Depression and AnxietyLauren EllisExercise for Special PopulationsPEP 4370

Overview Epidemiology What are the types of depression and anxiety? Signs and symptoms Diagnosis, tests and evaluations Complications Treatment/medications Effects of disease on ability to exercise Effects of medications on ability to exercise Effects of a bout of exercise on patient with disease Effects of training on disease or patient with disease Exercise Testing Exercise prescription Summary & conclusions

EpidemiologyDepressionFourth highest cause of disability worldwide6.7% of Adults in the US (30% severe)11.2% of13-18 yr. old In the US (3.3% severe) 14% of Adults and adolescents in Utah experience severe psychological distressWomen are affected twice as often as men$83+ billion per year which exceeds the costs of the war in Afghanistan.

Anxiety18.1% of US adults in the US (22% severe)25.1% of13-18 13-18 yrs. In the US (5.9% severe)Women are twice as likely to be affected as men. $42+ billion per year for anxiety conditions

What are the types depression and anxiety?

DepressionDysthymia(chronic)Minor Psychotic PostpartumSeasonal affective disorder (SAD)Bipolar disorder

AnxietyGeneralized Anxiety DisorderObsessive-Compulsive Disorder (OCD)Panic DisorderPost-Traumatic Stress Disorder (PTSD)Social Phobia

Video Depression

http://www.youtube.com/watch?v=IeZCmqePLzM

Signs and Symptoms of Clinical Depression

Physical:Sleep disturbances-insomnia, oversleeping, waking up earlyChanges in appetite or eating: much more or much lessDecreased energy, fatigueHeadaches, stomachaches, digestive problems unexplainedBehavioral/Attitude:Loss of interest or pleasure in activities that were once enjoyed, such as going out with friends, hobbies, sports, sex, etc.Difficulty concentrating, remembering, or making decisionsNeglecting responsibilities or personal appearanceEmotional:Persistent sad or "empty" mood, lasting two or more weeksCrying "for no reason"Feeling hopeless, helpless, guilty or worthlessFeeling irritable, agitated or anxiousThoughts of death or suicide

Video Anxiety

http://www.youtube.com/watch?v=dRmBJhtys9g&feature=relmfu

Signs and Symptoms of Anxiety

Diagnosis, tests and evaluationDepressionSee a doctorRule out all other possibilitiesPhysical examination, interview, and/or lab tests can be usedComplete history of symptomshttp://www.depressedtest.com/

AnxietySee a doctorInterview to discus health history to rule out all other possibilities.If symptoms are positive patient will be referred to psychiatrist or psychologist for special diagnosing. Diagnosis is based on duration and intensity of symptoms.http://psychcentral.com/quizzes/anxiety.htm

Complications

DepressionTreatments/medications

Alternative Treatments Psychotherapy- “Talk therapy“Two main types of psychotherapies-cognitive-behavioral

therapy (CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression by teaching new ways of thinking and behaving.

Electroconvulsive therapy- ”Shock therapy" Can provide relief for people with severe depression who

have not been able to feel better with other treatments. St. John’s Wort- Top-selling botanical

product in USA trial found that St. John’s wort was no more effective than

the placebo in treating major depression. Still performing clinical trials to see the benefits on minor depression.

Anxiety Treatments/medications

Medication: Drugs used to reduce the symptoms of anxiety disorders include anti-depressants and anxiety-reducing drugs.

Psychotherapy: Dealing with their disorder. Cognitive-behavioral therapy: The person

learns to recognize and change thought patterns and behaviors that lead to troublesome feelings.

Dietary and lifestyle changes Relaxation therapy

•If untreated, depression leads to suicide in about 15% of the people it affects.•Depression is the leading cause of disability and premature death in adults and is predicted to be the second leading cause of disability in people of all ages by the year 2020.•Anxiety affects over 40 million Americans each year (18+ yrs. old)

Just to think about….

Effects of disease on ability to exercise… For both diseases, the only point to take

into consideration are their medications.

Depending on what the side effects are trainer should plan accordingly (need to have a detailed list of medications).

Medications effect on exercise Beta-blockers: Attenuation of HR response Proxilin: Possible increase of blood pressure Nefadzodone: Infrequent tachycardia,

hypertension, and angina pectoris Antipsychotic medication: Possible gait

disturbances in relation to tardive dyskinesia, and often dehydration

Antidepressants: Insomnia, weight gain, and dizziness

Antianxiety medications: Drowsiness, potential of alcohol effects, and withdrawal

Effects of a bout of exercise on patient…- One single bout of exercise should not

affect patient. * Important to consider primary diagnosed

mental illness and current medications.

Effects of training on disease or patient with disease…

Improved mood

Improved self-concept

Improved work behavior

Decreased depression and anxiety

Improved social networks

Exercise Testing

Extensive orientation to the exercise testing facilities, personnel, and mode of exercise are a must.

Moods are ever-changing depending on what medications they are on. Adjust accordingly.

Treadmills can be intimidating due to medications so bike ergometers are better.

Measuring gas exchange is rarely if ever indicated, especially because of possible anxiety.

Special considerations-Allow time to practice the test or mode-Understanding that anxiety disorders, social phobias, lock of

motivation are commonly caused by emotional conditions and or medication.

-Emphasizing low to moderate intensity and enjoyment of participation.

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Exercise Prescription for Depression and Anxiety

Same as apparently healthy individuals unless comorbidities are present.Programs including walking or running, and group dynamic movement activities.Low to moderate intensity (50-65% of MHR)20-60 minutes*The prevalence of obesity, physical inactivity and low self-esteem are high is this population structured, supervised programs may be needs to reinforce beginning stages of program.

Summary and Conclusions Women are twice as likely to be affected as men

by depression and anxiety. Together they cost $125+ billion per year Can become life threatening if untreated Special considerations much be made when

planning exercise testing (should be enjoyed) Medications (side effects) must be documented

to plan testing and exercises programs accordingly.

Regular exercise is extremely beneficial for patients with depression and anxiety.

ResourcesRetrieved April 2012, from National Institute of Mental Health: http://www.nimh.nih.gov/index.shtml Retrieved April 2012, from http://www.adaa.org/about-adaa/press-room/facts-statistics Retrieved April 2012, from Herbal Remedies for Depression: http://herbaldepressionremedies.org/depression-symptoms/ Retrieved April 2012, from http://findarticles.com/p/articles/mi_m0903/is_n4_v12/ai_15256667/Retrieved April 2012, from WebMD: http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disordersRetrieved April 2012, from Best Practice: http://bestpractice.bmj.com/best-practice/monograph/55/basics/epidemiology.htmlRetrieved April 2012, from National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/how-is-depression-diagnosed-and-treated.shtmlRetrieved April 2012, from Depressed Test: http://www.depression-primarycare.org/images/pdf/phq_9_eng.pdfAll about depression.. Retrieved April 2012, from http://www.allaboutdepression.com/cau_02.html  Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression

treatmentoutcomes with the patient health questionnaire-9. Medical Care, 2004. 42(12): 1194-201

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