Transcript 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
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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 4050% chance of recurrence, which
increases to 60-70% for a third episode
after 2, and 90+ % for a fourth episode
after three
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 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
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 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 undertreatment
 Anxiety and other conditions may occur with
depression
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 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
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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)
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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)
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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
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 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
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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
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 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
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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
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Cognitive
behavioral
Exploratory
Psychodynamic
Combination
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ECT (electroconvulsant therapy)
Deep
brain stimulation
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Postpartum
depression versus baby
blues
Premenstrual disorder
Seasonal Affective Disorder (SAD)
Dysthymic Disorder
Adjustment Disorder
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Support and
understanding-
acceptance
Healthy diet. Consider inclusion of
Omega-3 fatty acids from fish
Regular sleep
Regular exercise
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Avoid
recreational drugs:
disinhibition effects
Structure the day
Talk with clergy or spiritual
advisors
Prayer, meditation, Tai Chi
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