Domina

What is depression?

Depression is a mood disorder that produces severe symptoms which interfere with a person's ability to function in daily tasks like eating, sleeping, and working
It affects individuals of all age groups, both adults and children

Depression in Adolescents and Adults:

What are its causes?

There is no single cause of depression. It can occur due to several reasons and has many different triggers. Some of its causes include:
- Sad events: Loss of a loved one or experiencing a separation
- Low self-esteem and self-deprecation
- Genetic factors
- Pregnancy and childbirth
- Feeling of loneliness and emptiness
- Chronic or life-threatening illnesses, such as heart diseases or cancer
- Head injuries: They represent an unknown cause of depression, as severe head injuries can lead to mood swings and emotional issues
- Thyroid gland dysfunction

What is the mechanism of depression?

It occurs due to a decrease in the levels of neurotransmitters in the central nervous system, such as serotonin, norepinephrine, and dopamine

Who is more susceptible to depression, women or men?

Both are susceptible to depression, but it is diagnosed more frequently in women than in men. Typically, men tend to suppress their emotions and emotional issues or even discuss and seek help for them

What are the symptoms of depression?

Persistent depressed mood and a constant feeling of sadness
Loss of pleasure in enjoyable activities
Insomnia or excessive sleeping
Changes in appetite or unintended weight changes
Restlessness or slowed physical movements
Fatigue and loss of energy
Difficulty concentrating
Feelings of guilt, worthlessness, and hopelessness
Thoughts of death or suicide attempts

When can we say that someone is suffering from depression?

If they experience the aforementioned symptoms daily for most of the time, for a duration of at least two weeks

What are the types of depression?

Major Depression:

Symptoms include persistent feelings of sadness and loss of pleasure, lasting for at least two weeks and significantly impairing daily functioning

Persistent Depressive Disorder:

Symptoms are less severe but last for an extended period (at least two years)

Perinatal Depression:

Depression occurring during or after pregnancy. Depression during pregnancy is known as perinatal depression, and depression after childbirth is known as postpartum depression

Seasonal Affective Disorder (SAD):

Depression that correlates with seasonal changes. Typically, symptoms manifest in late fall and early winter, disappearing in spring and summer

Psychotic Depression:

Considered a severe form of depression where the individual experiences hallucinations or delusions

Premenstrual Dysphoric Disorder (PMDD):

Depression that affects women before, during, or after their menstrual cycle or after menopause

How is depression treated?

There are two main approaches to treatment:

Psychotherapy
Pharmacotherapy

Research has shown that a combination of both treatment approaches is more effective than using each treatment separately

What is psychotherapy?

Psychotherapy is a treatment that teaches patients with depression:
- New ways of thinking and behaving
- Breaking negative patterns that contribute to their depression
Common psychotherapeutic methods for treating depression include:

Cognitive-Behavioral Therapy (CBT):

Involves identifying thoughts and behaviors that need to be changed. The therapist helps create a plan (using coping skills and other tools) to modify these thoughts and behaviors. Cognitive-Behavioral Therapy often focuses on finding practical solutions to problems.

Interpersonal Therapy (IPT):

Links mood with personal relationship issues. These problems may involve difficulties adapting to social or occupational life, complicated grief, and interpersonal issues between the individual and others.

What is pharmacotherapy?

Pharmacotherapy involves the use of antidepressant medications to elevate low levels of neurotransmitters in the brain

First-line treatment:

Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line treatment
They have demonstrated effectiveness and safety in randomized trials
This class of medications is the most commonly prescribed and used to treat depression
Key medications in this class include sertraline, fluoxetine, and escitalopram
Selective Serotonin Reuptake Inhibitors (SSRIs) increase serotonin levels only, without significantly affecting other neurotransmitters such as norepinephrine or dopamine
Additionally, their effect on adrenergic, cholinergic, and histaminergic receptors is less than that of other antidepressants (tricyclic antidepressants and MAOIs), making them have fewer side effects compared to other drug classes

Fluoxetine and sertraline are considered the first-line treatment for adults

Fluoxetine is also considered the first-line treatment for adolescents

Lostrile:

Active Ingredient: Sertraline
First-line treatment for:
- Depression in adults
- Premenstrual dysphoric disorder
- Obsessive-compulsive disorder
- Panic disorder
- Post-traumatic stress disorder
- Social anxiety disorder.
Preferred choice for elderly patients and pregnant women suffering from depression

Fluoxetin Domina

Active Ingredient: Fluoxetine
FDA approved for the treatment of depression in adolescents
First-line treatment for:
- Eating disorders (bulimia nervosa)
- Obsessive-compulsive disorder
- Panic disorder
- Major depressive disorder associated with bipolar disorder (can be used concurrently with Olan-Prexa)

Second-line of treatment:

This includes serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin modulators, and atypical antidepressants, which are considered an acceptable alternative to selective serotonin reuptake inhibitors (SSRIs)

Third-line of treatment:

This includes monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs)
However, these are not considered entirely safe, especially at higher doses, and have potential side effects. Hence, they are usually not used as initial treatments for depression
Monoamine Oxidase Inhibitors (MAOIs):
- MAOIs work by inhibiting the enzyme that breaks down serotonin, norepinephrine, and dopamine. They come with many side effects and drug interactions.
Tricyclic Antidepressants (TCAs):
- TCAs inhibit the reuptake of norepinephrine and serotonin at the nerve ending. They can cause many anticholinergic and dizziness side effects.

