Archive for the 'Major Depressive Disorder (MDD)' Category

Michael Phelps, Allison Schmitt talk about battling depression

Physician Suicide

Wayne Brady Opens Up About His Depression

Life’s most stressful events

Postpartum Struggles

Ever wonder what it feels like to have a mental disorder?

Here are some incredibly powerful depictions of common mental disorders that may help promote understanding and reduce stigma about mental disorders:

Popular YouTuber Anna Akana fights stigma about antidepressants

Much respect for this YouTube celebrity. Antidepressants are the number two most-prescribed medication class, second only to cholesterol medication (1). 6.7% of American adults suffered a major depressive episode in 2014 – a whopping 15.7 million people (2). A staggering 16.7% of all Americans have suffered at least one major depressive episode in their lifetime (3). Lets heed this brave young woman’s call to fight stigma about depression and antidepressants – if you suffer from depression, know that you are not alone, and that treatment (talk therapy +/- medications) can be incredibly helpful. If you don’t suffer from depression, know that 1-2 people out of every 10 people you know fights this illness – please be understanding, supportive, or at the very least non-judgmental; for tips on what NOT to say to someone who is fighting depression see this young lady’s Facebook post.

References:
1)
http://pharma.about.com/od/Sales_and_Marketing/a/The-Most-Prescribed-Medications-By-Drug-Class.htm

2) http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
3) http://jama.jamanetwork.com/article.aspx?articleid=196765

Depression and Medications Workshop

Thank you to Menlo Park Presbyterian Church for inviting me to be a workshop speaker for their annual Community Mental Health Conference yesterday May 8th, 2010.  I hope to be getting an audio recording of the workshop that I will post on my website when I receive it.   The slides from my presentation, as well as a handout that has the answers to Selective Serotonin Reuptake Inhibitors Frequently Asked Questions (SSRI FAQ) are now available on my Resources page under “Depression”.

Thank you again to all the volunteers that made the event a success, and hopefully a useful resource for education and encouragement to the community.

Depression

Depression is an extremely common problem that many people struggle with.  I hope that this article will be helpful and educational.

Introduction

It is estimated that in any given year, 6.7 percent of the U.S. population has Major Depressive Disorder (MDD), the clinical name for what people generally refer to as depression.  A medication used to treat depression is the third most prescribed medication in the U.S., behind only cholesterol-lowering medication and asthma medication.  Although everyone has ups and downs in their moods, people with MDD have such severe downs that it significantly affects their daily function.

Symptoms

The main symptom of MDD is depressed mood, plus additional common symptoms as described by the mnemonic SIGECAPS:

S: Sleep (decreased or increased)
I: Interest (decreased, also known as anhedonia)
G: Guilt (feeling worthless, hopeless, helpless)
E: Energy (decreased)
C: Concentration (decreased)
A: Appetite (decreased or increased)
P: Psychomotor retardation or activation (feeling slowed or feeling restless)
S: Suicidal thoughts

Diagnosis

As with most mood disorders, MDD is diagnosed clinically, based on history.  There is no blood test or imaging test that is diagnostic for MDD.  However, if there are clinical signs that suggest a medical problem may be contributing to your depression, your doctor may order blood tests to check for infections and check your thyroid, liver, kidneys, and vitamin B12 and folate levels to see if there are any other factors contributing to your depression.  At times, brain imaging may be helpful to make sure there are not any underlying brain abnormalities that are contributing to your depression.  Before initiating medication treatment of MDD, it is important that your doctor screen you for Bipolar Affective Disorder (BPAD), as many anti-depressant medications that can help people with MDD can actually make people with BPAD much more unstable.

Treatment

Treatment can involve psychotherapy, medications, or combined treatment, depending on patient preference and severity of symptoms.

  • Psychotherapy: Cognitive Behavioral Therapy (CBT) has been shown to be effective for Major Depressive Disorder. I recommend a CBT workbook to my depressed patients –  The Feeling Good Handbook by David D. Burns.   Many patients find it helpful to go through the workbook and suggested exercises with the guidance of a mental health professional, though the workbook is made to be self-guided.  Some patients find insight-oriented psychotherapy or supportive therapy to be more helpful types of therapy than CBT.
  • Medications: The most commonly used medications for treating Major Depressive Disorder are selective serotonin reuptake inhibitors (SSRI’s).  These medications can be prescribed by your primary care doctor, or by your psychiatrist.  If SSRI’s are not effective, serotoinin-norepinephrine reuptake inhibitors (SNRI’s), other anti-depressants such as bupropion (Wellbutrin), atypical antipsychotics, and other adjunctive medications can be effective.  Older medications such as monoamine oxidase inhibitors (MAOI’s) and tricyclic antidepressants (TCA’s) can also be alternatives if newer, safer medications are not effective.  The best predictor of your response to medications is how you have responded to medications in the past.   How blood-relatives have  responded to medications in the past can also help your doctor choose the best medication for you.
  • Combined Treatment: For many patients, the combination of psychotherapy and medications is the most effective form of treatment.

