Claudia L. Reardon, MD Assistant Professor University of
Wisconsin School of Medicine and Public Health NAMI Wisconsin
Annual Meeting April 24, 2015
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Overview of depression Treatment options Q&A
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Overview of depression Treatment options Q&A
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5 or more of the following symptoms for at least 2 wks:
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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
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The symptoms cause clinically significant distress or
impairment in functioning. The symptoms are not due to a substance
or general medical condition.
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Overview of depression Treatment options Q&A
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Psychotherapy Medications Exercise Complementary and
alternative treatments Light therapy Other biologic treatments
When should we use medications for symptoms of depression?
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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
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When to try support or psychotherapy before medications:
Typical grief reaction Symptoms mild or short-lived Symptoms
clearly a reaction to life events
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When to consider antidepressants with caution: Bipolar disorder
Pregnant or nursing women
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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
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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
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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.
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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?
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St. Johns Wort SAMe Omega 3 fatty acids (fish oil) Vitamin D
Yoga Tai Chi Bibliotherapy Acupuncture Massage Chinese herbals
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St. Johns Wort SAMe Omega 3 fatty acids (fish oil) Vitamin D
Yoga Tai Chi Bibliotherapy Acupuncture Massage Chinese herbals
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Especially helpful for winter depression Sit in front of light
box 30-60 minutes every morning Generally well-tolerated