DEPRESSION WORKSHOP CHRONIC DISEASES AND DEPRESSION

Transcription

1 DEPRESSION WORKSHOP CHRONIC DISEASES AND DEPRESSION

2 THE VICIOUS CYCLE Chronic Illness and Depression are often different expressions of the same underlying condition Chronic medical problems can cause or worsen depression Some of the medications we use to treat those conditions can precipitate or worsen depression Depression can worsen medical illness Depression can lead to noncompliance and failure to follow medical advice

3 The Vicious Cycle Depression can lead to poor lifestyle choices, self-medication and maladaptive coping mechanisms. Impaired coping mechanism and lack of motivation and procrastination can interfere with successful treatment of the disease process both of the chronic disease and the associated depression.

4 The Vicious Cycle Chronic illness usually lasts for a longer period of time, cannot be completely cured but can often be controlled with lifestyle changes, diet, exercise and appropriate supplementation and therapeutic intervention. Chronic illness is characterized by loss of homeostasis, abnormal function and /or altered chemical and/or physical processes. Depression is one of the most common complications of chronic illness up to 1/3 of individuals with serious chronic illness experience symptoms of depression. Depression can result in augmentation of symptoms and can interfere with treatment.

5 The Vicious Cycle Symptoms of Illness and chronic disease can be identical to those of depression. Depression is both a major contributor to, and a common result of, many chronic health conditions. Dr. Robert Hedaya, MD, DFAPA Professor of Psychiatry, Georgetown University, Washington, D.C. 16 th International Symposium oon Functional Medicine

6 Symptoms of Depression Depressed mood most of the day nearly everyday for 2 weeks Markedly diminished interest or pleasure in all or almost all activities most of the day Significant weight loss or weight gain or decrease or increase in appetite Insomnia or Hypersomnia nearly every day Diagnostic Criteria from DSM-IV-TR American Psychiatric Association

7 Symptoms of Depression Psychomotor agitation or retardation Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate Recurrent thoughts of death 5 out of 9 qualify Diagnostic Criteria from DSM-IV-TR

8 Risk of Depression Females 10-25% in a lifetime Males 5-12% in a lifetime Chronic illness 25-33% MedicineNet.com

9 Risk of Depression Heart Attack 40-65% CAD 18-20% Parkinsons disease 40% Multiple Sclerosis 40% Stroke 10-27% Cancer 25% Diabetes 25% www. Clevelandclinic.org/health/

10 Diabetes and Depression Patients with Type II diabetes have twice the rate of depression as the general population, and the coexistence of both conditions is responsible for an increase in mortality that is greater then that due to having either condition alone. McCollum M, Ellis Sl, Regensteiner JC, Zhang W., Sullivan PW. Minor depression and health status among US adults with diabetes mellitus. The American Journal of Managed Care 2007;13(2):65-72 Hanninin IA, Takala JK, Keinanen-Kiukaanniemi SM, Depression in Subjects with Type 2 Diabetes. Predictive factors and relation to quality of Life. Diabetes Care 1999:22(6)

11 THE COMMON DENOMINATOR Alteration of brain electric activity or chemical transmitter function Chemical or nutritional imbalance or deficiencies Hormonal imbalances Toxicity( heavy metals or selenium) Trauma/structural damage Disruption of a regular routine/circadian clock or general homeostasis

12 The common denominator cont. Simple factors affecting function Sleep/Rest Light Oxygen Water

13 Medical Conditions associated with Depression NEUROLOGIC DISEASES Head injuries Structural changes Inflammation/Infection Toxicity Disability/loss of function HEART DISEASE MI OR CAD CANCER and associated treatment ENDOCRINE/HORMONAL FACTORS Diabetes mellitus

14 Medical Conditions associated with Depression Thyroid disease- too little or too much Adrenal disorders too little or too much Low levels of pituitary hormones Post partum depression PMS or PMD Menopause Andropause Hyperparathyroidism

15 Medical Conditions.. SLEEP DISORDERS vicious cycle Sleep apnea Problems with sleep maintenance INFECTIONS of the nervous system meningitis/encephalitis Viral Illnesses: Mononucleosis Viral hepatitis Influenza AIDS TB and Syphilis