Clomi-Franil:

Active Ingredient: Clomipramine
Available in 10 mg and 25 mg coated tablets (pack contains 20 tablets)
Treats obsessive-compulsive disorder, depression in adults and children, and nocturnal enuresis in children

How long does it take for antidepressant medications to show results?

Improvement is often noticeable after two weeks, but it typically takes 4-8 weeks to see the full effect
Sleep, appetite, and attention problems often improve before mood does
It is important to allow sufficient time for the medication to take effect before deciding whether it's appropriate or not

Can antidepressant medications be stopped suddenly?

No, abruptly stopping antidepressant medication can lead to withdrawal symptoms

Depression in Children:

Do children experience depression?

Yes, children can experience depression
Initially, it is normal for a child to feel sad or have a bad mood
However, when this state persists for two weeks with changes in their behaviors and affects their social and academic life, it may be due to depression

What are the causes of depression in children?

Experiencing loss or trauma: Such as parental separation
Physical or emotional abuse: Including comparison with peers
Sexual abuse
Bullying
Genetic factors

What are the symptoms of childhood depression?

Poor mood
Isolation and lack of interaction with friends
Low self-esteem
Lethargy and fatigue
Loss of interest in activities they used to enjoy
Sleep and appetite disturbances
Pain unresponsive to treatment

How is depression treated?

There are two main types of treatment:

Psychotherapy
Pharmacotherapy

Psychotherapy:

For childhood depression, cognitive-behavioral therapy (CBT) is the main form of psychotherapy used. Therapists help children feel welcomed and supported, encouraging them to talk about their thoughts and feelings. They might use stories, play, or lessons to help children feel more comfortable and make the most of cognitive-behavioral therapy.

Pharmacotherapy:

Fluoxetine is the only antidepressant approved by the U.S. Food and Drug Administration (FDA) for use in children aged 8 and above

How can I help a child showing signs of depression?

Understand what's going on: Get to know how the child feels in different situations and specifically when they feel sad
Encourage alternative forms of expression: Never force the child to talk, but encourage other creative forms of expression like drawing, crafting, or writing down their thoughts
Seek insights from trusted individuals: Consult people you trust and who know the child well, such as a favorite teacher or a close friend, to see if they've noticed anything concerning
Promote positive habits: Help the child maintain regular eating and sleeping habits, stay active, as physical activity and music can be great mood enhancers
Protect them from a harmful environment: Keep the child away from situations where they might experience excessive pressure, abuse, or violence
Reassure and spend time: Reassure the child as much as possible, encourage them to come to you whenever they feel upset, and let them know you love and support them unconditionally. Spend quality time with them
Minimize distractions: Keep your phone and other devices away to reduce distractions and help you be fully present for the child
Take care of yourself: Your happiness can positively influence the child, so taking care of yourself will help the child feel happier too

1. National Institute of Mental Health. Depression. 2023; Available from: https://www.nimh.nih.gov/health/topics/depression#:~:text=Depression%20(also%20known%20as%20major,sleeping%2C%20eating%2C%20or%20working.).

2.NHS. Causes - Depression in adults 2023 [Available from: https://www.nhs.uk/mental-health/conditions/depression-in-adults/causes/.

3. Rush, A.J. Unipolar major depression in adults: Choosing initial treatment. 2023; Available from: https://www.uptodate.com/contents/unipolar-major-depression-in-adults-choosing-initial-treatment?search=depression%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H432086717.

4. Hasler, G., Pathophysiology of depression: do we have any solid evidence of interest to clinicians? World Psychiatry, 2010. 9(3): p. 155-61.

5. American Psychological Association. Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts. 2021; Available from: https://www.apa.org/depression-guideline.

6. Chu, A. and R. Wadhwa. Selective Serotonin Reuptake Inhibitors. 2023; Available from: https://www.ncbi.nlm.nih.gov/books/NBK554406/.

7. Lexicomp. FLUoxetine. 2023; Available from: https://online-lexi-com.ezproxy.lau.edu.lb:2443/lco/action/doc/retrieve/docid/multinat_f/4669729?cesid=adDDgTQSnA7&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dfluoxetine%26t%3Dname%26acs%3Dfalse%26acq%3Dfluoxetine.

8. Lexicomp. Sertraline. 2023; Available from: https://online-lexi-com.ezproxy.lau.edu.lb:2443/lco/action/doc/retrieve/docid/multinat_f/4669050?cesid=8h2qMI0eccF&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dsertraline%26t%3Dname%26acs%3Dfalse%26acq%3Dsertraline.

9.Sheffler, Z.M., P. Patel, and S. Abdijadid. Antidepressants. 2023.

10 .Lexicomp. Clomipramine. 2023; Available from: https://online-lexi-com.ezproxy.lau.edu.lb:2443/lco/action/doc/retrieve/docid/multinat_f/4669657?cesid=4vMZCmBuIPY&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dclomipramine%26t%3Dname%26acs%3Dfalse%26acq%3Dclomipramine#canbnlist.

11.Lyness DA. Childhood Depression: What Parents Need to Know 2021 [Available from: https://kidshealth.org/en/parents/understanding-depression.html]

12. UNICEF. Supporting children with depression, stress and anxiety 2023 [Available from: https://www.unicef.org/rosa/stories/supporting-children-depression-stress and-anxiety.]