Transcript Depression
Nancy Gerrard June 8, 2014 Alternative depression 3 treatments for new medications Drugs of abuse Young adult years have also been called the AGE of INSTABILITY EMERGING ADULTHOOD Children and adolescents increasingly take antidepressants (1/13 on psych meds) Thin line between diagnosing depression and teaching youth to view any emotional upset as pathological NY Times, Iarovici, April 2014 Patients I see at the University Health Center: Anxiety Depression Bipolar disorder First episode psychosis Obsessive Compulsive Disorder Eating disorders ADHD Transgender clients Alternative therapies Depressed mood most of day Diminished interest in pleasurable activities Decrease or increase in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive guilt Diminished ability to think or concentrate Recurrent thoughts of death, recurrent suicidal thoughts or attempts These symptoms occur nearly every day and they cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Genetics Situational (life events and environmental stress) Personality or temperament Biological/medical factors Drug/alcohol induced Therapy Medications Combination of therapy and medication Hospitalization Prozac Paxil Zoloft Celexa Lexapro Cymbalta Effexor Pristiq Wellbutrin Sleep Healthy diet No alcohol or drugs Limit caffeine use Get outside for natural light at least 20 minutes per day Exercise daily Socialize with positive people Hastens the effects of antidepressant drugs Rapid onset of antidepressant action Antidepressant effects mediated through eyes Useful as a nonpharmacological intervention during pregnancy Use a light box with full spectrum light – 10, 000 lux Time with patient’s circadian phase of melatonin secretion (7.5-9 hrs after evening melatonin secretion Rare side effects such as: headache, eyestrain, nausea, and agitation Approved for treatment resistant depression Electromagnetic coil placed against scalp and delivers pulses Session is between 30-50 minutes Treatments are 5x week for 4-6 weeks Occasional headache after treatment Some insurance coverage Deep brain stimulation (same as what is used for Parkinsons) Electroconvulsive therapy (ECT) Sleep Deprivation (still being studied) L- methylfolate or Deplin A form of folate that can cross blood brain barrier 70% of depressed persons have a genetic factor that limits their ability to convert folic acid or folate in food to l-methylfolate. L-methylfolate regulates neurotransmitter production Used as an adjunct to antidepressant medications St John’s wort – antidepressant effects (mild to modest effects) SAMe – possible benefit for depression Omega 3 – possible benefit for depression Melatonin- possible benefit for depression but can improve sleep Psychotherapy Visualization Journaling Meditation Acupuncture Fetzima – antidepressant Works on norepinephrine and serotonin In same family as cymbalta, pristiq, effexor Latuda – atypical antipsychotic Using for mood stabilization, psychosis, adjunct for depression Same family as Abilify, Geodon, Zyprexa, Seroquel Brintellex – antidepressant Works on serotonin but several different receptors involved. Less weight gain and less sexual side effects reported Most frequently used drug by teens ½ of jr high students drink monthly 14% of teens intoxicated at least 1x in past yr. 8% of teens who drink, drink 5+ drinks Underage drinking attracts many developing adolescents Peer pressure Increased independence Easy access Increased stress Lowers attention/car accidents Decreases memory Tend to mix with other drugs – DANGER Intoxication associated with suicides and suicide attempts Males tend to complete less yrs of education if abusing alcohol Drinking increases risk of engage in unsafe sexual practices, or victimization Brain is still developing in adolescents Family history of alcoholism Genetics Environment Family problems Peers abusing alcohol Psychiatric problems Personality (risk takers) Dried flowers, leaves, stems, seeds from hemp plant Cannabis Sativa which contains THC Most common illicit drug used in US Hand rolled in cigarettes or used in pipes or water pipes (bongs). Can also be mixed in food or brewed as a tea THC rapidly passes through lungs into blood which carries chemical to brain and other organs Influences pleasure, memory, thinking, concentration, sensory, and time perception Can affect brain development in young people – affects thinking and memory Increases HR by 20-100% which can last 3 hrs. Increased risk of heart attack High doses of marijuana can cause a temporary psychotic reaction (hallucinations and paranoia) Possible link between marijuana and later development of psychosis Long term marijuana users trying to quit have irritability, sleeplessness, decreased appetite, anxiety, drug craving In 1980, the concentration of THC in marijuana was 4% In 2012, the concentration of THC in marijuana was around 15% Big problem on college campuses Stimulants cannot make you