1. Depression Overview October 2011

2. Introduction to Harvest Healthcare Experience. Education. Excellence. Harvest is a leading full-service behavioral health provider, specializing in the delivery of progressive and innovative consultative behavioral health services for patients and residents residing in skilled nursing, rehabilitation, and assisted living facilities. Our multidisciplinary team of highly skilled professionals work together to offer a broad menu of services including but not limited to 24-hour prescriber on-call services and hospitalization support, comprehensive cognitive assessments, documentation review, OBRA compliance support and customized educational programs designed for the individual needs of your facility.

3. Objectives This presentation was developed for the continuing education of healthcare providers At the conclusion of this presentation the audience will have a basic understanding of depression including symptoms and management. Mental health professionals should be consulted for the management of patients with depression.

4. Depression Depression may be described as feeling sad, blue, unhappy, miserable or down in the dumps. Most of us feel this way at one time or another for short periods of time. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.

6. Causes, incidence, and risk factors Exact cause is not known Researchers believe it is caused by chemical changes in the brain, which may be genetic or triggered by stressful events. Some types of depression run in families, but depression can occur if you have no family history of the illness. Anyone can develop depression, even kids and elderly.

7. The following may play a role in depression: Alcohol or drug abuse Certain medical conditions: underactive thyroid, cancer, chronic pain, heart disease, diabetes Some medication such as steroids Sleeping problems Stress such as death or illness of someone close to you, loss of job, loss of independence, chronic medical problems, social isolation

8. Symptoms of Depression Depression can change/distort the way you see yourself, your life and those around you Everything seems more negative Becomes difficult to see how problems will get resolved Untreated symptoms of depression may evolve into psychotic symptoms such as hallucinations and delusions.

9. Symptoms Agitation, restlessness, irritability Dramatic change in appetite, often with weight gain or loss Very difficult to concentrate Fatigue and lack of energy Feelings of hopelessness and helplessness Feelings of worthlessness, self-hate, and guilt Becoming withdrawn or isolated Loss of interest or pleasure in activities that were once enjoyed Thoughts of death or suicide Trouble sleeping or excessive sleeping

10. 9 Types of Depression in DSM IV Major Depressive Episode Hypomanic Episode Manic Episode Mixed Episode Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Major Depressive Disorder Dysthymic Disorder

11. Diagnosis of Depression Studies show that 74% of people seeking help for depression go to their PCP and that 50% of those cases are misdiagnosed. Of the cases correctly diagnosed, 80% are given too little medication for too short of a time. The American Psychiatric Association has clearly outlined criteria for each of the nine types of depression.

12. Criteria for Major Depression You have had an episode of depression lasting at least two weeks with at least five of the following symptoms: (1) You are depressed, sad, blue, tearful. (2) You have lost interest or pleasure in things you previously liked to do. (3) Your appetite is much less or much greater than usual and you have lost or gained weight. (4) You have a lot of trouble sleeping or sleep too much. (5) You are so agitated, restless, or slowed down that others have begun to notice. (6) You are tired and have no energy. (7) You feel worthless or excessively guilty about things you have done or not done. (8) You have trouble concentrating, thinking clearly, or making decisions. (9) You feel you would be better off dead or have thoughts about killing yourself. These symptoms are severe enough to upset your daily routine, or to seriously impair your work, or to interfere with your relationships. The depression does not have a specific cause like alcohol, drugs, medication side effect, or physical illness. Your depression is not just a normal reaction to the death of a loved one.

13. Process of Diagnosing Depression Healthcare provider will ask questions about medical history and symptoms. Information from family or caregivers will be collected. Blood and urine tests may be done to rule out other medical conditions similar to depression. Depression inventories and or mental status exam questionnaires may be used

14. Treatment In general treatment includes both medication and psychotherapy. Medication used to treat depression is called antidepressant medication. Psychotherapy (talk therapy) has been found to be as beneficial as antidepressant medication in the treatment of depression in the early phases of depression.

15. Antidepressant Medication May take weeks before there is a consistent response May have transient side effects in the first few days that can be treated May cause a worsening in depression and even suicidal thoughts May induce agitation or impulsive behaviors

16. Psychotherapy Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them. Cognitive behavioral therapy teaches one how to fight off negative thoughts. Learning how to become more aware of symptoms and how to spot things that make depression worse creates problem-solving skills. Psychotherapy can help one to understand the issues that may be behind thoughts and feelings. Joining a support group of people who are sharing similar problems can also help

17. Prevention Do not drink alcohol or use illegal drugs. These substances can make depression worse and might lead to thoughts of suicide. Take medication exactly as instructed. Ask the prescriber about the possible side effects and how to manage them. Learn to recognize the early signs that your depression is getting worse. The following tips might help you feel better: ◦Get more exercise ◦Maintain good sleep habits ◦Seek out activities that bring you pleasure ◦Volunteer or get involved in group activities ◦Talk to someone you trust about how you are feeling ◦Try to be around people who are caring and positive

18. Thought Provoking Questions How is the syndrome of depression different from feeling sad? What is the most common treatment for depression and how fast does it work? How can you make a referral for the evaluation of a patient with depression?