Transcript Depression, Anxiety

Depression
and Anxiety
Lauren Ellis
Exercise for Special Populations
PEP 4370
Overview
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Epidemiology
What are the types of depression and anxiety?
Signs and symptoms
Diagnosis, tests and evaluations
Complications
Treatment/medications
Effects of disease on ability to exercise
Effects of medications on ability to exercise
Effects of a bout of exercise on patient with disease
Effects of training on disease or patient with disease
Exercise Testing
Exercise prescription
Summary & conclusions
Epidemiology
Depression
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Fourth highest cause of
disability worldwide
6.7% of Adults in the US
(30% severe)
11.2% of13-18 yr. old In the US
(3.3% severe)
14% of Adults and adolescents
in Utah experience severe
psychological distress
Women are affected twice as
often as men
$83+ billion per year which
exceeds the costs of the war
in Afghanistan.
Anxiety
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18.1% of US adults in the US
(22% severe)
25.1% of13-18 13-18 yrs. In the US
(5.9% severe)
Women are twice as likely to be
affected as men.
$42+ billion per year for anxiety
conditions
What are the types depression
and anxiety?
Anxiety
Depression
 Generalized Anxiety
 Dysthymia(chronic)
Disorder
 Minor
 ObsessiveCompulsive Disorder
 Psychotic
(OCD)
 Postpartum
 Panic Disorder
 Seasonal affective
 Post-Traumatic Stress
disorder (SAD)
Disorder (PTSD)
 Social Phobia
 Bipolar disorder
Video Depression
http://www.youtube.com/watch?v=IeZCmqePLzM
Signs and Symptoms of
Clinical Depression
Physical:
 Sleep disturbances-insomnia, oversleeping, waking up early
 Changes in appetite or eating: much more or much less
 Decreased energy, fatigue
 Headaches, stomachaches, digestive problems unexplained
Behavioral/Attitude:
 Loss of interest or pleasure in activities that were once enjoyed,
such as going out with friends, hobbies, sports, sex, etc.
 Difficulty concentrating, remembering, or making decisions
 Neglecting responsibilities or personal appearance
Emotional:
 Persistent sad or "empty" mood, lasting two or more weeks
 Crying "for no reason"
 Feeling hopeless, helpless, guilty or worthless
 Feeling irritable, agitated or anxious
 Thoughts of death or suicide
Video Anxiety
http://www.youtube.com/watch?v=dRmBJhtys9g&feature=relmfu
Signs and Symptoms of Anxiety
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Feelings of panic, fear, and  Palpitations
uneasiness
 An inability to be still and
Uncontrollable, obsessive
calm
thoughts
 Dry mouth
Repeated thoughts or
 Numbness or tingling in the
flashbacks of traumatic
hands or feet
experiences
 Nausea
Nightmares
 Muscle tension
Ritualistic behaviors, such as  Dizziness
repeated hand washing
Problems sleeping
Anything where the reaction is
Cold or sweaty hands
inappropriate to the situation.
and/or feet
Shortness of breath
Diagnosis, tests and evaluation
Depression
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See a doctor
Rule out all other
possibilities
Physical examination,
interview, and/or lab tests
can be used
Complete history of
symptoms
http://www.depressedtest.
com/
Anxiety
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See a doctor
Interview to discus health
history to rule out all other
possibilities.
If symptoms are positive
patient will be referred to
psychiatrist or psychologist
for special diagnosing.
Diagnosis is based on
duration and intensity of
symptoms.
http://psychcentral.com/qui
zzes/anxiety.htm
Complications
Depression
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Alcohol abuse
Substance abuse
Anxiety
Work or school problems
Family conflicts
Relationship difficulties
Social isolation
Suicide
Self-mutilation, such as
cutting
Premature death from other
medical conditions
Anxiety
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Depression
Substance abuse
Trouble sleeping (insomnia)
Digestive or bowel problems
Headaches
Teeth grinding (bruxism)
Substance use disorders
Depression
Treatments/medications
The newest and most
popular types of
antidepressant medications
include:
 Fluoxetine (Prozac)
 Citalopram(Celexa)
 Sertraline (Zoloft)
 Paroxetine (Paxil)
 Escitalopram (Lexapro)
 Fluvoxamine (Luvox)
Serotonin and
norepinephrine reuptake
inhibitors (SNRIs) are similar to
SSRIs and include:
 Venlafaxine (Effexor)
 Duloxetine (Cymbalta)
Everyone reacts differently.
There is no one-size-fits-all
approach to medication
Alternative Treatments
 Psychotherapy-
“Talk therapy“
Two main types of psychotherapies-cognitive-behavioral
therapy (CBT) and interpersonal therapy (IPT)-have been shown
to be effective in treating depression by teaching new ways of
thinking and behaving.
