Understanding & Managing DEPRESSION - PowerPoint PPT Presentation

Loading...

PPT – Understanding & Managing DEPRESSION PowerPoint presentation | free to download - id: 3c5fb1-MjdhZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Understanding & Managing DEPRESSION

Description:

Understanding & Managing DEPRESSION J. Subramani, M.D. and Nancy Losinno, LCSW Psychotherapy The issue of suicide No verbal threats (vague or otherwise) should ... – PowerPoint PPT presentation

Number of Views:79
Avg rating:3.0/5.0
Slides: 37
Provided by: bnlGoveap
Learn more at: http://www.bnl.gov
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Understanding & Managing DEPRESSION


1
Understanding Managing
DEPRESSION
  • J. Subramani, M.D.
  • and
  • Nancy Losinno, LCSW

2
Depression
3
Depression Statistics
  • Lifetime prevalence Major-17
  • Minor-17
  • Women Men ratio is 21(19 million )
  • 25 of drug and alcohol problems related to
    depression
  • 30-40 of depressed individuals have sudden bouts
    of anger
  • Only 20 of depressed receiving adequate Tx.

4
Causes of Depression
  • Genetics Family history could
  • increase likelihood six-fold
  • Biological Factors
  • Neurotransmitters-
  • Serotonin, Nor-epinephrine, Dopamine
  • Sleep disorders
  • Light deprivation
  • Reproductive Hormones
  • Sudden fluctuations of estrogen
  • progesterone

5
Emotional Physical Signs of Depression
  • Depression can range from mild to severe and
    transitory to chronic
  • Onset can occur at any age
  • Can be triggered by 1 event or a series of
    events
  • Depressed mood alone does not constitute a
    depressive disorder.

6
Sadness
7
Emotional Symptoms of Depression
  • Sadness, tearfulness, low self-esteem, obsessive
    self-critical thoughts, inability to experience
    pleasure, loss of ambition, loss of interest,
    inability to focus on tasks
  • Irritability, anger, pessimism, guilt,
    helplessness, loss of hope, or feelings of
    despair, including thoughts of suicide.

8
Physical Signs of Depression
  • In the sleep realm problems falling asleep,
    staying asleep or early A.M. wakening
  • Appetite changes including changes in body
    weight
  • Social withdrawal/isolation
  • Increased somatic complaints, including anxiety
    about illness, and having many vague body
    complaints.

9
Child Adolescent Depression Symptoms
  • Episodes last avg. 7-9 months
  • Sadness, loss of interest in friends or
    activities, feel they are not liked/loved by
    others
  • Feel pessimistic about the future, are
    indecisive, have trouble concentrating in school
    may lack energy motivation.
  • Usually present with more anxiety, and are
    reactive to family changes (divorce, abandonment
    or death).

10
Types of Depressive Disorders
  • Adjustment Disorder
  • Dysthymic Disorder
  • Bipolar Disorder
  • Cyclothymic Disorder
  • Major Depressive Disorder

11
Adjustment Disorders
  • Usually in response to an identifiable stressor
  • In men women, prevalence is 5-20, condition is
    short-term generally treated with talking
    therapy
  • Continuing stressors may lengthen the persistence
    of the adjustment disorder.

12
Dysthymic Disorder
  • Chronically depressed mood that is present most
    of the time for at least 2 yrs in adults and 1 yr
    in children
  • Dysthymia affects 6 of the population, esp.
    women
  • Depressed feeling is experienced as normal
  • Untreated dysthymia and its stressors may
    precipitate an episode of major depression.

13
(No Transcript)
14
BiPolar Disorder
  • Mood instability which alternates between bouts
    of depression and episodes of mania
  • Condition often begins in adolescence
  • Manic episode racing thoughts, overconfidence,
    talks excessively, spending binges, exaggerated
    or delusional ideas about abilities.
  • People often experience a manic episode as a
    relief from depression.

15
Cyclothymic Disorder
  • A mild form of bi-polar disorder
  • Does not include psychotic thought processes
  • Treatment may include psychotherapy and
    medication.

16
Major Depression
  • A serious health problem characterized by 1
    major depressive episodes
  • Females carry more risk factors for depression
    worry more about body image, rejection
    relationship difficulties females are also
    vulnerable to hormonally related mood
    fluctuations throughout the reproductive life
    cycle for which there is great stigma.

