TO-
Understand the behaviors, emotions, and ideas that contribute to her depression
Understand and identify the life problems or events—like a major separation issue, finances, a loss of a job and divorce—that contribute to her depression and help her understand which aspects of those problems may be able to solve or improve
Regain a sense of control and pleasure in life Learn coping techniques and problem-solving skills

21. TYPES OF PSYCHOTHERAPY
Individual psychotherapy
Group psychotherapy
Couple psychotherapy
Janet can attend individual or group therapy. Couple therapy may not be appropriate for her at this stage.

22. INTERPERSONAL PSYCHOTHERAPY
Interpersonal therapy focuses on the behaviors and interactions a depressed patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self esteem during a short period of time. Therapy usually lasts three to four months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.
Psychodynamic and interpersonal therapies help patients resolve depression caused by:
Loss (grief)
Relationship conflicts
Role transitions (such as becoming a mother or a caregiver)

23. COGNATIVE BEHAVIOUR THERAPY
Cognitive behavioral therapy helps people with depression to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps patients establish new ways of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others.
Cognitive-behavioral therapy is recommended for patients: - Who think and behave in ways that trigger and perpetuate depression With mild-to-moderate depression as the only treatment or in addition to treatment with antidepressant medication Who refuse or are unable to take antidepressant medication Of all ages who have depression that causes suffering, disability, or interpersonal problems
In Janet's case this is an appropriate therapy.

24. REFRENCES
Bennett, P. (2003). Abnormal and Clinical Psychology: An introductory textbook. (1stEd.). Maidenhead: Open University Press.
Dubovsky, S.L., & Dubovsky, A.N. (2005) Mood Disorders. New York: American Psychiatric Publishing Inc.
Firestone, P., & Marshall, W.L. (Eds). (2003). Abnormal Psychology: Perspectives. Toronto, Ontario, Pearson Ed.
Long, P. W. (1998). Major Depressive Disorder: Treatment. Internet Mental Health.
Retrieved,from
Nevid, J., Greeve, B., Johnson, P., Taylor, S., & Macnab, M. (2013). Essentials of Abnormal Psychology (3rd Ed.).Toronto, Ontario: Pearson Ed.
Public Health Agency of Canada. (2002). A report on Mental Illnesses in Canada.
Retrieved from
Sadock, B. J., & Sadock, V.A. (2007). Synopsis of Psychiatry Behavioral Science/ Clinical Psychiatry (10th Ed.). New York: Wolters Kluwer/Lippincott Williams& Wilkins.
Tracy, N.,(2012). Major Depression (Major Depressive Disorder) Symptoms, Causes, Treatments, HealthyPlace.com .
Retrieved fromhttp://