Author's details
Reviewer's details
Mood Disorder (Depressive Disorder)
Mood can be defined as a pervasive and sustained emotional tone or feeling that influences a person’s behaviour and colours the individual’s perception of the world. Depressive disorder is characterized by undue sadness which cannot be traced to any recent happening or if it is, its severity is much more exaggerated than what is expected for that event, poor sleep, reduced concentration, low self-esteem, negative thinking, lack of enjoyment, reduced energy and slowness. The rate of depression in the general population in Nigeria is 3.9% and between 7.8% to 30.6% in controlled population groups such as in adolescents, geriatrics and those with other physical conditions.
Depression is known to reduce the quality of life and severely affect the psychosocial functioning of those affected with the World health organization projecting it to be the leading cause of mental illness in 2030. It is the most common mental health related cause of suicide.
This is either subjectively felt or observed by others:
Marked diminished interest or pleasure in nearly all activities.
Significant weight loss when not dieting or weight gain or
Decrease/increase in appetite,
Insomnia or hypersomnia.
Psychomotor retardation or agitation.
Fatigue or loss of energy.
Feelings of worthlessness or inappropriate guilt.
Diminished ability to think or concentrate.
Recurrent suicidal ideation with /without a plan.
The above symptoms must be present every day or nearly every day during the same 2-week period.
According to the DSM-5 (5th edition of the diagnostic and statistical manual), five of the above-named symptoms must be present in the same 2-week period. The symptoms should cause impairment in social, occupational and other important areas of functioning. The depressive episode must not be attributable to the physiological effect of a substance or any other medical or mental condition. There must not have been a past episode of mania or hypomania.
Apart from normal sadness in which there won’t be other symptoms of depression, there are two broad categories: medical conditions which can cause depressive symptoms and mental health conditions with symptoms of depression.
Medical conditions such as adrenal and thyroid dysfunction. Neurological conditions such as Parkinson’s disease, dementia, epilepsy, cerebrovascular disease and tumours.
Mental health disorders: adjustment disorders with depressive symptoms, other mood disorders, anxiety disorders, alcohol-use disorders, somatization disorders and schizophrenia.
This should be done to rule out organic condition: FBC, E/U/Cr, TFT, MRI, Chest X-ray and other relevant ones based on patients presenting symptoms.
A combination of pharmacological therapy and psychotherapy is essential for treatment of a major depressive disorder.
The objectives of pharmacotherapy are symptom remission not just symptom reduction. The various classes used with examples:
Tricyclic antidepressant (amitriptyline, nortriptyline, doxepine and imipramine),
Selective serotonin re-uptake inhibitor (sertraline, escitalopram, fluoxetine, paroxetine), Norepinephrine and serotonin reuptake inhibitor (venlafaxine and duloxetine).
Psychosocial therapies commonly used in major depressive disorders include: cognitive therapy, behavioural therapy and inter-personal the
rapy.
Medications should be continued for a minimum of 6 months or the length of a previous episode, whichever is greater. Prophylactic treatment is effective in reducing the number and severity of the recurrences. Several studies indicate that maintenance anti-depressant medication appear to be safe and effective in preventing chronic depression.
Depression is the most common mood disorder treated in the Nigerian population. The disorder is commonly looked at as a mild and tolerable kind of mental illness in the society. Although, the far-reaching effect in the productivity of the populace is not well known. More emphasis should be placed on identifying this condition in primary health care centers across the country, where programs like the mhGAP can be used to identify individuals with the condition and early treatment started as soon as possible.
Mrs. A.K. a 55-year-old trader who presented to the clinic with her son on account of a 3 weeks history of depressed mood, anhedonia, easy fatiguability, taedium vitae, unrefreshed sleep, poor appetite, mild weight loss, delusion of guilt, passive suicidal ideation; undue fear, palpitation, difficulty in breathing and tremors. The delusion of guilt was a persistent feeling of guilt of infidelity towards her husband 12 years ago ,which she strongly feels that supernatural forces are currently harming her and making her sick ;and believes that her situation cannot be redeemed due to the gravity of her offense. She held on to this despite the fact that her husband had already forgiven her which was corroborated by the son and the husband.
She is a known hypertensive for about 20 years and has been compliant with medications prior to the onset of depressive symptoms.
Mental state examination showed a middle -aged woman fairly groomed and appeared drowsy and weak during the interview. She does not maintain eye contact during the interview. Her speech had low tone and low volume. She described her mood as sad and tired. Judgement was impaired and insight was lacking.