For Further Information

See the Wikipedia entry on MDD, a handout from the National Institute for Mental Health (NIMH), or contact a qualified mental health professional.

Article written 12/1/09 by Minyang Mao, M.D.  Revised 12/1/09 by Minyang Mao, M.D.

Disclaimer: This article is intended as an educational resource only, and is not intended to be a replacement for treatment. For evaluation and treatment, please contact a qualified mental health professional.

Content © 2009 Minyang Mao, M.D.  Image © 2009 Bob Lin.  All rights reserved.

Seasonal Affective Disorder

Seasonal Affective Disorder-1It’s that time of the year again when sunlight hours get short and Seasonal Affective Disorder starts to rear its ugly head.   I hope this article will be timely and helpful.

Introduction

Seasonal Affective Disorder, or SAD, is a mood disorder related to the shortening of sunlight hours during winter.  It is more common in northern latitudes, in Finland for example.  It is difficult to have an accurate estimate of actual prevalence in the U.S., but estimates range from 0 to 9.7%.

Symptoms

Symptoms of SAD are the same as those of depression, with the main symptom of depressed mood, plus additional common symptoms as described by the mnemonic SIGECAPS:

S: Sleep (decreased or increased)
I: Interest (decreased, also known as anhedonia)
G: Guilt (feeling worthless, hopeless, helpless)
E: Energy (decreased)
C: Concentration (decreased)
A: Appetite (decreased or increased)
P: Psychomotor retardation or activation (feeling slowed or feeling restless)
S: Suicidal thoughts

The unique aspect of SAD versus non-seasonal depression is that SAD regularly appears in the fall or winter, and SAD tends to disappear during spring and summer months, whereas non-seasonal depression has no correlation to the changing of seasons.

Diagnosis

There is not currently a distinct diagnosis of “Seasonal Affective Disorder” in the DSM-IV.  Psychiatrists diagnose SAD by adding a “Seasonal Pattern Specifier” to a Major Depressive Episode that appears as part of Major Depressive Disorder or Bipolar Type I or Type II Disorder.  As with most mood disorders, SAD is diagnosed clinically, based on history.  There is no blood test or imaging test that is diagnostic for SAD.

Treatment

Treatment can involve psychotherapy, medications, light therapy, or combined treatment, depending on patient preference and severity of symptoms.

  • Psychotherapy: Cognitive Behavioral Therapy (CBT) has been shown to be effective for Seasonal Affective Disorder.  Because SAD is a subtype of depression, I recommend the same workbook to my SAD patients that I recommend for my depressed patients –  The Feeling Good Handbook by David D. Burns.   Many patients find it helpful to go through the workbook and suggested exercises with the guidance of a mental health professional, though the workbook is made to be self-guided.
  • Medications: The most commonly used medications for treating Seasonal Affective Disorder are the same medications for non-seasonal depression: selective serotonin reuptake inhibitors (SSRI’s).  These medications can be prescribed by your primary care doctor, or by your psychiatrist.
  • Light Therapy: Because the cause of Seasonal Affective Disorder appears related to the lack of sunlight exposure during fall/winter months, light therapy treatments have been developed.  Most studies have focused on 10,000 lux light therapy for 30 minutes per day, given early in the morning.  There are commercially available lightboxes and light visors that deliver this light in various forms.  The key factors for effectiveness are intensity (lux) and duration.  It is important to keep in mind that as you get farther from the light, the lux drops significantly.  Most lightboxes require that you are within 12 inches of the light to deliver the recommended 10,000 lux.  Important safety considerations are to make sure that you are not being exposed to UV light which can predispose you to skin cancer.  Some boxes use special UV-free bulbs, others use a UV light filter to screen out UV rays.  There is investigation into whether blue-light can be more effective than full-spectrum light.  Another safety issue is that light therapy can cause patients with Bipolar Disorder to become manic or hypomanic.  Thus, I recommend that light therapy be initiated and conducted under the supervision of a psychiatrist.
  • Combined Treatment: For some patients, the combination of psychotherapy, medications, and light therapy is the most effective form of treatment.

For Further Information

See the Wikipedia entry on SAD, a Mayo Clinic article on SAD, an article from the American Academy of Family Physicians, or contact a qualified mental health professional.

Article written 11/10/09 by Minyang Mao, M.D.  Revised 11/10/09 by Minyang Mao, M.D.

Disclaimer: This article is intended as an educational resource only, and is not intended to be a replacement for treatment. For evaluation and treatment, please contact a qualified mental health professional.

Content © 2009 Minyang Mao, M.D.  Image © 2009 Bob Lin.  All rights reserved.