Improving your likelihood of antidepressant medication response

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

As of 2014, about 15.7 million people in the US had at least 1 major depressive episode in the last year, and about two thirds of the individuals had a severe impairment in their ability to manage at home, work/school, or relationships with others (1).

Treatment options for major depression include counseling, medications, life-style, and other strategies. These options can be used alone or in combination with each other.

A recent study looked at a major factor impacting your response to antidepressant medication for major depression.

How do you define depression?

A major depressive episode is defined as an episode of depressed mood or loss of pleasure in daily activities lasting 2 weeks or longer in the past 12 months and at least some additional symptoms, such as problems with sleep, eating, energy, concentration, and self-worth (2).  Additionally there must be some impairment in a person’s ability to function at home, work, relationships or social settings.

What was the study? (3)

792 patients receiving usual care for depression in 83 clinics for at least six months between 2008 and 2010 (4).

How was depression measured?

Depression was measured using, Patient Health Questionnaire–9, a validated instrument to measure the severity and treatment response to depression (3,4).

Was there a key finding?

According to the study article, patients reporting fair or poor health were significantly less likely to improve depression compared with patients with good, very good, or excellent health (3).

What do the results mean?

In my practice, I often discuss the mental health benefits of healthy lifestyle habits such as healthy eating habits, healthy (not excessive) exercise, adequate sleep, avoidance of alcohol, illicit drugs; yoga, meditation, etc.

This study suggests that individuals suffering from Major Depression with good overall health had a better chance of benefiting from antidepressant medications than those with depression who reported fair or poor health.

In other words, while good overall health might help many people with depression, if you are still depressed, having good overall health improves your chances of responding to medications.

This is a small study and further studies would be helpful.

What are some resources regarding health improvement?

What are some of OSU’s campus resources that might help with reducing depression?

What are some resources regarding depression?

Counseling at the OSU Student Life Counseling and Consultation Service
• Mindfulness and Body scan techniques at the OSU Wexner Medical Center
Depression information at the National Institute of Mental Health
Anonymous mental health screen
Depression and Bipolar Support Alliance

National Alliance on Mental Illness (NAMI)

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  3. Rossom RC, et. al.  Predictors of Poor Response to Depression Treatment in Primary Care.  Published online: July 15, 2016. Psychiatric Services in Advance (doi: 10.1176/appi.ps.201400285)
  4. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a Brief Depression Severity Measure.J Gen Intern Med. 2001 September; 16(9): 606–613.

How You Can Become More Resilient

By R. Ryan S Patel DO, FAPA, OSU-CCS Psychiatrist

Many students will experience more stress as the semester comes to an end.

Many will also experience other stressful events such as life tragedies, trauma, difficulties with finances, work, relationships, health, emotions, etc.

Practicing and increasing resilience in yourself can be helpful with these situations.

What is resilience?

Resilience has many definitions, here are some useful ways of thinking about resilience:

  • An ability to recover from or adjust easily to misfortune or change (1)
  • Emotional resilience is one’s ability to adapt to stressful situations (2).

What are some ways to increase resilience?

The key is to adjust.

The American Psychological Association’s report on Resilience (3) offers 10 methods to increase resilience:

Adjust your thinking

1. Practice developing confidence in your ability to solve problems.  It can be helpful to occasionally remind your self about times in the past where things were difficult and you problem solved through it.

2. Keep perspective.  Take a step back and remind yourself of the big picture, and where your current situation fits. Are you blowing things out of proportion? Or are you being realistic?

3. Keep a positive outlook by visualizing what you want instead of worrying about what you don’t want.

4. Look for solutions.  Stressful things will happen but shifting your focus from worrying about the problem to looking for solutions can be powerful. Just the change in thinking can help you feel better; and the solutions are a bonus!

5. Accept that there will often be change. It can be very helpful to accept the things that you cannot change and shift your energy to the things that you can change.

Act differently:

6. Move toward your goals:

  • Make sure that your goals are realistic.
  • Take a small step. Doing things regularly, even something small, that move you towards goals will help you feel better.

7. Take decisive actions towards problems instead of avoiding or procrastinating. This will also help reduce feelings of frustration.

8. Look for opportunities for self-discovery.

  • What lesson can you gain from the loss or setback?
  • The report goes on to say that many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.

9. Connect with others:

  • Accept help and support. Counseling at OSU is a great resource.
  • Helping others can also benefit the helper. Some examples include: student organizations, civic groups, non-profit organizations, faith-based organizations, volunteer groups, or other local groups.

10. Connect with yourself:

  • Do activities that you enjoy and find relaxing.
  • Exercise regularly.
  • Get enough sleep.
  • Avoid alcohol, caffeine, drugs.

The report also suggests other ways that might strengthen resilience:

  • Journaling your thoughts and feelings
  • Meditation/Yoga
  • Spiritual and/or religious practices

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. http://www.merriam-webster.com/dictionary/resilience
  2. http://stress.about.com/od/understandingstress/a/resilience.htm
  3. http://www.apa.org/helpcenter/road-resilience.aspx

 

 

Study: Does Marijuana help with PTSD?

By R. Ryan Patel DO, FAPA OSU-CCS Psychiatrist

About 7-8 % of people may experience PTSD (or Post Traumatic Stress Disorder) at some point in their lives (2).
Individuals with PTSD are more likely to use marijuana to try and cope with their symptoms (3).
A recent study tried to look at how marijuanna impacts PTSD (4).

What is PTSD?
• PTSD can occur after an individual witnesses or experiences a traumatic or dangerous event (1).
• Symptom areas can include re-experiencing trauma, avoidance behaviors, increased reactivity or “on edge” feelings, as well as mood and cognitive (thought) related symptoms (1).
• Depression, substance abuse, or other anxiety conditions can often co-occur with PTSD (1).

Who were the study participants?
• 2276 veterans were over a 9 year period who were admitted to specialized Veterans Affairs treatment programs.
• Participants were mostly male and average age was in the 50’s.
• They were assessed at the beginning of PTSD treatment and 4 months after discharge from the PTSD treatment program.

What was asked in the study?
• Participants were asked about the severity of PTSD symptoms, drug and alcohol use, violent behavior, and employment.

What were the study results?
• After PTSD treatment, the group that stopped using marijuana or never used marijuana had the lowest levels of PTSD symptoms (P < .0001); –they improved the most.
• According to the study, those who kept using marijuana were significantly more likely to have:
o Worse outcomes in PTSD symptom severity (P < .01),
o Violent behavior (P < .01),
o Higher use of alcohol and drugs (P < .01)
• Those who started using Marijuana after PTSD treatment had the highest levels of violent behavior (P < .0001).

What are some caveats?
• This is a large study done over the long term in this subject.
• Since most of the participants were older males, it is possible that results may be different in other age groups or populations.
• This study used a survey method which tells us about snapshot in time but does not about cause and effect.
• This study did not include individuals who were using alcohol or other drugs.
• It may be that participants were self-medicating because they were not feeling better or the use of marijuana prevented them from feeling better (4).
• The amount and type of marijuana use was not identified.
• Other smaller studies show mixed results, but also had different methods.

Do you have PTSD? Are you smoking Marijuana? Is it worsening your ptsd symptoms?

What are some resources regarding PTSD?
OSU Student Life-Counseling and Consultation Service
National Institue for Mental Health
National Center for PTSD

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References

1. http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
2. http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
3. Cougle, J.R., et. al. (2011). Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychology of Addictive Behaviors, 25, 554-558.
4. Wilkinson ST et al. Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry 2015 Sep; 76:1174.