Presentation is loading. Please wait.

Presentation is loading. Please wait.

Depression and Anxiety: Two Sides of the Serotonin Coin Successful Students III Dr. Tim Johanson Metropolitan Pediatric Specialists.

Similar presentations


Presentation on theme: "Depression and Anxiety: Two Sides of the Serotonin Coin Successful Students III Dr. Tim Johanson Metropolitan Pediatric Specialists."— Presentation transcript:

1 Depression and Anxiety: Two Sides of the Serotonin Coin Successful Students III Dr. Tim Johanson Metropolitan Pediatric Specialists

2 Parenting Thoughts: Parental guilt Parental fear Parental hopelessness Parental frustration

3 Love Must Evolve In order for kids to become young adults, a parent’s love must evolve over time Infant: adored and protected  teen/young adult: free and equipped When your kid falls behind, don’t panic…

4 Depression Unipolar: MDD (major depressive disorder) Dysthymia: chronic mild-moderate depression Bipolar Disorder: manic depressive disorder

5 Increased risk for: Illness, both real and psychosomatic Interpersonal difficulties Academic problems

6 Scope of Childhood Depression 2.5% children before teen years 8.3% adolescents age Female : male is 70:30 Childhood depression often predicts depression in adulthood

7 Depression-Suicide Link 3 rd most common cause of death in year olds 4 th most common cause of death in year olds Triggers that lead to feelings of hopelessness, feeling trapped, unable to handle life anymore Believe suicide is the only way to solve their problems, a welcome escape

8 Signs of Possible Attempt: Talks about death and/or suicide Plans ways to kill him or herself Expresses worries that nobody cares Has attempted suicide in the past Dramatic changes in personality Withdraws from interacting with friends/family Shows signs of a substance abuse problem Begins to act recklessly Begins to give away sentimental possessions Spends time online interacting with people who glamorize suicide

9 Diagnosis in Children…Difficult change with developmental ages Signs/symptoms change with developmental ages of children and teens identifying and expressing Kids have a harder time identifying and expressing their internal emotions adults in their lives are actually less likely to identify depression For teens, adults in their lives are actually less likely to identify depression in them than the teen themselves (less connected, blame on other factors like hormones, etc)

10 Symptoms of Depression Persistent sadness Irritable mood or agitation Loss of interest, loss of energy Excessive tiredness or inability to sleep Feeling of worthlessness Inappropriate guilt Difficulty concentrating Recurrent thoughts of death or suicide

11 DSM-4 MDD (Major Depressive Disorder) if 5 or more symptoms are present for greater than two weeks

12 Signs of Depression Frequent school absences Hear them talk about running away Drug and alcohol use/abuse Engaging in reckless behavior Change toward extreme withdrawl

13 Triggers Stress, bereavement, loss, break-ups, abuse, neglect, trauma including natural disasters Usually, if depression has an identifiable trigger, counseling is the most effective way to manage it.

14 Parenting Thought: Life is difficult Our child’s greatest opportunity to grow and mature usually involves adversity Parents should embrace things that may be on the “checklist to adulthood” Attitude of a parent matters

15 Anxiety Disorders GAD: generalized anxiety disorder OCD: obsessive compulsive disorder Phobias Panic disorders

16 Scope of Childhood Anxiety 25% of year olds will experience episodic or chronic anxiety 6% of year olds will experience severe anxiety Female : Male is 60:40

17 Symptoms of Childhood Anxiety Excessive worry Palpitations, hyperventilation, dizziness Tremors Poor concentration Sleep onset problems HA, SA, fatigue

18 Signs of Childhood Anxiety Avoidance Frequent unwarranted tantrums “CONTROL FREAK!!!” Hypersensitive and over-reactive

19 Triggers Social challenge like bullying Academic underachievement Extracurricular pressure “Overload Syndrome” Unstable home environment Moves, new school

