Depressive Disorders and Substance Use Disorders
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Depressive Disordersand
Substance Use Disorders
Major Depressive Disorder
Major depression is a treatable disorder
Major depression has a significant morbidity (prevalence) and a notable mortality rate (leading to death)
Major depression is one of a number of different mood disorders
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 EpisodeA. 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 day2) Loss of interest or pleasure in most all activities,
every day3) Significant weight loss w/o dieting4) Insomnia / hypersomnia every day5) Psychomotor agitation / retardation every day6) Fatigue or energy loss every day7) Worthlessness or inappropriate guilt feelings nearly
every day8) Decreased ability to think, concentrate or make
decisions nearly every day9) 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)
Prevalence
The National Comorbidity Survey found:For any mood disorder• Life time prevalence was 19.3%• Annual prevalence was 11.3%
For Major Depressive Episode• Life time prevalence was 17.1%• Annual prevalence was 10.3%
Female to male ratio is 2:1
A Spectrum of Depression
Some of the types of depressive disorders include
Dysthymic DisorderMajor Depressive Disorder “clinical depression”Post Partum DepressionSeasonal Affective DisorderMood disorder secondary to a medical conditionSubstance induced mood disorder
Other mood disorders can include depressive episodes, such as Bipolar disorder
Gender differences
The lifetime prevalence rate of major depression is estimated at
between 5 to 12% for men
between 10 to 25% for women
Age
Depression can happen at any age Teenagers can have depression
-adolescent rate is between 3 and 8% -teen depression is estimated to be 6x more likely when a parent also has depression-signs/symptoms can be masked “irritable moodiness”-suicide is the 3rd leading cause of death for 15-25 year olds
Co-Occurring Medical Conditions
Nearly 70% of all anti depressant medication prescriptions are written by primary care doctors
Certain medical disorders are associated with higher-than-expected rates of depression
StrokeNeurodegenerative disordersHIV/AIDSEndocrine disordersDiabetes
What isn’t depression?
“The blues” – temporary Normal grief – situational
Depression is an illness, while “the blues” are normal reactions to life situations.
Symptoms of depression include multiple moods, thoughts, and bodily functions whereas the blues is composed of a single state of being in a low mood
Depression may persist for months, years, decades
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
Other forms of depression
Postpartum DepressionA condition which describes a range of physical and
emotional changes a woman may have after having a baby. Most partum depression can range from a mild degree to severe with psychotic features (postpartum psychosis).
This is not the “baby blues”. -happens from several days to several months post
childbirth-higher level of intensity-interferes with functioning
Postpartum DepressionSymptoms include: Restlessness Irritability Feeling sad Crying a lot Lack of energy Headaches Chest pains, heart palpitations Difficulty sleeping and/or eating Trouble concentrating Sense of being overly worried about baby Not having any interest in the child Feelings of worthlessness, guilt Fear of harming self or child
Seasonal Affective Disorder
It is noticed that animals react to the changing seasons in mood & behavior and human beings are no exception. Most people have a tendency to eat and sleep a little more in the winter and dislike the dark mornings and short days. For some, it seems to have a more intense effect in disrupting their lives and causing significant distress.
Symptoms include:Change in appetite, weight gain, “heavy feeling” in arms/legs, drop in energy
level, fatigue, oversleeping, difficulty concentrating, irritability, increase sensitivity to others, avoidance of social situations.
Estimated 10-20% may experience some mild form of SAD, more common in women
Usually starts after age 20 More common in northern geographic regions, September – April
There’s an association with lack of bright light- bright light makes a difference to the brain chemistry although they are not sure by what means the sufferers are affected.
Treatment includes natural light, light box/full spectrum light, behavioral therapy, medication when necessary.
What about Depression & Substance Use?
For discussion:
Why would someone with depression use substances?
What is the risk of using substances when there is a co-occurring depressive disorder?
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
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
Why does depression happen?
Emerging data supports that
stress genetic predisposition differences in brain chemistry & brain
structures life experiences
Interact to cause depression.
Genetic Factors
First degree relatives of depressed individuals have a higher rate of depression.
Brain Structures
Post-mortem receptor studies in depressed suicide victims show differences in the hippocampus, hypothalamus, and prefrontal cortex.
Neruo imaging studies shows impaired regulation of serotonergic activity.
Life Experiences
Abnormal stress at critical development periods may have long lasting effects on the CNS development. Emerging evidence indicates that individuals with depression are more likely (than controls) to have a history of childhood abuse, deprivation, or abandonment
Suicide Awareness The vast majority of people who SEEK treatment have
success in alleviating symptoms. Not everyone who has depression becomes suicidal, but
over 90% of those who die of suicide have a diagnosable mental illness
Warning signs include: Talking about suicide. Statements about hopelessness, helplessness, or worthlessness. Preoccupation with death. Suddenly happier, calmer. Loss of interest in things one cares about. Visiting or calling people one cares about. Making arrangements; setting one's affairs in order. Giving things away.
Seek Help!
Community Crisis Response Team (CCRT) 734-994-8048 (24/7)
Psychiatric Emergency Services734-936-5900 (24/7)
CSTS or other mental health providers
Hotlines 1-800-SUI-CIDE 1-800-273-TALK
For every 25 attempts there is 1 death. Take attempts seriously. Seek help!
Treatment options
“Multi modal” Anti depressant medication Psychotherapy Behavior/lifestyle:
exercise, nutrition, sleep light therapy ECT
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 lifestyle balance (including proper diet, exercise, sleep habits)
Any Questions or comments?
Thank you for coming!
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