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Depression and Its Treatment

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.

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Depression and Its Treatment

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  1. Depression and Its Treatment Les Secrest, M.D.

  2. Worldwide Depression accounts for a high level of disability and decreased functioning

  3. Depression is a frequent occurrence with approximately 20% of the population affected by Depression

  4. Depression is more frequent in women than in men.

  5. Suicide is greater in men than women. • Suicide attempts are greater in women than in men

  6. Consider The faces of 20% of the population with Depression

  7. Consider The woman who has recently given birth to her child and has post partum depression

  8. Consider The alcoholic who drinks constantly or episodically and is depressed

  9. Consider The child or adolescent who is irritable and performing poorly in school

  10. Consider The person who is persistently pessimistic and is rarely happy or humorous

  11. Consider The person with mood swings varying from highly productive to apathy and unable to get out of bed

  12. Consider The person with somatic complaints and few confirming findings

  13. Depression Disorders Reviewed • Major Depressive Disorder • Single Episode • Recurrent • Dysthymic Disorders • Bipolar Disorder • Most recent episode Depressed • Most recent episode Mixed • Mood disorder due to a medical condition • Substance induced mood disorder

  14. Major Depressive Episode is Characterized by: • Either depressed mood or loss of interest or pleasure • Weight change • Change in sleep patterns • Psychomotor agitation on

  15. Major Depressive Episode is Characterized by: • Fatigue • Feelings of worthlessness/ excessive inappropriate guilt • Decreased Concentration • Recurrent thoughts of death/suicide.

  16. AntidepressantsConsidered - • Tricyclic Antidepressants have safety issues in overdose situations • New generation – Safer profile with overdose

  17. Antidepressants Considered - • Selective Serotonin Reuptake Inhibitors • Norepinepherine Reuptake Inhibitors • Dopamine Reuptake Inhibitors

  18. Star*D Level 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 therapy Sertraline -17.6% Venlafaxine - 24%

  19. Star*D • Level III Non Remission • Monotherapy • Noratriptyline – 19.8%/12.4% • Mirtazapine - 12.3%/80% • Augmentation • Lithium • T3 Thyroid Hormone

  20. Mirtazapine/Remeron • Antagonist of Presynaptic Alpha2 Adrenergic Autoreceptors Heteroreceptors on Serotonin and Norepinephrine Neurons • Antagonist postsynaptic serotonin 5-Ht2 and 5-Ht 3 Receptors 3. Inhibits the release of corticotropin – releasing hormone

  21. Nortriplyline • Inhibits Nonepinephrine Transporter • Antagonizes Serotonin 3 • Modestly inhibits Gaba Transporters • Mild inhibition of Seratonin Transporters

  22. Star* D Study (Sequenced treatment alternatives to relieve depression) - Illustrated that we should: • Continue citalpram/Celexa for eight weeks • Use rating scales routinely to monitor response to treatments

  23. Treatment Highest treatment response rated thought to be related to medication and cognitive therapy

  24. Cognitive Therapy • Stimulus • Perception • Process • Response

  25. Treatment of Depression • Use any antidepressant • Consider antidepressants Cognitive Stimulation Appetite Stimulation Sedation • Consider stopping • Caffeine • Alcohol • Side effects • Sexual

  26. Refer where • Manic symptoms emerge • Need to augment • Antidepressant combination • Mood stabilizers • Antipsychotics • Psychotherapy • Possible ECT

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