20 Parenting Thought: Anxiety leads to high arousal states Parenting a kid who is in a high arousal state usually doesn’t work very well Understand how your child self-protects: rage, withdrawl, power, perfectionism, blame, or self-contempt

21 Neurobiology 101 (These Disorders are Real)

22 Normal left, OCD right

23 Doritos left, Nuts right

24 Serotonin (5-HT) Considered our “happy” neurotransmitter Regulates mood, appetite, and sleep Meds that regulate serotonin used to treat patients with depression, GAD, and phobias

25 ReceptorK i (nM)[12]Receptor function[Note 1] 5-HT 1 receptor family signals via G i/o inhibition of adenylyl cyclase.G i/o inhibition of adenylyl cyclase. 5-HT 1A 3.17Memory (agonists ↓); learning (agonists ↓); anxiety (agonists ↓); depression (agonists ↓); positive, negative and cognitive symptoms of schizophrenia (partial agonists ↓); analgesia (agonists ↑); aggression (agonists ↓); dopamine release in the prefrontal cortex (agonists ↑); serotonin release and synthesis (agonists ↓) 5-HT 1A 3.17Memory (agonists ↓); learning (agonists ↓); anxiety (agonists ↓); depression (agonists ↓); positive, negative and cognitive symptoms of schizophrenia (partial agonists ↓); analgesia (agonists ↑); aggression (agonists ↓); dopamine release in the prefrontal cortex (agonists ↑); serotonin release and synthesis (agonists ↓) 5-HT 1B 4.32Vasoconstriction (agonists ↑); aggression (agonists ↓); bone mass (↓). Serotonin autoreceptor. 5-HT 1B 4.32Vasoconstriction (agonists ↑); aggression (agonists ↓); bone mass (↓). Serotonin autoreceptor. 5-HT 1D 5.03Vasoconstriction (agonists ↑) 5-HT 1D 5.03Vasoconstriction (agonists ↑) 5-HT 1E HT 1E HT 1F 10 5-HT 1F 10 5-HT 2 receptor family signals via G s activation of phospholipase C.G s activation of phospholipase C. 5-HT 2A 11.55Psychedelia (agonists ↑); depression (agonists & antagonists ↓); anxiety (antagonists ↓); positive and negative symptoms of schizophrenia (antagonists ↓); norepinephrine release from the locus coeruleus (antagonists ↑); glutamate release in the prefrontal cortex 5-HT 2A 11.55Psychedelia (agonists ↑); depression (agonists & antagonists ↓); anxiety (antagonists ↓); positive and negative symptoms of schizophrenia (antagonists ↓); norepinephrine release from the locus coeruleus (antagonists ↑); glutamate release in the prefrontal cortex 5-HT 2B 8.71Cardiovascular functioning (agonists increase risk of pulmonary hypertension) 5-HT 2B 8.71Cardiovascular functioning (agonists increase risk of pulmonary hypertension) 5-HT 2C 5.02Dopamine release into the mesocorticolimbic pathway (agonists ↓); acetylcholine release in the prefrontal cortex (agonists ↑); appetite (agonists ↓); antipsychotic effects (agonists ↑); antidepressant effects (agonists & antagonists ↑) 5-HT 2C 5.02Dopamine release into the mesocorticolimbic pathway (agonists ↓); acetylcholine release in the prefrontal cortex (agonists ↑); appetite (agonists ↓); antipsychotic effects (agonists ↑); antidepressant effects (agonists & antagonists ↑) Other 5-HT receptors 5-HT 3 ?Emesis (agonists ↑); anxiolysis (antagonists ↑) 5-HT 3 ?Emesis (agonists ↑); anxiolysis (antagonists ↑) 5-HT Movement of food across the GI tract (agonists ↑); memory & learning (agonists ↑); antidepressant effects (agonists ↑). Signalling via G αq activation of adenylyl cyclase. 5-HT Movement of food across the GI tract (agonists ↑); memory & learning (agonists ↑); antidepressant effects (agonists ↑). Signalling via G αq activation of adenylyl cyclase. 5-HT 5A 251.2Memory consolidation.[13] Signals via G i/o inhibition of adenylyl cyclase 5-HT 5A 251.2Memory consolidation.[13] Signals via G i/o inhibition of adenylyl cyclase 5-HT Cognition (antagonists ↑); antidepressant effects (agonists & antagonists ↑). G s signalling via activating adenylyl cyclase. 5-HT Cognition (antagonists ↑); antidepressant effects (agonists & antagonists ↑). G s signalling via activating adenylyl cyclase. 5-HT Cognition (antagonists ↑); antidepressant effects (antagonists ↑). Acts by G s signalling via activating adenylyl cyclase. 5-HT Cognition (antagonists ↑); antidepressant effects (antagonists ↑). Acts by G s signalling via activating adenylyl cyclase.

