Depression 101

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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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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

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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

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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

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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

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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)

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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

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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

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Treatment of Depression
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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

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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

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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. Johns
  Wort (hypericum), SAM-e

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Psychotherapy types

• Cognitive behavioral
• Exploratory
• Psychodynamic
• Combination

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Other Modalities

• ECT (electroconvulsant therapy)
• Deep brain stimulation

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Other types of depression

• Postpartum depression versus baby blues
• Premenstrual disorder
• Seasonal Affective Disorder (SAD)
• Dysthymic Disorder
• Adjustment Disorder

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What else helps

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

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What else helps

• Avoid recreational drugs disinhibition effects
• Structure the day
• Talk with clergy or spiritual advisors
• Prayer, meditation, Tai Chi

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Questions?