Depression

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Depression
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DSM IV diagnosis for Major Depression

• Category 1 persistent depressed mood
• pervasive anhedonia
• Category 2 sleep disorder
• change in weight/appetite
• fatigue or loss of energy
• psychomotor retardation/aggitat
  ion
• difficulty concentrating/indeci
  sive
• guilt/low self esteem
• recurrent thought of
  death/suicide

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Subtypes of Depression

• Major depressive disorder
• Dysthymic disorder
• Bipolar disorder
• Cyclothymic disorder
• Mood disorder due to general meds
• Substance induced mood disorder
• Seasonal affective disorder
• Premenstrual dysphoric disorder

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Demographics

• 19 million americans
• 9.5 of the population any given year
• 10-25 of women once in a lifetime
• 5-12 of men once in a lifetime
• 2/3 effected never seek tx
• 30 billion each year
• 80-90 seeking tx get better in few weeks

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Western Medicine Approach

• Behavioral Health Centers
• Supported by insurance companies
• (on the back of most cards)
• Once taken in, a multidisciplinary approach
  used to treat the patientpsychiatrists,
  psychologists, counselors/therapists and social
  services.
• Outpatient treatment sites well established
• Workmans comp also has a fast tract to assess
  employees with a diagnosis of mental health
  issues (EAP)

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Eastern Medicine Approach

• Never to separate mind and body to begin
  with.
• probably one of the reasons western
  culture still views mental health disorders as
  nuts, wacko, schizto, crazy, mental.
• Although in California, seeing a shrink was
  in during the 80s, rehab made it in the
  90s..now it seems to be sensationalized. (/-?)

Warning off track!off track!
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Reasons for Occurance

• Genetic predisposition
• Stress trigger
• Chronic pain trigger
• Hormonal changes (childbirth)
• Thyroid disorder
• Nutritional deficiency
• Traumatic life event
• Viral infection long term
• Chemical brain imbalance

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Neurochemical

• Neurons send impulse throughout the brain
• At junctions between nerves, transmitters are
  released from one and are received by the other
  to send on the impulse
• Depression is thought to not have enough
  transmitters to continue the message/impulse from
  one axon to another

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Treatment Options

1. Supportive Care
2. Tricyclic Antidepressants
3. Selective Serotonin Reuptake Inhibitors (SSRIs)
4. Serotonin Antagonists
5. NE and Dopamine reuptake inhibitors
6. Electroconvulsive Therapy

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Support

• Psychotherapy
• Emotional support from family
• Group support
• Social service
• Scheduled activities
• Exercise

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Tricyclics

• Not well understood but thought to inhibit
  reuptake of norepinephrine, serotonin, dopamine
• Great for other things neuropathic pain,
  headache, insomnia, smoking
• Side fx drymoutn, blurred vision, constipation,
  hyperthermia

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SSRIs

• Selective Serotonin Reuptake Inhibitors
• Increase the amount of serotonin in the synapse
  continuing the impulse
• Side fx
• Nausea, drowsiness, headache, change in appetite,
  anorgasmia, diminished libido, suicide

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MAO inhibitors

• Inhibit monoamine oxidase allowing more mao in
  the synapse
• Interactions with many other drugs limits their
  use
• Side fx exitement, hypertension, hallucination

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ECT

• Electroconvulsive therapy
• Treatment of choice for psychotic depression or
  refractory depression
• Side fx temporary short term memory loss

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Light therapy

• Bright light suppresses release of melatonin from
  the pituitary gland
• Light therapy requires sitting 2-3 feet in front
  of a light source rated at up to 2500 lux for
  15minto few hours
• Light therapy also found in taking weekend trips
  to Florida for lectures!

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Diet

• Limit sodas and artificial sweetners that may
  block serotonin formation
• Avoid sugar, refined carbohydrates and caffeine
  (ok.maybe before long lectures on a saturday)
• Omega 3 fish oil (EFAs found to be low in
  depressed and help with nerve insulation/conductiv
  ity) or cold water fish 2x a week and walnuts,
  ground flaxseed
• Carbs at night, protein with essential fatty
  acids daily.

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Carbs

• Simple carbs like white bread, pasta and rice
  cause more sedation and weight gain
• Complex carbs legumes, whole grains, nuts,
  seeds, vegetables and fruits

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Total Life Counseling James West, MD
ADHD Diet
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Dr Wests ADHD Diet
AM-Protein/Fruit
Noon-Protein/Vegetables
Dinner-Carbs/Vegetables
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Herbal Rx

• Kava Kava MAO-like, increases dopamine and
  noradrenaline
• Side fx euphoria, liver toxicity
• Omega 3 fish oil more evidence linking
  depression with altered fatty acid metab and low
  dietary
• Side fx - GI upset, diarrhea

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More Herbal Rx

• St Johns wort ssri-like, works for mild to
  moderate depression
• Side fx gastrointestinal, dizziness, fatigue

..Lavender should be considered as an aroma
therapy supplement.
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The Saguil Approach

• Get a doctor that listens (80 is in the hx)
• Depending on the severity, always good to have a
  psychiatrist or behavioral health center know you
• (Jim West, MD)
• Get an psychotherapist, (Tori Kelly, Ph.D, Helen
  Vella, Ph,D) herbalist, nutritionist
• Consider time off from work (permanently?)
• Find a close, cheap place to exercise (tai chi,
  yoga)
• Get rid of clutter (get the family involved!)
• Change the diet
• Advance as tolerated but dont do it yourself
  (introspection difficult with neurochemical
  imbalance)