Download Bipolar Disorder and Substance Use Disorders

Depressive Disorders
and
Substance Use
Disorders
Major Depressive Disorder



Major depression is a treatable
disorder
Major depression has a significant
morbidity (prevalence) and a
notable mortality rate (leading to
death)
Major depression is one of a
number of different mood disorders
Major Depressive Disorder



Presence of one (Single
Episode) or more
(Recurrent) Major
Depressive Episodes
Not better accounted for
by a Schizoaffective or
other type of disorder
Not accompanied by any
episodes of mania
Depressive Episode
A.
Five or more of the
following are present
during the same 2week period, and
represent a change
from previous
functioning, and at
least one of the
symptoms is either (1)
depressed mood, or
(2) loss of interest . . .
Depressive Episode
1)
2)
3)
4)
5)
6)
7)
8)
9)
Depressed mood most of the day, every day
Loss of interest or pleasure in most all activities,
every day
Significant weight loss w/o dieting
Insomnia / hypersomnia every day
Psychomotor agitation / retardation every day
Fatigue or energy loss every day
Worthlessness or inappropriate guilt feelings nearly
every day
Decreased ability to think, concentrate or make
decisions nearly every day
Recurrent thoughts of death, or suicidal ideation,
with or without plan &/or attempt
Depressive Episode
B.
Symptoms cause
clinically significant
distress or
impairment in
social,
occupational, or
other important
areas of
functioning
Depressive Episode
C.
Symptoms are NOT
due to the effects of a
substance (e.g., drug
of abuse, or
medication) or a
general medical
condition (e.g.,
hyperthyroidism)
Depressive Episode
D.
Symptoms are not better
accounted for by
Bereavement (i.e. lasting
longer than 2 months after a
significant loss, or
characterized by severe degree
of functional impairment,
preoccupation with
worthlessness, suicidal
ideation, psychotic symptoms,
or psychomotor retardation)
Prevalence

The National Comorbidity Survey
found:
For any mood disorder
•
Life time prevalence was 19.3%
•
Annual prevalence was 11.3%
For Major Depressive Episode
• Life time prevalence was 17.1%
• Annual prevalence was 10.3%
Female to male ratio is 2:1
A Spectrum of Depression

Some of the types of depressive
disorders include
Dysthymic Disorder
Major Depressive Disorder “clinical depression”
Post Partum Depression
Seasonal Affective Disorder
Mood disorder secondary to a medical condition
Substance induced mood disorder
Other mood disorders can include depressive
episodes, such as Bipolar disorder
Gender differences

The lifetime prevalence rate of
major depression is estimated at
between 5 to 12% for men
between 10 to 25% for women
Age


Depression can happen at any age
Teenagers can have depression
-adolescent rate is between 3 and 8%
-teen depression is estimated to be 6x more likely
when a parent also has depression
-signs/symptoms can be masked “irritable
moodiness”
-suicide is the 3rd leading cause of death for 15-25
year olds
Co-Occurring Medical Conditions


Nearly 70% of all anti depressant medication
prescriptions are written by primary care doctors
Certain medical disorders are associated with
higher-than-expected rates of depression
Stroke
Neurodegenerative disorders
HIV/AIDS
Endocrine disorders
Diabetes
What isn’t depression?





“The blues” – temporary
Normal grief – situational
Depression is an illness, while “the blues” are
normal reactions to life situations.
Symptoms of depression include multiple moods,
thoughts, and bodily functions whereas the blues is
composed of a single state of being in a low mood
Depression may persist for months, years, decades
Dysthymic Disorder

Depressed mood for
most of the day, for
more days than not, as
indicated either by
subjective account or
observation by others,
for at least 2 years, but
without a major
depressive episode
occurring.
Dysthymic Disorder

Dysthymic depression has 2 or
more of the following:






Poor appetite, or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making
decisions
Feelings of hopelessness
Other forms of depression

Postpartum Depression
A condition which describes a range of physical and
emotional changes a woman may have after having
a baby. Most partum depression can range from a
mild degree to severe with psychotic features
(postpartum psychosis).
This is not the “baby blues”.
-happens from several days to several months post
childbirth
-higher level of intensity
-interferes with functioning
Postpartum Depression
Symptoms include:

Restlessness

Irritability

Feeling sad

Crying a lot

Lack of energy

Headaches

Chest pains, heart palpitations

Difficulty sleeping and/or eating

Trouble concentrating

Sense of being overly worried about baby

Not having any interest in the child

Feelings of worthlessness, guilt

Fear of harming self or child
Seasonal Affective Disorder
It is noticed that animals react to the changing seasons in mood & behavior
and human beings are no exception. Most people have a tendency to eat
and sleep a little more in the winter and dislike the dark mornings and
short days. For some, it seems to have a more intense effect in disrupting
their lives and causing significant distress.
Symptoms include:
Change in appetite, weight gain, “heavy feeling” in arms/legs, drop in energy
level, fatigue, oversleeping, difficulty concentrating, irritability, increase
sensitivity to others, avoidance of social situations.



