1

B. PHARMACY 7th SEMESTER

Project Report On

CONFOUND SYMPTOMS OF DEPRESSION and TREATMENT

SUBMITTED BY – AAYUSHI DARA

B.PHARMA 7 TH SEMESTER

ROLL NO – PIET-BPH-2001

SUPERVISOR – MS. Palika Sehgal

Faculty of Pharmaceutical Sciences

(PHARMACEUTICS)

DEPARTMENT OF PHARMACY
 CERTIFICATE

The work embodied in the project entitled “Confound Symptoms of Depression

Is based on my project work carried out under the supervision of MS. PALIKA

SEHGAL Faculty of Pharmaceutical Sciences, Panipat Institute of Engineering

And Technology, Samalkha.

PLACE – SAMALKHA

DATE - AAYUSHI DARA

MS. PALLIKA SEHGAL

FACULTY of PHARMACEUTICAL SCIENCES

Panipat Institute of Engineering and Technology

SAMALKHA
 3

ACKNOWLEDGEMENT

I owe a deep sense of gratitude for my mentor and supervisor MS.

Palika Sehgal, Dean, Faculty of Pharmaceutical Sciences for her
keen interest at every stage of my work. Her prompt inspiration,
timely suggestions with kindness, enthusiasm and dynamism have
enabled me to complete my project work.

It is a genuine pleasure to express my deep sense of thanks and

Gratitude to Ms. Pallika Sehgal for her kind support in completing
this project report. Her timely advice, meticulous scrutiny, scholarly
advice and scientific approach have helped me to a very great extent
to accomplish this task.

I thank profusely to all the teachers for their kind help and support
throughout my study period.

Aayushi Dara
 PROJECT WORK UNDERTAKEN
PATIENT SURVEY –

Work undertaken by the pharmacy practice school includes a clinical study on patients suffering from an auto-
immune disease namely Rheumatoid Arthritis (RA)

. RA is an autoimmune disease that causes inflammatory disorders throughout the body, causing chronic pain and
disability. Medication can delay its progress and relieve some of the pain, but there is no cure, and living with RA
can lead to depression, anxiety, isolation, and overall impaired quality of life. Working with the board-certified IFS
(Internal family systems) therapist two randomized groups were created a control group received regular mail and
phone calls regarding disease symptoms and management while the other received IFS therapy as well. The goal of
the IFS group was to teach patients how to accept and understand their inevitable fear, hopelessness, and anger and
to treat those feelings as members of their own “internal family”

. RA patients were Alexithymic they never complained about their problems unless they were overwhelmed during
therapy. The other group shut out their bodily sensations and emotions that they could not effectively collaborate
with their doctors, felt worthless sticking to bed all the time and felt their pain and suffering was useless and nobody
wanted to hear about it. The managers who were in charge of the control group told these patients to “grin and bear
it” as nobody wanted to hear their problems and pain. Months later control group when became overwhelmed with
pain and let their stoic part hold back it was analyzed that these individuals felt worthless staying in bed all day and a
part of them that could not accept the process of aging and being in exile wanted to yell and break the havoc. It was
also recollected that as children most of these individuals needed to be seen and felt a lack of safety. No doubt, the
other group of RA patients under therapy were made aware of their body needs and accepted the process of aging.
They were also trained to apply language to the parts of their daily happenings.

Six months later, when both the groups were assessed and IFS group showed measurable improvements in joint
pain, physical function, and self-compassion relative to the control group. The IFS group’s pain symptoms and
depressive symptoms were sustained one year later. Although other objective medical tests showed no improvement
in inflammation in particular. But what changed most was the ability of the patient to live with the disease. Hence,
psychological safety and comfort are reflected in a better-functioning immune system.

CASE STUDY –

Another was the research case study undertaken of the American singer and songwriter, Selena Gomez. Right after a
traumatic event she was diagnosed with high functioning depression/Bipolar disorder which led to an auto-immune
 5

disorder of Neuro Psychiatric Systemic Lupus Erythmatosus (NPLSE). NPLSE is a severe form of lupus occurring
due to damaged Blood-Brain-Barrier causing the Antibody attack. Brain Cytoplasmic- Ribonucleic acid (BC-RNA)
influences the entry of foreign particles from entering the brain.

But due to damaged Blood-Brain-Barrier autoantibodies produced by the brain attack there own CNS. Lupus mainly
affects a person’s kidneys, hearts, lungs, blood vessels, and brain. Women are more prone to this disease from age
groups 15 to 45.

The exact cause of the disease is still uncertain but one in million can be diagnosed with the rare disorder

stemming up from psychiatric conditions. The predictions related to this disorder are related to hormones, stress, or
even genetics.

The singer also witnessed a kidney transplant due to kidney failure because of Lupus. Alongwith being diagnosed of
a major disease she also faced backlash in the career for which she had to take career gap when her fame was at the
notch.

