PharmCare4 - Clinical Pharmacy

MAJOR DEPRESSIVE
DISORDER (MDD)
and
EATING DISORDERS
Presented by GROUP 4
CLARITE, JAVINO, MELGAR
SALIGUMBA, VILLANUEVA
YATAR
 M DEFINITIO
N
D
a mood disorder characterized by persistent sadness and other

D
symptoms of a major depressive episode but without
accompanying episodes of mania or hypomania or mixed
episodes of depressive and manic or hypomanic symptoms.
Also called major depression.
APA Dictionary of
 M SYMPTOM
S

•
D
Feelings of sadness, emptiness or hopelessness

D
• Irritability or frustration, even over small matters
• Loss of interest or pleasure in activities
• Sleep disturbances, including insomnia or hypersomnia
• Fatigue
Mayo Clinic
 M SYMPTOM
S

•
D
Anorexia and weight loss or Hyperphagia and weight gain

D
• Anxiety
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, and self blaming
• Trouble thinking, concentrating, and forgetfulness
Mayo Clinic
M SYMPTOM
S
D
D
• Frequent or recurrent thoughts of death, suicidal thoughts,
suicide attempts or suicide
Mayo Clinic
M KEY
FACTS
D
• Depression is a common mental disorder. Globally, it is estimated that
5% of adults suffer from depression.
• Depression is a leading cause of disability worldwide and is a major

D
contributor to the overall global burden of disease.
• More women are affected by depression than men.
• Depression can lead to suicide.
• There is effective treatment for mild, moderate, and severe depression.

WHO
 M HIGH RISK
FACTORS
D
• Certain personality traits, such as low self-esteem, self-critical or

D
pessimistic
• Traumatic or stressful events, such as abuse or loss.
• Blood relatives with a history of depression
• Being lesbian, gay, bisexual or transgender, or being born intersex in an
unsupportive situation
Mayo Clinic
 M HIGH RISK
FACTORS
D
• History of other mental health disorders
• Abuse of alcohol or recreational drugs

D
• Serious or chronic illness, including cancer, stroke, chronic pain or heart
disease
• Certain medications, such as some antihypertensives or sleeping pills
(talk to your doctor before stopping any medication)
Mayo Clinic
M DIAGNOSE
S
• Depression is difficult to diagnose accurately. Primary care physicians

D
and other non-psychiatrists physicians miss two-thirds of cases and
unnecessarily treat other patients (Gibson, 2021)

• Before a diagnosis of depression is made, a physician should perform a

complete medical exam to rule out any possible physical cause for the

D
suspected depression. If no such cause is found, a psychological
evaluation should be done by the physician or by referral to a
psychiatrist or psychologist. (Rosh, 2007)
 M DIAG PHYSICA
L EXAM
Physical examination of patients with major depressive disorder is usually normal.

NOSE
A mental status examination may provide valuable information in patients with major depressive
disorder.

D
• General appearance • Thought content • Speech

retardation. S
Psychomotor agitation or Suicidal ideation
Pervasive feelings of
hopelessness, helplessness,
Little or no spontaneity
Monosyllabic
Long pauses
Poor eye contact.
Tearful worthlessness, guilt Soft, low monotone
Poverty of through content
Inattentive to personal

D
Mood-congruent hallucinations • Cognition
appearance
and delusions
Distractile
• Affect Difficulty concentrating
• Mood
Constricted or labile Poor memory
Depressed Irritable
• Insight and judgment Frustrated Sad
Apparent disorientation
Impaired Impaired abstract thinking
 M DIAG PSYCHIATRIC
EVALUATION
A psychiatric evaluation is a clinical interview that comprises the first visit to a psychiatrist. Its

NOSE
purpose is to formulate working psychiatric diagnoses.

• Emergency Evaluations

D
An emergency psychiatric evaluation is ordered when it needs to be done immediately for
protection
S
• General Psychiatric Evaluations
A general psychiatric evaluation is ordered when there’s suspicion that
we have a mental health condition. During the assessment, the patient’s medical

D
and family history will be reviewed.

