Download Depression:Diagnosis & Treatment Options

Depression:
Diagnosis &
Treatment Options
Eugene B. Smith Jr. PharmD, MPH, Associate Professor, UT College of Pharmacy
Laura Jones, MS, Extension Assistant, UT Extension
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UT Center for Community Health Literacy
Objectives• This presentation will help you to
understand:
– The signs and symptoms of depression.
– There are different treatment options
available for people with depression. This
lesson will focus on current drug therapies.
– Depression can be treated effectively
with minimal side effects.
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Did You Know?...
• Depression affects more than 10% of the
population.
• It is one of the leading causes of disability.
• Women are affected about twice as
often as men.
• It is more common in low income
households.
• Many depression sufferers avoid
treatment because they fear the stigma
sometimes associated with mental health
issues.
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Types of Depression
• The most common type of depression
is called Major Depressive Disorder
(MDD)
• Other types of depression include:
– Dysthymia
– Post partum depression
– Seasonal affective disorder
– Bipolar disorder (also called: manic
depression)
– Psychotic depression
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What Causes Depression?
• The exact cause is unknown, but there
are known factors that can predispose
someone to depression:
– Genetic factors
– Brain chemistry disorders
– Situational issues that can trigger
depression (Ex: job loss, loss of a loved
one, financial problems, chronic
physical conditions)
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Symptoms of Depression
• Depressed mood
• Loss of interest or pleasure in previously
enjoyable activities that lasts for 2-4
weeks
• Weight changes
• Change in sleep patterns
• Agitation
• Fatigue/loss of energy
• Feelings of worthlessness or excessive
guilt
• Diminished ability to concentrate
• Suicidal thoughts
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Impact of Depression
• Depression can have a negative
impact on a person’s:
– Relationships
– Job or academic performance
– Health status
– Ability to maintain financial responsibility
• It has been estimated that the
decrease in worker productivity due
to depression costs the economy 50
billion dollars a year!
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A complex problem
• Other issues that coincide with
depression may make it more difficult
to treat:
– Other mental disorders and anxiety
disorders
– Chronic diseases
– Substance use and/or abuse
– Family beliefs about treatment options
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Treatment Options
• Different treatment options are
available for depression:
– Drug therapy
– Psychotherapy
– Electroconvulsive therapy
– Combination therapy
• Discuss treatment options with
your doctor. It is ok to ask
questions. Treatment
suggestions are not mandatory.
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Drug Therapy
• Different classes of anti-depressants:
– SNRI: Serotonin-Norepinephrine Reuptake
Inhibitors
• Cymbalta, Effexor
– SSRI: Selective Serotonin Reuptake
Inhibitors
• Zoloft, Prozac, Paxil
– Tricyclic antidepressants
• Elavil, Tofranil, Norpramin
– Monoamine oxidase inhibitors
• Nardil, Marplan, Ensam
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Drug Interactions
• Always carry a current and detailed
list of all medications that you take,
including the dose, strength and
frequency that you take them.
• This information is needed in order to
avoid potentially dangerous drug
interactions when new prescriptions
are added.
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Drug Selection
• Different antidepressants work for
different people. No single drug is a
depression “magic bullet.”
• Antidepressants affect brain chemistry
and usually take 6-8 weeks to take full
effect.
• It is best to give a drug time to reach
full effectiveness before discontinuing
use or asking for a different drug.
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What about side effects?
• All drugs have side effects, including
anti-depressants.
• Be informed about possible side
effects:
– Read the medication information sheet
that comes with the medication.
– Search for information using credible Web
sites (Ex: Medline Plus).
– Ask your doctor or pharmacist questions
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when you have concerns.
Don’t Stop ColD turkey!
• Many patients stop taking their antidepressants because:
– They start to feel better and think they no
–
longer need it.
They don’t think it is working.
• Stopping medications abruptly can
have serious adverse effects.
• If you would like to stop a medication,
talk to your primary care provider
about decreasing your dose gradually.
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What Can I expect from
treatment?
• Remission or complete absence of
depressive symptoms occurs in only
about 1/3 of patients.
• Generally antidepressants are taken
for 9-12 months but some patients
require longer administration.
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SunShine again…
• Around 80% of those diagnosed with
depression are able to complete
successful treatment so that
depression is no longer disabling and
can go on to lead happy, productive
lives.
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What about St. John’S Wort?
• Research conducted by the National
Institute of Health suggests that St.
John’s Wort may help mild cases of
depression but had no greater effect
than a placebo in treating major
depression of moderate severity.
• St. John’s Wort interacts with many
drugs. Always include herbal
supplements when discussing current
medications with your doctor.
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Psychotherapy
• Psychotherapy (or “talk therapy”) can
be used alone or along with drug
therapy.
• Talk therapy is meant to help a patient
discover behaviors and mind sets that
produce depression and to help
identify new ways of thinking and
behaving.
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Electroconvulsive therapy
• ECT is used in severe depression that is
unresponsive to other interventions.
• An electric shock is administered that
which induces a small seizure.
• How ECT works is not completely
understood; however, it is a very
effective treatment for depression.
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How Can I Help?
• If someone you love is
dealing with depression:
– Encourage them to get
professional help so that
they can get treatment.
– Encourage them to
continue treatments.
– Listen to them and let them
share how they are feeling.
– Protect their privacy.
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When Should I intervene?
• It is important to take action
immediately if someone you know
appears to be acting in a way
that would cause harm to himself
or others, specifically if they are
threatening suicide:
– Call 911 or take them to an emergency
room.
– Call the toll free 24 hour hotline of the
National Suicide Prevention Lifeline at
1-800-273-talk (1-800-273-8255).
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More inforMation…
• www.medlineplus.nih.gov
• American Psychiatric Association
www.psych.org
• American Psychological Association
www.apa.org
• National Institute of Mental Health
www.nimh.nih.gov
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