1. Depression: Depression: Diagnosis & Treatment Options Eugene B. Smith Jr. PharmD, MPH, Associate Professor, UT College of Pharmacy Laura Jones, MS, Extension Assistant, UT Extension UT Center for Community Health Literacy 1

2. Objectives- This presentation will help you to understand: – The signs and symptoms of depression. – There are different treatment options available for people with depression. This lesson will focus on current drug therapies. – Depression can be treated effectively with minimal side effects. 2

3. Did You Know?... Depression affects more than 10% of the population. It is one of the leading causes of disability. Women are affected about twice as often as men. It is more common in low income households. Many depression sufferers avoid treatment because they fear the stigma sometimes associated with mental health issues. 3

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5. Types of Depression The most common type of depression is called Major Depressive Disorder (MDD) Other types of depression include: – Dysthymia – Post partum depression – Seasonal affective disorder – Bipolar disorder (also called: manic depression) – Psychotic depression 5

6. What Causes Depression? The exact cause is unknown, but there are known factors that can predispose someone to depression: – Genetic factors – Brain chemistry disorders – Situational issues that can trigger depression (Ex: job loss, loss of a loved one, financial problems, chronic physical conditions) 6

7. Symptoms of Depression Depressed mood Loss of interest or pleasure in previously enjoyable activities that lasts for 2-4 weeks Weight changes Change in sleep patterns Agitation Fatigue/loss of energy Feelings of worthlessness or excessive guilt Diminished ability to concentrate Suicidal thoughts 7

8. Impact of Depression Depression can have a negative impact on a person’s: – Relationships – Job or academic performance – Health status – Ability to maintain financial responsibility It has been estimated that the decrease in worker productivity due to depression costs the economy 50 billion dollars a year! 8

9. A complex problem Other issues that coincide with depression may make it more difficult to treat: – Other mental disorders and anxiety disorders – Chronic diseases – Substance use and/or abuse – Family beliefs about treatment options 9

10. Treatment Options Different treatment options are available for depression: – Drug therapy – Psychotherapy – Electroconvulsive therapy – Combination therapy Discuss treatment options with your doctor. It is ok to ask questions. Treatment suggestions are not mandatory. 10

11. Drug Therapy Different classes of anti-depressants: – SNRI: Serotonin-Norepinephrine Reuptake Inhibitors Cymbalta, Effexor – SSRI: Selective Serotonin Reuptake Inhibitors Zoloft, Prozac, Paxil – Tricyclic antidepressants Elavil, Tofranil, Norpramin – Monoamine oxidase inhibitors Nardil, Marplan, Ensam 11

12. Drug Interactions Always carry a current and detailed list of all medications that you take, including the dose, strength and frequency that you take them. This information is needed in order to avoid potentially dangerous drug interactions when new prescriptions are added. 12

13. Drug Selection Different antidepressants work for different people. No single drug is a depression “magic bullet.” Antidepressants affect brain chemistry and usually take 6-8 weeks to take full effect. It is best to give a drug time to reach full effectiveness before discontinuing use or asking for a different drug. 13

14. What about side effects? All drugs have side effects, including anti-depressants. Be informed about possible side effects: – Read the medication information sheet that comes with the medication. – Search for information using credible Web sites (Ex: Medline Plus). – Ask your doctor or pharmacist questions when you have concerns. 14

15. Don’t Stop Cold Turkey! Many patients stop taking their anti- depressants because: – They start to feel better and think they no longer need it. – They don’t think it is working. Stopping medications abruptly can have serious adverse effects. If you would like to stop a medication, talk to your primary care provider about decreasing your dose gradually. 15

16. What Can I expect from treatment? Remission or complete absence of depressive symptoms occurs in only about 1/3 of patients. Generally antidepressants are taken for 9-12 months but some patients require longer administration. 16

17. Sunshine again… Around 80% of those diagnosed with depression are able to complete successful treatment so that depression is no longer disabling and can go on to lead happy, productive lives. 17

18. What about St. John’s Wort? Research conducted by the National Institute of Health suggests that St. John’s Wort may help mild cases of depression but had no greater effect than a placebo in treating major depression of moderate severity. St. John’s Wort interacts with many drugs. Always include herbal supplements when discussing current medications with your doctor. 18

19. Psychotherapy Psychotherapy (or “talk therapy”) can be used alone or along with drug therapy. Talk therapy is meant to help a patient discover behaviors and mind sets that produce depression and to help identify new ways of thinking and behaving. 19

20. Ect Electroconvulsive therapy ECT is used in severe depression that is unresponsive to other interventions. An electric shock is administered that which induces a small seizure. How ECT works is not completely understood; however, it is a very effective treatment for depression. 20

21. How Can I Help? If someone you love is dealing with depression: – Encourage them to get professional help so that they can get treatment. – Encourage them to continue treatments. – Listen to them and let them share how they are feeling. – Protect their privacy. 21

22. When Should I intervene? It is important to take action immediately if someone you know appears to be acting in a way that would cause harm to himself or others, specifically if they are threatening suicide: – Call 911 or take them to an emergency room. – Call the toll free 24 hour hotline of the National Suicide Prevention Lifeline at 1-800-273-talk (1-800-273-8255). 22

23. More Information… www.medlineplus.nih.gov American Psychiatric Association www.psych.org www.psych.org American Psychological Association www.apa.org www.apa.org National Institute of Mental Health www.nimh.nih.gov www.nimh.nih.gov 23