Depressive Disorders and Substance Use Disorders

Dysthymic Disorder  Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years, but without a major depressive episode occurring.

Dysthymic Disorder  Dysthymic depression has 2 or more of the following: Poor appetite, or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness

Major Depressive Disorder  Presence of one (Single Episode) or more (Recurrent) Major Depressive Episodes  Not better accounted for by a Schizoaffective or other type of disorder  Not accompanied by any episodes of mania

Depressive Episode A. Five or more of the following are present during the same 2- week period, and represent a change from previous functioning, and at least one of the symptoms is either (1) depressed mood, or (2) loss of interest...

Depressive Episode 1) Depressed mood most of the day, every day 2) Loss of interest or pleasure in most all activities, every day 3) Significant weight loss w/o dieting 4) Insomnia / hypersomnia every day 5) Psychomotor agitation / retardation every day 6) Fatigue or energy loss every day 7) Worthlessness or inappropriate guilt feelings nearly every day 8) Decreased ability to think, concentrate or make decisions nearly every day 9) Recurrent thoughts of death, or suicidal ideation, with or without plan &/or attempt

Depressive Episode B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Depressive Episode C. Symptoms are NOT due to the effects of a substance (e.g., drug of abuse, or medication) or a general medical condition (e.g., hyperthyroidism)

Depressive Episode D. Symptoms are not better accounted for by Bereavement (i.e. lasting longer than 2 months after a significant loss, or characterized by severe degree of functional impairment, preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation)

Dual Diagnosis Issues  Certain intoxication syndromes (usually with depressant substances) &/or withdrawal syndromes (usually from stimulants) can mimic some of the symptoms of a depressive episode, thus making accurate diagnosis and effective treatment more complicated.  Exs. Sedative intoxication, Cocaine withdrawal

Sedative Intoxication Inappropriate sexual or aggressive behavior Slurred speech Stupor Impaired attention or memory Mood lability Impaired judgment Psychomotor retardation or agitation Impaired social, occupational, or other functioning

Cocaine Withdrawal Depressed mood Fatigue Vivid, unpleasant dreams Insomnia or hypersomnia Increased appetite Psychomotor retardation or agitation Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Principles of Treatment

Principles of Dual Recovery  Treatment of both mental illness and substance abuse at the same time  Individualized dual recovery plan  Collaboration and coordination  Keeping hope alive

Principles of Dual Recovery  Medication adherence  Dual diagnosis &/or other treatment groups  Self-help groups (DRA, DBSA, AA, NA), other support networks  Family support and problem solving  Individual therapy  Motivational strategies

Principles of Dual Recovery  Managing stressors, triggers, relapse risk factors  Skill-building in areas of need  Increased overall structure and balance (including proper diet, exercise, sleep habits)

Any Questions or comments?

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