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.

Hidden Consequence E-cigs

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

Electronic cigarettes or E-cigs, have become popular in recent years for a variety of reasons.
Some tout the tobacco free alternative as a way to lower cancer risk.  Others claim it’s less addictive and less risk of lung disease.  These claims have been investigated via long term studies.

There are also risks of much higher nicotine ingestion than traditional (tobacco based) cigarettes leading to nicotine toxicity (1).
A recent small study, by Barrington-Trimis and colleagues, suggest another unexpected consequence of e-cigarette use (2).
Who was studied?
300 students,  in the 11th or 12th grade (2).
What was the study design? (2)
  • Questionnaires were given in the 11th or 12th grade, and again after they turned 18 years old.
  • Some questions included whether they use e-cigarettes, traditional (tobacco) cigarettes, whether they  smoke tobacco based cigarettes now or intend to do so in the future.
What were the results?  (2)
  • 40% of participants who reported e-cigarette use at the beginning of the study ended up using traditional (tobacco) cigarettes by age 18, vs only 11% of students who never used e-cigarettes.
  • After adjusting for different variables,  e-cigarette users were over 5 times as likely to initiate traditional smoking as those who had never used e-cigarettes.
  • The e-cigarette users who reported having no intention of smoking traditional (tobacco) cigarettes at the beginning of the study had a 9.7 x odds ratio of using traditional cigarettes by the end of the study.
What do the results mean?
  • According to this study, smoking e-cigarettes might increase your chances of smoking tobacco based cigarettes.
  • This is concerning because of the variety of negative mental health and physical consequences of tobacco use.
  • Smoking cigarettes can increase depression and anxiety (3,4).
Is e-cigarettes worth the feelings of anxiety, depression, and tiredness? Will you feel better if you exchange it for healthier ways of living?
What are some resources regarding tobacco use?
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. Ordonez J, Forrester MB, Kleinschmidt K. Electronic cigarette exposures reported to poison centers. Clin Toxicology 2013;51:685
2. Barrington-Trimis JL, Urman R, Berhane K, et al. E-Cigarettes and Future Cigarette Use. Pediatrics. 2016; 138(1):e20160379
3. https://u.osu.edu/emotionalfitness/2015/04/15/does-smoking-increase-anxiety-and-depression-if-i-quit-will-i-feel-better/
4. Taylor G, et al. Change in mental health after smoking cessation: systematic review and meta-analysis. OPEN ACCESS. BMJ 2014;348:g1151 doi: 10.1136/bmj.g1151 (Published 13 February 2014)

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