The Modern Plagues: Depression

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The Modern PlaguesDepression Anxiety

• DSM-IV
• National Institute of Mental Health
• Speak Softly, Love Loudly.com
• Nmha.org
• Wm A. Baughman, Ph.D.
• Cornerstone Counseling, Inc.
• 770/222-1980
  4/18/09

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Depression Introduction

• I am the most miserable man living...
• Famous Folks No Boundaries.
• Depression involve body, mood and thought.
• There are changes in brain function
  (i.e.neurotransmitters, structure).

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• Average age of onset is 40.
• 9.5 in any given year will develop depression
  -25 of women at some point in life.
• Economic Cost of 30 billion a year/ major cause
  disability.
• Emotional Cost incalculable to sufferers,
  families, friends.

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• 50 chance of depression re-occurring once
  experienced.
• 12 of men suffer.
• 1/3 of sufferers seek Tx.
• 80-90 who seek Tx get some relief in a few
  weeks.

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• 60-70 given antidepressants recover in 3-6
  weeks.
• ½ of teens suffer, 5 develope major depression.
• 15 suicide rate for depression lasting more than
  a month.
• 30,000 each year/ 500,000 attempts according to
  MHA

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Types of Mood Disorders Major Depression

• Impaired function (work, sleep, enjoyment).
• Suicide risk.
• Dysthymic Disorder
• Lesser symptoms and impairment.
• Chronic.

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Bipolar Disorder/ Manic Depression

• Alternating periods of depression and mania.
• Hypomania mixed state.
• Bipolar I Bipolar II rapid cycling (4x month).

Cyclothymic Disorder
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Depression Symptoms

• Persistent sadness, anxiety, empty feelings.
• Feeling hopeless, helpless, worthless.
• Anhedonia (loss of pleasure).
• Decreased energy (fatigue).
• Decreased motivation.

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• Concentration and/or memory and decision making
  difficulty.
• Insomnia or hypersomnia disrupted early waking.
• Appetite and/or weight change (loss or gain).
• Morbid and/or suicidal thoughts or attempts.

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• Negativity.
• Restlessness, irritability (especially in teens).
• Aches and pains not responding to medical
  treatment.
• Less care of appearance and/or hygiene.
• Psychomotor/ retardation or agitation.

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Manic Symptoms

• Excessive/ abnormal elation.
• Decreased need for sleep.
• Grandiose notions.
• Increased talkativeness.

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• Racing thoughts.
• Increased Sexuality.
• Markedly increased energy.
• Poor judgment.
• Inappropriate social behavior.
• Spending sprees, drug and alcohol use,
  aggressiveness, denial.

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Other Forms Seasonal Affection Disorder

• During winter months experience.
• Mood may be normal otherwise.
• Postpartum Depression
• 15 occurs one week to six months after giving
  birth. Once occurs risk increases.

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Premenstrual Dysphoric Disorder

• Symptoms occur or increase prior to menstration
  (supercharged PMS).
• 3-9 women suffer (disrupts daily routine) (PMS
  occures in 75 of women).
• Secondary Mood Disorder to Medical Conditions
• Correlation with Physical Issues.

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Substance-Induced Mood Disorder

• Symptoms caused or worsened by substance use.
• The reverse of self-medicating.
• Self-medicating.

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• Etiology
• Genetic
• Predisposition (family history).
• Attitudinal
• Pessimism, Low Self Esteem.
• Social and Environmental
• Stress.

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• Medical
• Stroke, heart attack, cancer, Parkinson's,
  hypothyroidism.
• Combination
• Genetic, psychological and environmental.

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Diagnostic Interview

• Physical Exam (rule out physical issues).
• History of Symptoms?
• Experienced in symptoms in past?
• Drug and alcohol use?
• Do family members have a history?
• If received past treatment, what worked?

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TreatmentSSRIs (minimum period of 4-9 months)

• Prozac (fluoxetine)
• Paxil (paroxetine)
• Luvox (fluvoxamine)
• Serzone (neflazodene)
• Zoloft (sertraline)
• Celexa (citalopram)

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Side Effects

• Headache.
• Nausea.
• Nervousness and insomnia.
• Agitation.
• Sexual problems.

