You are taking treatment for depression; however your symptoms do not improve. In such cases, you may have treatment-resistant depression.

With treatment-resistant depression, standard treatments like antidepressant medications or psychotherapy do not improve the symptoms of depression. In some cases symptoms improve only to return after some time.

Treatment-resistant depression requires different approaches of treatment. You should consult your psychiatrist for considering your situation.

Consultation with doctor for Treatment-resistant depression

  • Your psychiatrist may perform the detail evaluation of your case and review your medical history.
  • You may be asked questions about your lifestyle and various factors that trigger your depression.
  • Your response to various standard treatments is evaluated including medications or psychotherapy tried by you.
  • The timings and dosage of various medications including antidepressants and other herbal supplements are evaluated.
  • Your psychiatrist may perform the diagnosis for presence of any mental health disorder that can worsen depression.
  • You may be asked to conduct blood tests or other tests for ruling out the presence of other diseases such as thyroid disorders, anaemia and other medical problems.

Adjusting your medications  

One of the reasons your medications might not have worked for you is the incorrect dosage or ineffective combination of medications.

You may follow the below mentioned medication strategies

  • Take your medications for some more time as antidepressants may take up to eight weeks to show their effect. In some cases, it takes even longer.
  • Your psychiatrist may make adjustments in dosage of your medications. Usually, the increase in dosage provides improvement in symptoms.
  • Your psychiatrist may switch your antidepressant medications if the prescribed antidepressant isn’t effective.
  • If one antidepressant is not effective, your doctor may add another antidepressant to the treatment. The combination of antidepressants may yield more effective results as they affect a wide range of brain chemicals.
  • You may be prescribed medications used for another health disorder such as mood stabilizers, beta blockers, antipsychotics and stimulants, anti-anxiety medications, anti-seizure medications, etc.

Psychotherapy

Psychotherapy is very effective in individuals who do not respond to antidepressants alone. With psychotherapy, patients can learn to find better ways for coping with life’s challenges and managing healthier relationships.

  • Cognitive behavioural therapy includes the counselling session with patients. During the session, the feelings and behaviours of patient responsible for affecting mood are addressed.

It assists in identifying patterns of negative thinking. Patients learn to cope the stresses of life in better way.

  • Interpersonal psychotherapy deals with resolving relationship issues responsible for causing depression.
  • Family therapy involves counselling session with family members or spouse for resolving the issues responsible for stress in your relationships.
  • Group psychotherapy involves counselling session with group of people who share their feelings and symptoms with others.

Procedures for Treatment-resistant depression

The treatment resistant depression can be treated by following the below mentioned procedures.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy is widely practised in treating severe cases of depression as it can immediately reverse symptoms of depression. It is usually administered in those depressed patients who do not respond to other treatments.

Changes in the brain chemistry can be achieved by passing electricity through brain. This phenomenon is known as Electroconvulsive therapy. When electric currents are passed through the patient’s brain, it triggers a brief seizure resulting in changes in brain chemistry.

Vagus nerve stimulation

A Vagus Nerve Stimulation is newly designed brain stimulation procedure where electrical impulses are sent into the patient’s brain for treating depression symptoms.

Transcranial magnetic stimulation

Transcranial magnetic stimulation involves using magnetic fields for stimulating the nerve cells in brain for improving the symptoms of depression.

It is a relatively new procedure that is recommended in patients who do not respond to other standard treatments such as medications and psychotherapy.

When a blood supply does not reach a part of brain, it results in stroke. This blockage of blood flow occurs either due to blood clot or bursting of blood vessel.

As brain regulates the activities of entire body, the brain stroke can result in impairment of essential body tasks.

Strokes may cause inability to perform daily tasks, speech problems, or paralysis in severe cases.

The effects of depression may be temporary or permanent in nature. Usually the patients get into depression after the stroke.

How stroke leads to depression?

Studies have revealed that stroke survivors get into depression after the stroke. In fact, many stroke patients are treated by psychiatrists for improving their depression symptoms.

The severity of depression after stroke depends on various factors including area of the brain suffered by stroke, family history of depression, and any depression symptoms that were existed before the stroke.

Stroke survivors may become more irritable and do not follow strict course of treatment. It tends to make them more depressed.

