Depression and Its Treatment
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Transcript of Depression and Its Treatment
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Depression and Its Treatment
Les Secrest, M.D.
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• Worldwide Depression accounts for a high level of disability and
decreased functioning
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Depression is a frequent occurrence with approximately
20% of the population affected by Depression
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• Depression is more frequent in women than in men.
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• Suicide is greater in men than women.
• Suicide attempts are greater in women than in men
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Consider The faces of 20% of the population with Depression
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Consider The woman who has recently
given birth to her child and has post partum depression
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Consider The alcoholic who drinks constantly or episodically and is depressed
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Consider The child or adolescent who is irritable and performing poorly in school
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Consider The person who is persistently pessimistic and is rarely happy or humorous
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Consider The person with mood swings varying from highly productive to apathy and unable to get out of bed
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Consider The person with somatic complaints and few confirming findings
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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
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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
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Major Depressive Episode is Characterized by:
5. Fatigue6. Feelings of worthlessness/
excessive inappropriate guilt7. Decreased Concentration8. Recurrent thoughts of
death/suicide.
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AntidepressantsConsidered -
• Tricyclic Antidepressants have safety issues in overdose situations
• New generation – Safer profile with overdose
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Antidepressants Considered -
• Selective Serotonin Reuptake Inhibitors• Norepinepherine Reuptake Inhibitors• Dopamine Reuptake Inhibitors
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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%
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Star*D
• Level III Non Remission– Monotherapy
• Noratriptyline – 19.8%/12.4%• Mirtazapine - 12.3%/80%
– Augmentation• Lithium• T3 Thyroid Hormone
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• 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
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• Nortriplyline1. Inhibits Nonepinephrine Transporter2. Antagonizes Serotonin 3
3. Modestly inhibits Gaba Transporters4. Mild inhibition of Seratonin Transporters
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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
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Treatment
Highest treatment response rated thought to be related to
medication and cognitive therapy
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Cognitive Therapy
1. Stimulus2. Perception3. Process4. Response
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Treatment of Depression1. Use any antidepressant2. Consider antidepressants
Cognitive StimulationAppetite StimulationSedation
3. Consider stopping• Caffeine• Alcohol
4. Side effects• Sexual
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Refer where
• Manic symptoms emerge• Need to augment
– Antidepressant combination– Mood stabilizers– Antipsychotics
• Psychotherapy• Possible ECT
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