Neuronal hijacking and losing oneself at the time of the trauma or during adverse situations leads one to extreme
verge of losing it diseases or emotional rebound. Emotions do hold energy and the very essence of it seen to be in
the evolutionary history of the Animal Kingdom. Emotional brain was first observed in lower Order of species
generation linked with Olfactory bulbs connecting a sense of their immediate surroundings into them. Detecting
food, mate for Sexual process, enemy, shelter, etc.

Even when the saying goes for snakes eating their own offspring for eventually not having emotions or being called-
heartless also emerges out from the development process during the course evolution. It’s been observed that they do
actually possess the emotional brain but the intellectual brain which manages our actions out of emotions rather than
being influenced by the reality or holding onto some practicality. The limbic brain was the first part of the brain to
have formed in connection with emotional brain. The brain develops from the bottom up CNS in connection with
our major organs for sensory perception leads way into the brainstem from the hollow notch as a semi-circled (eaten
beacon) shape. This came during the course of evolution when in lower Primates to be linking emotional senses to
warn against danger, good or bad, in terms of food, friends and foes, directing the paths.

This part hence tells us how emotions often tend to affect our decision making process. It’s often noticed that when
emotions hold power the rational comes to rest or, that when, rational brain has a logic and wants to take certain
actions but often swayed away by emotions

Another sighting of this emotions getting physical holds up in a study by Dr. Sarno who almost spent his life proving
T-personality or Tension Myosinus Syndrome popularly known as TMS Theory. Dr, Sarno has four books catering
to the theory and almost his entire life spent around patients healing from he severe muscular pains because of
holding emotions but his findings were often repudiated by Physicians because they were not backed by certain
evidence proving those to be correct anyhow. But that’s what it is mainly about the brain has so many such
phenomenon which Doctor’s can not really provide certain evidence except for the fact that they are just there and
that’s how the brain works.

Coherently not promising to a controversial theory but also denying the fact of it it’s explanation goes as follows,
according to Dr. Sarno when something tragic happens or when we are holding certain emotions like rage, sadness,
apathy, shame, responsibility, etc it is stored into the brain not just because you’re weak, sensitive or naïve to the
incidence but you hold onto certain emotions which strikingly make an impact the brain stores them around certain
parts of your body and the oxygen supply to the body part is decreased resulting in severe pains. The stored
emotions hence become pain and they definitely do not or will go away by changing the circumstance of situation.
For let’s say if you’re overwhelmed with the work and it causes pain in your shoulders, getting the work done
simply will not cure the pain. It just stays but the circumstance to which it responds varies throughout life.

Massage or medication or simply going to therapy will simply not cure the pain. Hence for a body responding to
stress there are so many divergent and existential pains as I would call them Headache, Migraine, Meningitis,
Choking throat, pain in the shoulders or lower back excruciating pain, tonsillitis, confining a person to a wheelchair,
thyroid disease, the adversity might vary but symptoms are highly distinct.

There’s so many area’s of the body the trauma acts upon and causes pain. Summing up, trauma hence causes a
decrease in immunity, rise in inflammation, eating disorders,cellular damage, memory issues, toxin elimination and
change in appearance eventually.

We further move into the treatment procedures depending upon the severity and symptoms of this disease ang
understand it’s confoundness.
 7

INDEX

SERIAL NO. CONTENTS PAGE NO

1 Title Page 1

2 Certificate 2

3 Acknowledgement 3

4 Work Undertaken 4

5 Index page 5

6 Introduction 6-10

7 Aim of the study 11

8 Challenge and Objectives 11-12

9 Types 12-13

10 Pathophysiology 13-14

11 Symptoms 14-15

12 Pharmacotherapy 15-23

13 Non- pharmacotherapy 24-28

14 Other psycho-Interventions 29-30

15 Somatic Treatments 30-36

16 Conclusion 36

17 Refrences 37-39
 INTRODUCTION

The facing of trauma. One does not have to be a combat soldier, or visit a refugee camp in Syria or the Congo to
encounter trauma. Trauma happens to us, our friends, our families, and our neighbors. Research by the Centers for
Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four
was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical
violence.A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten
or hit. Scientific interest in trauma has fluctuated wildly during the past 150 years. However, in the early 1950s a
group of French scientists had discovered a new compound, Chlorpromazine( sold under the brand name
Thorazine), that could “tranquilize” patients and make them less agitated and delusional. That inspired hopes that
drugs could be developed to treat serious mental problems such as depression, panic, anxiety, and mania, as well as
to manage some of the most disturbing symptoms of schizophrenia. Being traumatized means continuing to organize
your life as if trauma were still goin on- unchanged and immutable as every new encounter or event is
contaminated by the past. After trauma the world is experienced with a different nervous system. The survivor’s
energy now becomes focused on suppressing the inner chaos, at the expense of spontaneous involvement in their

life. These attempts to maintain control over unbearable physiological reactions can result in a whole range of
physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. This explains why it is
critical for trauma treatment to engage the entire organism, body, mind and brain.