Risk factors of depression in stroke patients

  • Individuals who have High blood pressure
  • Individuals who are overweight
  • Older people who have heart disease

Symptoms of depression in patients with Stroke

Patients who suffer from stroke may experience various symptoms of depression.

  • Lack of self esteem
  • Loss of appetite
  • Tendency to eat more or loss of appetite
  • Lack of energy or fatigue
  • Feeling of worthlessness, sad mood
  • Difficulty in concentrating
  • Difficulty in sleeping (too much sleep or too less sleep)
  • Lack of interest in enjoying tasks that were once pleasurable
  • Difficulty in concentrating
  • Suicidal tendency
  • Increasing intake of alcohol, drugs, or tobacco

Treatment of depression in patients with Stroke

Psychiatrists treat the depression in patients with stroke by employing combination of various therapies for obtaining the desired results.

Antidepressants medications take many weeks to show their results. Psychiatrists usually combine medications with other therapies such as Cognitive-behavioural therapy or ongoing talk therapy.

The dosage of these medications may be adjusted depending on the patient’s response for reducing the side effects and achieving the optimal results.

  • Medications like antidepressants and antipsychotic medications

Selective serotonin reuptake inhibitor (SSRI)

Serotonin and nor epinephrine reuptake inhibitor (SNRI)

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy
  • Physical exercise
  • Support from families/friends
  • Lifestyle changes including regular aerobic exercises that boost the patient’s mood
  • Medications for building new bones and stopping bone loss

Doctors may perform certain selected investigations in order to rule out other causes.

  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection
  •  Subjective cognitive complaints in older depressed people

Tips for coping up with depression

  • Develop circle of friends and social support
  • Treatment at the early occurrence of a problem
  • Learn ways of controlling stress
  • Increase your resilience
  • Aware of the causes or triggers of the disease
  • Learn various ways of boosting low self-esteem
  • Long-term maintenance treatment for preventing relapse of depression

Have you ever observed any older adults who experience tremor or shakings in their hands, leg or face?

These individuals suffer from Parkinson’s disease that occurs due to lack of dopamine, responsible for controlling movement in body.

The symptoms of Parkinson’s disease get worsened over time and are commonly found in people above 50 years of age. There is no established cure for treating Parkinson’s disease.

Common Symptoms of Parkinson’s disease

  • Tremor or shaking in body parts such as hands, legs, face, etc.
  • Stiff arms and legs
  • Slow movement
  • Inability to balance and coordinate
  • Adverse affect on thinking and emotions

How Depression and Parkinson’s disease are related?

Depression increases the severity of symptoms of parkinson’s disease in affected patients and vice versa. Thus, Depression and Parkinson’s disease can worsen the symptoms of each other.

As per researchers, people who have depression along with Parkinson’s disease have more severe symptoms like movement problems and high anxiety levels than patients who have either depression or parkinson’s disease alone.

Patients who have both depression and parkinson’s disease experience great difficulty in concentrating although they may have show less sign of worthlessness or sadness than patients who are depressed but do not have parkinson’s disease.

Patients who have Parkinson’s disease have high number of reuptake pumps for Serotonin. These overactive pumps decrease the serotonin levels leading to depression.

Signs and Symptoms of Depression in patients who have Parkinson’s disease

  • Feeling of sadness
  • Mood Disorders
  • Slow movement
  • Inability to balance and coordinate
  • Adverse affect on thinking and emotions
  • Difficulty in concentrating
  • Difficulty in making decisions
  • Feeling of worthlessness, hopelessness
  • Feeling irritable or restlessness
  • Loss of interest in activities that were once pleasurable
  • Feeling tired frequently
  • Loss of memory
  • Loss of appetite
  • Suicidal tendency

Treatment of Depression in patients who have Parkinson’s disease

Although there are no medications available to check the progress of Parkinson’s disease, there are various medications that provide considerable relief from its symptoms.

Psychiatrists treat the depression in patients with Parkinson’s disease by employing combination of various therapies for obtaining the desired results.

The dosage of these medications may be adjusted depending on the patient’s response for reducing the side effects and achieving the optimal results.

