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Depression 101

Depression 101. David S. Leader, MD Medical Director of Mental Health and Neurosciences Dreyer Medical Clinic Senior Staff Member, Provena Mercy Medical Center October 16, 2012. Introductory Facts (not to depress you!):.

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Depression 101

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  1. Depression 101 David S. Leader, MD Medical Director of Mental Health and Neurosciences Dreyer Medical Clinic Senior Staff Member, Provena Mercy Medical Center October 16, 2012

  2. Introductory Facts (not to depress you!): • Depression affects at least one out of every 8 Americans during some time of their lives • Approximately 18 million people per year in the U.S. are dealing with depression • This may be a recurrent illness: individuals with one episode have a 40-50% chance of recurrence, which increases to 60-70% for a third episode after 2, and 90+ % for a fourth episode after three

  3. Introductory Facts (continued): • Depression is very treatable, although medical treatments do not provide a permanent cure • Depression is not a manifestation of laziness, lack of education, a character flaw or spiritual weakness • There are genetic as well as experiential tendencies within families for depression and other related affective disorders, such as alcohol dependence and bipolar disorder

  4. Introductory Facts (continued): • Depression is most probably a syndrome rather than a specific medical condition. This related set of disorders are associated with chemical imbalance in the brain that affects many of our biologic and physical functions • Stigma is due to fears about brain illness and leads to under-reporting of symptoms and under-treatment • Anxiety and other conditions may occur with depression

  5. Differences between depression and “the blues” • Sadness is universal and a normally experienced emotion. • Sadness is often associated with identifiable stresses. A particular trigger or set of triggers may or may not be identifiable when depression occurs. • Sadness generally ends when the stresses end. True depression may linger for a much longer period of time or may be much more intense than what is seen when a person is sad

  6. Symptoms of depression • Per DSM: Need at least 5 diagnostic symptoms (below) present at the same time over a two week period, which represent a change from the previous level of functioning. Either or both of the following need to be present: depressed mood or loss of interest or pleasure. • Diagnostic symptoms : most of the day during most days ( subjective report or by observations of others) • Depressed mood Marked reduction of interest or pleasure • Significant appetite change and/or weight loss when not dieting, or significant weight gain (e.g. 5% of body weight within a month) • Significant change in sleep (insomnia or hypersomnia)

  7. Symptoms (continued) • Psychomotor agitation or retardation • Fatigue or loss of energy • Worthlessness feelings or excessive/inappropriate guilt • Reduced ability to think or concentrate or to make decisions • Recurrent thoughts about dying (more than just a fear of dying), recurrent suicidal thoughts or suicide plan or action

  8. Symptoms (continued) • Symptoms cause significant distress or impairment: social, occupational, etc. • Symptoms are not due to substance use, intoxication or withdrawal, or another medical condition (e.g. low thyroid, anemia, etc.) • Symptoms do not better represent bereavement or are not mixed with mania/hypomania

  9. Treatment of Depression

  10. General Principles: • Combination therapy (medication and psychotherapy/counseling) are more effective than either one alone • Antidepressants restore the former balance of brain chemistry, so the person returns to their pre-depressed state • Many individuals respond to antidepressants but remission of symptoms is the goal • Antidepressants are not stimulants, happy pills, addictive. They do not change your personality

  11. General Principles (continued) • Take medication as prescribed • Side effects usually pre-date response. Report side effects promptly to the prescriber • Be an active part of the treatment: report concerns and hopes about the condition/treatment • Length of treatment generally 6-12 months after remission occurs

  12. Antidepressant types • SSRI (Selective serotonin reuptake inhibitors): Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), Zoloft (sertraline), Luvox (Fluvoxamine) • SNRI (Serotonin norepinephrine reuptake inhibitors): Pristiq (desvenlafaxine), Effexor (venlafaxine), Remeron (mirtazepine) • Other agents: Wellbutrin (bupropion), TCA (tricyclic antidepressants), MAOI (monoamine oxidase inhibitors) • Synergist agents: Buspar (buspirone), psychostimulants, Lithium, thyroid hormone, etc. • Complementary/Alternative Medicines: St. John’s Wort (hypericum), SAM-e

  13. Psychotherapy types • Cognitive behavioral • Exploratory • Psychodynamic • Combination

  14. Other Modalities • ECT (electroconvulsant therapy) • Deep brain stimulation

  15. Other types of depression • Postpartum depression versus baby blues • Premenstrual disorder • Seasonal Affective Disorder (SAD) • Dysthymic Disorder • Adjustment Disorder

  16. What else helps • Support and understanding-acceptance • Healthy diet. Consider inclusion of Omega-3 fatty acids from fish • Regular sleep • Regular exercise

  17. What else helps • Avoid recreational drugs: disinhibition effects • Structure the day • Talk with clergy or spiritual advisors • Prayer, meditation, Tai Chi

  18. Questions?

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