Alternative Treatments For Anxiety And Depression

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Alternative Treatments For Anxiety And Depression-Elective Therapy Treatments for Depression and Anxiety

1. Pharmacology and Beyond… MOOD DISORDERS © Daniela M. White, MD, 2011

2. Objectives OF THIS PRESENTATION  Create recognition with the utilization of psychometric scales to help in the differential finding of inclination issue  Formulate an integrative treatment, custom-made to the individual needs of the patient  Provide comprehension of the standards of more up to date medications of sorrow (i.e.TMS)

3. STYLE OF THIS PRESENTATION  Created on account of the clinical approach as an accumulation of clinical “pearls”  Suggests an open way deal with an assortment of treatment modalities  Open to exchange and inquiries, best toward its finish


5. What’s more, LAST BUT NOT LEAST…  MOOD DISORDER NOS.  When nothing else fits, a determination of a state of mind issue nos. is proper  Very accommodating for the youngster and youthful patients with ‘serious aggravation of demeanor’ (a conceivable future analysis in DSM – V)
1e3cd75ec295a038126b5b2559a49a60 Alternative Treatments For Anxiety And Depression

7. Fundamentals OF DIAGNOSIS  Sleep changes  Interest (loss of)  Guilt (uselessness, lament)  Energy misfortune or weakness  Concentration challenges  Appetite changes  Psychomotor impediment or unsettling  Suicidality


9. PHQ-9 AND QIDS-SR  Psychometric scales for melancholy  Help the patient to have a target feeling of their gloom  Help us to assess the reaction to the treatment  Very valuable for legitimate statements

10. PHQ-9 AND QIDS-SR  PHQ-9 is a patient wellbeing poll, involving 9 questions.  Scoring helps separating between various degrees of seriousness of the dejection  QIDS-SR – brisk stock of depressive indications, likewise permitting scoring and separating the degrees of melancholy

11. Keep in mind that… .IT’S NOT A BIPOLAR DISORDER IF….  THERE IS NO HISTORY OF A MANIC OR HYPOMANIC EPISODE…  MDQ is an exceptionally convenient instrument for surveying the hyper/hypomanic indications

12. MDQ  Mood Disorder Questionnaire  Screening for bipolarity, particularly touchy for Bipolar I  13 things, auditing indications of madness  7 things replied with yes, occurring inside a similar timeframe  Level of seriousness – direct  Developed by Hirschfeld, MD

13. ONE MANIC OR HYPOMANIC EPISODE  Changes the analysis to a Bipolar Disorder  Changes the treatment  Changes the result

14. If all else fails:  ITS BETTER TO BE SAFE THEN SORRY  Is more secure to blunder in favor of bipolar issue (esp. in youngsters and teenagers when the criteria are less very much characterized)  In doing as such, disclose your method of reasoning to the parental figures  Finding the correct solution can be an exercise in careful control (unipolar versus bipolar dejection, reactions versus remedial impacts)


16. BIO-PSYCHO-SOCIAL MODEL  Represents factors that we should know about so as to make an exact finding and treatment BEHAVIOR Coping sickness COGNITIVE Appraisal Meaning discernment SOCIO-CULTURAL Social help Customs esteems ENVIRONMENT Life occasions BIOLOGY Genetics; Biological reaction BIO-PSYCHO-SOCIAL

17. Science OF DEPRESSION • Genetic inclination (proposed by the familial idea of the despondency or disposition issue) • Medical conditions: low vitamin D, low B12, hypothyroidism, immune system issue; low testosterone, blood dyscrasias ( pallor)

18. Science OF DEPRESSION  Depletion of monoamine levels;  Abnormalities of intracellular flag transmission or potentially quality articulation;  Other neurotransmitters (GABA, glycine and so on);  Hormones (thyroid and adrenal hormones);  Neuropeptides (CRH,endorphins, substance P)

19. NEUROENDOCRINE FACTORS  Abnormalities of the HPA hub (hypothalamic-pituitary-adrenal pivot): expanded cortisol, expanded ACTH  Most discouraged patients are euthyroid; some have subclinical hypothyroidism ( more relationship with psychological debilitation)  BDNF( cerebrum determined neurotropic factor) levels are diminished with pressure

20. Mind IMAGING  Decreased left prefrontal cortex (PFC) bloodstream and digestion  Basal ganglia irregularities  Increased amygdala action  Abnormalities in the hippocampus

21. NEURAL MODEL  Dysfunction of the DLPFC, limbic and striatal frameworks hinder the adjustment of the amygdala/hippocampal structures  Neuroimaging isn’t savvy for the clinical practice, now (not utilized for analysis purposes)

22. Brain science OF DEPRESSION  Psychoanalytic and psychodynamic hypotheses (melancholy because of misfortune, outrage betrayed self … )  Behavioral and subjective speculations ( intellectual twists and distortion of life occasions)