  • Medications like antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Tricyclic antidepressants

Monoamine oxidase inhibitors (MAOIs)

Atypical antidepressants

  • Cognitive-behavioural therapy/ Psychotherapy
  • Physical exercise
  • Electroconvulsive therapy (ECT) is recommended in treatment resistant depression however it may be effective in treating symptoms of parkinson’s disease
  • Vagus nerve stimulation
  • Tran cranial magnetic stimulation (TMS)
  • Alternative medicine including Herbal remedies and supplements

For patients, who do not respond well with the medications, psychiatrists usually recommend deep brain stimulation Surgery.

During DBS surgery, surgeons place a battery-operated neurostimulator inside the body. This medical device produces electrical stimulation in brain areas responsible for controlling movement.

As we grow older, our bones become weak due to decline in bone mass. These fragile bones are prone to fractures easily. This phenomenon of weakening of bones is called as osteoporosis.

Osteoporosis can happen at any age however it is prevalent in older patients. Depression is found to accelerate the process of osteoporosis in older adults.

How are depression and osteoporosis related?

Researchers have revealed that older people who have depression possess lower bone mass as compared to normal older people. Bone mass is the amount of calcium present in the bones.

Risk Factors for low bone mass

  • Younger women who have depression
  • Women with mild depression who have not yet reached menopause
  • Being women
  • Older men with depression

Due to presence of osteoporosis, patients have to adopt several lifestyle changes which eventually cause symptoms of depression.

  • Osteoporosis patients may not be able to take part in activities that were once enjoyable due to fear of fracture of fragile bones.
  • Difficulty in performing everyday tasks
  • Loss of independence
  • Fear of going to crowded places for fear of fracturing a bone

Symptoms of depression in patients with Osteoporosis

Patients who are suffering from osteoporosis may experience various symptoms of depression.

Patient may not observe some of these symptoms; however his/her friends or family members may notice them.

  • Feeling of worthlessness, sad mood
  • Difficulty in concentrating
  • Difficulty in sleeping (too much sleep or too less sleep)
  • Loss of appetite
  • Tendency to eat more or loss of appetite
  • Lack of energy or fatigue
  • Lack of interest in enjoying tasks that were once pleasurable
  • Difficulty in concentrating
  • Suicidal tendency
  • Lack of self esteem
  • Increasing intake of alcohol, drugs, or tobacco

Diagnostic Tests for Depression in patients with heart diseases

The diagnosis of the major depression is performed by doctors after thorough medical examination of the depressed patient.  Patient is asked various questions related to medical history and symptoms.

Common Diagnostic Procedures

  • Full patient medical history
  • Physical Assessment
  • Thorough evaluation of symptoms
  •  Standardized questionnaires

Treatment of depression in patients with osteoporosis

Psychiatrists treat the depression in patients with osteoporosis by employing combination of various therapies for obtaining the desired results.

  • Medications like antidepressants and antipsychotic medications

Selective serotonin reuptake inhibitor (SSRI) including citalopram, sertraline, and fluoxetine

Serotonin and nor epinephrine reuptake inhibitor (SNRI) including venlafaxine and duloxetine

Antidepressants medications take many weeks to show their results. Psychiatrists usually combine medications with other therapies such as Cognitive-behavioural therapy or ongoing talk therapy.

The dosage of these medications may be adjusted depending on the patient’s response for reducing the side effects and achieving the optimal results.

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy
  • Physical exercise
  • Support from families/friends
  • Lifestyle changes including regular aerobic exercises that boost the patient’s mood
  • Medications for building new bones and stopping bone loss

Psychiatrists recommend exercise as an important part of osteoporosis treatment. Exercise helps in treatment by following ways.

  • Strengthen bones and muscles for preventing fractures
  • Boosting mood of patients by treating depression

The moment you come to know that you have HIV infection; you are bound to get visuals of painful death. The trauma associated with AIDS/HIV keeps you in a state of shock, grief and sadness. Eventually it leads to Depression.

According to the results of various studies, the rates of depression in HIV infected patients are around 60% as compared to only 5% to 10% in general population. Moreover, depression associated with AIDS/HIV is more common in women than men.

To face AIDS/HIV infection requires you to be mentally strong. However in majority of cases, patients succumb to pressure and social stigma attached with AIDS and get into depression.

