The Modern Plagues: Depression & Anxiety

1. The Modern Plagues:Depression & 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

2. 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).

3. 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.

4. 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.

5. 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

6. Types of Mood DisordersMajor Depression • Impaired function (work, sleep, enjoyment). • Suicide risk. Dysthymic Disorder • Lesser symptoms and impairment. • Chronic.

7. Bipolar Disorder/ Manic Depression • Alternating periods of depression and mania. • Hypomania; mixed state. • Bipolar I; Bipolar II; rapid cycling (4x month). Cyclothymic Disorder

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

9. 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.

10. 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.

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

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

13. 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.

14. 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.

15. Substance-Induced Mood Disorder • Symptoms caused or worsened by substance use. • The reverse of self-medicating. • Self-medicating.

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

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

18. 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?

19. Treatment:SSRIs (minimum period of 4-9 months) • Prozac (fluoxetine) • Paxil (paroxetine) • Luvox (fluvoxamine) • Serzone (neflazodene) • Zoloft (sertraline) • Celexa (citalopram)

20. Side Effects • Headache. • Nausea. • Nervousness and insomnia. • Agitation. • Sexual problems.

21. Other Medications • Effexor (venlaflaxine) • Wellbutrin (bupropion) • Cymbalta (duloxetine HCI) • PRISTIQ® (desvenlafaxine) 50mg

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

23. Alternative Treatments • Omega 3 (Fish oil) • Tyrosine (Amino acid-N&D makes) • Folic Acid • B1,B12,B complex • SAMe • St. John’s Wort • Kava

24. 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).

25. TreatmentLithium • Cibalith-S (lithium citrate) • Eskabith (lithium carbonate) • Lithobid (lithium carbonate)

26. Anticonvulsants • Valproate (depakote) • Carbomazepine (tegretol)

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

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

29. Psychosocial Treatment/Talk Therapy • Cognition reconstructing. • Psychoeducation. • Family Therapy. • ***Co-Morbidity – ANXIETY DISORDERS.

30. 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)

31. 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

32. 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 isn’t pleasurable. • Thoughts of harming loved ones, sexual fears, religion, symmetry, order, germs. • Y-BOC/CY-BOC

33. 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.

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

35. 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

36. Etiology of Anxiety and Depression • Genetics.-1.5-3Xs risk with close bio-relative • Trauma.-accident, abuse, loss • Stress.-often gradual process

37. Treatment Medications • SSRI’s • Fluoxetine (Prozac)- OCD, PTSD, Social • Sertraline (Zoloft) “ • Cacitalopram (Lexapro) “ • Paroxetine (Paxil) “ • Citalopram (Celexa) “

38. Venlafaxine (Effexor) GAD • Cymbalta (Duloxetine) Pain & “ • Tricyclics • Imipromine (Topamil) GAD • Clomipramine (Anafranil) OCD

39. MAOI’s (avoid foods with tyramine) • Anti-anxiety/Anxiolytics • Benzodiazepines • Lorazepan (Ativan) Panic • Alprazolam (Xanax) Panic, GAD

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

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

42. Words of Wisdom/Conclusion/Discussion • A bad case of the blu flu. • Irrational resistance to medication. • Can’t just snap out of depression. • Many don’t recognize they are depressed. • There is masked depression.

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