23. SOCIAL-ENVIRONMENTAL FACTORS ASSOCIATED WITH DEPRESSION  Life occasions ( passing, separate, loss of adored one, loss of profession, change in vocation, work conflicts…)  Evaluate interpersonal organization ( how about we do not overlook the online networking… FB, twitter)  Evaluate profound or religious life, conviction framework  Family life, living circumstance, family chart, family clashes…  Military administration  Hobbies, extracurricular exercises  Exercise, nourishment, rest propensities

24. WHAT FOLLOWS NEXT?  How would we plan treatment?  Following similar rules of the bio-psycho-social model… towards an integrative approach in psychiatry

25. INTEGRATIVE TREATMENT  Pharmacological (SSRI, SNRI, NRI, SSRI+ 5HT1 halfway agonist, SSRI+ 5HT2 opposition)  Biological medications (TMS, light treatment)  Psychological treatment (different types of treatment)  CAM (reciprocal and elective prescription) including Meditation for push administration (yoga) – Dietary rules, work out, healthful supplements – Botanical cures – Bibliotherapy ( successful treatment for mellow direct)

26. PHARMACOLOGICAL TREATMENT  Antidepressants (SSRI, SNRI, NRI, SSRI+5HT1 incomplete agonists)  Check for a family history of a decent reaction to a specific energizer  What worked before will work again  Some patients are touchy to the distinction amongst brands and diverse generics

27. PHARMACOLOGICAL TREATMENT  Always upgrade one prescription before exchanging the class or expanding  Discuss symptoms ( tolerant training is extremely useful to build consistency)  Take into account patient’s money related concerns (expands consistence)  Discontinue medicines that don’t work to maintain a strategic distance from superfluous polypharmacy  More measurements, less consistency

28. SSRIs  All of them in non-specific structures, including Lexapro;  Mostly accommodating in the gloom with tension, over the top highlights;  Less attractive for torpid types of sadness;  Increased desire for starches, conceivable weight pick up and sexual reactions;

29. SSRI’s proceed..  Risk of SSRI initiated unresponsiveness ( patients are not discouraged any longer, just blah..)  Risk of SIADH – uncommon, yet conceivable particularly with polypharmacy  Possible medication tranquilize communications with fluoxetine, paroxetine, less with escitalopram  Prozac FDA endorsed for youngster/immature misery

30. SSRI’S proceeds  Sertraline FDA endorsed for OCD in youngsters and youthful patients  Lexapro affirmed for GAD and sorrow in 10-13 years of age  Discuss with patients and the families the discovery cautioning ( suicide hazard under age 24)  MDD could end with suicide, as a result to the absence of medicinal mediation

31. SNRI-Cymbalta, Effexor, Pristiq  Think about them like the expansive range anti-microbial… chip away at serotonin and norepinephrine  Cymbalta has leveled with activity on both S and NE from a lower measurement  Effexor and Pristiq tend to act more on NE as the dosage heightens, at bring down dosages acts like SSRI (pretty much)  Less lack of care in light of the NE segment  Less sexual symptoms in view of NE segment (particularly with ladies)

32. SNRI proceed  Risk of HTN with Pristiq, Effexor, less with Cymbalta  Less end disorder with Cymbalta, as a result of the more drawn out half-life time  Warnings for the Serotonin disorder from the drug stores and makers

33. NRI – Wellbutrin, aplenzin and generics  Great antidepressants, however not antianxiety solutions  Rarely valuable in on edge discouraged patients, could build the nervousness levels  No sexual reactions, no weight pick up  Help with the SSRI prompted detachment, in light of the NE segment.

34. TRAZODONE AND VIIBRYD  Practically weight unbiased and not causing sexual symptoms  Viibryd functions as SSRI and incomplete 5HT1 agonist  Trazodone fills in as an SSRI and 5HT2 enmity( SARI=serotonin foe reuptake hindrance)  Oleptro (Trazodone – ER) assists with rest, the detailing permits qhs dosing, less following day sleepiness then Trazodone-IR  Viibryd: assimilation is expanded with sustenance ( additionally sickness, a primary reaction is alleviated when given with nourishment)

35. MIRTAZAPINE  Antagonism of pre-synaptic alpha2-receptors  Helps the sadness related with uneasiness  Main reactions are weight pick up and sedation; no sexual symptoms Have antiemetic properties  Could cause granulocytopenia (focus on increment recurrence of sore throat grievances)

36. MOST COMMON STRATEGIES  Augmentation with atypical antipsychotics (Abilify, Seroquel, Zyprexa)  Weight pick up a conceivable reaction, and in addition following day sedation; akathisia conceivable with Abilify  Fairly fast reaction, inside two weeks partition on MADRAS scales from fake treatment

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