If the amygdala is the smoke detector in the brain, think of the frontal Lobes- and specifically the medial prefrontal
cortex (MPFC), located directly above our eyes- as the watchtower, offering a view of the scene from on high. Is
that smoke you smell the sign that your houseis on fire and you need to fight back or escape, even before the frontal
lobes get a chance to weigh in with their assessment.

As long as you are not too upset, your frontal lobes can restore your balance by helping you realize that you are
responding to a false alarm and abort the stress response. In PTSD this balance is lost.

The amygdala’s danger signals trigger the release of powerful stress hormones including cortisol and adrenaline,
which increases the heart rate, blood pressure, and rate of breathing, preparing us to fight back or run away. Once the
danger is past, the body returns to its normal state fairly quickly. But when recovery is blocked, the body is triggered
to defend itself, which makes people feel agitated and aroused. Traumatic people, hence, usually find it difficult to
form safe and secure relationships at workplace or home.
 9

FIG 1 – Trauma affects the entire human organism- body, mind and brain. In PTSD the body continues to defend
against a threat that belongs to the past. Healing from PTSD means being able to terminate this continued stress
mobilization and restore the entire organism to safety.

SPEECHLESS HORROR-

In the 1990s novel brain-imaging techniques opened up undreamed-of capacities to gain a sophisticated
understanding about the way the brain processes information. Positron emission tomography (PET) and later,
functional magnetic resonance imaging (fMRI) based on physics and technology enabled scientists to visualize how
different parts of the brain of the brain are activated when people are engaged in certain tasks or when they
remember events from the past.

In PTSD, the most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s
area. In this case the change in color meant that there was a significant decrease in that part of the brain, which is
often affected in stroke patients when the blood supply to that region is cut off. It is a region of the frontal lobe of the
dormant hemisphere, usually the left, of the brain with functions linked to speech production. Without a functioning
Broca’s area, you cannot put your thoughts and feelings into words. Hence, all trauma is preverbal.
 11

Picturing the brain on trauma. Brain spots (A) the limbic brain, and (B) the visual cortex, show heightened
activation. In drawing (C) the brain’s speech center shows markedly decreased activation
 AIM OF THE STUDY

The aim of the project report includes an in-depth studying of the different affected area’s of the brain during
processing of trauma and comparison with healthy individuals to formulate a drug therapy regimen and diagnosing
of the severity of condition.

The report further goes on elaborating drug therapy role in treatment along with non-pharmacological therapy in the
treatment of the disorder with a clinical survey on the impact of trauma in other auto-immune diseases highlighting
the case of Rheumatoid Arthritis.

CHALLENGES AND OBJECTIVES

Diagnosing of the disease requires a deep insight of the symptoms and impacts of mental health disorder. Once
diagnosed the symptoms are sometimes relative with other personality and trauma disorders which often leads to
clinicians confusing one for the other.

Psychiatric knowledge and tests are often included to diagnose in such situations and alter the neurofeedback and
neuroplasticity conditions for patients.

Drug therapy alone is not the best alternative. More profound therapeutic procedures offer more advantages over
the custom procedures.

The Objectives include :-

1) Brain imaging scans of patient for in depth study of symptoms.

2) Treatment procedures including pharmacological drugs to non-pharmacological treatment measures.
3) Social-environmental impacts of a clinical study on Rheumatoid Arthritis patients and chronic pains/TMS
theory.
 13

TYPES OF DEPRESSION

MAJOR
DEPRESSION

PERSISTANT
POST
TRAUMATIC TYPES DEPRESSIVE
DISORDER

POSTPARTUM
DEPRESSION

There are several forms of depression but some major and common are discussed below –

1) Major Depression – Suffering person usually experiences a constant state of sadness and losing interest in
activities they used to enjoy.
2) Persistent depressive disorder – When the symptoms last for more than 2 years and lack of energy is
inevitable where person more or less seems to enjoy or join group settings.
3) Postpartum depression – After giving birth, some people experience heightened sadness which lasts more
than a month to several years.
4) Post traumatic Stress disorder – A disorder that lasts in patients after a traumatic or shocking experience and
the trauma lives in the body even after years of the incidence as if that was still going on in the present and
the patient’s body still goes into freeze or flight to combat the experience that happened years ago.

