Depression Symptoms Treatment
Archive for the ‘Disorders’ Category
A common component of an anxiety disorder is the panic attack. A panic attack may be a familiar experience to many, as 15% of people have reported the occurrence of one over their lifetime. It is defined as a discrete period of intense fear or discomfort in the absence of real danger that is accompanied by 4 of 13 somatic or cognitive symptoms. This attack can occur suddenly and peak quickly, usually within 10 minutes or less. A panic attack can be unexpected or situational in nature. A partial panic attack incorporates 1 to 3 of the characteristic symptoms of a panic attack.
This article will utilize the panic attack as a model for better insight into all of the anxiety disorders. If one can understand the symptomatology and characteristics of a panic attack, one can apply this knowledge to all of the anxiety disorders if certain modifications and limitations of this model are considered.
In a panic attack, a message of misperceived, severe danger is sent from the brainstem area to several other areas of the brain, including the cortex. There the message is intercepted as an acute lack of oxygen Read more [...]
54%–75% of adolescents "wish for more sleep"
It is widely recognized that many older Americans suffer from a variety of sleep disorders. In fact, more than half of all Americans older than age 65 have a sleep problem, and disturbed sleep is among the most frequently cited problems affecting institutionalized older Americans. As the population ages, it is estimated that at the end of this decade nearly 80 million Americans will have a sleep problem.
Problem of the Young
It is not so universally recognized that sleep disorders also affect the young. Although there are few large-scale epidemiologic studies of daytime sleepiness in adolescents and young adults, existing data suggest that problem sleepiness affects a significant percentage of youths. About 25% of American children aged 1–5 experience some kind of sleep disturbance. From 20%–25% of 9th through 12th grade students reportedly experience behaviors associated with problem sleepiness, such as difficulty getting up for school, falling asleep in school, or struggling to stay awake while doing homework. According to one report, 54%–75% Read more [...]
The American Psychiatric Association (1983) reports that recurrent episodes occur in at least 50% of patients who seek treatment for major depressive disorder (MDD). Most studies, though, have examined only single occurrences. To help describe the episodic nature of MDD, the National Institute of Mental Health initiated the Collaborative Program on the Psychobiology of Depression, a prospective, naturalistic, longitudinal investigation. This program's early research found the cumulative probability of recurrence was nearly 30% six months after recovery from an index episode of unipolar major depression.
Since the 1983 report, many of the original study subjects have experienced multiple recurrences of major depressive disorder (MDD). In a study published in the Feb. issue of The American Journal of Psychiatry, David A. Solomon, M.D., and colleagues prospectively focused on the time to recurrence of MDD across multiple episodes. They predicted that the risk of recurrence would decrease as time of recovery increased. They also predicted that each recurrence would increase the risk of a subsequent Read more [...]
Success shown with drugs and psychotherapy
People plagued by panic attacks need not fear one thing: Treatment works.
Panic disorders respond well to psychotherapy, drug treatment and a combination of the two, according to one of the largest studies of the condition.
Panic disorder affects several million Americans, crippling them with recurrent bouts of profound anxiety and physical symptoms that can include chest pain and pounding, as well as rapid heartbeats and shortness of breath. Many people also feel that, in the midst of an attack, they're in danger of dying.
Perhaps it's understandable, then, that people with this condition often feel there's no hope of treatment. Fortunately for them, they're wrong.
This conclusion won't come as a surprise to specialists, who've been treating the condition with drugs and psychotherapy for many years. But, the researchers say, it should reinforce the message that panic disorder is a real diagnosis, and one that can be brought under control. Their findings appear in this week's issue of the Journal of the American Medical Association.
Boston University Read more [...]
Chronic Pain. Depression. They are regarded as the one-two punch that — even as we refine and improve medical and pharmaceutical technology — keeps millions of Americans out of work and on their backs. Indeed, pain and depression might be considered the Bonnie and Clyde of misery—so rarely is one without the other.
Ariadne Montare, 33, a Manhattan lawyer, has battled the combination for over a year-ever since she was diagnosed with fibromyalgia, a syndrome characterized by sleep disturbances, muscle pain, and overwhelming fatigue.
"When I first started experiencing pain and depression together, it was like the chicken and the egg riddle," she says. "I couldn't tell which came first, or if they were separate or linked."
Montare battled the two alone for months, convinced at times that the moodiness that accompanied her pain was all in her head. "I'd never thought of myself as an unhappy person," she says, "yet here I was, unable to get out of bed." That is, until her doctor hit upon the right treatment combination, which includes pain medication and antidepressants.
Montare's struggles Read more [...]
But treatments are increasingly effective
Feeling anxious? You're not alone.
