How Dare You say I’m Moody Kim Marben and Ellen Snoxell

What is depression? Major Depressive Disorder Five or more of the following symptoms present over the same 2 week period and are nearly constant Depressed mood, diminished interest or pleasure in nearly all activities, significant weight change, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, decreased concentration or indecisiveness, recurrent thoughts of death Symptoms cause significant distress or impairment in social, occupational or other important areas of functioning

Why Screen for Depression? Depressive symptoms can be fairly easily identified Depression can be effectively treated Untreated depression can exacerbate other medical conditions Best practice in Minnesota through MN Community Measurement expects screening using Patient Health Questionnaire (PHQ) To determine if remission from depressive symptoms occurs and is maintenance

Importance of screening and phq-9

What is the Incidence of Depression in individuals with Spina bifida? Females: 16 completed 8 (50%) at-risk N = 69 patients Male = 26 (38%) Female = 43 (62%) Males: 10 completed 2 (20%) at-risk What is the Incidence of Depression in individuals with Spina bifida? PHQ-9 ≤9 16 patients low risk >9 10 patients at-risk [1 patient no history of depression] PHQ-2 43 (62%) patients no concerns 26 (38%) patients with concerns Show me the Data! The literature reports: 25 - 44% with developmental disability (Pinto-Meza et.al., 2005) 25.8% with Spina bifida (Dicianno et. al., 2015) Average age 32.4 yrs (Range 18-77) Males = 29.9 yrs Females = 33.9 yrs PHQ-9 completed by 26 patients

Treatment of depression Medications Psychotherapy

Medications Affect the neurotransmitters—serotonin, dopamine and norepinephrine—in the brain Tricyclic (examples—amitriptyline, nortriptyline) SSRI’s (examples—Prozac, Zoloft, Paxil, Lexapro, Celexa) SNRI’s (example—Cymbalta, Effexor, Fetzima, Pristiq) NDRI’s (example—Wellbutrin) Atypical (examples—Trazodone, Brintellix, Remeron, Viibryd)

Who should prescribe? Primary care provider Psychiatrist/Nurse Practitioner or Physician’s Assistant with specialized training and expertise Other specialists have individually differing degrees of comfort prescribing

The alphabet soup of evidenced based psychotherapy Cognitive Behavioral Therapy (CBT) Dialectical Behavior Therapy (DBT) Acceptance and Commitment Therapy (ACT)

Behavior Thoughts Feelings CBT

Maladaptive thoughts and unrealistic expectations Catastrophizing (Awfulizing) Illogical Assumptions Perfectionism Absolutism (black or white thinking)

DBT Philosophy People are doing the best they can and need to be more effective People may not have caused all their problems and yet they have to solve them

Dbt skills categories Mindfulness Distress Tolerance Emotional Regulation Interpersonal Effectiveness Middle Path

ACT Philosophy Human suffering is to a great extent related to the verbal processes of experiential avoidance, cognitive fusion, reason-giving and needing to be right

ACT Strategies Goal Setting Recognizing and dealing with avoidance Cognitive de-fusion (Just because we have a thought doesn’t mean we have to believe it; Get off your “buts”)