Depression OverviewDepression OverviewOctober 2011

Introduction to Harvest Introduction to Harvest HealthcareHealthcare

Experience. Education. Excellence. Harvest is a leading full-service behavioral health provider,

specializing in the delivery of progressive and innovative consultative behavioral health services for patients and residents residing in skilled nursing, rehabilitation, and assisted living facilities. Our multidisciplinary team of highly skilled professionals work together to offer a broad menu of services including but not limited to 24-hour prescriber on-call services and hospitalization support, comprehensive cognitive assessments, documentation review, OBRA compliance support and customized educational programs designed for the individual needs of your facility.

ObjectivesObjectives

This presentation was developed for the continuing education of healthcare providers

At the conclusion of this presentation the audience will have a basic understanding of depression including symptoms and management.

Mental health professionals should be consulted for the management of patients with depression.

DepressionDepression

Depression may be described as feeling sad, blue, unhappy, miserable or down in the dumps.

Most of us feel this way at one time or another for short periods of time.

True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.

Causes, incidence, and risk factorsCauses, incidence, and risk factors

Exact cause is not knownResearchers believe it is caused by

chemical changes in the brain, which may be genetic or triggered by stressful events.

Some types of depression run in families, but depression can occur if you have no family history of the illness.

Anyone can develop depression, even kids and elderly.

The following may play a role in The following may play a role in depression:depression:

Alcohol or drug abuseCertain medical conditions: underactive

thyroid, cancer, chronic pain, heart disease, diabetes

Some medication such as steroidsSleeping problemsStress such as death or illness of someone

close to you, loss of job, loss of independence, chronic medical problems, social isolation

Symptoms of DepressionSymptoms of Depression

Depression can change/distort the way you see yourself, your life and those around you

Everything seems more negativeBecomes difficult to see how problems will

get resolvedUntreated symptoms of depression may

evolve into psychotic symptoms such as hallucinations and delusions.

SymptomsSymptoms

Agitation, restlessness, irritabilityDramatic change in appetite, often with weight

gain or lossVery difficult to concentrateFatigue and lack of energyFeelings of hopelessness and helplessnessFeelings of worthlessness, self-hate, and guiltBecoming withdrawn or isolatedLoss of interest or pleasure in activities that were

once enjoyedThoughts of death or suicideTrouble sleeping or excessive sleeping

9 Types of Depression in DSM IV 9 Types of Depression in DSM IV

Major Depressive EpisodeHypomanic EpisodeManic EpisodeMixed EpisodeBipolar I DisorderBipolar II DisorderCyclothymic DisorderMajor Depressive DisorderDysthymic Disorder

Diagnosis of DepressionDiagnosis of Depression

Studies show that 74% of people seeking help for depression go to their PCP and that 50% of those cases are misdiagnosed.

Of the cases correctly diagnosed, 80% are given too little medication for too short of a time.

The American Psychiatric Association has clearly outlined criteria for each of the nine types of depression.

Criteria for Major DepressionCriteria for Major Depression

You have had an episode of depression lasting at least two weeks with at least five of the following symptoms: (1) You are depressed, sad, blue, tearful. (2) You have lost interest or pleasure in things you previously liked to do. (3) Your appetite is much less or much greater than usual and you have lost or gained weight. (4) You have a lot of trouble sleeping or sleep too much. (5) You are so agitated, restless, or slowed down that others have begun to notice. (6) You are tired and have no energy. (7) You feel worthless or excessively guilty about things you have done or not done. (8) You have trouble concentrating, thinking clearly, or making decisions. (9) You feel you would be better off dead or have thoughts about killing yourself.

These symptoms are severe enough to upset your daily routine, or to seriously impair your work, or to interfere with your relationships.

The depression does not have a specific cause like alcohol, drugs, medication side effect, or physical illness.

Your depression is not just a normal reaction to the death of a loved one.

Process of Diagnosing DepressionProcess of Diagnosing Depression

Healthcare provider will ask questions about medical history and symptoms.

Information from family or caregivers will be collected.

Blood and urine tests may be done to rule out other medical conditions similar to depression.

Depression inventories and or mental status exam questionnaires may be used

TreatmentTreatment

In general treatment includes both medication and psychotherapy.

Medication used to treat depression is called antidepressant medication.

Psychotherapy (talk therapy) has been found to be as beneficial as antidepressant medication in the treatment of depression in the early phases of depression.

Antidepressant MedicationAntidepressant Medication

May take weeks before there is a consistent response

May have transient side effects in the first few days that can be treated

May cause a worsening in depression and even suicidal thoughts

May induce agitation or impulsive behaviors

PsychotherapyPsychotherapy

Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.

Cognitive behavioral therapy teaches one how to fight off negative thoughts. Learning how to become more aware of symptoms and how to spot things that make depression worse creates problem-solving skills.

Psychotherapy can help one to understand the issues that may be behind thoughts and feelings.

Joining a support group of people who are sharing similar problems can also help

PreventionPrevention

Do not drink alcohol or use illegal drugs. These substances can make depression worse and might lead to thoughts of suicide.

Take medication exactly as instructed. Ask the prescriber about the possible side effects and how to manage them.

Learn to recognize the early signs that your depression is getting worse.

The following tips might help you feel better:◦ Get more exercise◦ Maintain good sleep habits◦ Seek out activities that bring you pleasure◦ Volunteer or get involved in group activities◦ Talk to someone you trust about how you are feeling◦ Try to be around people who are caring and positive

Thought Provoking QuestionsThought Provoking Questions

How is the syndrome of depression different from feeling sad?

What is the most common treatment for depression and how fast does it work?

How can you make a referral for the evaluation of a patient with depression?