According to an article from the Chicago Tribune, published in the The Record, of Bergen County, N.J., anxiety disorders are one of the most common mental disorders. More than 19 million Americans suffer from them during any given year, according to figures from the National Institute of Mental Health. But only one-third of the sufferers receive adequate treatment.
Researchers say anxiety disorders are the result of a complex combination of genetic, behavioral and developmental factors. In the 1980s, drug therapies were developed to help with anxiety disorders. These kind of problems often start when the part of the brain that controls the "fight or flight" mechanism starts firing at an abnormally high rate. That is called "autonomic overload." Usually it's the fibers of the norepinephrine-producing cells in the nucleus of the brain stem that are firing. Then, when you are introduced to a specific stimulus, the brain starts firing off again, even if you are not in imminent danger. When scientists discovered the connection Read more [...]
Selective Serotonin Reuptake Inhibitors
Most recently, the selective serotonin reuptake inhibitors (SSRIs) have provided an alternative to the older pharmacologic treatments. Although paroxetine and, very recently, sertraline have FDA-approved indications for the treatment of panic disorder, a significant body of literature exists, as well, for fluvoxamine and, to a lesser extent, fluoxetine. Sheehan and Harnett-Sheehan have comprehensively reviewed the role of SSRIs and Jefferson has reviewed the antidepressants in general in the treatment of panic disorder. As a group, these agents are significantly different from the tricyclic antidepressants, monoamine oxidase inhibitors, and benzodiazepines. They demonstrate little or no abuse potential, orthostatic hypotension, anticholinergic side effects, sedation, or ability to produce hypertension secondary to drug-drug and drug-food interactions. On the whole, they display a profile of CNS-stimulating side effects (e.g., anxiety, insomnia, headaches, nausea, weight loss). Among the serotonin reuptake inhibitors, fluoxetine is the most stimulating and Read more [...]
As many as 70% of patients with panic disorder fulfill the diagnostic criteria for major depression at some point in their lives.
Epidemiology and Clinical Features
Panic disorder is one of the primary anxiety disorders described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. It is a chronic disorder with a lifetime prevalence estimated to be between 1.5% and 3.5% and an onset generally in early adulthood. It is characterized by the occurrence of recurrent, unexpected panic attacks followed by at least one month of persistent concern about experiencing further attacks, worry about the consequences of the attacks, or a significant change in behavior secondary to the attacks. The attacks may last seconds to minutes and are characterized by dyspnea, palpitations, tremulousness, dizziness, hot and cold flashes, diaphoresis, chest pain, feelings of unreality, numbness or tingling, faintness, fear of going crazy, and fear of dying (see Table 1). These attacks are extremely frightening and disabling; many of these patients Read more [...]
Patient Education
Tips to Help Patients Improve Sleep
Did you know that your behavior can affect how well you sleep? It can be helpful to examine your habits and determine if some simple adjustments can get your sleep pattern back on track.
Do you spend too much time lying awake in bed?
When you cannot fall asleep, you may think you need to force yourself to lie there until you do. However, you may actually be worsening the problem. Lying awake in bed for too long causes you to associate the bed with an inability to fall asleep. If you have not fallen asleep within 30 minutes, move to another room and do something nonstimulating, boring or relaxing. After 30–60 minutes of the activity, you can make another attempt to fall asleep.
Have you figured out how much sleep you need?
You may have been taught that eight hours is normal, but individual sleep requirements vary. As long as you feel refreshed and alert during the day, you are getting enough sleep. Do not try to force yourself to sleep longer. Lying in bed trying to achieve an additional amount of sleep in order to attain the norm Read more [...]
Novel Nonbenzodiazepine Hypnotic Drugs
Zolpidem: Zolpidem was marketed in the United States in the early 1990s as the first nonbenzodiazepine hypnotic with a specific effect on the omega-1 receptor. Due to its specificity, zolpidem lacks anticonvulsant, muscle relaxant, and anxiolytic effects, and has been shown to have less effect on sleep architecture and next-day performance compared to benzodiazepines. Its hypnotic efficacy is the same as that of benzodiazepine hypnotics. Rebound insomnia, memory impairment, dependence and withdrawal are uncommon. A 10 mg dose of zolpidem is recommended and has demonstrated hypnotic efficacy for five weeks without affecting sleep stages or producing tolerance, rebound, or detrimental effects on psychomotor performance. Nightly doses greater than 10 mg do not provide additional hypnotic effect and are associated with greater adverse effects. In the elderly, the recommended initial dose of zolpidem is 5 mg.
Because much of the clinical literature on triazolam is based on higher doses of 0.25 to 0.5 mg, its greater reports of rebound insomnia, memory and psychomotor Read more [...]