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Depression
What is it?
– More than just a persistent sadness.
– Not any type of personal weakness
– Clinical depression: characterized by a
cluster of feelings, thoughts and behaviors
that are strikingly distinct from a person’s
normal range of feelings and functioning.
– Depression is caused by a complex
interaction of biological, social and
psychological factors.
Depression: Facts
• More than 17 million Americans suffer from a
depressive illness each year.
• The United States spent more than 44 billion
dollars in 1990 as a result of depression.1
• 200,000,000 days of work are lost each year as a
result of depression related illnesses.2
• Nearly 2/3 of depressed individuals do not get
appropriate treatment.
• 80% of the people receiving treatment improve,
and can return to their normal activities, usually
in a matter of weeks.
Depression: Types
Major Depression, Dysthymia, and Bipolar Depression
– Major Depression: affects 15% of Americans at
one point in their life time
A chronic, recurring illness.
– Dysthymia: characterized by milder, persistent
symptoms that may last for years.
– Bipolar Depression: disorder cycles between
episodes of major depression and highs known as
mania.
Major Depression
Symptoms: Major Depression
Major Depression:
At least 5 of the following symptoms listed below must occur
for a period of at least two weeks, and they must represent a
change from ones previous behavior and mood.
Depressed mood on most days for most of each day.
Total or very noticable loss of pleasure most of the time
Significant increase/decreasein appetite, weight or both
Sleep Disorders - insomnia or excessive sleepiness - nearly every day
Feelings of agitation or a sense of intense slowness
Loss of energy and a daily sense of tiredness.
Sense of guilt and worthlessness nearly all the time.
Inablity to concentrate, occuring nearly every day
Recurrent thoughts of death or suicide.
Treatments for
Depression
– Psychotherapeutic Options:
Cognitive-Behavioral Therapy, Psychodynamic
Psychotherapy, Interpersonal Therapy, and
Supportive Psychotherapy.
– Drug Treatments for Depression:
Antidepressant: Selective Serotonin-Reuptake
Inhibitors (SSRIs), Tricyclic Antidepressants, and
Monoamine Oxidase Inhibitors (MAO).
– Other promising treatments: Estrogen
and St. John’s Wort.
Selective Serotonin Reuptake inhibitors
What are they, and what do they do?
– SSRIs have become the first line of
treatment against major depression.
– SSRIs increase the levels of serotonin in
the brain. SSRIs act on serotonin
specifically, causing fewer side effects (vs.
tricyclic antidepressants).
– Light bulb analogy
– SSRIs include fluoxetine (Prozac),
sertraline (Zoloft), paroxetine (Paxil).
– SSRIs are believed to help people with
most forms of depression: S.A.D, major
depression, and dysthymia.
SSRIs
– SSRIs work by blocking the reuptake
process of the neurotransmitter serotonin.
As a result, serotonin remains active in the
brain for a longer period of time, exerting its
effect on the central nervous system.
– Serotonin helps in elevating ones mood,
regulating sleep, and in keeping ones
circadian rhythms, all of which help in
keeping a person emotionally balanced.
– Fluoxetine (Prozac) was introduced in 1987,
and is now the most widely used medication
for depression on the United States.
Are SSRIs miracle drugs?
– When Prozac was first introduced, it
caused a media craze that still continues
today, more than 10 years later.
– In 1992 sales of the drug topped $1 billion.4
– SSRIs are no more effective (statistically)
against depression than the older drugs
that have been used for more than 30
years (tricyclic antidepressants)
Why are SSRIs so popular?
– Side effects are much less severe than
older antidepressants.
– Patient suffering from depression now
have more serotonin available to elevate
their mood, with less risk of side effects.
– SSRIs side effects are nausea,
gastrointestinal problems, and anxiety.
They tend to wear off over time.
– SSRIs are usually taken only once a day
Downside of SSRIs
– Long term effects are unknown. Are there
connections between antidepressant use
and cancer? 5
– Cost of medicine is much higher. Cost of
generic tricyclic antidepressant is $6.50 per
month, while Prozac costs $60 or more per
month. 6
– A feeling of loss associated with SSRIs.
– Tolerance: individuals take SSRIs, and
drugs simply stop working.
SSRIs and the Placebo
Effect
• According to several studies, the placebo effect
accounts for 50-75% of the success of SSRIs. 7
• Only 25% of drugs success can be attributed to a
true drug effect.
• This suggests that for a typical patient, 50-75% of the
benefit associated with anti-depression medication is
a result of placebo effect .
• Possible that the 25% attributed to a drug effect is a
result of side effects, and thus an enhancement of
the placebo effect.
Conclusions
• The large amount of interest in the United States
generated by SSRIs has been positive.
• Ideas of depression as a “personal weakness” are
disappearing as the public becomes more informed.
• Researchers are learning more and more about
depression every day.
• With all of the different treatment options available
today, people are no longer forced to live a life
covered in a “veil of sadness.”
End Notes
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1. http://www.intelihealth.com
2. http://www.nmisp.org/depression.htm
3. http://www.health.excite.com
4. http://www.prozac.com/index.htm
5. http:www.health.excite.com
6. http:www.health.excite.com
7.“listening to Prozac but hearing Placebo: A meta-analysis of Antidepressant
medication.” I. Kirsch and G. Sapirstein. Available at http://journals.apa.org
Bibliography
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1. http://apa.org
2. http://breggin.com/prozac.html
3. http://www.britanica.com
4. http://www.excite.health.com
5. http://www.health-center.com
6. http://www.intelihealth.com
7. http://www.journals.apa.org/prevention/volume1
8. http://www.mentalhealth.com
9. http://www.prozac.com