Although depression associated with HIV is dreadful condition, it is not easily recognised and doctors may associate the depression symptoms with signs of advancing HIV.

Effect of depression on HIV/AIDS

Depression can adversely affect the treatment in patients infected with HIV. Patients struggle to cope with the intense treatment regime and pressure associated with it.

Patients get reluctant to take active part in their treatment and tend to miss out their doses of medication. Moreover, in severe cases depression promotes high-risk behaviours that may spread HIV infection in others.

Depression may lead to fast progression of HIV disease and activated the latent viral infections.

It also interferes with your ability to enjoy life.

Causes of Depression linked with HIV

People infected with HIV are likely to get depressed due to following reasons.

  • Medications used for treating AIDS/HIV may worsen the depression symptoms
  • Low levels of testosterone
  • Low levels of Vitamin B6 or vitamin B12
  • Hiding about your disease from others
  • Failure of HIV treatmen

Symptoms of depression in HIV patients

The symptoms of depression in HIV patients vary from one person to other. Generally, patients begin to show feelings of depression from the moment they are aware of their HIV infection. If these feelings persist for longer term, patient gets depressed.

  • Tiredness or Fatigue
  • Reluctant to engage in any activity
  • Difficulty in concentrating or memorising
  • Very low sex drive
  • Sleep disturbances including too much sleep or too less sleep
  • Loss of appetite or tendency to overeat
  • Weight loss or weight gain
  • Feeling of worthlessness or hopelessness

Treatment of depression in HIV patients

Psychiatrists perform the comprehensive evaluation of depressed HIV patients before deciding about the antidepressants and other treatment therapies.

As some of the antidepressants cause various side effects so doctors need to monitor how their patients are responding to medication. The psychiatrists usually prescribe the drugs that produce maximum benefits with least side effects in patients.

Antidepressants should be used in supervision of a doctor who is taking care of HIV treatment.

  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • tricyclics
  • psychostimulants
  • dehydroepiandrosterone (DHEA)

Common side effects of antidepressants are loss of sexual desire, anxiety, insomnia, fatigue, lack of appetite, upset stomach, diarrhoea, etc.

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy
  • Physical exercise
  • Support from families/friends

Other therapies for treating depression in HIV patients

Lifestyle changes

  • Daily regular exercise
  • Good sleeping habits
  • Exposure to sunlight
  • Counselling Sessions
  • Stress management training that involves training the patients to cope up with various stressful situations
  • Problem-solving therapy that assist in identifying the problems and learning ways for solving them.
  •  Support group where patients can express their emotions freely
  • Coping Skills for taking care of depression and cancer treatment

Alternative therapies

  • Massage therapy
  • Acupuncture
  • St. John’s Wort
  • Supplements of vitamins B6 or B12

A diabetic patient has increased levels of blood glucose due to lack of sufficient insulin production.

It is a very common disease that affects large number of people in general population.

A diabetic patient has to manage diabetes everyday and it leads to stress. Eventually it may contribute to depression in individuals.

As per recently concluded studies; Diabetes is linked with depression. The diabetic patients are more prone to depression as compared to normal individuals. Also, the severity of diabetic symptoms is more pronounced in depressed patients in comparison to normal diabetic patients.

How depression is related to diabetes?

It is still not clear if diabetes leads to depression or depression increases the possibility of diabetes.

Diabetes can cause worsening of the symptoms in depressed patients. It’s very challenging to manage diabetes on a daily level. Patient has to maintain strict dietary habits and take regular insulin injections/medications.

On other hand, depression cause profound effect on physical and mental health of patients. Thus, depression may lead to worsening of diabetic symptoms and also increases the risk of diabetes.

Depressed patients tend to feel sad and may overlook the restricted diet regimen or medications.

It puts them at risk of facing severe diabetic symptoms.

Diagnostic Tests for Depression in diabetic patients

Psychiatrists may perform complete physical examination of the depressed patients who have diabetes. Patient is asked various questions associated with his/her lifestyle and symptoms to ascertain the exact reason of depression.

  • Physical Assessment
  • Thorough evaluation of symptoms
  • Standardized questionnaires

Some tests are performed for ruling out other diseases.

