Definition (সংজ্ঞা)

Psychogenic Depression হলো এমন ধরনের ডিপ্রেশন যা প্রধানত মানসিক, সামাজিক বা পরিবেশগত কারণে উদ্ভূত হয়, কোন স্পষ্ট শারীরিক/বায়োকেমিক্যাল কারণ ছাড়া। এটা Major Depressive Disorder (MDD) এর একটি subtype হিসাবে বিবেচিত হতে পারে যদি মানসিক ট্রিগার স্পষ্ট থাকে।

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Etiology / Causes (কারণ)

1. Stressful life events: প্রিয়জনের মৃত্যু, চাকরি হারানো, অর্থনৈতিক সমস্যা।
2. Chronic interpersonal conflicts: পরিবার বা সম্পর্কের সমস্যা।
3. Trauma: শারীরিক বা মানসিক আঘাত, child abuse history।
4. Personality factors: perfectionism, low self-esteem, neuroticism।
5. Social isolation: loneliness, lack of social support।

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Clinical Features / Symptoms (লক্ষণ)

• দীর্ঘমেয়াদী দুঃখ, hopelessness, guilt।
• আগ্রহহীনতা বা pleasure না পাওয়া (anhedonia)।
• শক্তি কমে যাওয়া, fatigue।
• ঘুমের সমস্যা: insomnia বা hypersomnia।
• খাবারের পরিবর্তন: anorexia বা overeating।
• মনোযোগ/decision-making সমস্যা।
• আত্মহত্যার চিন্তা বা আত্মঘাতী আচরণ।
• মানসিক উত্তেজনা বা anxious feeling।

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Clinical Diagnosis (ক্লিনিকাল ডায়াগনোসিস)

• DSM-5 criteria অনুযায়ী:
  • কমপক্ষে 2 সপ্তাহ ধরে উপরের লক্ষণগুলো থাকা।
  • Functioning (social, occupational) প্রভাবিত।
  • Organic বা drug-induced depression বাদ।
• Clinical interview (structured or semi-structured)।
• Mental status examination (MSE)।

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Investigation / Lab Workup (পরীক্ষা)

Psychogenic depression এ কোন নির্দিষ্ট test নেই, তবে rule out organic causes জন্য:

1. CBC, RFT, LFT → metabolic or infection check।
2. Thyroid function tests (TSH, T3, T4) → hypothyroidism বা hyperthyroidism check।
3. Vitamin B12, folate → deficiency depression।
4. Screening for substance abuse (alcohol, drugs)।
5. ECG → যদি pharmacotherapy start করতে হোক।

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Treatment / Management (পরিচালনা)

A. Pharmacological Treatment (Point-wise)

1. Fluoxetine (SSRI)
   • Dose: 20 mg per day, morning; increase up to 60 mg/day if needed।
   • Capsule 1.Prolert 20 mg AS A Fluoxetine Hydrochloride AS A Phenothiazine related drugs..
   • Duration: Minimum 6–12 months maintenance।
   • Purpose: Improves mood, anxiety, energy।
   • Side effects: Nausea, insomnia, sexual dysfunction, headache।
   • Drug interactions: MAO inhibitors (serotonin syndrome), NSAIDs (bleeding risk)।
2. Sertraline (SSRI)
   • Dose: 50 mg/day, increase 50 mg every 1–2 weeks; max 200 mg/day।
   • Tablet 2.Repose 50 Mg AS A Sertraline Hydrochloride AS A SSRIs & related anti-depressant drugs.
   • Duration: 6–12 months maintenance।
   • Purpose: Anxiety and depression symptom relief।
   • Side effects: Diarrhea, nausea, insomnia, sexual dysfunction।
   • Interactions: Warfarin (bleeding), MAO inhibitors।
3. Escitalopram (SSRI)
   • Dose: 10 mg/day, increase to 20 mg/day।
   • Tablet 3.Esita 10 Mg  AS A Escitalopram Oxalate AS A SSRIs & related anti-depressant drugs.
   • Duration: 6–12 months।
   • Purpose: Mood stabilization, fewer side effects।
   • Side effects: Nausea, headache, fatigue।
   • Interactions: MAO inhibitors, St. John’s Wort।
4. Venlafaxine (SNRI)
   • Dose: 75 mg/day, increase up to 225 mg/day।
   • Tablet 4.Venlax 75 mg AS A Venlafaxine Hydrochloride AS A (SNRI).
   • Duration: 6–12 months।
   • Purpose: Depression with anxiety, neuropathic pain।
   • Side effects: Nausea, hypertension, insomnia।
   • Interactions: MAO inhibitors, alcohol।
5. Mirtazapine (NaSSA)
   • Dose: 15–30 mg/day, bedtime।
   • Tablet 5.Mirapro 15 mg AS A Mirtazapine AS A Atypical anti-depressant drugs.
   • Duration: 6–12 months।
   • Purpose: Improves sleep, appetite, mood।
   • Side effects: Sedation, weight gain, dry mouth।
   • Interactions: MAO inhibitors, serotonergic drugs।

