DEPRESSION & TREATMENT

Depression:-

A possible fourth type of depression is

• Atypical depression.

Why is this important? We believe that, as with any illness, the person suffering from it can’t be properly treated unless the specifics of their illness are understood.

We therefore believe that people who are depressed should receive a sophisticated assessment identifying their particular type of depression and its broad causes, whether biological, psychological or other.

Treatments should be selected according to the specific type of depression experienced by an individual, and its causes.

A description of the different types of depression follows.

Melancholic depression

Melancholic depression is the classic form of biological depression. Its defining features are:

• a more severe depression than is the case with non-melancholic depression, with a lack of pleasure and difficulty in being cheered up
• psychomotor disturbance (e.g. low energy, poor concentration, slowed or agitated movements)

Melancholic depression is a relatively uncommon type of depression. It affects less than 10 per cent of people presenting with a depression diagnosis. The numbers affected are roughly the same for men and women.

Melancholic depression has a low spontaneous remission rate. It responds best to physical treatments (for example antidepressant drugs) and only minimally (at best) to non-physical treatments such as counselling or psychotherapy.

Further information on treatments for depression
More information on the biology of depression

Non-melancholic depression

‘Non-melancholic depression’ essentially means that the depression is not melancholic, or, put simply, not primarily biological. Instead, it has to do with psychological causes, and is very often linked to stressful events in a person’s life, alone, or in conjunction with the individual’s personality style.

Non-melancholic depression is the most common of the three sub-types of depression. It accounts for up to 90% of cases of depression seen in clinical practice.

Non-melancholic depression can be hard to accurately diagnose because it lacks the defining characteristics of the other 2 depressive sub-ypes (namely psychomotor disturbance or psychotic features). Also in contrast to the other 2 depressive sub-types, people with non-melancholic depression can usually be cheered up to some degree.

People with non-melancholic depression experience

• a depressed mood for more than two weeks
• social impairment (for example, difficulty in dealing with work or relationships).

In contrast to the other sub-types of depression, non-melancholic depression has a high rate of spontaneous remission. This is because it is often linked to stressful events in a person’s life, which, when resolved, tend to assist the depression to lift.

Non-melancholic depression responds well to different sorts of psychological treatments as a first step (such as psychotherapies and counselling), and the treatment selected should respect the cause and maintenance of that depressive episode (e.g. stress, personality style). Antidepressant medications can also be used to treat non-melancholic depression.

Further information on treatments for depression
Read about the causes of depression

Psychotic depression

Psychotic depression is a less common type of depression than either melancholic or non-melancholic depression.
The defining features of psychotic depression are:

• an even more severely depressed mood , than is the case with either melancholic or non-melancholic depression
• more severe psychomotor disturbance than is the case with melancholic depression
• psychotic symptoms (either delusions or hallucinations, with delusions being more common) and over-valued guilt ruminations.

Psychotic depression has a very low spontaneous remission rate. It responds only to physical treatments (such as antidepressant drugs).

Further information on treatments for depression
Find about the causes of depression

Atypical depression

Atypical depression is a name that has been given to expressions of depression that contrast with the usual characteristics of depression. For example, rather than experiencing appetite loss the person instead experiences appetite increase; and sleepiness rather than insomnia. Someone with atypical depression is also likely to have a personality style of interpersonal hypersensitivity ( expecting others not to like or approve of them).

The features of atypical depression include:

• Being able to be cheered up by pleasant events
• Significant weight gain or increase in appetite (especially to comfort foods)
• Excessive sleeping (hypersomnia)
• Heaviness in the arms and legs
• A long-standing sensitivity to interpersonal rejection —the individual is quick to feel that others are rejecting of them.
• There are a wide range of psychological treatments for depression.
  Some of the main ones are:
  
  • Cognitive Behaviour Therapy (CBT)
  • Interpersonal Therapy (IPT)
  • Mindfulness-Based Cognitive Therapy
  • Positive Psychology 
  • Psychotherapies
  • Counselling
  • Narrative Therapy
  Psychological treatments provide either an alternative to medication or work alongside medication. As always, a thorough assessment of the person is needed in order to decide on the best set of approaches.

  Cognitive Behaviour Therapy (CBT)

  People suffering from depression - particularly 'non-melancholic depression' - will often have an ongoing negative view about themselves and the world around them. This negative way of thinking is often not confined to depression, but is an ongoing part of how the person thinks about life. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so entrenched that they don't even notice the errors of judgement caused by thinking irrationally.
  Cognitive behaviour therapy aims to show people how their thinking affects their mood and to teach them to think in a less negative way about life and themselves. It is based on the understanding that thinking negatively is a habit, and, like any other bad habit, can be broken.
  CBT is conducted by trained therapists either in one-on-one therapy sessions or in small groups. People are trained to look logically at the evidence for their negative thoughts, and to adjust the way they view the world around them. The therapist will provide 'homework' for between sessions. Between 6-10 sessions can be required but the number will vary from person to person. More recently, a number of online programs have been developed to deliver CBT to people in their own homes.
  CBT can be very beneficial for some individuals who have depression but there will be others for whom it is irrelevant.
  