PATHOPHYSIOLOGY
 It is difficult to determine the pathophysiology of major depressive disorder because of its clinical and
etiological heterogeneity; however, there are numerous neurobiological theories that have the strongest
empirical support. These include:

1 Emotions :- Sadness
Anxiety
Guilt
Anger
Mood swings
Irritability
2 Thoughts :- Self-criticism
Impaired memory
Indecisiveness
Confusion
Suicidal thoughts
Intrusive thoughts
3 Physical :- Chronic fatigue
Lack of energy
Insomnia/oversleeping
Obesity/ Underweight
Loss of motivation
Alcohol addiction
4 Behaviour :- Withdrawal from others

Neglect of responsibilities

Changes in physical appearance.

Apathy

PHARMACOTHERAPY

New antidepressants are constantly being researched and produced, even if selective serotonin reuptake inhibitors
(SSRIs) continue to be the gold standard for treating depression. Finding a chemical with rapid effectiveness and few
adverse effects is the ultimate objective.

Daniel Bovet conducted structural research on histamine, the trigger for allergic reactions, in an effort to identify an
antagonist. An antagonist was eventually synthesized in 1937. Since then, a great deal of study has been done on the
relationship between the structures and functions of various antihistaminic substances, which has helped to uncover
 15

nearly all antidepressants.

The most commonly used drugs in routine psychiatric practice are highlighted in the ensuing subsections, which list
the major classes of antidepressants in chronological order of apparition.

SELECTIVE
MONOAMINE
TRICYCLIC ANTI SEROTONIN
OXIDASE
DEPRESSANTS REUPTAKE
INHIBITOR
INHIBITOR

SELECTIVE
KETAMINE AND
NOREPINEPHRINE
RELATED
REUPTAKE
COMPOUNDS
INHIBITOR

MONOAMINE OXIDASE INHIBITORS

MARKETED FORMULATION –

S.No. Generic Drugs Branded Drugs

1. Pehenlzine Nardil (Pro)
2. Tranylcypromine Parnate (Pro)
3. Selegiline Emsam (Pro)
4. Isocarboxazid Marplam (Pro)
5. Selegiline Zelapar (Pro)
6. Selegiline Eldepryl (Pro)
The first medication to be categorized as an antidepressant was isoniazazid; it was subsequently reclassified as a
monoamine oxidase inhibitor (MAOI). Since 1957, a number of additional MAOIs have been released. MOAIs have
a variety of adverse effects, including hepatotoxicity and hypertensive crises, which can result in fatal intracranial
hemorrhages, because they irreversibly inhibit monoamine oxidase. As a result, MAOIs have been used less
frequently over time.

Studies have shown that the effectiveness of MAOIs is similar to that of tricyclic antidepressants (TCAs). However,
patients who have not reacted to multiple different pharmacotherapies, including TCAs, are now almost exclusively
administered MAOIs due to their dietary limitations, potential hazardous side effects, and drug interactions.
Additionally, MAOIs have proven to be particularly effective in treating atypical forms of depression, including
reactive moods, reversal neuro-vegetative symptoms.

TCAs

MARKETED FORMULATION-

S.NO. Branded Drugs Generic Drugs

1. Elavil Amitryptyline
2. Silenor Doxepin
3. Anafranil Clomepramine
4. Pamelor Nortryptyline
5. Tofranil Imepramine
6. Sinequan Doxepine
7. Norpramin Desipramine
 17

The first TCA was discovered and released for clinical use in 1957 under the brand name Tofranil. Since then, TCAs
have remained among the most frequently prescribed drugs worldwide. TCAs-such as amitriptyline, nortriptyline,
protriptyline, imipramine, desipramine, doxepin, and trimipramine-are about as effective as other classes of
antidepressants-including SSRIs, SNRIs, and MAOIs-in treating major depression.

However, some TCAs can be more effective than SSRIs when used to treat hospitalized patients. This efficacy can
be explained by the superiority of TCAs over SSRIs for patients with severe major depressive disorder (MDD)
symptoms who require hospitalisation.

However, no differences have been detected in outpatients who are considered less severely ill. In most cases, TCAs
should generally be reserved for situations when first-line drug treatments have failed.

SSRIs

MARKETED FORMULATION –

S.No. Generic Drugs Branded Drugs

1. Citalopram Celexa
2. Escitalopram Lexapro
3. Fluoxetine Prozac, Symbyax
4. Paroxetine Paxil, Pexeva
5. Sertaline Zoloft
 6. Vilazodone Viibryd
A set of clinical experiments conducted in December 1987 established that fluoxetine, an SSRI, was just as effective
at treating depression as TCAs with fewer side effects. Its use grew faster than that of any other psychoactive in

history once it was put on the market. It was the world's second-best-selling medication in 1994.

The SSRIs fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram are now on the market.
They have caused varying degrees of tolerance and adverse effects, the most of which have been sexual and
digestive (nausea and appetite loss), along with headaches, anxiety, irritability, and insomnia. SSRIs do, however,
have a good profile of tolerance.

The majority of systematic reviews and meta-analyses have shown that SSRIs and TCAs are equally effective, and
there isn't any compelling data to support the superiority of any other class.