 Electroconvulsive
therapy- ”Shock therapy"
Can provide relief for people with severe depression who have
not been able to feel better with other treatments.
 St.
John’s Wort- Top-selling botanical product in US
A trial found that St. John’s wort was no more effective than the
placebo in treating major depression. Still performing clinical
trials to see the benefits on minor depression.
Anxiety
Treatments/medications
 Medication:
Drugs used to reduce the symptoms
of anxiety disorders include anti-depressants and
anxiety-reducing drugs.
 Psychotherapy: Dealing with their disorder.
 Cognitive-behavioral therapy: The person learns
to recognize and change thought patterns and
behaviors that lead to troublesome feelings.
 Dietary and lifestyle changes
 Relaxation therapy
Just to think about….
• If untreated, depression leads to suicide in
about 15% of the people it affects.
• Depression is the leading cause of disability and
premature death in adults and is predicted to
be the second leading cause of disability in
people of all ages by the year 2020.
• Anxiety affects over 40 million Americans each
year (18+ yrs. old)
Effects of disease
on ability to exercise…
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both diseases, the only point to take
into consideration are their medications.
 Depending on what the side effects are
trainer should plan accordingly (need to
have a detailed list of medications).
Medications effect on exercise
 Beta-blockers:
Attenuation of HR response
 Proxilin: Possible increase of blood pressure
 Nefadzodone: Infrequent tachycardia,
hypertension, and angina pectoris
 Antipsychotic medication: Possible gait
disturbances in relation to tardive dyskinesia, and
often dehydration
 Antidepressants: Insomnia, weight gain, and
dizziness
 Antianxiety medications: Drowsiness, potential of
alcohol effects, and withdrawal
Effects of a bout
of exercise on patient…
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One single bout of exercise should not
affect patient.
* Important to consider primary diagnosed
mental illness and current medications.
Effects of training on disease
or patient with disease…
 Improved
mood
 Improved
self-concept
 Improved
work behavior
 Decreased
 Improved
depression and anxiety
social networks
Exercise Testing
Extensive orientation to the exercise testing facilities,
personnel, and mode of exercise are a must.
 Moods are ever-changing depending on what medications
they are on. Adjust accordingly.
 Treadmills can be intimidating due to medications so bike
ergometers are better.
 Measuring gas exchange is rarely if ever indicated,
especially because of possible anxiety.
Special considerations
-Allow time to practice the test or mode
-Understanding that anxiety disorders, social phobias, lock of
motivation are commonly caused by emotional conditions and
or medication.
-Emphasizing low to moderate intensity and enjoyment of
participation.
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Exercise Prescription
for Depression and Anxiety
Same as apparently healthy individuals unless
comorbidities are present.
Programs including walking or running, and group
dynamic movement activities.
Low to moderate intensity (50-65% of MHR)
20-60 minutes
*The prevalence of obesity, physical inactivity and
low self-esteem are high is this population structured,
supervised programs may be needs to reinforce
beginning stages of program.
Summary and Conclusions
 Women
are twice as likely to be affected as men
by depression and anxiety.
 Together they cost $125+ billion per year
 Can become life threatening if untreated
 Special considerations much be made when
planning exercise testing (should be enjoyed)
 Medications (side effects) must be documented to
plan testing and exercises programs accordingly.
 Regular exercise is extremely beneficial for patients
with depression and anxiety.
Resources
Retrieved April 2012, from National Institute of Mental Health:
http://www.nimh.nih.gov/index.shtml
Retrieved April 2012, from http://www.adaa.org/about-adaa/press-room/facts-statistics
Retrieved April 2012, from Herbal Remedies for Depression:
http://herbaldepressionremedies.org/depression-symptoms/
Retrieved April 2012, from
http://findarticles.com/p/articles/mi_m0903/is_n4_v12/ai_15256667/
Retrieved April 2012, from WebMD: http://www.webmd.com/anxiety-panic/guide/mentalhealth-anxiety-disorders
Retrieved April 2012, from Best Practice: http://bestpractice.bmj.com/bestpractice/monograph/55/basics/epidemiology.html
Retrieved April 2012, from National Institute of Mental Health:
http://www.nimh.nih.gov/health/publications/women-and-depression-discoveringhope/how-is-depression-diagnosed-and-treated.shtml
Retrieved April 2012, from Depressed Test: http://www.depressionprimarycare.org/images/pdf/phq_9_eng.pdf
All about depression.. Retrieved April 2012, from
http://www.allaboutdepression.com/cau_02.html
Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression
treatment
outcomes with the patient health questionnaire-9. Medical Care, 2004. 42(12):
1194-201
Questions?