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Michael Panzer, MD ThedaCare Behavioral Health

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Presentation on theme: "Michael Panzer, MD ThedaCare Behavioral Health"— Presentation transcript:

1 Michael Panzer, MD ThedaCare Behavioral Health
DEPRESSION Michael Panzer, MD ThedaCare Behavioral Health

2 PEARLS SCREEN FOR BIPOLAR HIGH RECURRENCE RISK THERAPY LIFESTYLE

3 HOW WILL YOU APPLY THIS TALK TO YOUR PRACTICE?

4

5 SYMPTOMS OF DEPRESSION
DEPRESSED MOOD OR PLEASURE CHANGE IN APPETITE / WEIGHT CHANGE IN SLEEP PSYCHOMOTOR CHANGE

6 …SYMPTOMS FATIGUE WORTHLESSNESS OR GUILT DECREASED CONCENTRATION MORBID THOUGHTS

7 …SYMPTOMS (NON-DSM) CRYING NEEDLESS WORRY IRRITABILITY WITHDRAWAL DIURNAL PATTERN

8 NATURAL HISTORY AGE IF GOES UNTREATED… SUICIDE BECOMES HARDER TO TREAT

9 RECURRENCE RISK 1 EPISODE: 50 % OLDER ONSET RESIDUAL SX RISKS FROM RECURRENCE

10 MDQ MOOD SLEEP PAINFUL CONSEQUENCES
MANIA MDQ MOOD SLEEP PAINFUL CONSEQUENCES

11 ANTIDEPRESSANTS MAOIs TCAs SSRIs SNRIs

12 SSRIs fluoxetine paroxetine fluvoxamine citalopram sertraline escitalopram

13 SSRI STRATEGIES START LOW, GO SLOW PATIENCE DO NOT STOP SUDDENLY BROAD SPECTRUM

14 OTHER ANTIDEPRESSANTS
MIRTAZAPINE NEFAZODONE VILAZODONE VORTIOXETINE

15 ANXIETY AND DEPRESSION
EACH TENDS TO CAUSE THE OTHER USEFUL TO KNOW WHICH IS PRIMARY

16 DSM 5 ANXIETY FAREWELL: OCD, PTSD, ASD, OVERANXIOUS WELCOME: MUTISM SEPARATION ANXIETY

17 DSM 5 ANXIETY PANIC AND AGORAPHOBIA GENERALIZED ANXIETY SOCIAL ANXIETY DISORDER (OCD) PHOBIAS (PTSD, ASD)

18 BENZODIAZEPINES CLONAZEPAM 0.25-0.5 mg ALPRAZOLAM 0.5 mg LORAZEPAM 1.0 mg DIAZEPAM 5-10 mg

19 BENZODIAZEPINE RISKS DEPENDENCE ABUSE WITHDRAWAL PSYCHOMOTOR IMPAIRMENT COGNITION SEDATION

20 DOCUMENTATION – BZs driving alcohol collateral sources patient tolerance alternatives tried PDMP mad relatives

21 OTHER ANXIOLYTICS. HYDROXYZINE
OTHER ANXIOLYTICS *HYDROXYZINE *BUSPIRONE GABAPENTIN PREGABALIN ATYPICALS? PROPRANOLOL *approved

22 LITHIUM Excellent stabilizer, some antidepressant effect
Lowers the risk of suicide! (do not stop suddenly) Narrow therapeutic window, levels important Renal, thyroid, GI, tremor, thirst, weight Interactions (NSAIDS, diuretics, ACE inhibitors) Avoid dehydration TSH, creatinine, 12-hour level, (calcium)

23 LAMOTRIGINE (Lamictal)
Anticonvulsant More antidepressant than antimanic Like an antidepressant that does not destabilize Well-tolerated (HA, rash) Slow No labs (+/- level) Interactions: valproic acid, CBZ, estrogen

24 QUETIAPINE (Seroquel)
Atypical antipsychotic Robust antidepressant and antimanic activity Sleep / sedation, weight gain, metabolics EPS, TD, dizziness Baseline fasting labs, 3m and yearly, and discussion of metabolic effects

25 ARIPIPRAZOLE (Abilify)
Atypical antipsychotic Unipolar depression (adjunct) Mania and mixed Nonapproved use for bipolar depression Some potential for sedation and weight gain EPS, TD, dizziness Baseline fasting labs, 3m and yearly, and discussion of metabolic effects

26 EXERCISE WORK FINANCES MEDICAL
LIFE FACTORS EXERCISE WORK FINANCES MEDICAL

27 THERAPY CBT MINDFULNESS EXPOSURE MARITAL

28 DON’T DO TOO MUCH CONSIDER MAJOR STRESSORS CAREFUL ABOUT DOSES NOT TOO MANY MEDICATIONS CONSIDER YOUR LIMITS CONSULT

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