Depression

and
Seasonal Affective Disorder

Regan Dettmer, PharmD

Jeremy Gregersen, PharmD
Quynh Nguyen, PharmD
Lutheran Hospital
Content

Non-
Background Prevention medication Medications
Treatments
Background - Definition

Depression

Severe symptoms
that can affect your
daily living

*needs to be diagnosed by a professional provider

Background - Types

Major Persistent Perinatal Seasonal Depression

Depression Depressive Depression Affective with
Disorder Disorder Psychosis

*needs to be diagnosed by a professional provider

Background - Signs & Symptoms

What are some signs and ❖ Having a depressed mood

❖ Loss of interest or pleasure in activities once enjoyed
symptoms of depression
❖ Changes in appetite
that you know about? ❖ Change in sleep
❖ Loss of energy or increased fatigue despite
increased sleep hours
❖ Feeling worthless or guilty
❖ Difficulty thinking, concentrating, or making
decisions
❖ Thoughts of death or suicide

*needs to be diagnosed by a professional provider

Prevention
Identify Early Warning Signs Take Action Seek Help

❖ Triggers ❖ Healthy Coping Skills ❖ Initiation of treatment

❖ Signs/Symptoms ➢ Exercise should be discussed
➢ Physical ➢ Sleep Hygiene with healthcare
➢ Emotional ➢ Healthy Eating professionals
➢ Cognitive ❖ Identify stressful situations ❖ Identify a support
➢ Behavioral ❖ Manage stressful situations network
➢ Start slow
➢ Have realistic
expectations
➢ Ask for help
Non-Medication Treatment Strategies

❖ Cognitive Behavioral Therapy

❖ Light Therapy
❖ Exercise
❖ Maintaining Relationships
Cognitive Behavioral Therapy

❖ A type of mind therapy treatment that helps one

learn how to identify and change destructive or
disturbing thought patterns into more objective
and realistic thoughts
❖ Can be self driven or can work in line with a
therapist for help
Cognitive Behavioral Therapy Examples

Journaling
Meditation

Role Playing Exposure Therapy Therapy Session

Cognitive Behavioral Therapy Benefits

❖ Promotes self-awareness
➢ Can be applied to other behaviors
❖ Improvements can be seen quickly
❖ Can be more affordable than other types of therapy
❖ Does not require medication
Light Therapy

❖ May alter brain chemicals linked to mood

and sleep
❖ Avoid using UV light emitters
➢ Tanning beds are not an alternative
❖ Light needs to enter eyes indirectly
❖ Key Elements
➢ Intensity
➢ Duration
➢ Timing
Light Therapy Risks

Headache Mood Swings

Eye Strain Nausea Irritability

Light Therapy Success

❖ Be consistent
❖ Track time while using
❖ Talk with your doctor
➢ About getting the right box
➢ If symptoms don’t improve
Exercise

❖ Natural resolution of many mental health issues

❖ If difficult to get outdoor exercise, consider indoor alternatives
❖ Aim for 30 - 60 minutes at least 3 - 5 days per week
Maintaining Relationships

❖ Meet up with an old friend for coffee

❖ Join support group to make new friends
❖ Volunteer your time
Activity

Journal:
❖ Personal warning signs
❖ What activity helps when you feel
overwhelmed
❖ What does not help when you feel
overwhelmed
❖ Who you can talk with in stressful situations
Medications for Depression

❖ Lots of brand name and generic prescription

medications are available to help treat depression

❖ Common medications:
➢ Sertraline (ZoloftⓇ)
➢ Fluoxetine (ProzacⓇ)
➢ Bupropion (Wellbutrin XLⓇ)
➢ Duloxetine (CymbaltaⓇ)
Medications for Seasonal Affective Disorder

❖ Usually the same medications as for depression

❖ Only one FDA approved medication

➢ Bupropion (Wellbutrin XL Ⓡ)
Precautions with Antidepressant Medications

❖ Nausea ❖ The side effects are not

❖ Drowsiness the same with all
❖ Insomnia antidepressant
❖ Anxiety medications. Talk to your
❖ Sexual Problems doctor or pharmacist
❖ Dry Mouth about what you should
❖ Suicidal Thoughts expect if starting a new
medication.
Medications - Special considerations

❖ Some medications are not absorbed well after bariatric surgery

➢ Immediate release medications are usually better than extended release medications

❖ Antidepressant medications often impact weight

➢ Some medications lead to weight loss
➢ Others can cause weight gain
➢ Talk to your doctor about weight changes you should expect when starting a new
antidepressant
Common Weight Changes with Antidepressants

Weight Gain No Weight Weight Loss

Change
Mirtazipine (Remeron ®) Duloxetine (Cymbalta®) Bupropion (Wellbutrin®)

Aripiprazole (Abilify®) Sertraline (Zoloft®)

Supplements for Depression

❖ Melatonin
❖ Vitamin D
❖ Tryptophan
❖ There is not very much evidence for the use of these supplements for depression
or seasonal affective disorder

*Talk to you doctor or pharmacist before starting new over the counter medications
Risks with Supplements for Depression

❖ Natural supplements can interact with prescription

medications
❖ May cause nausea, constipation, changes in appetite,
or kidney problems (Vitamin D)
❖ Can cause drowsiness (Melatonin)
❖ May cause dizziness, nausea, blurred vision, or tremors
(Tryptophan)
Key Takeaways

❖ Signs and symptoms of depression differ from person to person. It’s best to
discuss with your doctor if you believe you have had symptoms of
depression
❖ There are several non-medication strategies that can be tried, even on your
own depending on your comfort level
❖ There are many medications that can help with depression or SAD. Talk to
your doctor about what might be the best choice for you if medication is
needed.
Questions??