17
Depression in women
18
Major Depression in Women
  • Twice as many woman as men
  • During extreme hormonal shifts
  • Early puberty
  • 22 incidence in ages 20-45
  • Perimenopausal symptom
  • Pregnancy especially around wk 32
  • Post partum 2wks- 3 months

19
Menopause
20
Depression in Men
21
Major Depression in Men
  • Commonly occurs with attempts to self-medicate
    with alcohol, drugs, food, gambling or sex
  • Men often do not experience these behaviors as
    signs of depression and have more reluctance to
    ask for professional help.
  • Depression may be precipitated by loss of ability
    to function in an impt or especially valued area
    of life.

22
Depression Life Changes
  • Even happy eagerly anticipated events (birth of
    a baby, retirement, new job, etc.) can
    precipitate a mild depression
  • The chronicity of other stressors can have a
    profound impact on a at-risk individual (caring
    for an aging parent, aftermath of divorce, job
    lay-off, problematic family issues)

23
Depression Aging Issues
  • Increased weight gain and changes in body image
  • Poor sleep habits, including undiagnosed sleep
    disorders
  • More medications to take MD visits to monitor
    meds
  • Loss of friends or relatives to illness,
    relocation, or death
  • Fears of crippling diseases, concerns for adult
    children, financial worries about retirement.

24
Depression Medical Issues
  • Do you know that, in some at- risk people, there
    is a link between depression undiagnosed
    diabetes?
  • Post-operative cardiac patients are at high risk
    for depression their cardiac prognosis improves
    with anti-depressant use.
  • Untreated long term depression has an adverse
    effect on our immune response.

25
What About S.A.D.?
  • Seasonal affective disorder (SAD) affects only
    1.4 of pop living in the South and 9.7 of
    people living in the North. Person may crave
    carbohydrates (serotonin sub.)
  • Is a response to decreases in daylight, starting
    as early as August and lasting through February.
  • Treatment can include use of medication,
    increasing amount of direct sunlight, use of a
    lightbox, or a combination of the above.

26
A Changing Landscape
  • JAMA Study, 2002 N32,000
  • Kinds of Treatment Received
  • 1987 1997
  • Antedepressants 37 75
  • alone
  • Psychotherapy 71 60
  • alone

27
Classes of antedepressants
  • SSRIs serotonin
  • NRIs norepinephrine
  • SNRIs serotonin/norepinephrine
  • Atypical
  • Wellbutrin dopamine NE
  • Trazodone Nefazadone
  • Over ctr SAMe St. Johns

28
Role of neurotransmitters
  • Neurotransmitters Behavior
  • Serotonin
  • Anxiety, rumination, irritability,
  • aggression, suicidality
  • Catecholamines
  • Anhedonia, apathy, impaired attention, low
    energy

29
Medications
30
Medications to Treat Depression
  • Depression is highly treatable, but some people
    may become impatient with the process (high
    expectations, intolerance of side effects,
    inability to keep med monitoring appts.)
  • Different generations of anti-depressant
    medications may be used
  • Individual variability from person-to-person
  • Psychiatrist strives to use the tx dose, while
    minimizing side effects.

31
Chronic Depression
  • Affects a small of those diagnosed
  • Usually maintained on a daily dose of meds that
    is monitored regularly by MD in order to reduce
    kindling effect
  • Person needs to become aware of buildup pattern
    (rejection, overwork, poor sleep, family stress)
    and take active steps to intervene with MD help
  • Important to develop a supportive psychotherapy
    relationship to minimize stress prevent
    relapse.

32
Stress reduction
33
Choice of Professional
  • Family doctor
  • Psychiatrist
  • Psychotherapist (PhD, MSW, etc.) cant prescribe
    meds
  • Most common source of lack of response in major
    depression is the administration of inadequate
    doses, or the use of psychotherapy alone.

34
Psychotherapy
35
The issue of suicide
  • No verbal threats (vague or otherwise) should be
    dismissed or treated lightly!
  • Depressed females may think about it, but
    depressed males have more follow-through.
  • Suicide more likely after former depressed person
    shows small improvement but now has the energy to
    follow-through on previous suicidal thinking.

36
Your BNL EAP
  • Your BNL EAP Manager Nancy Losinno avail
    Mon-Fri. Call X4567 to make appt.
  • 24/7 crisis coverage provided by Magellan
    Behavioral health at 1-800-327-2182 or go to
    www.magellanhealth.com/member
  • Employees and their household members are covered
    for 5 free visits to a Magellan-network provider.
    Call EAP Manager for referrals
About PowerShow.com