Mood Disorders and OMM
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1 Mood Disorders and OMM Teodor Huzij DO FACN Medical Director, Trinity Institute AOA OMED 2012
2 Objectives 1. Review literature for manual medicine and mood disorders 2. Review Anatomy and Physiology related to current evidence for mood disorders 3. Discuss proposed osteopathic manipulative medicine (OMM) interventions based on objectives 1 and 2.
3 Literature Review: Manual Medicine
4 Overall Search terms included: depression, major depressive disorder, dysthymic disorder, dysthymia, bipolar, manic depression, mood disorder, manual medicine, osteopathic, osteopathy, osteopathic manipulative treatment, osteopathic manipulative medicine, OMT, OMM, manual medicine, chiropractic, massage, manipulation and spinal manipulation
5 Citations Found Massage and Depression: 13 OMT and Depression: 2 Spinal manipulation and Depression: 1 Massage and Bipolar: 1
6 Massage - Depression 4 studies: Patient s with co-morbid condition (OA, CA, HIV, ESRD)- Decreased Depression 2 studies: Pregnant women - Mixed results 1992 Pilot Study: Inpt Psych C&A- Decreased Depression Choi 2006, Wilkinson 2007, Fulk 2004, McDougall 2005, Field 2004, Dimidjian 2009, Field 1992
7 Massage - Depression Critical Reviews Immediate +, Long term No evidence Improvement = to psychotherapy RCTs did not support efficacy Manber 2002, Moyer 2004, Coelho 2008
8 OMT - Depression Pilot Study: Adjunctive OMT with Paxil for Depressed Women y.o. Women, 8wks (weekly sessions) Control (9): Cognitive therapy, Neurolinguistic programming, Paxil, OSE Treatment (8): Same as control + OMT OMS administered, Physician supervised No specific OMT protocol (20 min limit) Plotkin. JAOA. Sep 2001
9 OMT - Depression Pilot Study: Adjunctive OMT with Paxil for Depressed Women Zung Depression Scale Both groups significantly better Control: 30% reached normal range OMT: 100% reached normal range Plotkin. JAOA. Sep 2001
10 OMT - Depression Quality of life for OMT referrals SF-36 only administered Lower quality of life vs controls Undetermined impact of OMT on QOL Licciardone. JAOA. Mar 2002
11 Spinal Manipulation - Depression Systematic review of RCT for spinal manipulation and psychological outcomes Included osteopathic (2) and others Small significant benefit in first 5 mo vs talking treatment Williams. Comp Therapies in Med. 2007
12 Massage - Bipolar Review of complimentary and alternative treatment for Bipolar Aromatherapy massage & Massage Therapy almost entirely lacking evidence Andreescu. Jrnl Aff Dis
13 Literature Summary Most Evidence: Massage Therapy for Depression but mixed OMT: Depression Pilot study is the best evidence available
14 Literature Review: Neuro - A&P
15 MDD: Findings Vary Reduced Frontal Lobe volume Reduced Caudate Reduced Putamen Reduced CBF Anterior Cingulate Gyrus Increased CBF Medial Orbital Cortex Increased CBF Left Amygdala & Medial Thalamus Increased CBF Cerebellar Vermis Amygdala-Medial- Thalamus-Ventral- Prefrontal Cortex Limbic-Striatal- Pallidal-Thalamic Ebert 1996, Soares 1997, Drevets 1998, Daroff 2012
16 MDD: Most Evidence Hypoperfusion Dorsolateral/Dorsomedial Prefrontal Cortex Increased CBF Medial Thalamus Hypoperfusion of Anterior Cingulate Gyrus Reduced Frontal Lobe volume Coffey 1993, Ito 1996, Ebert 1996, Soares 1997, Drevets 1998, Daroff 2012
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22 Bipolar: Findings Vary Bilateral anterior frontal Anterior cingulate gyrus Left superior temporal Bilateral anterior insular Cerebellar vermis Inferior prefrontal Amygdala Striatum Hippocampus Third ventricle Ito 1996, Soares 1997, Strakowski 2004, DelBello 2004, Lyoo 2006, William 2007, Ellison-Wright 2010
