Depressive Disorders and Substance Use Disorders

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Depressive DisordersandSubstance Use Disorders
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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

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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

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Depressive Episode

• Five or more of the following are present during
  the same 2-week 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 . . .

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Depressive Episode

• 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

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Depressive Episode

• Symptoms cause clinically significant distress or
  impairment in social, occupational, or other
  important areas of functioning

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Depressive Episode

• 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)

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Depressive Episode

• 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)

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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 21

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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

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Gender differences

• The lifetime prevalence rate of major depression
  is estimated at
• between 5 to 12 for men
• between 10 to 25 for women

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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

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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

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What isnt 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

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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.

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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

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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

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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

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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
• Theres 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.

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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?

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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

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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

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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

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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

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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

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Why does depression happen?

• Emerging data supports that
• stress
• genetic predisposition
• differences in brain chemistry brain structures
• life experiences
• Interact to cause depression.

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Genetic Factors

• First degree relatives of depressed individuals
  have a higher rate of depression.

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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.

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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

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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.

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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!

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Treatment options

• Multi modal
• Anti depressant medication
• Psychotherapy
• Behavior/lifestyle
• exercise, nutrition, sleep
• light therapy
• ECT

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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

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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

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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)

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• Any Questions or comments?

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Thank you for coming!