  • Blood tests
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection

Signs and Symptoms of Depression in diabetic patients

  • Feeling of worthlessness, hopelessness or sadness
  • Difficulty in concentrating or making decisions
  • Feeling irritable or restlessness
  • Sleep disturbances
  • Loss of interest in activities that were once enjoyable
  • Increasing intake of alcohol, drugs, or tobacco
  • Getting tired frequently/Fatigue
  • Loss of appetite or increased appetite
  • Suicidal tendency

Treatment of depression in people who have cancer

The treatment of depression in diabetic patients is multi-fold in approach. In addition to standard treatment (Antidepressant medications and Psychotherapy); psychiatrists uses various other alternative therapies for obtaining the desired results.

Diabetic patients who are treated for depression find it easy to manage their diabetes. With the improvement in the symptoms of depression, patients experience elevated mood levels and better blood glucose control.

There is wide range of antidepressants available in the market. Psychiatrist needs to select the antidepressant cautiously as many antidepressants cause various side effects.

Depending on the condition of the patient, doctors choose antidepressant with maximum benefits and minimum side effects.

Common Treatment Therapies

  • Medications like antidepressants and antipsychotic medication

Selective serotonin reuptake inhibitor (SSRI)

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Tricyclics

Monoamine oxidase inhibitors (MAOIs)

Paroxetine

Mirtazapine

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy
  • Physical exercise
  • Support from families/friends

Pain that simply does not go away is termed as Chronic pain. In some cases, it may lasts for even few years.  Your regular pain killer does not offer relief in chronic pain.

Chronic pain usually results due to long term disease, injury or infection. However it may result without any apparent reason.

There is no known underlying reason for depression due to chronic pain. However, chronic pain interferes with regular activities of individuals, causes sleep disturbances and reduces quality of life.

As per researchers, chronic pain often leads to worsening of depression symptoms. Moreover, it is one of the risk factors for suicide in depressed patients.

How chronic pain causes depression?

The severity of depression often increases with intensity of pain.

Depressed people have higher levels of cytokines that are responsible for intensity and length of immune system response to any infection.

These cytokines lead to inflammation (body response to infection) and thereby produces pain in the body. Here pain manifests as a sign of inflammation.

Inflammation is thought to play a significant role in depression linked to chronic pain.

Fibromyalgia and Depression

Fibromyalgia is often associated with depression. A patient suffering from fibromyalgia experiences chronic and widespread pain in muscles and multiple tender points on body.

Studies have revealed that patients with fibromyalgia are more prone to mental disorders including depression compared to other normal individuals.

Diagnostic Tests for Depression in patients with chronic pain

The diagnosis of the depression in patients with chronic pain is performed by psychiatrists after thorough medical examination of the depressed patient.

Psychiatrists may ask wide range of questions from the patient to ascertain various possible reasons for depression.

Diagnostic Procedures

•             Full patient medical history

•             Physical Assessment

•             Thorough evaluation of symptoms

•             Standardized questionnaires

Blood Tests and other laboratory tests may be performed for ruling out other causes of depression.

Symptoms of depression in patients with chronic pain

Patients who are suffering from chronic pain may experience various symptoms of depression.

Patient may not observe some of these symptoms; however his/her friends or family members may notice them.

  • Feeling of worthlessness, sad mood
  • Difficulty in concentrating
  • Difficulty in sleeping (too much sleep or too less sleep)
  • Loss of appetite
  • Tendency to eat more or loss of appetite
  • Lack of energy or fatigue
  • Lack of interest in enjoying tasks that were once pleasurable
  • Difficulty in concentrating
  • Suicidal tendency
  • Lack of self esteem
  • Increasing intake of alcohol, drugs, or tobacco

Treatment of depression in patients with chronic pain

Psychiatrists treat the depression in patients with chronic pain by targeting the underlying cause of

chronic pain.

Psychiatrists employ combination of various therapies for obtaining the desired results.

  • Medications like antidepressants and antipsychotic medication including Selective serotonin reuptake inhibitor (SSRI) and Serotonin and nor epinephrine reuptake inhibitor (SNRI)
  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy
  • Physical exercise
  • Support from families/friends
  • Lifestyle changes including regular aerobic exercises that boost the patient’s mood

o wonder even the thought of having cancer can make you depressed. Cancer is a really a life threatening disease. However there is no proof that cancer can lead to depression or vice versa.