NOREPINEPHRINE REUPTAKE INHIBITORS

MARKETED FORMULATION –
 19

BRANDED GENERIC
DRUGS DRUGS
CYMBALTA DULOXETINE
PRISTIQ DESVENLAFAXINE
EFFEXOR VENLAFAXINE

SAVELLA MILNACIPRAN
FETZIMA LEVOMILNACIPRAN
IRENKA DULOXETINE

Other monoamine (norepinephrine, serotonin, and dopamine) neurotransmitter reuptake inhibitors called
SNRIs were launched to protect patients against the adverse effects of SSRIs. Currently available SNRIs are
venlafaxine, desvenlafaxine and duloxetine. The extended-release form of venlafaxine is the very widely used
for 24-48hrs delayed effect. These guidelines are commonly given to patients not responding to SNRI.

In individual studies, venlafaxine and duloxetine are more effective as SSRIs. They are also beter than TCAs.
Some analysis shows that raboxetine (an SSRI) is better than veneflaxaine an SNRI. Such incidences are
common but less preserved for effectiveness.

KETAMINE AND RELATED MOLECULE

Ketamine acts relatively quickly on refractory unipolar (and potentially bipolar) depression and acute suicidal
thoughts when administered intravenously in sub-anesthetic dosages. Ketamine's antidepressant effects can last for a
few days before gradually wearing off. Oral and intranasal Ketamine formulations have been mentioned in a few
papers for treatment-resistant depression, however there is currently no information regarding any possible
correlation between the mode of administration and the time of action. Dizziness, neurotoxicity, cognitive
dysfunction, impaired vision, psychosis, dissociation, urinary malfunction, restlessness, headaches, nausea,
vomiting, and cardiovascular symptoms are among the common side effects of Ketamine. When receiving acute,
low-dose therapies, these side effects are typically transient; nevertheless, chronic exposure can put patients at risk
for neurotoxicity and drug dependence. Lastly, given that Ketamine use is linked to an increased likelihood of drug
abuse.
Ketamine is not a magic bullet, and there are still a lot of unanswered questions regarding its best uses, including
dosage and delivery method. The growing use of ketamine treatment for depression is made more difficult by the
current absence of rules regarding the therapeutic monitoring of this treatment. Ketamine may never make it to
market, but it has sparked interest in the neurology of depression and led to studies on short- and long-term
antidepressant candidates. The main metabolite of ketamine, hydroxynorketamine, can stimulate glutamatergic
receptors quickly and persistently. It ought to be researched because it doesn't appear to have many of the safety
issues related to ketamine.

Since esketamine (S-ketamine), especially intranasal, has a three to four times higher affinity for the N-methyl-D-
aspartate (NMDA) receptor than ketamine, research on this is potentially beneficial. In March 2019, the US Food
and Drug Administration approved it for the treatment of depression that was not responding to treatment. But our
understanding of the consequences of long-term esketamine treatment is currently limited. Furthermore, due to the
possibility of abuse, esketamine use needs to be closely observed. Small studies have assessed additional glutamate
receptor modulators as stand-alone treatments or as supplements to other antidepressants. Examples include NR2B
subunit-specific NMDA receptor antagonists (traxoprodil), noncompetitive NMDA receptor antagonists
(memantine, dextromethorphan/quinidine, dextromethorphan/bupropion, and lanicemine), NMDA receptor glycine
site partial agonists (D-cycloserine, rapastinel), and metabotropic glutamate receptor antagonists.

Non-Pharmacological Therapies
 21

COGNITIVE AND BEHAVIOURAL THERAPY

INTERPERSONAL PSYCHOTHERAPY

PROBLEM-SOLVING THERAPY

SPEECH-LANGUAGE THERAPY

GROUP THERAPY

MINDFULNESS-BASED COGNITIVE THERAPY

Cognitive and behavioral therapies:

CBT is one of the most researched and proven psychotherapy techniques out there, with a strong body of data
supporting it. The foundation of interventional techniques is changing maladaptive thoughts and behaviors. CBT
challenges and corrects the erroneous ideas and distorted cognitions held by depressed patients, which in turn
prolongs their symptoms. As a result, CBT is a well-known and successful therapy option for MDD, and most
guidelines advise using it as a first line of treatment. However, a patient's ability to recognize and alter their own
beliefs and behaviors is a prerequisite for CBT to be effective. Several easy methods were devised to address this
problem, particularly in the management of primary care. One such strategy is behavioral activation, which is
incorporating enjoyable activities into everyday life to boost the quantity and quality of good interactions
CBT also includes acceptance and commitment treatment. Based on functional contextualism, this kind of treatment
can assist patients in accepting and adjusting to ongoing issues. It seems to be useful in lessening the symptoms of
depression and averting relapses. Computerized CBT (CCBT) is an additional type of CBT that can be used by
patients who are confined, isolated, or in a quarantine. It is delivered using a computer and a CD-ROM, DVD, or
online CCBT. For self-motivated patients with mild to severe major depression, cognitive behavioral therapy
(CCBT) and guided bibliotherapy based on CBT may be explored as an adjunctive treatment to medication. In
addition to medications, CBT is advised for people with resistant depression.

