Depression

1. Depression

2. DSM IV diagnosis for Major Depression • Category 1 – persistent depressed mood • pervasive anhedonia • Category 2 – sleep disorder • change in weight/appetite • fatigue or loss of energy • psychomotor retardation/aggitation • difficulty concentrating/indecisive • guilt/low self esteem • recurrent thought of death/suicide

3. Subtypes of Depression • Major depressive disorder • Dysthymic disorder • Bipolar disorder • Cyclothymic disorder • Mood disorder due to general meds • Substance induced mood disorder • Seasonal affective disorder • Premenstrual dysphoric disorder

4. Demographics • 19 million americans • 9.5% of the population any given year • 10-25% of women once in a lifetime • 5-12% of men once in a lifetime • 2/3 effected never seek tx • $30 billion each year • 80-90% seeking tx get better in few weeks

5. Western Medicine Approach • Behavioral Health Centers • Supported by insurance companies (on the back of most cards) • Once “taken in”, a multidisciplinary approach used to treat the patient…psychiatrists, psychologists, counselors/therapists and social services. • Outpatient treatment sites well established • Workman’s comp also has a fast tract to assess employees with a diagnosis of mental health “issues” (EAP)

6. Eastern Medicine Approach Never to separate mind and body to begin with……. probably one of the reasons western culture still views mental health disorders as “nuts, wacko, schizto, crazy, mental”. Although in California, seeing a “shrink” was “in” during the 80’s, rehab made it in the 90’s…..now it seems to be sensationalized. (+/-?) Warning: off track!off track!

7. Reasons for Occurance: • Genetic predisposition • Stress trigger • Chronic pain trigger • Hormonal changes (childbirth) • Thyroid disorder • Nutritional deficiency • Traumatic life event • Viral infection long term • Chemical brain imbalance

8. Neurochemical • Neurons send impulse throughout the brain • At junctions between nerves, transmitters are released from one and are received by the other to send on the impulse • Depression is thought to not have enough transmitters to continue the message/impulse from one axon to another

10. Treatment Options • Supportive Care • Tricyclic Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRIs) • Serotonin Antagonists • NE and Dopamine reuptake inhibitors • Electroconvulsive Therapy

11. Support • Psychotherapy • Emotional support from family • Group support • Social service • Scheduled activities • Exercise

12. Tricyclic’s • Not well understood but thought to inhibit reuptake of norepinephrine, serotonin, dopamine • Great for other things – neuropathic pain, headache, insomnia, smoking • Side fx – drymoutn, blurred vision, constipation, hyperthermia

13. SSRI’s • “Selective Serotonin Reuptake Inhibitors” • Increase the amount of serotonin in the synapse continuing the impulse • Side fx: • Nausea, drowsiness, headache, change in appetite, anorgasmia, diminished libido, suicide

14. MAO inhibitors • Inhibit monoamine oxidase allowing more mao in the synapse • Interactions with many other drugs limits their use • Side fx – exitement, hypertension, hallucination

15. ECT • Electroconvulsive therapy • Treatment of choice for psychotic depression or refractory depression • Side fx – temporary short term memory loss

16. Light therapy • Bright light suppresses release of melatonin from the pituitary gland • Light therapy requires sitting 2-3 feet in front of a light source rated at up to 2500 lux for 15minto few hours • Light therapy also found in taking weekend trips to Florida for lectures!

17. Diet • Limit sodas and artificial sweetners that may block serotonin formation • Avoid sugar, refined carbohydrates and caffeine (ok….maybe before long lectures on a saturday) • Omega 3 fish oil (EFA’s found to be low in depressed and help with nerve insulation/conductivity) or cold water fish 2x a week and walnuts, ground flaxseed • Carbs at night, protein with essential fatty acids daily…….

18. Carb’s • Simple carbs = like white bread, pasta and rice cause more sedation and weight gain • Complex carbs = legumes, whole grains, nuts, seeds, vegetables and fruits

19. Total Life Counseling James West, MD ADHD Diet:

20. Dr West’s ADHD Diet: AM-Protein/Fruit Noon-Protein/Vegetables Dinner-Carbs/Vegetables

21. Herbal Rx • Kava Kava – MAO-like, increases dopamine and noradrenaline • Side fx – euphoria, liver toxicity • Omega 3 fish oil – more evidence linking depression with altered fatty acid metab and low dietary • Side fx - GI upset, diarrhea

22. More Herbal Rx • St Johns wort – ssri-like, works for mild to moderate depression • Side fx – gastrointestinal, dizziness, fatigue “…..Lavender should be considered as an aroma therapy supplement.”

23. The Saguil Approach • Get a doctor that listens (80% is in the hx) • Depending on the severity, always good to have a psychiatrist or behavioral health center know you (Jim West, MD) • Get an psychotherapist, (Tori Kelly, Ph.D, Helen Vella, Ph,D) herbalist, nutritionist • Consider time off from work (permanently?) • Find a close, cheap place to exercise (tai chi, yoga) • Get rid of clutter (get the family involved!) • Change the diet • Advance as tolerated but don’t do it yourself (introspection difficult with neurochemical imbalance)