Depression & Anxiety Kerri Smith, D.O. Outpatient Report January 2015

“Melancholy” c.460-c.370 B.C

Epidemiology Depression Prevalence Depression Risks -United States -Gender -Worldwide -Ethnicity -Internalizing Factors: Neuroticism, Low self-esteem, Early onset anxiety disorders, Hx of Depression -External Factors: Genetics, Substance abuse, Conduct Disorder, Chronic illness -Adversity: Trauma, Parental Loss, Low parental warmth, Marital problems, Low education, Low socioeconomic status

Diagnosis DSM-V: History of one or more major depressive episodes and no history of mania or hypomania “SIGECAPS” Patient Health Questionnaire (PHQ9) -Sleep -Interest -Guilt -Energy -Concentration -Appetite -Psychomotor -Suicide

Depression cntn’d -Subsyndromal (Minor) Depression -Dysthymia -Premenstrual Dysphoric Disorder -Post Partum Depression

Treatment Medication Therapy -SNRI: Venlafaxine, Duloxetine -Cognitive Behavioral Therapy -SSRI: Citalopram, Fluoxetine, Paroxetine, Sertraline -SNRI: Venlafaxine, Duloxetine -TCA: Amitriptyline, Nortriptyline -Serotonin Agonists/Norepinephrine Agonist: Mirtazipine -Norepinephrine and Dopamine Reuptake Inhibitors:Bupropion -MAOI: Selegiline

Epidemiology Anxiety Prevalence Anxiety Risks -History of depression -Female Gender -History of depression -Younger age (25 to 34 years) -Lower education level -Living alone -Unemployment -Parental psychiatric history -Childhood trauma

Diagnosis DSM-V: Excessive anxiety and worry which cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Difficult to control the worry The anxiety and worry are associated with at least 3 of the following: -Restlessness or feeling keyed up or on edge -Being easily fatigued -Difficulty concentrating or mind going blank - Irritability - Muscle tension - Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) The Disturbance is not attributed to substance use or mental disorder

Diagnosis cntn’d Social Anxiety Disorder Post Traumatic Stress Disorder (PTSD) Obsessive Compulsive Disorder (OCD)

Treatment Medication Therapy -SNRI: Venlafaxine, Duloxetine -Cognitive Behavioral Therapy -SSRI: Citalopram, Fluoxetine, Paroxetine, Sertraline -SNRI: Venlafaxine, Duloxetine -Benzodiazepines: Lorazepam, Alprazolam

Referrals -Psychiatric Referral -Psychological Referral

References Medical Knowledge Self Assessment Program, 16th Edition; Copyright 2012, American College of Physicians; www.cdc.gov www.history.com www.Medscape.org www.uptodate.com