Schema therapy: Schema therapy is an additional CBT-derived treatment that can be administered to patients, such
as those with associated personality disorders, who have not responded well to conventional CBT. When it comes to
treating depression, schema therapy and CBT are roughly equal. CBT is also a suggested treatment for depression in
adolescent patients, as evidenced by numerous trials. In the meantime, despite inconsistent trial results, it continues
to be the first-line treatment for youngsters. Given the paucity of available information, CBT is a promising
treatment for elderly individuals with depression, although sufficient evidence supporting this claim is currently
lacking.

IPT:

Determining the causes of depression symptoms or episodes is

the aim of IPT.These triggers could be things like social isolaton, losses, or trouble interacting with others. The inter
vention's goals are to help the patient identify their own affect, help them grieve (if they have experienced a bereave
ment), and fix their dysfunctional social interactions by strengthening their social networks and social skills. IPT is
proven well proven therapy for depression in teenagers and is often the first-line treatment of the disorder in adults.

Problem-solving therapy:

Problem solving therapy is for estimating or judging the nature or value of something or someone even if it includes
your parent and creating boundaries. PST has been applied in a variety of clinical contexts, including treating
individuals with moderate depressive symptoms, particularly in primary care, and preventing depression in the
elderly. PST is similar to other psychotherapy techniques used to treat depression, despite its modest effect sizes.

ST:

Despite lacking the structure and evaluation of CBT or IPT, ST is nonetheless frequently utilized to assist people
with depression. ST calls for emotionally attuned listening, sympathetic paraphrasing, clarifying the nature of the
patient's pain, as well as comforting and motivating them, in addition to listening sympathetically and expressing
care for the patient's issues. With the use of these techniques, the patient can better express and embrace their
emotions, build their self-worth, and develop flexible coping mechanisms.
 23

Group therapy:

A variety of short- to long-term psychological interventions based on psychoanalytic theories are included in
psychodynamic therapy. Intrapsychic conflicts involving shame, suppressed urges, and issues with emotional
caregivers throughout early childhood that result in low self-esteem and inadequate emotional self-regulation are the
main topics of this kind of treatment. The effectiveness of psychodynamic therapy in the acute stage of major
depressive disorder (MDD) is well-established when compared to other psychotherapy modalities. Group therapy
(GT) is still not widely used for MDD. A few data points to the effectiveness of several GT techniques that were
influenced by CBT and IPT. Effective post-depressive symptomatology treatment for patients with sub-threshold
depression is group cognitive behavioral therapy (CBT), but not during the follow-up phase. Depressive symptoms
are lessened by supportive GT and group CBT, particularly in individuals who also have common comorbid
illnesses. Studies in this area are still sparse, though.

MBCT:

The relatively new method known as MBCT blends mindfulness-based stress reduction with components of CBT.
Research has demonstrated that MBCT treatment for eight weeks during remission lowers the risk of relapse.
Therefore, in patients who are at a high risk of relapse (i.e., those who have had more than two episodes of
depression and those who have experienced childhood abuse or trauma), it is a potential alternative to reduce or even
stop antidepressant treatment without increasing the risk of depressive recurrence.

OTHER PSYCHO INTERVENTIONS

MOVING THE BODY

PSYCHO PHYSICAL SOMATIC

MINDFULNESS PRACTICES

ASSISSTED NEURAL MOVEMENT

EDUCATION EXCERCISE TREATMENT

Psycho-Education –

This kind of intervention teaches depressed individuals about the signs and treatments of depression, as well as how
to manage them (with the patient's consent). The patient should be able to grasp the language used to provide this
instruction. It is important to address issues including misconceptions regarding medicine, length of therapy, relapse
risk, and depression prodromes. In order to avoid sadness and improve their general mental health, patients should
also be urged to lead healthy lifestyles and develop their social skills. Numerous research works have emphasized
the significance of psycho-education in enhancing the clinical trajectory, adherence to treatment, and psychosocial
functioning in depression patients.

Physical Exercise:

The majority of depression treatment guidelines, such as those from the American Psychiatric Association, the
Royal Australian and New Zealand College of Psychiatrists, and the National Institute for Health and Care
Excellence, advise depressed patients to engage in regular physical activity as a way to manage their symptoms and
avoid relapses. Enhancements to one's overall quality of life are also encouraged by exercise. Exercise is thought to
be a supplement to other antidepressant medications, nevertheless.