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B. Non-Pharmacological Management

1. Cognitive Behavioral Therapy (CBT) – thought pattern correction।
2. Interpersonal Therapy (IPT) – relationship-based stress relief।
3. Lifestyle: Regular exercise, proper sleep, nutrition।
4. Social support: Family, friends, support groups।

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Prevention (প্রিভেনশন)

• Stress management techniques: mindfulness, meditation।
• Healthy lifestyle: exercise, balanced diet, adequate sleep।
• Early recognition of depressive symptoms।
• Building social support network।
• Avoid substance abuse।

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Summary / Overview

• Psychogenic depression হলো মানসিক বা সামাজিক কারণে উদ্ভূত ডিপ্রেশন।
• Clinical diagnosis DSM-5 অনুযায়ী এবং lab test দ্বারা organic causes বাদ দেয়া হয়।
• Treatment pharmacological (SSRI, SNRI, NaSSA) এবং psychotherapy, lifestyle modification।
• Prevention stress management, social support, এবং early symptom recognition।

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References

1. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 10th Edition, Chapter 16: Mood Disorders.
2. WHO Guidelines for the Management of Depression (2022).
3. NICE Guidelines: Depression in Adults: Treatment and Management (2022).
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th Edition.
5. Cipriani A, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in adults: a systematic review and network meta-analysis. Lancet. 2018;391:1357–1366. DOI: 10.1016/S0140-6736(17)32802-7

Drug (Generic)	Class	Dose	Duration	Purpose / Use	Common Side Effects	Key Drug Interactions
Fluoxetine	SSRI	20 mg/day (morning), up to 60 mg/day	6–12 months	Improves mood, energy, anxiety relief	Nausea, insomnia, sexual dysfunction, headache	MAO inhibitors (serotonin syndrome), NSAIDs (bleeding risk)
Sertraline	SSRI	50 mg/day, titrate up to 200 mg/day	6–12 months	Depression with anxiety, mood stabilization	Diarrhea, nausea, insomnia, sexual dysfunction	Warfarin (bleeding), MAO inhibitors
Escitalopram	SSRI	10 mg/day, up to 20 mg/day	6–12 months	Mood stabilization, fewer side effects	Nausea, headache, fatigue	MAO inhibitors, St. John’s Wort
Venlafaxine	SNRI	75 mg/day, titrate up to 225 mg/day	6–12 months	Depression with anxiety, neuropathic pain	Nausea, hypertension, insomnia	MAO inhibitors, alcohol
Mirtazapine	NaSSA	15–30 mg/day (bedtime)	6–12 months	Improves sleep, appetite, mood	Sedation, weight gain, dry mouth	MAO inhibitors, serotonergic drugs

✅ Notes / Clinical Points:

• SSRI = Selective Serotonin Reuptake Inhibitor
• SNRI = Serotonin-Norepinephrine Reuptake Inhibitor
• NaSSA = Noradrenergic and Specific Serotonergic Antidepressant
• Duration: Minimum 6 months, often extended to 12 months to prevent relapse
• Titrate dose slowly based on response and side effects

Md.Rafiqul Islam Lipu,Date:-14-05-2026 Thursaday Time:-04-36-33 Pm