Estimated 10-20% may experience some mild form of SAD, more common
in women
Usually starts after age 20
More common in northern geographic regions, September – April
There’s an association with lack of bright light- bright light makes a difference
to the brain chemistry although they are not sure by what means the
sufferers are affected.
Treatment includes natural light, light box/full spectrum light, behavioral
therapy, medication when necessary.
What about Depression &
Substance Use?

For discussion:
Why would someone with
depression use substances?
What is the risk of using substances
when there is a co-occurring
depressive disorder?
Dual Diagnosis Issues


Certain intoxication syndromes
(usually with depressant
substances) &/or withdrawal
syndromes (usually from
stimulants) can mimic some of the
symptoms of a depressive episode,
thus making accurate diagnosis and
effective treatment more
complicated.
Exs. Sedative intoxication, Cocaine
withdrawal
Sedative Intoxication
•
•
•
•
•
•
•
•
Inappropriate sexual or
aggressive behavior
Slurred speech
Stupor
Impaired attention or
memory
Mood lability
Impaired judgment
Psychomotor retardation or agitation
Impaired social, occupational, or other
functioning
Cocaine Withdrawal
•
•
•
•
•
•
•
Depressed mood
Fatigue
Vivid, unpleasant dreams
Insomnia or hypersomnia
Increased appetite
Psychomotor retardation or agitation
Symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning
Sedative Intoxication
•
•
•
•
•
•
•
•
Inappropriate sexual or
aggressive behavior
Slurred speech
Stupor
Impaired attention or
memory
Mood lability
Impaired judgment
Psychomotor retardation or agitation
Impaired social, occupational, or other
functioning
Cocaine Withdrawal
•
•
•
•
•
•
•
Depressed mood
Fatigue
Vivid, unpleasant dreams
Insomnia or hypersomnia
Increased appetite
Psychomotor retardation or
agitation
Symptoms cause clinically
significant distress or impairment
in social, occupational, or other
important areas of functioning
Why does depression happen?

Emerging data supports that




stress
genetic predisposition
differences in brain chemistry & brain
structures
life experiences
Interact to cause depression.
Genetic Factors
First degree relatives of depressed
individuals have a higher rate of
depression.
Brain Structures


Post-mortem receptor studies in
depressed suicide victims show
differences in the hippocampus,
hypothalamus, and prefrontal
cortex.
Neruo imaging studies shows
impaired regulation of serotonergic
activity.
Life Experiences

Abnormal stress at critical
development periods may have long
lasting effects on the CNS
development. Emerging evidence
indicates that individuals with
depression are more likely (than
controls) to have a history of
childhood abuse, deprivation, or
abandonment
Suicide Awareness


The vast majority of people who SEEK treatment have
success in alleviating symptoms.
Not everyone who has depression becomes suicidal, but
over 90% of those who die of suicide have a diagnosable
mental illness
Warning signs include:

Talking about suicide.

Statements about hopelessness, helplessness, or worthlessness.

Preoccupation with death.

Suddenly happier, calmer.

Loss of interest in things one cares about.

Visiting or calling people one cares about.

Making arrangements; setting one's affairs in order.

Giving things away.
Seek Help!





Community Crisis Response Team
(CCRT) 734-994-8048 (24/7)
Psychiatric Emergency Services
734-936-5900
(24/7)
CSTS or other mental health
providers
Hotlines 1-800-SUI-CIDE
1-800-273-TALK
For every 25 attempts there is 1 death. Take attempts seriously.
Seek help!
Treatment options

“Multi modal”





Anti depressant medication
Psychotherapy
Behavior/lifestyle:
exercise, nutrition, sleep
light therapy
ECT
Principles of Dual Recovery




Treatment of both
mental illness and
substance abuse at
the same time
Individualized dual
recovery plan
Collaboration and
coordination
Keeping hope alive
Principles of Dual Recovery






Medication adherence
Dual diagnosis &/or
other treatment groups
Self-help groups (DRA,
DBSA, AA, NA), other
support networks
Family support and
problem solving
Individual therapy
Motivational strategies
Principles of Dual Recovery



Managing stressors,
triggers, relapse risk
factors
Skill-building in areas
of need
Increased overall
structure and lifestyle
balance (including
proper diet, exercise,
sleep habits)
Any Questions or
comments?
Thank you for coming!