  

  Interpersonal Therapy (IPT)

  The causes of depression, or our vulnerabilities to developing depression, can often be traced to aspects of social functioning (work, relationships, social roles) and personality .
  Therefore, the underlying assumption with interpersonal therapy is that depression and interpersonal problems are interrelated.
  The goal of interpersonal therapy is to help a person understand how these factors are operating in their current life situation to lead them to become depressed and put them at risk for future depression.
  Therapy occurs in three main phases:
  • an evaluation of the patient's history
  • an exploration of the patient's interpersonal problem areas and the development of a treatment contract
  • recognition and consolidation by the patient of what has been learnt and developing ways of identifying and countering depressive symptoms in the future.
  Usually 12-16 sessions of IPT will be required.

  Mindfulness-Based Cognitive Therapy

  Mindfulness-based Cognitive Therapy is a relatively new form of treatment for depression. This approach was developed by Segal, Williams and Teasdale (adapted from the work of Jon Kabat-Zin) in order to prevent relapse for those who had previously experienced an episode of depression.
  
  Mindfulness is a form of self-awareness training that has been taken from mindfulness meditation. Mindfulness is about being aware of what is happening in the present on a moment by moment basis, while not making judgements about whether we like or don’t like what we find.
  Generally Mindfulness-based Cognitive Therapy is undertaken in an 8-week group program format, however often psychologists use these techniques in one-on-one therapy sessions depending on their training and experience.
  Other mindfulness-based approaches have also been developed that may be used for depression (eg. MiCBT) and therapies such as Dialectical Behaviour Therapy and Acceptance and Commitment Therapy also use components of mindfulness in their approach.
  See our handout for tips and techniques on how to use mindfulness in everyday life.

  Positive Psychology

  Positive Psychology is a new area of psychology that focuses on the conditions that contribute to flourishing or optimal functioning.
  "Positive Psychology is founded on the belief that people want more than an end to suffering. People want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, to enhance their experiences of love, work, and play. We have the opportunity to create a science and a profession that not only heals psychological damage but also builds strengths to enable people to achieve the best things in life." Professor Martin Seligman, founder of Positive Psychology.
  Positive Psychology researchers have identified many everyday activities that improve wellbeing. These include; keeping a gratitude diary, performing small acts of kindness, learning to savour enjoyable moments and varying pleasant experiences to avoid routine. 
  
  

  Psychotherapies

  Psychotherapy is an extended treatment (months to years) in which a relationship is built up between the therapist and the patient. The relationship is then used to explore aspects of a person's past in great depth and to show how these have led to the current depression. Understanding this link between past and present - insight - is thought to resolve the depression and to make a person less vulnerable to becoming depressed again.
  
  

  Counselling

  Counselling encompasses a broad set of approaches and goals that are essentially aimed at helping an individual with problem solving - solving long-standing problems in the family or at work; or solving sudden major problems (crisis counselling).
  
  

  Narrative Therapy

  Narrative Therapy is a form of counselling based on understanding the 'stories' that people use to describe their lives. The therapist listens to how people describe their problems as stories and helps the person to consider how the stories may restrict them from overcoming their present difficulties. It sees problems as being separate from people and assists individuals to recognise the range of skills, beliefs and abilities that they already have (but may not recognise) and that they can apply to problems in their lives.
  Narrative Therapy differs from many therapies in that it puts a major emphasis on identifying people's strengths, particularly as they have mastered situations in the past and therefore seeks to build resilience rather than focus on their shortcomings.
• medication treatment :-
•   psychotic & anxiolytic drugs .
• 1.carbanmezapin group
• 2.tricyclic anti depresent drugs (TCADs)
• 
  3.MOA  drugs .
• social factors :-
• 1.economically weakness problems .
• 2.environmental changing /societies 
• 3.food 
• 4.self medication .
  
  
  
  
  

