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Depression & Mental Health FAQs
US Centers for Disease Control and Prevention (CDC) estimated 40 million Americans living today will suffer from major depressive illness during their lives. Seasonal affective disorder is major depression that appears in the fall or winter and goes away in spring, thought to be caused by lack of sunlight.
Postpartum depression occurs within four weeks of a women giving childbirth. Most new mothers suffer from some form of the �baby blues.� Postpartum depression, by contrast, is major depression, thought to be triggered by changes in hormonal flows associated with childbirth. Catatonic depression is a rare form of major depression characterized by (at least two): Stupor, excessive motor activity, extreme negativism, peculiarities in voluntary movement, and repetition of other people's words or actions. - mcmanweb.com
Psychotic depression is a rare form of depression characterized by delusions or hallucinations, such as believing you are someone you are not and hearing voices.
According to the National Institute of Mental Health, approximately 18.8 million American adults, or about 9.5 percent of the US population age 18 and older in a given year, have a depressive disorder. Depression is a chronic illness that exacts a significant toll on
America's health and productivity. It affects more than 21 million
American children and adults annually and is the leading cause of
disability in the United States for individuals ages 15 to 44.
Lost productive time among U.S. workers due to depression is estimated
to be in excess of $31 billion per year. Depression frequently
co-occurs with a variety of medical illnesses such as heart disease,
cancer, and chronic pain and is associated with poorer health status
and prognosis. It is also the principal cause of the 30,000 suicides
in the U.S. each year. In 2004, suicide was the 11 th leading cause of death in the United States, third among individuals 15-24.
According to the World Health Organization, depression is presently on track to becoming the world's second-most disabling disease (after heart disease) by the year 2020. Depression is responsible for some $87 billion a year in lost productivity in the US (a conservative estimate), and according to Bank One, is responsible for most lost work days in its employees after pregnancy and childbirth. Additionally, one million people worldwide die by their own hand, most as a result of a mood disorder. Finally, the linkage between depression and a host of physical illnesses makes it arguably the world's greatest killer.
Research presented at the 56th Annual Conference of the Canadian
Psychiatric Association shows a marked link between bipolar disorder
and migraines. The odds of migraine in persons with bipolar disorder were 40% higher than the general population. Data
obtained from 36,984 people aged 15 and over, who screened positive for
manic or depressive episodes with migraine, were compared against those
who screened positive for mania but who didn�t suffer from migraines. Amongst
males, 14.9% of those with manic episodes were also diagnosed with
migraines compared with 5.8% of the general population. Amongst
females, 34.7% had both migraines and bipolar disorder compared with
14.7% who only had migraines.unquote.gif While the research was
skewed towards persons who were already diagnosed with bipolar
disorders, what does it mean for people who suffer from migraines but
who may have an undiagnosed bipolar disorder?
Migraines and headaches aren�t fully understood but the manifestations are very real and debilitating for their sufferers: Throbbing pain Nausea Heightened sensitivity to light or sound Seeing dots, wavy lines, flashing lights, or blind spots Difficulty with speech, sensation, or movement
An estimated 2.1 million
American adolescents have experienced major depression within the last
year, according to a new comprehensive government study. Researchers
surveyed more than 67,000 young people ages 12 to 17 and found that one
in 12 had suffered from serious depression in the previous year.Nearly
13 percent of girls had struggled with depression, compared to less
than 5 percent of boys. Odds of depression increased with age -- just 4
percent of 12-year-olds experienced depression but that climbed to 11
percent for older teens.
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Sex and Antidepressants
Question
I have a patient who reported sexual side effects before with selective serotonin reuptake inhibitors (SSRIs). I started her on bupropion (Wellbutrin XL), but discontinued it because the patient could not tolerate headache for 2 weeks. I thought they would pass but they did not. Any suggestions about what I should do next?
Response from Michael E. Thase, MD Professor of Psychiatry, University of Pittsburgh Medical Center; Chief, Division of Adult Academic Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
About 1 in 3 patients treated with SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) experience significant sexual dysfunction. Because this side effect can sometimes lessen with the passage of time, a "wait-and-see" approach is often initially prudent. When the sexual side effect persists across a number of weeks, therapeutic action is generally necessary. Options include reducing the dose of the offending medication, adding a second medication with "antidote-like" effects, and switching to an alternate medication with a lower likelihood of sexual side effects.
Let's assume in the case described that dose reduction of the SSRI was attempted and resulted in a decrease in symptomatic benefit and the treating clinician opted to switch to bupropion. This is normally the best choice with respect to reversal of the SSRI-induced sexual dysfunction (ie, bupropion has about the same risk of causing sexual side effects as an inert placebo). However, bupropion, classified as a norepinephrine-dopamine reuptake inhibitor, is mechanistically unrelated to SSRIs and there are the possibilities of different side effect issues and/or lack of response. In this particular case, headache has emerged as an unacceptable side effect during bupropion therapy.
