Depressive Disorders and Substance Use Disorders

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Depressive DisordersandSubstance Use Disorders
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Dysthymic Disorder

• Depressed mood for most of the day, for more days
  than not, as indicated either by subjective
  account or observation by others, for at least 2
  years, but without a major depressive episode
  occurring.

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Dysthymic Disorder

• Dysthymic depression has 2 or more of the
  following
• Poor appetite, or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

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Major Depressive Disorder

• Presence of one (Single Episode) or more
  (Recurrent) Major Depressive Episodes
• Not better accounted for by a Schizoaffective or
  other type of disorder
• Not accompanied by any episodes of mania

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Depressive Episode

• Five or more of the following are present during
  the same 2-week period, and represent a change
  from previous functioning, and at least one of
  the symptoms is either (1) depressed mood, or (2)
  loss of interest . . .

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Depressive Episode

1. Depressed mood most of the day, every day
2. Loss of interest or pleasure in most all
   activities, every day
3. Significant weight loss w/o dieting
4. Insomnia / hypersomnia every day
5. Psychomotor agitation / retardation every day
6. Fatigue or energy loss every day
7. Worthlessness or inappropriate guilt feelings
   nearly every day
8. Decreased ability to think, concentrate or make
   decisions nearly every day
9. Recurrent thoughts of death, or suicidal
   ideation, with or without plan /or attempt

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Depressive Episode

• Symptoms cause clinically significant distress or
  impairment in social, occupational, or other
  important areas of functioning

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Depressive Episode

1. Symptoms are NOT due to the effects of a
   substance (e.g., drug of abuse, or medication) or
   a general medical condition (e.g.,
   hyperthyroidism)

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Depressive Episode

1. Symptoms are not better accounted for by
   Bereavement (i.e. lasting longer than 2 months
   after a significant loss, or characterized by
   severe degree of functional impairment,
   preoccupation with worthlessness, suicidal
   ideation, psychotic symptoms, or psychomotor
   retardation)

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Dual Diagnosis Issues

• Certain intoxication syndromes (usually with
  depressant substances) /or withdrawal syndromes
  (usually from stimulants) can mimic some of the
  symptoms of a depressive episode, thus making
  accurate diagnosis and effective treatment more
  complicated.
• Exs. Sedative intoxication, Cocaine withdrawal

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Sedative Intoxication

• Inappropriate sexual or
• aggressive behavior
• Slurred speech
• Stupor
• Impaired attention or
• memory
• Mood lability
• Impaired judgment
• Psychomotor retardation or agitation
• Impaired social, occupational, or other
  functioning

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Cocaine Withdrawal

• Depressed mood
• Fatigue
• Vivid, unpleasant dreams
• Insomnia or hypersomnia
• Increased appetite
• Psychomotor retardation or agitation
• Symptoms cause clinically significant distress or
  impairment in social, occupational, or other
  important areas of functioning

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Principles of Treatment
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Principles of Dual Recovery

• Treatment of both mental illness and substance
  abuse at the same time
• Individualized dual recovery plan
• Collaboration and coordination
• Keeping hope alive

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Principles of Dual Recovery

• Medication adherence
• Dual diagnosis /or other treatment groups
• Self-help groups (DRA, DBSA, AA, NA), other
  support networks
• Family support and problem solving
• Individual therapy
• Motivational strategies

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Principles of Dual Recovery

• Managing stressors, triggers, relapse risk
  factors
• Skill-building in areas of need
• Increased overall structure and balance
  (including proper diet, exercise, sleep habits)

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• Any Questions or comments?

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Thank you for coming!