depression and its treatment
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Depression and Its Treatment. Les Secrest, M.D. Worldwide Depression accounts for a high level of disability and decreased functioning. Depression is a frequent occurrence with approximately 20% of the population affected by Depression. Depression is more frequent in women than in men. - PowerPoint PPT PresentationTRANSCRIPT
Depression and Its Treatment
Les Secrest, M.D.
• Worldwide Depression accounts for a high level of disability and
decreased functioning
Depression is a frequent occurrence with approximately
20% of the population affected by Depression
• Depression is more frequent in women than in men.
• Suicide is greater in men than women.
• Suicide attempts are greater in women than in men
Consider The faces of 20% of the population with Depression
Consider The woman who has recently
given birth to her child and has post partum depression
Consider The alcoholic who drinks constantly or episodically and is depressed
Consider The child or adolescent who is irritable and performing poorly in school
Consider The person who is persistently pessimistic and is rarely happy or humorous
Consider The person with mood swings varying from highly productive to apathy and unable to get out of bed
Consider The person with somatic complaints and few confirming findings
Depression Disorders Reviewed
1. Major Depressive Disorder– Single Episode– Recurrent
2. Dysthymic Disorders3. Bipolar Disorder
– Most recent episode Depressed– Most recent episode Mixed
4. Mood disorder due to a medical condition
5. Substance induced mood disorder
Major Depressive Episode is Characterized by:
1. Either depressed mood or loss of interest or pleasure
2. Weight change3. Change in sleep patterns4. Psychomotor agitation on
Major Depressive Episode is Characterized by:
5. Fatigue6. Feelings of worthlessness/
excessive inappropriate guilt7. Decreased Concentration8. Recurrent thoughts of
death/suicide.
AntidepressantsConsidered -
• Tricyclic Antidepressants have safety issues in overdose situations
• New generation – Safer profile with overdose
Antidepressants Considered -
• Selective Serotonin Reuptake Inhibitors• Norepinepherine Reuptake Inhibitors• Dopamine Reuptake Inhibitors
Star*DLevel I• Citatalopram approximately
– 30% respondents to remission– 50% respondents but not with remission
• Non remission – Level II– Augmented to Wellbutrin/bupropion or with bupropion
on cognitive therapy - 30.2% – Switch to monotherapy
Buproprion - 21.3%Cognitive therapySertraline -17.6%Venlafaxine - 24%
Star*D
• Level III Non Remission– Monotherapy
• Noratriptyline – 19.8%/12.4%• Mirtazapine - 12.3%/80%
– Augmentation• Lithium• T3 Thyroid Hormone
• Mirtazapine/Remeron1. Antagonist of Presynaptic Alpha2
Adrenergic AutoreceptorsHeteroreceptors on Serotonin and Norepinephrine Neurons
2. Antagonist postsynaptic serotonin 5-Ht2
and 5-Ht 3 Receptors
3. Inhibits the release of corticotropin – releasing hormone
• Nortriplyline1. Inhibits Nonepinephrine Transporter2. Antagonizes Serotonin 3
3. Modestly inhibits Gaba Transporters4. Mild inhibition of Seratonin Transporters
Star* D Study
(Sequenced treatment alternatives to relieve depression)
- Illustrated that we should:
1. Continue citalpram/Celexa for eight weeks2. Use rating scales routinely to monitor
response to treatments
Treatment
Highest treatment response rated thought to be related to
medication and cognitive therapy
Cognitive Therapy
1. Stimulus2. Perception3. Process4. Response
Treatment of Depression1. Use any antidepressant2. Consider antidepressants
Cognitive StimulationAppetite StimulationSedation
3. Consider stopping• Caffeine• Alcohol
4. Side effects• Sexual
Refer where
• Manic symptoms emerge• Need to augment
– Antidepressant combination– Mood stabilizers– Antipsychotics
• Psychotherapy• Possible ECT