1

B. PHARMACY 7th SEMESTER

Project Report On

CONFOUND SYMPTOMS OF DEPRESSION and TREATMENT

SUBMITTED BY – AAYUSHI DARA

B.PHARMA 7TH 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. PALIKA 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,
Faculty of Pharmaceutical Sciences for her keen interest at every stage of my work.
Her prompt inspirations, 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 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 was 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.
 5

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 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 damage Blood-Brain-Barrier auto-antibodies produced by the brain attack their 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. Along with
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 the 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 cannot
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 areas 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 and understand its 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 7. Conclusion 36

17 8. Refrences 37-39

1.0. 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 going
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 house is on fire and you need to
fight back or escape, even before the frontal lobes get a chance to weigh in with their assessment.
 9

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.

Figure: 01– 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.

1.1. 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 traumas is preverbal.

Figure :02 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

2.0. AIM OF THE STUDY

The aim of the project report includes an in-depth studying of the different affected areas 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.

2.1. 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 thecustom procedures.

The Objectives include:-

 Brain imaging scans of patient for in depth study of symptoms.

 Treatment procedures including pharmacological drugs to non-pharmacological treatment
measures.
 11

 Social-environmental impacts of a clinical study on Rheumatoid Arthritis patients and chronic

pains/TMS theory.

3.0. TYPES OF DEPRESSION:

POST MAJOR
TRAUMATIC DEPRESSION

TYPES

POSTPARTU PERSISTANT
M DEPRESSIVE
DEPRESSION DISORDER

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

 Major Depression-Suffering person usually experiences a constant state of sadness and losing
interest in activities they used to enjoy.
  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.
 Postpartum depression-After giving birth, some people experience heightened sadness which
lasts more than a month to several years.
 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.

3.0. 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 .PHYSICAL :- CHRONIC FATIGUE

Lack of energy
Insomnia/oversleeping
Obesity/ Underweight
Loss of motivation
Alcohol addiction

3 .BEHAVIOR :- WITHDRAWAL FROM OTHERS

Neglect of responsibilities

Changes in physical appearance

4.0. 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
 13

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 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.

MONOAMINE
TRICYCLIC ANTI
OXIDASE DEPRESSANTS
INHIBITOR
SELECTIVE SELECTIVE
SEROTONIN NOREPINEPHRINE
REUPTAKE REUPTAKE
INHIBITOR INHIBITOR

KETAMINE AND
RELATED
COMPOUNDS

4.1.1MONOAMINE OXIDASE INHIBITORS:

MARKETED FORMULATION –

SR.NO GENERIC DRUGS BRANDED DRUGS

.
1. Pehenlzine Nardil (Pro)
2. Tranylcypromin Parnate (Pro)
e
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.

4.1.2. TRICYCLIC ANTIDEPRESSANTS (TCAs):

MARKETED FORMULATION-

SR.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

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 hospitalization. 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.
 15

4.1.3.SELECTIVE SEROTONIN REUPTAKE (SRIs):

MARKETED FORMULATION –

SR.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.

4.1.4. NOREPINEPHRINE REUPTAKE INHIBITORS :

MARKETED FORMULATION –

SR.NO. GENERIC DRUGS BRANDED DRUGS

1. Cymbalata Duloxetrine
2. Pristiq Desvenlafaxine
3. Effexor Venlafaxine
4. Savella Milnacipran
5. Fetzima Levomilnacipran
6. 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 better than TCAs. Some analysis shows that raboxetine (an SSRI) is
better than veneflaxaine an SNRI. Such incidences are common but less preserved for effectiveness.

4.1.5. 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
 17

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.

5.0. NON-PHARMACOLOGICAL THERAPIES:

5.1. 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.

5.2. 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.
5.3. INTERPERSONAL PSYCOTHERAPY (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 ot
hers. The intervention's goals are to help the patient identify their own affect, help them grieve
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.

5.4. 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.

5.5. SPEECH-LANGUAGE THERAPY (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.

5.7. 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
 19

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.

5.8. MINDFULLNESS –BASED COGNITIVE THERAPY (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.

6.0. OTHER PSYCHO INTERVENTIONS:

PMSYI P
MHOY SO
A SS
C
NDHOF SIC
V INA MST
IS A
ED
U LNU L G TIC
ED
CESS
A TI EX CE
TH TR
NEE
ON ER C I AT
PRA BO UR
SE ME
C TI DY AL
NT
C ES MO
VE
ME
NT

6.1. 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.

6.2. 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.

SOMATIC THERAPY TREATMENT

TRANS CARDIO
VAGUS NERVE
MAGNETIC LUXTHERAPY
STIMULATION
STIMULATION

DIRECT CURRENT MAGNETIC SEIZURE

PHOTOTHERAPY
STIMULATION THERAPY

6.2.1 SOMATIC 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.

6.2.1.1 TRANS CARDIO MAGNETIC STIMULATION (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
 21

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.

6.2.1.2 TRANS DIRECT CURRENT STIMULATION (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.

6.2.2.1.VAGUS NERVOUS SYSTEM (VNS) ( THERAPY):

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 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, randomized, 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.

6.2.2.2. 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.

6.3.1. 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.

7.0. CONCLUSION
 23

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.

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.
 25

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