Depression Symptoms Treatment
Archive for the ‘Disorders’ Category
CRITERIA FOR DIAGNOSIS
An estimated 3% to 8% of women of reproductive age suffer from premenstrual dysphoric disorder. Health care providers have made many attempts to define PMDD and its characteristics to help distinguish it from the common and simple symptoms of PMS.
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) defines PMDD as a "depressive disorder not otherwise specified," emphasizing its emotional and cognitive-behavioral symptoms. To be diagnosed with premenstrual dysphoric disorder, a patient must experience at least five of 11 symptoms given in DSM-IV. Table 2 lists the criteria. According to DSM-IV, the five symptoms must occur during the luteal phase to eliminate diagnosis of PMS.
Table 2. Research Criteria for PMDD
A.
In most menstrual cycles during the past year, five (or more) of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week postmenses, with at least one of other symptoms being either Read more [...]
PMS/PMDD SYMPTOMS
Premenstrual syndrome affects as many as 75% of women of reproductive age at some point in their life. However, studies have not defined an exact age-group or time course for this syndrome to occur. But one study suggests that the 25 to 34 age-group of women was the most commonly affected (10.4%) compared to the 18 to 24 age-group (8.7%) and the 35 to 44 age-group (4.5%), which were not affected as often.
Table 1. Physical, Behavioral, and Mood Symptoms of Both PMS and PMDD
Physical
Behavioral
Mood
Swelling
Hypersomnia/insomnia
Irritability
Body aches
Appetite changes
Mood swings
Breast tenderness
Poor concentration
Anxiety/tension
Headache
Social withdrawal
Depression
Bloating/weight gain
Decreased interest
Feeling out of control
Some of the most common emotional, physical, and behavioral symptoms attributed to both premenstrual syndrome and premenstrual dysphoric disorder are listed in Table 1. As shown, many symptoms experienced during the menstrual cycle are common to both PMS and PMDD. Hence, without further evaluation, premenstrual dysphoric disorder Read more [...]
ETIOLOGY AND PATHOPHYSIOLOGY
While many studies have focused on the predisposing factors related to premenstrual dysphoric disorder, the relative contributions to this disorder are unclear. Small studies of monozygotic twins have suggested a hereditary link to premenstrual symptoms. Other considerations include a patient's onset of menses. Onset at a young age (i.e., less than 11 years old) has been found to be an increased risk factor for many gynecological disorders such as breast cancer, endometriosis, and of importance to this article, premenstrual symptoms. In addition to the genetic and developmental factors that may contribute to the risk of PMDD, research has shown that a history of major depressive disorder, bipolar disorder, postpartum depression, and family history of mood disorders of premenstrual depression may increase a woman's risk for premenstrual dysphoric disorder. Studies have also indicated that women with PMDD are at a higher risk for lifetime history of depression compared to women without premenstrual dysphoric disorder (30% to 76% vs. only 15%, respectively).
The ACOG Read more [...]
SM is a 24-year-old Asian Indian female who presents to her gynecologist with a chief complaint of "severe abdominal pain, breast tenderness, headaches, and weight gain" during her menstrual cycle. She states that her cramps feel like "pins through her stomach." Her boyfriend states that SM cries sporadically during her menstruation and is often depressed. He also states that she appears to be a lot more anxious and tense during this time of the month. In addition, he has observed that her emotional and mental symptoms during her menstruation result in a strain in their relationship. SM experiences increased appetite and a marked lack of energy during this time. Although both SM and her boyfriend are aware of the premenstrual symptoms that most women experience during the menstrual cycle, they are convinced that her emotional disturbances during her menstruation need medical attention.
SM's past medical history is insignificant, but her social history is of concern. She states that she drinks about three cans of Coke a day and doesn't follow a "healthy" diet. Her usual diet consists of no breakfast, Read more [...]
Depression, Morbidity, and Suicide Risk
Why is it so important to assess the risk for depression in a senior with insomnia who may not feel comfortable with the subject or who feels stigmatized by self-reporting a depressed mood? As mentioned earlier, a depressive disorder is among the most common causes for sleep disturbances in the elderly. Furthermore, depression is one of the most common psychiatric disorders among the elderly, with clinically significant depressive symptoms appearing in 30% of institutionalized seniors and in 8% to 15% of community-dwelling elderly. It has been shown that patients with any medical diagnosis were twice as likely to develop depression than were patients without a medical diagnosis. Depression increases mortality in hospitalized patients, increases medical morbidity, worsens the outcomes of medical disorders, increases the perception of poor health and the use of medical services, and increases the economic burden on the health care system.