16 Medical Conditions.. AUTOIMMUNE DISEASES Lupus Rheumatoid arthritis Auto-immune hepatitis Thyroiditis ALLERGIES AND HYPERSENSITIVITY Food allergies Celiac disease NEUROLOGIC STRUCTURAL DISEASES OR IFLAMMATORY DISEASES Parkinsons disease Multiple Sclerosis Seizure disorder OBS

17 Disorders associated with depression. Chronic Liver or Kidney disease Chronic Lung disease Chronic Fatigue Syndrome Fibromyalgia Vitamin B deficiency/pernicious anemia Vitamin D deficiency Folate deficiency

18 The new discovery Vitamin D 3 deficiency can cause fatigue, depression, myalgias, osteoporosis and impaired immune regulation.

19 Medications which have been associated with Depression Bloodpressure medications Beta Blockers Clonidine Aldomet Reserpine Diuretics Hormonal preparations - BCP - Steroids - Cortisone

20 Medications associated with Depression cont. Tranquilizers/anti psychotics NSAIDS Pain medications/narcotics Withdrawal from narcotics or amphetamines Anti-infectious agents Stomach Medications- Cimetidine Antihistamines Chemotherapy agents:vincristine and vinblastine

21 Deficiencies associated with Depression Vitamin D3 deficiency Vitamin B 12 deficiency (antidepressants/tricyclics) Folate deficiency Vitamin B 6 deficiencies (BCP and Proton pump inhibitors) Omega 3 Fatty acid deficiency (low fat) Tryptophan deficiency (5HTP mg) Tyrosine deficiency (Tyrosine mg) Methionine deficiency (SAMe 1600mg) Magnesium deficiency critical mineral for neural messaging (75%) Coenzyme Q10 deficiency

22 Interventions which can help: Comprehensive medical history of past illnesses and present medical problems Lifestyle analysis and questionnaires Identify specific risk factors and then direct your particular intervention at the problems you have identified

23 Lab tests Basic lab tests: CBC, CMP, Thyroid function tests-tsh, free T3 and free T4 Other tests depending on symptoms and history: Ferritin, Vit D 25 OH, B12, B6, Folate, methylmalonic acid, homocystine, glucose tolerance test or Hgb A1c, celiac panel or deaminated gliadin abs,

24 Other tests to consider Sleep questionaire Epworth score Oximetry nocturnal or sleep lab evaluation Food diary and lifestyle diary/survey? Skips meals? Sugar?Alcohol, stimulants, soda, caffeine?vegetables, fruits and healthy fatty acids Exercise????????

25 Nutritional Intervention Eating on a regular basis and not skipping meals (stabilize blood sugar) Eating a healthy diet which includes lots of vegetables and fruits, unrefined high fiber foods, complex carbohydrates and reduced saturated fats. Avoid sugar Take in a diet or supplementation with cofactors which help with healthy nerve function EPA/DHA, Magnesium, Folate

26 Nutritional intervention cont. Coenzyme Q10 Vitamin B6 and B12- B complex Alpha Lipoic Acid Vitamin D3?Tumeric?Resveratrol

27 Regular Routine is the Key Regular Eating schedule Regular Sleep Schedule Avoid shift work Keep your environment stable to sleep Avoid light stimulation during the night and adequate light exposure during the day

28 Exercise Aerobic exercise Stretching Strength training Movement Several studies (Duke University) showed that 30 minutes 3 times a week of brisk walking for 16 weeks reduced depressive symptoms by 60.4%

29 Treat underlying hormonal Thyroid T4 vs. T3 Estrogen Progesterone Testosterone DHEA Vitamin D3 imbalance Other: Growth Hormone

30 Make sure you are aerobic Treat Sleep Apnea if present Regular Exercise

31 Form a treatment team Communicate with other health professionals Share your concerns regarding possible underlying disorders Find a physician you can work with Encourage your client to obtain medical help to control their underlying chronic medical disorders.

32 Attitude is crucial! Concentrate on thankfulness! Help us to help our patients to remember! Concentrating on the glass half full rather than half empty and appreciating the good in our lives helps to lift us up. Stress is ubiquitous. We cannot control all stress but we can control our response to stresses and manage our internal environment to become more stress resistant.