Beyond Sadness Powerpoint

7/31/2019 Beyond Sadness Powerpoint

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DepressionThere are at least two sides toevery story.


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Depression. Its not only a state of mind.

Reference: Adapted from

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.Fourth Edition,Text Revision. Washington, DC; American Psychiatric Association. 2000:345-356,489.

The symptoms of depression

Emotional Symptoms Include:

Sadness

Loss of interest or pleasure

Overwhelmed

Anxiety

Diminished ability to think orconcentrate, indecisiveness

Excessive or inappropriate guilt

Physical Symptoms Include:

Vague aches and pains

Headache

Sleep disturbances

Fatigue

Back pain

Significant change in appetiteresulting in weight loss or gain


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Reference:

1. Simon GE, et al.N Engl J Med. 1999;341(18):1329-1335.

Depression the physical presentation

In primary care, physical symptoms are often

the chief complaint in depressed patients

N = 1146 Primary care patients with major depression

In a New England Journal of Medicine

study, 69% of diagnosed depressedpatients reported unexplained physicalsymptoms as their chief compliant1


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Adapted from

1.Silverstein B.Am J Psychiatry. 1999;156(3):480-482.2.Silverstein B. Am J Psychiatry. 2002;159(6):1051-1052.

25%

17%

58%

37%

55%

38%35%

28%

0

10

20

30

40

50

60

70

Aches/Pain

(Women)

Aches/Pain

(Men)

Anxiety Disorder

(Women)

Anxiety Disorder

(Men)

%

ofDepressedP

atients

National ComorbiditySurvey

NIMH EpidemiologyStudy

Aches/pain a physical symptom of significance

Aches/Pain as common as anxiety among depressed patients


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76% of compliant depressedpatients with lingeringsymptoms of depressionrelapsed within 10 months1*

The importance of emotional and physical symptoms

*Psychiatric inpatients and outpatients.

Reference:1. Adapted from: Paykel ES, et al.Psychol Med. 1995;25:1171-1180.

94% of depressedpatients who experiencedlingering symptoms hadmild to moderatephysical symptoms1


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Serotonin5HT and NorepinephrineNE in the brain

Limbic System

Locus Ceruleus(NE Source)

PrefrontalCortex

Raphe Nuclei(5-HT source)

Cooper JR, Bloom FE. The Biochemical Basis of Neuropharmacology. 1996.


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There are at least two sides to the neurotransmitter story

Sex

Appetite

Aggression

Concentration

Interest

Motivation

DepressedMood

Anxiety

Irritability

Thoughtprocess

References:

1. Adapted from: Stahl SM. In: Essential Psychopharmacology:

Neuroscientific Basis and Practical Applications: 2nd

ed. CambridgeUniversity Press 2000.

2. Blier P, et al.J Psychiatry Neurosci. 2001;26(1):37-43.

3. Doraiswamy PM.J Clin Psychiatry. 2001;62(suppl 12):30-35.4. Verma S, et al.Int Rev Psychiatry. 2000;12:103-114.

Norepinephrine (NE)

Both serotonin and norepinephrine mediate a broad spectrumof depressive symptoms

Serotonin (5-HT)

Vague Achesand pain

Functional domains of Serotonin and Norepinephrine1-4


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The neurotransmitter pathway story

Adapted from References:

1. Stahl SM.J. Clin Psych. 2002;63:203-220.

2. Verma S, et al.Int Rev Psychiatry. 2000;12:103-114.

3. Blier P, et al.J Psychiatry Neurosci. 2001;26(1):37-43.

Dysregulation of Serotonin (5HT)and Norepinephrine (NE) in the brainare strongly associated withdepression

Dysregulation of 5HT and NE in thespinal cord may explain anincreased pain perception amongdepressed patients1-3

Imbalances of 5HT and NE may

explain the presence of bothemotional and physical symptoms ofdepression.

Its not all in your head

Descending Pathway

AscendingPathway

AscendingPathway

DescendingPathway


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Depression: Current treatment outcomes1

Up to 70% of depressed patients respond ( 50%decrease in HAM-D score) to treatment but fail toachieve remission from their emotional and physicalsymptoms1*

Approximately 30% of depressed patients achieveremission ( 7 score on the HAM-D) with treatment1*

References:

1. OReardon JR, et al.PsychiatrAnn. 1998;28:633-640.

* Antidepressant clinical drug trials.


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Response and Remission defined

Hamilton Depression Rating Scale (HAM-D): 17 Items, Total Score 0 - 52

15

7

Response

50% reduction from baseline HAM-Dscore

Remission: HAM-D Score 7

Depression

(Major Depressive Disorder)

References:

1. Frank E. Conceptualization and rationale for consensus definition terms in MDD, Arch Gen Psych. 1991; 48:851-855.

HAM-D17

Scores


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Study in chronic depressed patients

*p .05 vs nonresponse. **p .05 vs response.

Miller IW, et al. J Clin Psychiatry. 1998;59(11):608-619.

Normal(n=482)

Remission(n=202)

Response(n=122)

Nonresponse(n=299)

Soci

alAdjustmentScale-S

R

(MeanS

D)

***

*

1

2

3

5

Treatment outcome:Effect on work & social functioning

Higher Scoreindicates greater

impairment

Remitted patients virtually equaled healthy controls onfunctioning levels at endpoint of 12-week treatment trial

(Responders & non-responders did not)


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Many depressed patients are still depressed.

References:

1. Nierenberg AA, et al.J Clin Psychiatry. 1999:60(suppl 22):7-11.

2. OReardon JR, et al.PsychiatrAnn. 1998;28:633-640.

3. Lynch ME.J Psychiatry Neurosci. 2001;26(1):30-36.

Depressed patients continue to have needs that are not being fully addressed1

Depressed patients present with emotional and physicalsymptoms.

Approximately 30% of depressed patients achieveremission in clinical trials2*

Up to 70% of patients who respond fail to remit2*

Incomplete relief from symptoms may increase the riskof relapse2,3

Lingering emotional and physical symptoms mayjeopardize achieving remission.

*In antidepressant clinical drug trials.

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Beyond Sadness Powerpoint