Although there is no direct link between depression and cancer, the patients diagnosed with cancer experience high level of stress or sadness. Eventually these feelings result in depression.

Effect of Depression on Cancer

Depression can affect the treatment of cancer in patients who have cancer. Patients find it difficult to take active part in treatment as they are depressed and have negative feelings.

It is essential to treat depression in cancerous patients as it can generate more positive results.

Diagnostic Tests for Depression in patients who have cancer

The diagnosis of the depression in patients who have cancer is performed by trained and well qualified psychiatrists.

Doctors usually perform complete physical examination of the depressed patients who have cancer.  Patient is asked several questions associated with medical history and symptoms.

  • Physical Assessment
  • Thorough evaluation of symptoms
  • Standardized questionnaires
  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection

Signs and Symptoms of Depression in patients who have cancer

  • Feeling of sadness
  • Mood Disorders
  • Difficulty in concentrating
  • Difficulty in making decisions
  • Feeling of worthlessness, hopelessness
  • Feeling irritable or restlessness
  • Loss of interest in activities that were once pleasurable
  • Feeling tired frequently
  • Loss of memory
  • Loss of appetite
  • Suicidal tendency

Treatment of depression in people who have cancer

Psychiatrists need to treat depression in cancer patients after careful evaluation. As some of the antidepressants cause various side effects so doctors need to find the drugs that produces maximum benefits with least side effects in patients.

There are various therapies used by psychiatrists for treating depression in cancer patients.

  • Medications like antidepressants and antipsychotic medication

Selective serotonin reuptake inhibitor (SSRI)

Serotonin and norepinephrine reuptake inhibitor (SNRI)

  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy that inculcates the positive attitude and behaviours in the patients
  • Physical exercise
  • Support from families/friends

Other therapies for treating depression in cancer patients

  • Psycho education where patients are made to understand their illness and ways of its treatment
  • Stress management training that involves training the patients to cope up with various stressful situations
  • Problem-solving therapy that assist in identifying the problems and learning ways for solving them.
  •  Support group where patients can express their emotions freely
  • Coping Skills for taking care of depression and cancer treatment

Common Tips for treating depression in cancer patients

  • Maintain strict regimen of taking medications
  • Maintain proper sleeping habits
  • Get engage in socialising activities
  • Take interest in pleasurable activities
  • Exercise regularly and remain physical active
  • Minimize use of alcohol and other illegal drugs
  • Eating healthy foods
  • Express feelings to close friends and family
  • Quit smoking

Have you ever experienced symptoms of depression after receiving a mild or severe brain injury?

In fact, patients who have had traumatic brain injury are likely to feel sadness or depressed mood.

As per the researchers, any injury to brain (Mild. Moderate or severe) can lead to various physical or mental problems.

Common problems after brain injury

  • Headaches
  • Mood changes
  • Depressed mood or Anxiety
  • Difficulty to memorise or remember
  • Ringing sensation in your ears
  • Difficulty in concentrating
  • Sleep disturbances
  • Fatigue or loss of energy

In some cases, patients may experience symptoms of anxiety or depressed mood even after

many months or years following brain injury.

Risk factors of depression after brain Injury

  • Any sort of brain injury can lead to depression including mild, moderate, or severe injury.
  • Person of any age can experience depression after brain injury
  • Individuals with any gender can experience depression after brain injury
  • Depression may result irrespective of the part of brain that was injured

Diagnostic Tests for Depression after brain Injury

The diagnosis of the major depression is performed by doctors after thorough medical examination of the depressed patient. Patient is asked various questions related to medical history and symptoms.

  • Full patient medical history
  • Physical Assessment
  • Thorough evaluation of symptoms
  • Standardized questionnaires
  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection

Symptoms of depression in patients who have had brain injury

Patients who have had brain injury may experience various symptoms of depression. As a patient you may not observe some of these symptoms; however your friends/family members may notice them.

You should consult with your relatives, friends or people close to you if they have observed any changes in your mood or behaviours.