It must not be overlooked that depression is the psychiatric disorder most likely to raise the risk of successful suicide Read more [...]
The notion that aging is a multifactorial process is commonly accepted. Many of the age-related changes that occur in a senior's nervous system have an impact on the function of sleep. In the elderly, sleeping difficulties often occur in conjunction with depression. Because depression raises the risk of suicide in this population, it is important for pharmacists to question their elderly patients about sleeping difficulties.
Sleep Difficulties Increase With Aging
Complaints of sleep difficulty increase with age, tend to be more common in women than in men, and occur in about 50% of community-dwelling elderly people. The loss of sleep associated with sleep disturbances directly affects quality of life and often contributes to increased risk of chronic fatigue, falls, and accidents. Insomnia, a complaint of poor quality of sleep, results in a sense of nonrestorative sleep. Through both objective and subjective reporting, it has been shown that elderly adults, as compared to younger adults, have longer sleep latency (time to fall asleep), lower sleep efficiency (amount of sleep given the length Read more [...]
Many people need to be encouraged to seek help.
Five leading mental disorders affect 10 million Americans, but many people, especially those suffering from depression and panic disorder, do not seek help. It is estimated that during any one year, almost 18 million American adults will suffer from a depressive illness. Among people 65 years of age and older, an estimated 3% suffer from clinical depression.
Five Major Disorders
There are five major mental disorders.
Schizophrenia is a chronic disabling illness. About 100,000 patients with schizophrenia are in public mental hospitals. Schizophrenia affects men and women equally, but onset is earlier in men. The first psychotic symptoms are often seen in the teens or early 20s. Onset past the age of 40 is rare. A schizophrenic person may appear quite normal much of the time. Schizophrenia is not "split personality," which is an entirely different, and rare, disorder. The children of a parent with schizophrenia will have a 10% chance of developing the condition.
Depression, the most prevalent mental disorder, is divided among a number of clinical Read more [...]
Job stress found to cause a variety of mental ailments.
Being overworked and underchallenged are job-related stress issues that for women may lead to depression, anxiety and feelings of hostility, according to a study of a group of women employed by a large corporation in North Carolina. Women who had more manageable workloads and a greater sense of control over their jobs were less depressed or anxious. According to the researchers, the findings add to a growing body of research linking stress with physical and mental problems. One researcher said that 60% of visits to primary care doctors are due to psychological distress.
Pharmacotherapy
Drug therapy can be effective for short-term alleviation of insomnia but may not be sufficient for long-term management of chronic insomnia. Behavioral therapy, on the other hand, yields the most durable improvements in sleep patterns.
Benzodiazepines: Benzodiazepines are frequently prescribed to treat insomnia. These hypnotics reduce latency to sleep onset and total awakenings by increasing total sleep duration. Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the affinity of GABA for its receptor. Benzodiazepines nonselectively bind to at least three benzodiazepine receptor subtypes (BNZ-1, BNZ-2, BNZ-3), which accounts for their sedative, anxiolytic, myorelaxant, and anticonvulsant properties. Five benzodiazepines (estazolam, flurazepam, quazepam, temazepam, and triazolam) have an FDA-approved indication for the management of insomnia. Dose, distinguishing pharmacokinetic properties (absorption rate, distribution, and elimination half-life), and risk-benefit ratio should be considered when selecting the most appropriate Read more [...]
Insomnia is a subjective complaint of non-restorative sleep that may involve difficulty falling asleep, frequent or prolonged nocturnal awakenings, and early morning awakenings. Insomnia, whether transient, short-term, or chronic, appears to contribute to increased rates of absenteeism, healthcare utilization, and social disability. Pharmacologic and behavioral modification therapy are the treatment modalities currently employed to treat insomnia. The etiology, duration of symptoms, and patient-specific factors such as age and concomitant disease states should govern therapy. Despite half of American adults reporting periodic symptoms of insomnia, less than 15% of individuals with chronic
insomnia receive treatment.
Types of Insomnia
Insomnia can be subdivided into categories based on duration and etiology of symptoms. Transient insomnia generally lasts a few days, and is a result of acute illness or social stress, changes in circadian rhythm such as jet lag or work shift changes, and environmental disturbances such as noise, light, and temperature. Short-term insomnia can be caused by grief, Read more [...]