1. Claudia L. Reardon, MD Assistant Professor University of Wisconsin School of Medicine and Public Health NAMI Wisconsin Annual Meeting April 24, 2015

2.  Overview of depression  Treatment options  Q&A

3.  Overview of depression  Treatment options  Q&A

4.  5 or more of the following symptoms for at least 2 wks:

5. Depressed mood Diminished interest or pleasure (anhedonia) Weight loss or gain (or change in appetite) Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feeling worthless or excessively guilty Decreased concentration or indecisiveness Suicidal ideation

6.  The symptoms cause clinically significant distress or impairment in functioning.  The symptoms are not due to a substance or general medical condition.

7.  Overview of depression  Treatment options  Q&A

9.  Psychotherapy  Medications  Exercise  Complementary and alternative treatments  Light therapy  Other biologic treatments

10.  Cognitive behavioral therapy (CBT)  Interpersonal psychotherapy  Supportive psychotherapy  Insight-oriented therapies  Mindfulness/meditation  Group therapies

11.  When should we use medications for symptoms of depression?

13.  Serious symptoms: Appetite changes Sleep problems, especially early morning awakening Anhedonia Hopelessness Suicidality Psychotic symptoms  Symptoms interfering with functioning  Family history of depression, alcoholism, or suicide attempts  Comorbid anxiety or other mental illness

14.  When to try support or psychotherapy before medications: Typical grief reaction Symptoms mild or short-lived Symptoms clearly a reaction to life events

15.  When to consider antidepressants with caution: Bipolar disorder Pregnant or nursing women

16.  Newer antidepressants: Serotonin: SSRIs Serotonin and norepinephrine: SNRIs Dopamine and norepinephrine: bupropion Other: mirtazapine, trazodone, nefazodone  Older antidepressants: Serotonin and norepinephrine: tricyclics Serotonin, norepinephrine, dopamine, and others: MAOIs

17.  SSRIs usually first-line choice  If not SSRIs, then try to pick which side effects might be least harmful (and maybe even helpful!) for a patient. Main side effects to consider: Sedation Weight gain Degree of anticholinergic activity (dry mouth, constipation, blurred vision) Cardiac side effects (including dizziness) Sexual side effects

18.  For some people (and probably especially for mild depression), exercise can be just as helpful as psychotherapy and medications for treating depression.  Both aerobic exercise and strength training are helpful forms of exercise for depression.

19.  Walking is often easiest to do (cheap, can do from home, wear whatever you want, etc)  Set reasonable and SUSTAINABLE expectations  Keep track of your progress  Reward success  Nail down all the details: Time of day (more likely to become a habit if same time every day) Days of week Workout clothes Workout partner?

20.  St. John’s Wort  SAMe  Omega 3 fatty acids (fish oil)  Vitamin D  Yoga  Tai Chi  Bibliotherapy  Acupuncture  Massage  Chinese herbals

21.  St. John’s Wort  SAMe  Omega 3 fatty acids (fish oil)  Vitamin D  Yoga  Tai Chi  Bibliotherapy  Acupuncture  Massage  Chinese herbals

22.  Especially helpful for winter depression  Sit in front of light box 30-60 minutes every morning  Generally well-tolerated

23.  ECT  TMS  VNS

24.  Overview of depression  Treatment options  Q&A