Bright Nights: Understanding Depression
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1 Bright Nights: Understanding Depression KEVIN SETHI, MD MARCH 18 TH, 2019
2 Objectives Features of Depression Facts and Myths Treatment Options Medications Neuromodulation Cognitive Behavioral Therapy Mindfulness Lifestyle Modifications
3 How do you tell the difference between normal feelings and mental illness?
4 So, what exactly is depression? Common symptoms: Depressed or irritable mood Difficulty sleeping Poor concentration Low energy Mood swings Feeling worthless Social withdrawal Appetite change Thoughts of suicide Depression symptoms can last more than two weeks and impact functioning. Depression has many symptoms, not just blues /sadness.
5 Co-Morbid Anxiety with Depression Common symptoms: Excessive worry out of proportion to stressors Physical sensation of restlessness, sweating, and fast heart rate Trouble concentrating Muscle tension Poor sleep Irritability
6 Depression facts Leading cause of disability (ages 15-44) 2/3 people with depression don t seek treatment 80% of people treated show benefit Suicide is 2 nd leading cause of death (ages 15-44) One death by suicide every 12 minutes Bottom line: Depression and Anxiety are very common.
7 Depression myths Depression is not a real medical problem FALSE Depression is a result of lack of will power FALSE Antidepressants alter your personality FALSE Depression is ALWAYS triggered by something FALSE
8 Biology of Depression Hippocampus (memory center)- shrinks Amygdala (fear center)- hyperactive
9 Biology of Depression (cont) Increased stress hormone (cortisol) Decreased neuron regeneration
10 Treatment options Medications Neuromodulation Psychotherapy Cognitive Behavioral Therapy Mindfulness Lifestyle Modifications
11 Treatment Options: Medications Medications that work on various neurotransmitter systems SSRI, SNRI, NDRI, MAOi, TCA Cumulative remission rate: ~70% Symptom improvement rate much higher
12 Treatment Options: Ketamine Ketamine: NMDA blocker, Opioid activation, other mechanisms being researched IV Infusion: Rapid antidepressant effects Esketamine Nasal Spray: FDA Approval- March 2019
13 What is TMS? (Transcranial Magnetic Stimulation) Magnetic Field is generated Penetrates unimpeded through scalp and bone Magnetic Field induces Electrical Current in brain
14 Transcranial Magnetic Stimulation Outpatient treatment No anesthesia required Sessions around 40 min Typical course: 30 sessions over 6 weeks Targeting Prefrontal cortex FDA approval: 2008 Treatment Coil s Display
15 Transcranial Magnetic Stimulation Response: 58% Remission: 37%
16 Electroconvulsive Therapy: Basics Most effective antidepressant treatment (so far) Remission: 60-90% Safe in Pregnancy May be done inpatient/outpatient Inducing a short seizure
17 What is Cognitive behavioral therapy? Increase awareness of your thoughts/emotions/beliefs Cognitive Distortions aka pink lens Reshaping negative/inaccurate thinking CBT triangle
18 So what is Mindfulness? Mindfulness means paying full attention to something Slowing down to really notice what you are doing Being mindful is the opposite of rushing or multitasking When you are mindful, you are taking your time. You are focusing in a relaxed, easy way Simple exercises (only 3-5 minutes!)
19 Benefits of mindfulness Improved concentration Reduction in stress, anxiety, and depression Change our brain chemistry and connections
20 Helpful lifestyle changes Healthy eating Physical Exercise Proper sleep/sleep hygiene Positive relationships Stress management (ie. Movie, book, music)
21 Key takeaways Depression is a medical illness Many different treatment options There are lots of resources and help Early treatment/lifestyle changes helps reduce symptoms
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