Standard Treatment Guidelines

1. General guidelines about Depression

Depressive disorder (also known as depression) is a common mental disorder which involves a depressed mood or loss of pleasure or loss of interest in activities for long periods of time.

Ø Following symptoms should have been present for at least 2 weeks.

Symptoms

· Depressed mood

· Loss of interest and enjoyment

· Reduced energy leading

to fatiguability and diminished activity

· Reduced concentration

and attention

· Reduced self-esteem and

self- confidence

· Ideas of guilt

· Feeling of worthlessness,

helplessness, hopelessness

· Bleak and pessimistic views of the future

· Ideas of acts of self-harm or suicide

· Disturbed sleep

· Diminished appetite

History taking and examination including MSE Annexure 1 Special emphasis -

· History of metabolic diseases

· Autoimmune diseases

2. a) Investigations required

i. Psychometric investigations: Becks Depression Inventory-II (BDI-II)

ii. Laboratory: (if physical complications are present)

a) Comorbidity - anxiety disorders,substance use disorders.

b) Differential Diagnosis – Neurological causes such as cerebrovascular accident, multiple sclerosis, subdural hematoma, epilepsy, Parkinsons disease, Alzheimer disease.

3. Treatment

a) Psychopharmacology

· Treatment with Benzodiazepines and SSRI's

· Anti psychotic (if severe)

· Symptomatic and supportive

Symptoms should be causing significant socio occupational dysfunction

Rule out bereavement in past 2 months

Rule out the possibility of bipolar depression, (Ask about prior episode of manic symptoms such as elevated, expansive or irritable mood, increased activity and talkativeness, flight of ideas, decreased need for sleep, grandiosity, distractibility, loss of social inhibitions and extreme optimism leading to reckless behaviour.

For at least 2 weeks, has the person had at least 2 of the following Core symptoms:

Depressed mood (most of the day, almost every day), (for children and adolescents – irritability or depressed mood)

Loss of interest or pleasure in activities that are normally pleasurable

Decreased energy or easily fatigued

For a depressive episode: diagnostic criteria

b) Psychosocial Treatment

i. Psychoeducation – nature of illness, etiology, progression, consequences, prognosis, treatment.

For patient	For Caregiver/guardian
At the time of consultation	At the time of consultation

ii. Psychotherapy

· Cognitive Behavioural Therapy (CBT)- It helps you to change unhelpful or unhealthy ways of thinking, feeling and behaving.

· Physical Activity / Activity Scheduling

ü Exercising: Playing tennis, golf or basketball, going to the gym, or getting out for a hike

ü Nurturing relationships: Going out to dinner, seeing a movie, or attending a play with friends or family

ü Self-education: Taking a class, going to the library, reading more

ü Participating in hobbies: Taking a cooking class, learning how to knit or paint, or learning to play an instrument

ü Expanding self-care: Learning mindfulness techniques, practicing relaxation therapy, visualizing, or doing yoga

i. Family counselling

c) Combined Treatment

4. Follow-up

a. Psychiatry opd/ DMHP

b. Physical check-up at OPD

c. Through telephonic conversation TeleManas14416/18008914416

5. Referrals

a) Depending upon the severity and complications of the patient, he/she may need to be referred to Psychiatry department.

b) To TeleManas

c) To the nearest DMHP

d) To psychiatry OPD at Kulikawn Hospital an ZMC

e) To higher centers outside Mizoram through Referral Board.

Health & Family Welfare Department

Contents

Category

Information

General treatment guidelines about Depression

References

Revision History