23 Bipolar: Most Evidence Reduced Cerebellar Vermis Volume Reduced Right Anterior Cingulate Gyrus Volume Decreased CBF and Decreased Left Superior Temporal Cortex Volume Reduced Bilateral Insular Cortex Volume Increased Corpus Striatum Volume Ito 1996, Soares 1997, Strakowski 2004, DelBello 2004, Lyoo 2006, William 2007, Ellison-Wright 2010
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32 Proposed OMM
33 Not The Goal
34 Before You Begin Patient Selection Consent
35 Osteopathic Philosophy 1. Body is a Unit - Body, Mind, Spirit 2. Structure and Function are Interrelated 3. Self-healing Self-regulating Systems 4. Rationale treatment includes prior 3 Glossary of Osteopathic Terminology 2009, p33
36 Osteopathic Approach An osteopath reasons from his knowledge of anatomy - Still Principles of osteopathy follow the logic of an applied knowledge of anatomy-the science of structure, physiology-the science of function, and pathology-the science of disease - Webster Life is not a composite of the functions of the viscera - Korr Still-Research & Practice, Webster-Sage Sayings, Korr-Physiological basis
37 General Biomechanical Goals Optimize Structure and Function Whole Body Assessment Sympathetic Nervous System Lymphatic System and Secondary Respiration Vascular System Primary Respiration
38 Common Treatments Sympathetic Nervous System T1-6 Any modality
39 Common Treatments Lymphatic System Open Thoracic Inlet
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43 Common Treatments Secondary Respiration Re-dome Abdominal Diaphragm
44 Treating Cortical Tissue Avoid if recent vascular event Balanced Membranous Tension Assess Tension, Restriction Laxity, void Seek balance
45 Vascular Arterial Vertebrobasilar system, Post Comm Anterior Cerebral Middle Cerebral Venous Dural Venous Sinuses and Jugular Vein
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75 Major Depressive D/O Hypoperfusion Dorsolateral/Dorsomedial Prefrontal Cortex Vascular: Anterior & Middle Cerebral Arteries 1 Respiration:
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82 Major Depressive D/O Increased CBF Medial Thalamus Vascular: Vertebrobasilar, Post Comm Art 1 Respiration:
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88 Major Depressive D/O Hypoperfusion of Anterior Cingulate Gyrus Vascular: Anterior Cerebral Artery 1 Respiration:
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94 Major Depressive D/O Reduced Frontal Lobe volume Vascular: Anterior Cerebral Artery 1 Respiration:
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98 Bipolar D/O Reduced Cerebellar Vermis Volume Vascular: Vertebral and Basilar arteries 1 Respiration:
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105 Bipolar D/O Reduced Right Anterior Cingulate Gyrus Volume Vascular: Anterior Cerebral Artery 1 Respiration:
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109 Bipolar D/O Reduced Left Superior Temporal Cortex Volume Vascular: Middle Cerebral Artery 1 Respiration:
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117 Bipolar D/O Reduced Bilateral Insular Cortex Volume Vascular: Middle Cerebral Artery 1 Respiration:
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129 Bipolar D/O Increased Striatum Volume Vascular: Vertebral and Basilar 1 Respiration:
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140 Other Options? Cranial Vertebrae Charlotte Weaver DO Biodynamics James Jealous DO Brain Curriculum Bruno Chikly MD DO
141 SUMMARY Limited Evidence for OMM in Mood d/o Limited Evidence of anatomical/ physiological correlates in Mood d/o Rationale Approach utilizing OMM in Mood d/o
142 QUESTIONS?
Anatomy & Physiology of Mood Disorders
Anatomy & Physiology of Mood Disorders Teodor Huzij DO FACN Medical Director, Trinity Institute AAO Convocation March 2016 Disclosures No Industry Relationships American Osteopathic Board of Neurology
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