  • Feeling of sadness
  • Lack of energy or fatigue
  • Lack of interest in enjoying tasks that were once pleasurable
  • Difficulty in sleeping (too much sleep or too less sleep)
  • Loss of appetite
  • Difficulty in concentrating
  • Suicidal tendency
  • Feelings of guilt or worthlessness
  • Avoid spending time with family members or friends
  • Increasing intake of alcohol, drugs, or tobacco
  • Tendency to eat more or loss of appetite

Treatment of depression in patients who have had brain injury

Psychiatrists treat the depression by using combination of various therapies as it helps in obtaining the desired results.

  • There are many antidepressants used by psychiatrists for treating depression. Patients have to take these medications for long periods including months or even years.

Medications like antidepressants and antipsychotic medication

  • Selective serotonin reuptake inhibitor (SSRI) such as citalopram, sertraline, and fluoxetine
  •  Serotonin and norepinephrine reuptake inhibitor (SNRI) such as venlafaxine and duloxetine
  • Cognitive-behavioural therapy/ Psychotherapy/ or talk therapy that inculcates the positive attitude and behaviours in the patients
  • Physical exercise
  • Support from families/friends

Major depression with psychotic features

Major depression with psychotic features is a serious depression that is characterised by the hallucinations and loss of reality (psychosis).  Patient is not only depressed but also develops

delusions.

Major depression causes profound effect on the lifestyle of affected patients who find it difficult to work, eat, sleep, concentrate and enjoy social activities.

Causes of Major Depression with Psychosis

The exact cause of Major Depression with Psychosis is not known. However there are certain risk factors that make a patient more vulnerable to this disease.

Risk factors that trigger Major depression with Psychosis in individuals

•             Individuals with family history of depression or psychotic illness

•             Individuals who have had traumatic childhood experiences

•             Individuals with family history of alcoholism

•             Individuals with biological family members who have had committed suicide

•             Individuals who have faced unfortunate life events like death of loved ones, divorce,

•             Individuals who have experienced major life changes such as job change, retirement

•             Individuals who have experienced physical, sexual, or emotional abuse

•             Individuals who have had failed personal relationships

•             Postpartum depression in women who have given birth to child recently

•             Individuals with low self-esteem and feelings of being deprived

•             Individuals who are addicted to alcohol, nicotine or illicit drugs

Symptoms of Major Depression with Psychosis

Patients who have Major Depression with Psychosis are characterised by the occurrence of major depressive episode lasting for entire day for at least two weeks. They also exhibit symptoms of psychosis.

•             Delusions involving false beliefs regarding one’s identity and locations

•             Hallucinations involving seeing or hearing unrealistic things

•             Depressed mood

•             Lack of interest in activities that were once pleasurable

•             Significant weight loss or weight gain

•             Difficulty in sleeping

•             Excessive movement or slowing down

•             Fatigue

•             Feeling of worthlessness or guilt

•             Difficulty in concentrating or making decisions

•             Suicidal thoughts

Patients usually exhibit the delusions and hallucinations associated with their depressed feelings.

Diagnostic Tests for Major Depression with Psychosis

The diagnosis of the major depression is performed by doctors after thorough medical examination of the depressed patient.  Patient is asked various questions related to medical history and symptoms.

Common Diagnostic Procedures

•             Full patient medical history

•             Physical Assessment

•             Thorough evaluation of symptoms

•             Standardized questionnaires like Hamilton Rating Scale for Depression, and the Beck Depression Inventory

•             Blood tests for TSH and thyroxin levels for excluding hypothyroidism

•             Basic electrolytes and serum calcium for ruling out metabolic disturbances

•             Full blood count including ESR for ruling out a systemic infection

•             Adverse affective reactions for medications

•             Adverse affective reactions for alcohol misuse

•             Evaluation of Testosterone levels for diagnosing hypogonadism

Treatment of Major Depression with Psychosis

Patients who have major depression with psychosis require immediate medical care and treatment.

There are various treatment therapies available for treating Major Depression. The doctors usually employ the combination of various therapies to obtain the optimal results

•             Medications like antidepressants and antipsychotic medication

•             Cognitive-behavioural therapy/ Psychotherapy

•             Physical exercise

•             Electroconvulsive therapy (ECT)

•             Vagus nerve stimulation

•             Tran cranial magnetic stimulation (TMS)

•             Lifestyle and home remedies

•             Herbal remedies and supplements

•             Mind-body connections

•             Coping and support