Psychotherapy is a useful tool for treating depression and enhancing patients' quality of life, but its precise
mechanism of action against depressed symptoms is still unclear. Finding variables (such as interpersonal ones)
associated with treatment responses can assist therapists in selecting the most appropriate therapy approach for each
patient and direct research to adapt and create new therapies. Simplifying psychotherapy methods will promote the
use of psychological therapies for depression, especially in general practice, as depression is a primary care
condition. Short versions (six to eight sessions) of CBT and PST have previously demonstrated efficacy in the
treatment of depression. Still, in order to support and shield practitioners from sadness, easier fixes need to be made
available.
 25

SOMATIC TREATMENTS

TREATMEN
SOMATIC THERAPY
T

TRANS CRANIO
VAGUS NERVE
MAGNETIC LUXTHERAPY
STIMULATION
STIMULATION

DIRECT MAGNETIC
PHOTOTHERAP
CURRENT SEIZURE
Y
STIMULATION THERAPY

Somatic therapy can also be used to manage depression in certain cases. The most well-known treatment for resistant
depression is electroconvulsive therapy (ECT), whose efficacy and safety are well-supported by research. With
differing degrees of success, a number of novel approaches have been put forth in recent decades, including deep
brain stimulation (DBS), vagus nerve stimulation (VNS), transcranial direct current stimulation (tDCS), repetitive
transcranial magnetic stimulation (rTMS), and magnetic seizure therapy.
rTMS

Research on depression has made extensive use of this technique, which is a form of biological stimulation that
influences brain metabolism and neuronal electrical activity. According to recent research, rTMS and fictional
stimulation differ significantly in how well they treat depressed symptoms. Initial studies have demonstrated both
antagonistic (rTMS/cannabinoid receptor (CB1) antagonist) and synergistic (rTMS/quetiapine) interactions between
neuro-modulation and medication. Combining rTMS with antidepressants results in treatments that are far more
effective than placebo, have manageable side effects, and are well-tolerated. While hopeful, these results are not
consistent since rTMS treatment frequencies, settings, and stimulation sites vary. Large-scale clinical trials are
therefore required to determine the elements that contribute to favorable treatment responses. Furthermore, more
preclinical studies ought to look into the synergistic effects.

tDCS

With this method, electrodes are applied to the scalp to provide little currents to the brain. It is tolerable, safe, and
simple to use. When it comes to response rate and remission, the tDCS method works noticeably better than the
simulator. Its impact is still less than that of rTMS and antidepressants, though. For individuals with unipolar or
bipolar depression, it can be administered as a monotherapy or as a supplemental intervention to lessen depressed
symptoms. The reason for the delayed efficacy of transcranial direct current stimulation (tDCS) in treating
depression could be related to long-term neuroplastic alterations that persist beyond the acute phase of treatment.

Neurophysiological research has recently demonstrated that there is no clear linear link between the stimulation dose
and the therapeutic effects of transcranial magnetic stimulation (tDCS). Long treatment durations are made possible
by tDCS, a comparatively easy-to-use and portable technology that is ideal for remote supervised treatment and
assessment at home. Future clinical trials should employ longer evaluation periods and seek to identify responsive
patients using algorithms, as the optimal therapeutic benefits of transcranial direct current stimulation (tDCS) are
delayed.

VNS

For the past sixteen years, VNS has been employed as a therapeutic approach to treat resistant unilateral or bipolar
depression. It is not, however, frequently used, even though a number of clinical trials have attested to its favorable
benefit-risk ratio and the Food and Drug Administration approved it in 2005. In VNS, a pacemaker is implanted
beneath the collarbone and wired to an electrode that surrounds the left vagus nerve. Because it exposes the patient
to fewer possible unfavorable cardiac consequences, the left vagus nerve is favored. The majority of afferent fibers
 27

in the heart do, in fact, stem from the right vagus nerve. Numerous research conducted since the year 2000 have
shown that VNS is effective in treating resistant depression.

Nonetheless, only a single 10-week, randomised, double-blind, controlled study contrasting VNS with standard
medical care has been carried out. Furthermore, the study's findings did not suggest that using VNS in addition to
standard medical care was superior to using standard care alone. On the other hand, VNS has shown steadily
growing improvements in depressive symptoms, with notable improvements shown after six to twelve months; these
advantages can extend for as long as two years. To properly ascertain the predictors of the correct reaction, further
extensive research is required.

Magnetic seizure Therapy

Under anesthesia, magnetic stimulation of the brain is used to cause a therapeutic seizure in patients receiving
magnetic seizure therapy. The efficacy of this method as a substitute for ECT in the treatment of numerous
psychiatric conditions is still being researched. There is mounting evidence that it is less neurocognitive than ECT
and is effective in reducing depressive symptoms.