26 Norepinephrine Considered our “focus” neurotransmitter Regulates our concentration, attention, mood Also our primary “stress” hormone Low levels of NE make decisions difficult

27 Diagnosis and Surveys There is no blood test Brain scan research is still in the early stages Psychological evaluation through history taking and surveys usually lead to diagnosis Depression scales: CDI, PHQ-9 Anxiety scales: SCARED, SCAS, STAIC, RCMAS

28 Treatment Modalities Counseling Medications CAM-Complimentary/Alternative Medicine

29 Counseling: CBT CBT (Cognitive Behavior Therapy) Replacement Theory (recognizing cognitive distortions) Understanding realistic vs. unrealistic thoughts “Practical” thinking towards realistic perspectives Usually 3-4 months

30 Counseling: DBT DBT (Dialectical Behavior Therapy) Focuses on self-responsibility for decisions Gaining self-awareness of conflict and ways to manage reactions

31 Counseling: Individual and Family Helps individuals understand how anxiety or depression affects relationships Teaches ways for individuals and family members to better understand each other Works toward healthy communication skills, boundary setting, and cooperation

32 Medications Most commonly used to increase levels of serotonin SSRI: Prozac, Zoloft, Celexa, Lexapro, Paxil Wellbutrin

33 Optimal Therapy Research has shown a combination of counseling and meds results in the best outcome Counseling is usually the best place to begin If medications are started, close follow-up is a mandatory expectation

34 CAM: Complimentary-Alternative Medicine Acupressure, acupuncture, biofeedback, chiropractic, dietary supplements, guided- imagery, hypnosis, massage therapy, meditation, relaxation, and yoga

35 CAM Research has been varied as to the efficacy of different alternative therapies Many have experienced positive results Safety of combining traditional medicines with CAM is not known Most clinicians believe that using dietary or herbal supplements should not be done with prescription medications

36 Research is needed… CAM should be evaluated just like traditional methods through double-blinded placebo controlled studies Perhaps someday more effective, safer, less expensive, and better tolerated therapies can be found

37 Parenting Thought: “The Two Things” “The Two Things” approach: is the mindset of continuously asking yourself what are two things my child needs to learn next It doesn’t matter if your child is on their way to Harvard or on their way to juvenile detention It doesn’t matter if they’re four years old or seventeen

38 “The Two Things” Working on “Two Things” at a time is ultimately the most efficient way to grow These things might be: doing a good job vacuuming, getting up on your own, regulating time on video games… or in a countercultural way: being more social, dressing like a slob now and then, or study less

39 Final Comments: Seek the help you and your family need Love Must Evolve for your child to grow up Life Is Difficult is an important life lesson Avoid parenting in high arousal states Working on Two Things is the most efficient way to grow

40 Break time!!!!! See you all in 20 minutes…


Download ppt "Depression and Anxiety: Two Sides of the Serotonin Coin Successful Students III Dr. Tim Johanson Metropolitan Pediatric Specialists."

Similar presentations


Ads by Google