Ebola virus outbreak

List OF  outbreaks;Ebola virus

Major or massive cases

Year	Country	Virus	Human affection count	Human death count	Case fatality rate	Description
1976	Sudan	SUDV	284	151	53%	Occurred in Nzara, Maridi and surrounding areas between June and November 1976. Mainly spread by personal contact in hospitals. Many medical care personnel were infected.
1976	Zaire	EBOV	318	280	88%	Main article: Yambuku § Ebola outbreak Occurred in Yambuku and surrounding areas in August. Spread by personal contact and use of contaminated needles and syringes in hospitals/clinics.
1979	Sudan	SUDV	34	22	65%	Occurred in Nzara, Maridi. Recurrent outbreak at the same site as the 1976 Sudan epidemic.
1994	Gabon	EBOV	52	31	60%	Occurred in Mékouka and other gold-mining camps deep in the rain forest. Thought to be yellow fever until 1995.
1995	Zaire	EBOV	315	254	81%	Occurred in Kikwit and surrounding areas. Traced to index case-patient who worked in forest adjoining the city. Epidemic spread through families and hospitals.
1996	Gabon	EBOV	37	21	57%	Occurred in Mayibout area between January and April. A chimpanzee found dead in the forest was eaten by people hunting for food. Nineteen people who were involved in the butchery of the animal became ill; other cases occurred in family members.
1996–1997	Gabon	EBOV	60	45	75%	Occurred in Booué area with transport of patients to Libreville between July 1996 and January 1997. Index case-patient was a hunter who lived in a forest camp. Disease was spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected.
2000–2001	Uganda	SUDV	425	224	53%	Occurred in Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with Sudan virus infection were attending funerals of case-patients, having contact with case-patients in one's family, and providing medical care to case-patients without using adequate personal protective measures.
2001–2002	Gabon  Republic of the Congo	EBOV	122	96	79%	Occurred over the border of Gabon and the Republic of the Congo between October 2001 and July 2002. First reported occurrence of Ebola virus disease in the Republic of the Congo.
2002–2003	Republic of the Congo	EBOV	143	128	90%	Occurred in the districts of Mbomo and Kéllé in Cuvette Ouest Département between December 2002 and April 2003.
2003	Republic of the Congo	EBOV	35	29	83%	Occurred in Mbomo and Mbandza villages located in Mbomo district, Cuvette Ouest Département, between November and December.
2004	Sudan	SUDV	17	7	41%	Occurred in Yambio county in Western Equatoria of southern Sudan. This outbreak was concurrent with an outbreak of measles in the same area, and several suspected EVD cases were later reclassified as measles cases.
2007	Democratic Republic of the Congo	EBOV	264	187	71%	Occurred in Kasai-Occidental Province. The outbreak was declared over on November 20. Last confirmed case on October 4 and last death on October 10.
2007–2008	Uganda	BDBV	149	37	25%	First recognition of BDBV. Occurred inBundibugyo District in western Uganda between December 2007 and January 2008
2008–2009	Democratic Republic of the Congo	EBOV	32	14	45%	Occurred in the Mweka and Luebo health zones of the Province of Kasai-Occidentalbetween December 2008 and February 2009
2012	Uganda	SUDV	24	17	71%	Occurred in the Kibaale District between June and August.
2012	Democratic Republic of the Congo	BDBV	77	36	47%	Occurred in Province Orientale between June and November.
2013–present	Widespread:  Liberia  Sierra Leone  Guinea Limited and local:  Nigeria  Mali  United States  Senegal  Spain  United Kingdom	EBOV	21,364	8,459	71%	Main article: Ebola virus epidemic in West Africa The most severe Ebola outbreak recorded in regards to both the number of human cases and fatalities began in Guéckédou, Guinea, in December 2013, and spread abroad where it is still ongoing.
2014	Democratic Republic of the Congo	EBOV	66	49	74%	Main article: 2014 Democratic Republic of the Congo Ebola virus outbreak Occurred in Equateur Province. Outbreak detected 24 August and according to the WHO, as of 28 October 2014 twenty days had passed since the last reported case was discharged and no new contacts were being followed.Declared over on 15 November 2014.

Minor or single cases[edit]

Year	Country	Virus	Human cases	Human deaths	Description
1976	United Kingdom	SUDV or EBOV	1	0	Laboratory infection by accidental stick of contaminated needle.
1977	Zaire	EBOV	1	1	Noted retroactively in the village of Tandala.[
1989–1990	Philippines	RESTV	3	0	High mortality among crab-eating macaques in a primate facility responsible for exporting animals in the USA. Three workers in the facility developed antibodies but did not get sick.
1989	United States	RESTV	0	0	RESTV was introduced into quarantine facilities in Virginia and Pennsylvania by monkeys imported from the Philippines. No human cases.
1990	United States	RESTV	4	0	RESTV was introduced into quarantine facilities in Virginia and Texas by monkeys imported from the Philippines. Four humans developed antibodies but did not get sic
1992	Italy	RESTV	0	0	RESTV was introduced into quarantine facilities in Siena by monkeys imported from the same facility in the Philippines as the 1989 and 1990 US outbreaks. No human cases.
1994	Côte d'Ivoire	TAFV	1	0	First and thus far only recognition of TAFV. Approximately one week after conducting necropsies on infected western chimpanzees in Taï National Park, a scientist contracted the virus and developed symptoms similar to those of dengue fever. She was discharged from a Swiss hospital two weeks later, and fully recovered after six weeks.
1996	South Africa	EBOV	2	1	A medical professional traveled from Gabon to Johannesburg, South Africa, in October 1996 after having treated Ebola virus-infected patients. He was hospitalized, and the nurse that took care of him became infected and died.
1996	United States	RESTV	0	0	RESTV was introduced into a quarantine facility in Texas by monkeys imported from the same facility in the Philippines as the 1989 and 1990 US outbreaks. No human cases.
1996	Philippines	RESTV	0	0	RESTV was identified at a monkey export facility in the Philippines. No human cases.
1996	Russia	EBOV	1	1	Laboratory contamination.
2004	Russia	EBOV	1	1	Laboratory contamination.
2008	Philippines	RESTV	6	0	First recognition of RESTV in pigs. Strain closely similar to earlier strains. Occurred in November. Six workers from the pig farm and slaughterhouse developed antibodies but did not become sick.