LUXTHERAPY (PHOTOTHERAPY)

Intense light exposure was linked to a reduction in depressive symptoms for the first time in 1984. Two hours a day
of intense light exposure (2500 Lux) produced the best gains; morning exposure outperformed evening exposure.
More intense (but shorter) exposures (10000 Lux for 30 minutes per day or 6000 Lux for 1.5 hours per day) have the
same effectiveness, according to a review and meta-analysis. Crucially, people with seasonal depression as well as
those without it can benefit from this therapy approach. There have also been reports of phototherapy's benefits in
relation to medication treatments and sleep deprivation.

Patients with depression have several therapeutic choices available to them thanks to neuro-modulation therapies. In
this category, ECT is still the most well-researched and efficient technique. A well-tolerated profile is provided by
rTMS, an intriguing approach as well. On the other hand, the outcomes of tDCS, depending on the methods and
design of the study, are optimistic but variable. Further research is required to determine which patient clinical and
biological profiles correspond to which indications for each approach. These techniques are likely finding more
applications, and when they are patient-specific, their effectiveness rises as well. Moreover, somatic therapies for
depression must be routinely evaluated and incorporated into psychiatrists' treatment plans.

CONCLUSION

This comprehensive case study and survey on depression and its treatment methods have yielded valuable insights
into the complexity of this mental health condition. By integrating both qualitative and quantitative data, several
critical findings about the prevalence, impact, and efficacy of various depression treatments have emerged.

Prevalence and Impact of Depression –

Our research indicates that depression is a widespread mental health issue, affecting a diverse range of individuals.
The survey findings reveal that depression significantly disrupts daily life, impacting physical health, job
performance, social interactions, and overall well-being. These results highlight the need for prioritizing depression
in public health initiatives.

Treatment Methods-

The study evaluated various treatment approaches for depression, including medication, psychotherapy, lifestyle
changes, and alternative therapies. Key observations include:

1. Medication: Antidepressants, such as SSRIs and SNRIs, are widely used and can be effective for many
individuals. However, they often have side effects and may not be suitable for everyone.

2. Psychotherapy: Cognitive Behavioral Therapy (CBT) and other forms of talk therapy have proven effective,
especially for those who do not respond well to medication alone.

3. Lifestyle Changes: Regular exercise, a healthy diet, adequate sleep, and stress management techniques
significantly contribute to reducing depressive symptoms.

4. Alternative Therapies: Practices like mindfulness meditation, yoga, and acupuncture are increasingly
popular and have shown potential as complementary treatments.

Barriers to Treatment –

The survey identified several obstacles that hinder individuals from seeking or continuing treatment for depression,
including stigma, limited access to mental health services, financial issues, and lack of awareness about available
treatments. Addressing these barriers is essential for improving treatment accessibility and outcomes.
 29

Recommendations

From our findings, we suggest the following measures to enhance depression management:

1. Increase Awareness and Education: Public health campaigns should focus on reducing stigma and
educating people about depression symptoms and the importance of seeking help.

2. Improve Access to Care: Expanding mental health services, especially in underserved areas, is crucial.
This could involve telehealth services, increased funding for mental health programs, and integrating mental health
care into primary healthcare settings.

3.Personalized Treatment Plans: Recognizing the individual differences in depression, treatment plans
should be customized to meet the specific needs and preferences of each patient.

4. Support Research and Innovation: Ongoing research into new treatments and the mechanisms
underlying depression is essential for developing more effective interventions.

Final Thoughts

Depression remains a complex and challenging condition. However, through a holistic approach that includes
awareness, accessible treatment, personalized care, and continuous research, significant progress can be made in
reducing its impact. This study emphasizes the importance of a multi-faceted strategy in addressing depression,
suggesting that effective treatment requires a combination of tailored interventions to meet the unique needs of
each individual. Implementing the recommendations provided in this report can lead to meaningful advancements
in improving the lives of those affected by depression and alleviating its societal burden.

PERSONAL REFLECTIONS

Conducting this study has been incredibly enlightening. The participants' stories have highlighted the deep and
often hidden struggles that people with depression endure daily. It serves as a crucial reminder of the necessity for
compassion, understanding, and support within our communities. The varied treatment responses found in this
study show that there is no universal solution for depression. Each person's experience is different, and effective
treatment must be adaptable to individual needs. This insight has strengthened my belief in the importance of
personalized care and integrating multiple therapeutic methods. Additionally, the barriers to treatment identified in
this research call for urgent action. It's insufficient to merely have effective treatments available; they must also be
accessible to everyone in need. Reducing stigma, enhancing access to mental health services, and raising public
awareness are essential steps towards a more inclusive and supportive mental health care system. In conclusion,
this project underscores the urgent need for a comprehensive and empathetic approach to managing depression.
By combining education, accessible care, personalized treatment, and ongoing research, we can make significant
progress in supporting those affected by this widespread condition. I hope the insights gained from this study will
lead to meaningful improvements in how we address and treat depression in the future.

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