Alternate antidepressants also characterized by a low risk of sexual side effects include nefazodone, mirtazapine, and the seligiline patch. I'd favor the third option if the patient's initial presenting symptoms were anergic/
hypersomnolent and one of the first two options if insomnia and anxiety were more pronounced complaints. Because seligiline is a monoamine oxidase inhibitor, a medication wash-out is needed even when administered in the patch formulation. Nefazodone therapy is seldom used today because of a potential fatal, but fortunately rare, association with liver failure. Mirtazapine also is not so commonly used, primarily because it is often -- although not invariably -- associated with excessive daytime sedation and weight gain.
If antidepressant monotherapy is the primary goal and these options are not acceptable, a switch within the SSRI class may also be considered. In particular, results of 1 trial suggest that lower dose therapy with fluvoxamine might be associated with a lower risk of sexual dysfunction than that with other SSRIs.
Among the more widely used "antidotes" used in combination with SSRIs and SNRIs to combat sexual dysfunction is bupropion, which may not be a consideration here because of the headache when prescribed as a monotherapy. Another "off-label" antidote is the anti-anxiety medication buspirone -- a partial agonist for the serotonin (5-HT)1A receptor, which has been shown in both case series and post-hoc analyses of clinical trials to improve sexual function in patients taking SSRIs. Yet other antidotes, such
as cyproheptadine (Periactin) and phosphodiesterase/nitric oxidase inhibitors, can be taken as needed, usually 1 or 2 hours before sexual activity. Only anecdotal evidence supports the use of the former drug, which antagonizes 5-HT2 receptors and, in practice, its use is sometimes limited by side effects such as sedation, increased bowel sounds, and increased salivation.
Although the latter group of drugs is specifically approved for treatment of male erectile dysfunction, clinical experience and results of several controlled clinical trials suggest a broader range of symptomatic benefit for SSRI-induced sexual dysfunction; efficacy for female patients is less well-established. Other possibilities for as-needed therapies include psychostimulants, such as methylphenidate or amphetamine salts, and dopamine agonists, such as amantadine. In my clinical experience, the psychostimulants are effective, although caution is needed because of the potential for worsening anxiety and
insomnia and concerns about abuse liability and misuse of a controlled substance for a nonapproved indication.
Although none of these various strategies is highly effective, there is no shortage of possibilities and ultimately most patients with SSRI/SNRI-induced sexual dysfunction can be successfully treated without sacrificing the antidepressant response.
Supported by an independent educational grant from Bristol-Myers Squibb
Disclosure: Michael E. Thase, MD, has disclosed that he served as a consultant to AstraZeneca, Bristol-Myers Squibb; Cephalon, Inc.; Cyberonics, Inc.; Eli Lilly & Co.; Forest Laboratories, Inc.; GlaxoSmithKline; Janssen Pharmaceutica; Novartis, Organon, Inc.; Pfizer; Sepracor, Inc.; Shire US Inc.; and Wyeth Pharmaceuticals. Dr. Thase has disclosed that he is on the speakers' bureau for AstraZeneca; Bristol-Myers Squibb; Cyberonics, Inc.; Eli Lilly & Co.; GlaxoSmithKline; sanofi-aventis; and Wyeth Pharmaceuticals.
Source: Medscape Psychiatry & Mental Health Ask the Expert, March 2007
Medscape Psychiatry & Mental Health. 2007; ©2007 Medscape
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Depression & Mental Health FAQs 2
What is Clinical Depression? Clinical
depression can affect your body, mood, thoughts, and behavior. It can
change your eating habits, how you feel and think about things, your
ability to work and study, and how you interact with people. Clinical
depression is not a passing mood, a sign of personal weakness or a
condition that can be willed away. Clinically depressed people cannot
"pull themselves together" and get better. Depression can be
successfully treated by a mental health professional or certain health
care providers. With the right treatment, 80 percent of those who seek
help get better. And many people begin to feel better in just a few
weeks.
Depression a Big Factor in Poor Health World Health Organization Finds Depression Often Goes Untreated By Salynn Boyles WebMD Medical News Reviewed by Louise Chang, MD Sept.
6, 2007 -- Depression has a greater impact on overall health than
arthritis, diabetes, angina, and asthma, but it all too often goes
unrecognized and untreated, a report from the World Health Organization
(WHO) suggests. more... Depression a Big Factor in Poor Health
For Additional Information About Depression Write To: The National Institute of Mental Health (NIMH)6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD 20892-9663
For free brochures on depression and its treatment call: 1-800-421-4211. or visit: http://www.nimh.nih.gov
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