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

2. 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

3. 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

4. Importance of screening and phq-9

5. 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: completed (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:
% 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 = yrs
Females = 33.9 yrs
PHQ-9 completed by 26 patients

6. Treatment of depression
Medications
Psychotherapy

7. 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)

8. 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

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

10. Behavior
Thoughts
Feelings
CBT

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

12. 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

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

14. 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

15. 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”)