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Other Medications

• Effexor (venlaflaxine)
• Wellbutrin (bupropion)
• Cymbalta (duloxetine HCI)
• PRISTIQ (desvenlafaxine) 50mg

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Talk Therapy

• Support, encouragement, hope.
• Reality check and perspective.
• Cognitive reconstructing.
• 80 of patients complain 1st of physical symptoms

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Alternative Treatments

• Omega 3 (Fish oil)
• Tyrosine (Amino acid-ND makes)
• Folic Acid
• B1,B12,B complex
• SAMe
• St. Johns Wort
• Kava

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Bi-Polar Disorder

• 2.6 of population.
• Usually develops in late adolescence to early
  adulthood.
• Manic depression distorts moods and thoughts,
  initiates dreadful behaviors, destroys the basis
  of rational thought and too often erodes the
  desire and will to live (Jameson, 1995).

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Treatment Lithium

• Cibalith-S (lithium citrate)
• Eskabith (lithium carbonate)
• Lithobid (lithium carbonate)

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Anticonvulsants

• Valproate (depakote)
• Carbomazepine (tegretol)

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New Anticonvulsants

• Lamotrigine (Lamictal)
• Gobapentine (Neurontin)
• Topiranmate (Topamax)
• Often combine different classes of medication.

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Atypical Antipsychotics

• Clozapine (Clozanil)
• Olanzapine (Zyprexa)
• Risperidine (Risperdol)
• Quetiapine (Serequal)
• Ziprasidene (Geodon)
• Abilify (Aripiprazole) Dep.,Bi-Polar,Schizo.

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Psychosocial Treatment/Talk Therapy

• Cognition reconstructing.
• Psychoeducation.
• Family Therapy.
• Co-Morbidity ANXIETY DISORDERS.

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ANXIETY DISORDERS

• 18 of population in a given year.
• Irrationally feeling frightened, distressed,
  and/or uneasy resulting in reduced productivity
  and quality of life.
• Fight or Flight response in play.
• Frequent co-morbidity (dep.,adhd,schizo.,etc)

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Panic Disorder

• Intense fear that strikes often, without warning.
• Chest pain, heart palpitation, shortness of
  breath, dizziness.
• Feeling of unreality, fear of losing control/
  embarrassment, fear dying, impending doom.
• Can occur during sleep.
• Peaks at ten minutes for most.
• Only need one episode to dx

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Obsessive-Compulsive Disorder (OCD)

• Repeated unwanted thoughts or compulsions that
  seem impossible to stop.
• Checking counting hand washing touching.
• Behavior (including the cognitive) is meant to
  control anxiety, but isnt pleasurable.
• Thoughts of harming loved ones, sexual fears,
  religion, symmetry, order, germs.
• Y-BOC/CY-BOC

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Post Traumatic Stress Disorder (PTSD)

• Persistent symptoms after a traumatic event.
• Nightmares, flashbacks, negative daydreams,
  emotional numbness.
• Fear of similar situations or event re-occurring.
• Depression, anger, irritability, distractedness.
• Startle easily.

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Phobias

• Specific feared target that poses little or no
  real threat.
• Restricts life unnecessarily.
• Social phobia (fear of being watched or judged
  worry/dread).

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Generalized Anxiety Disorder (GAD)

• Constant exaggerated worry about anything and/or
  many things.
• Anticipate disaster, overly concerned about
  everyday issues.
• Lasts at least six months

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Etiology of Anxiety and Depression

• Genetics.-1.5-3Xs risk with close bio-relative
• Trauma.-accident, abuse, loss
• Stress.-often gradual process

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Treatment Medications

• SSRIs
• Fluoxetine (Prozac)- OCD, PTSD, Social
• Sertraline (Zoloft)
• Cacitalopram (Lexapro)
• Paroxetine (Paxil)
• Citalopram (Celexa)

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• Venlafaxine (Effexor) GAD
• Cymbalta (Duloxetine) Pain
• Tricyclics
• Imipromine (Topamil) GAD
• Clomipramine (Anafranil) OCD

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• MAOIs (avoid foods with tyramine)
• Anti-anxiety/Anxiolytics
• Benzodiazepines
• Lorazepan (Ativan) Panic
• Alprazolam (Xanax) Panic, GAD

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• Busperone (Buspar)
• Beta-Blockers
• Propanolol (Inderal)

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Psychotherapy

• Cognitive/Behavioral (i.e. learn not really
  having a heart attack).
• Exposure.
• Relaxation exercises.
• Symptom prevention.

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Words of Wisdom/Conclusion/Discussion

• A bad case of the blu flu.
• Irrational resistance to medication.
• Cant just snap out of depression.
• Many dont recognize they are depressed.
• There is masked depression.

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• Many people think how they feel is normal.
• Many symptoms are diagnosed as physical problems.
• Anti-anxiety drugs or sedatives are not
  antidepressants.
• Medications dont teach skills.
• Best treatment is usually meds therapy.