The symptom of poor sleep and poor appetite were rapidly progressing in the last one week and was a great concern to the relatives. Subsequently, she was admitted at the emergency and resuscitated with intravenous fluids for the first 48 hours. When there were some improvement in her energy levels, she was then admitted in the psychiatry ward for 2 weeks. She was managed for major depressive disorder (severe depression) with psychotic and anxious features. She was placed on Tab amitriptyline and risperidone for treatment of the mood disorder; Amlodipine, telmisartan and vasopril for control of hypertension. She had her delusion resolved after medications commenced which was successful. She was discharged after 2 weeks on admission, with weekly appointment for follow-up, to continue her cognitive and insight therapy. Symptoms were completely resolved 4 weeks after initial presentation, however the importance of continuing medications was emphasized.
1. Harrrison P, Cowen P, Burns T and Fazel M. Shorter Oxford Textbook of Psychiatry .7th edition. Oxford: Oxford University Press, 2018
2. American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders(5th ed.) Arlington VA :American Psychiatric Publishing; 2013.
3. Sadock BJ, Sadock VA, Ruiz P . Kaplan &Sadock’s Synopsis of Psychiatry .11th edition. Philadelphia :wolterkluwer/Lippioncott Williams and wilkins ; 2015.
4. Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fakoua AR et.al. Depression in Sub-Saharan Africa. IBRO Neuroscience. Rep 2022 March 17 ; 309-322. doi :10.1016/j.ibneur. 2022.03.005.
Author's details
Reviewer's details
Mood Disorder (Depressive Disorder)
Mood can be defined as a pervasive and sustained emotional tone or feeling that influences a person’s behaviour and colours the individual’s perception of the world. Depressive disorder is characterized by undue sadness which cannot be traced to any recent happening or if it is, its severity is much more exaggerated than what is expected for that event, poor sleep, reduced concentration, low self-esteem, negative thinking, lack of enjoyment, reduced energy and slowness. The rate of depression in the general population in Nigeria is 3.9% and between 7.8% to 30.6% in controlled population groups such as in adolescents, geriatrics and those with other physical conditions.
Depression is known to reduce the quality of life and severely affect the psychosocial functioning of those affected with the World health organization projecting it to be the leading cause of mental illness in 2030. It is the most common mental health related cause of suicide.
1. Harrrison P, Cowen P, Burns T and Fazel M. Shorter Oxford Textbook of Psychiatry .7th edition. Oxford: Oxford University Press, 2018
2. American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders(5th ed.) Arlington VA :American Psychiatric Publishing; 2013.
3. Sadock BJ, Sadock VA, Ruiz P . Kaplan &Sadock’s Synopsis of Psychiatry .11th edition. Philadelphia :wolterkluwer/Lippioncott Williams and wilkins ; 2015.
4. Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fakoua AR et.al. Depression in Sub-Saharan Africa. IBRO Neuroscience. Rep 2022 March 17 ; 309-322. doi :10.1016/j.ibneur. 2022.03.005.
Content
Author's details
Reviewer's details
Mood Disorder (Depressive Disorder)
Background
Mood can be defined as a pervasive and sustained emotional tone or feeling that influences a person’s behaviour and colours the individual’s perception of the world. Depressive disorder is characterized by undue sadness which cannot be traced to any recent happening or if it is, its severity is much more exaggerated than what is expected for that event, poor sleep, reduced concentration, low self-esteem, negative thinking, lack of enjoyment, reduced energy and slowness. The rate of depression in the general population in Nigeria is 3.9% and between 7.8% to 30.6% in controlled population groups such as in adolescents, geriatrics and those with other physical conditions.
Depression is known to reduce the quality of life and severely affect the psychosocial functioning of those affected with the World health organization projecting it to be the leading cause of mental illness in 2030. It is the most common mental health related cause of suicide.
Further readings
1. Harrrison P, Cowen P, Burns T and Fazel M. Shorter Oxford Textbook of Psychiatry .7th edition. Oxford: Oxford University Press, 2018
2. American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders(5th ed.) Arlington VA :American Psychiatric Publishing; 2013.
3. Sadock BJ, Sadock VA, Ruiz P . Kaplan &Sadock’s Synopsis of Psychiatry .11th edition. Philadelphia :wolterkluwer/Lippioncott Williams and wilkins ; 2015.
4. Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fakoua AR et.al. Depression in Sub-Saharan Africa. IBRO Neuroscience. Rep 2022 March 17 ; 309-322. doi :10.1016/j.ibneur. 2022.03.005.
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