smarter! Persons like to go after the “rush” or the “high” that stimulants can give Also allow to stay awake all night to study Statistics are hard to find for the amount of abuse Labeled as not for human consumption Camouflaged under names such as stain remover, insect repellant Active ingredients are a moving target Grown in popularity due to representation as legal and their limited detection by standard tests May present with s/s that resemble psychiatric disorders such as schizophrenia, anxiety, depression Longterm consequences relatively unknown First used in US in July 2010 Cheap ($20-50 per 50mg packet) Users predominantly young and male Often coingested with marijuana, alcohol, opiods Contain ingredients similar to ecstasy, methamphetamine, cocaine Contains cathinone in khat plant Increase in serotonin, dopamine, norepinephrine Purple wave Zoom Cloud Nine Lunar Wave White Lightening Scarface Vanilla Sky Bloom Cause a surge in dopamine Also surge in norepinephrine Desired effects: Euphoria Alertness Increased sociability Increased empathy Intensification of sensory experiences Sexual arousal Adverse effects Tachycardia Hypertension Hyperthermia/sweating Mydriasis Seizures/spasms Respiratory distress Death Behavioral side effects Panic attacks Agitation Hallucinations/psychosis/paranoia Aggression Self mutilation Insomnia Depression May be inhaled, injected, snorted, swallowed , or inserted into rectum or vagina Effects occur with doses of 2-5mg Typical dose is 5-20mg Effects occur 10-20 minutes after ingestion Desired effects last 2-4 hrs Addiction potential: strong urge to re-dose occurs 20-30” after ingestion May be 10x more addictive than methamphetamine in rat studies What to look for: May mimic a psychiatric disorder Disorientation/agitation Dilated pupils with nystagmus Lockjaw and teethgrinding Rapid, loud, incoherent speech Emotional, verbal, physical abuse Negative results on standard urine toxicology but developing new testing Treatment Mainly supportive Sedatives (benzodiazepines) Monitor for respiratory depression Antipsychotics Physical restraints may be necessary Lab work may show elevated liver enzymes Inderal for BP, tachycardia, tremors, sweating Pure form of MDMA or Ecstacy Many more times potent than MDMA Popular Makes it feel as if “everything is right with the world”, euphoria Usually taken as tablet or capsule Surge of serotonin – emotional closeness, sexual arousal Negative: confusion, depression, sleep problems, anxiety Synthetic cannabinoids Designed to mimic THC (tetrahydrocanninol) Carry a higher risk of causing psychois 1st appeared in US in 2008 77% of users are male Inhalation most common route of administration $10-20 per gram (usual dose is 0.3g) What to watch for: Agitation Anxiety/Depression Elevated Blood Pressure/Tachycardia Hallucinations/Paranoia Nausea Seizures Symptoms may last up to 6 hrs Commerical testing is available – formulations change so rapidly that testing quickly becomes obsolete IV benzodiazepines usually treat Kidney failure reported in several cases Possible 3x risk of psychosis Depression and suicidal ideation may continue Dependence and withdrawal reported Derived from salvia divinroum, a member of the mint family Works on kappa opiods Smoke or ingest salvia leaves Low addiction potential May have antidepressant effects Desired effects Relaxation/better mood Intense psychedelic effects Hallucinations Floating feeling, dream like experience Increase of sensual and aesthetic appreciation Increased self confidence/insight Spiritual experience Adverse effects Racing thoughts Sleeplessness Dizziness Anxiety Psychosis Agitation Sweating/chills Nausea/vomitting Website: www. Erowid.org National Institute of Health, www.nih.gov/ April 2014 Saddock & Saddock, Synopsis of Psychiatry, 9th edition, 2003 DSM-5, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, 2013 MedicineNet.com, March 2014 NEI Psychopharmacology Congress, 2013 Iarovici, NY Times, April 2014 A student with a history of illicit substance abuse is considering trying bath salts as a cheap alternative high that won’t be detectable in standard drug tests. Recent studies indicate: A. it is 10x more addictive B. 5x less addictive C. 10x less addictive In 2009, what percentage of 16-17 yr olds drove under the influence of drugs/alcohol A. 1.2% B. 3.6% C. 6.3% D. 10.7% Which of the following statements about adderall (stimulant) is true? A. It can make you smarter B. It can help a person focus, even if they don’t have ADHD C. It causes your body to need less sleep D. None of the above Alcohol and marijuana are the drugs most abused by teens. What comes next? A. Ecstacy B. Cocaine C. Bath Salts D. Prescription drugs and cough medicine E. Tobacco What are things dangerous about bath salts? A. Cause paranoia, hallucinations, violent behavior B. Made with cathinones C. May end up in emergency room after taking them D. Contain unknown ingredients E. All of the above