• Clinical Consultations
If the patient has been exhibiting mental health condition symptoms, we
can request a clinical consultation.
 M TREAT
MENT
In general, treatments for depression include:

D Medications called antidepressants

Talk therapy also known as psychotherapy
If we have mild depression, we may only need one of those treatments. People with

D
more severe depression usually need combination of both treatments. It takes time to
feel better, but there are usually day-to-day improvements. If suicidal or extremely
depressed and cannot function we need to be treated in a psychiatric hospital
(Maddaleni, 2013)
 M TREAT TALK
THERAPY
Talk therapy is counseling to talk about our feelings and thoughts, and help us learn how to deal

MENT
with them. Types of Talk Therapy include:

• Cognitive behavioral therapy teaches us how to fight off negative thoughts. We will

D
learn how to become more aware of our symptoms and how to spot things that makes
depression worse. We'll also be taught problem-solving skills.

• Psychotherapy can help us to understand the issues that may be behind our thoughts
and feelings.

D
• Joining a support group of people who are sharing
problems like ours can also help. Ask therapist or
doctor for a recommendation. (Lakshmi, 2013)
 M TREAT OTHER
TREATMEN
MENT TS
• Electroconvulsive therapy (ECT) is the single most effective treatment for severe

D
depression and it is generally safe. ECT may improve mood in those with severe
depression or suicidal thoughts who don't get better with other treatments. It may also help
treat depression in those who have psychotic symptoms. (Gibson, 2021)

• Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells

D
in the brain that are believe to affect mood. There is some research to suggest that it can
help relieve depression. (Gibson, 2021)

• Light therapy may relieve depression symptoms in the winter time. However, it is usually
not considered a first-line treatment. (Gibson,2021)
Eating Disorder
What is Eating
Disorder?
 Eating disorders are
behavioral conditions
characterized by severe and
persistent disturbance in
eating behaviors and
associated distressing
thoughts and emotions.
 Symptoms:
Behavioral/Emotional: Physical:
• Dieting • Weight fluctuation
• Obsession with weight loss • Stomach cramps
• Picky eating • Acid reflux
• Discomfort eating in front of • Missed period
others • Dizziness
• Skipping meals • Yellow skin
• Restriction like no carbs/vegan
• Extreme mood swings
Facts:
1. They are serious mental illnesses.
2. Life consuming
3. Serious and life threatening
4. Recovery is possible
5. They are not just women's disorder
6. Eating disorders affect all genders, all races and every ethnic
group.
7. Eating food is more complicated for those with eating disorders.
8. People with eating disorders cannot just “get over it.”
Risk Factors:
• age
• family history
• excessive dieting
• psychological health
• Life transitions
• Mental health issues
• Stress
• Activities and interest
 Types of Eating Disorder

 Anorexia Nervosa
 Bulimia Nervosa
 Binge Eating Disorder
 ARFID( Avoidant- restrictive eating
disorder)
 Pica
 Rumination Syndrome
Anorexia Nervosa
-is an eating disorder characterized by an abnormally low body weight, an intense fear
of gaining weight and a distorted perception of weight.
-symptoms: extreme weight loss, thin appearance, fatigue, insomnia, dizziness or
fainting, low blood pressure and dehydration.

Two subtypes of anorexia nervosa:

1. Restricting type
-An individual lose weight primarily by dieting, fasting or excessively exercising.
-restriction on the quantity and type of food they consume.
2. Binge Eating/ purging type
-this type of anorexia restricts on what food they eat. But this is accompanied by
binge eating and purging.
-purging the food through vomiting or misusing laxatives.
Bulimia Nervosa
-is a serious, potentially life-threatening eating disorder. People with bulimia
may secretly binge — eating large amounts of food with a loss of control over the
eating — and then purge, trying to get rid of the extra calories in an unhealthy way.
-Bulimia most affects women that starts during teenage years and can also
affect men.
-no known cause.
-it likely comes from families with a eating disorders history, physical illness
and other mental problems.
-symptoms: excessive fasting and exercise, self-induced eating, depression,
anxiety, tiredness and decreased energy
Binge eating disorder
-is a serious eating disorder in which you frequently consume
unusually large amounts of food and feel unable to stop eating.
-Binge means “eating too much of something”.
-severe, and life threatening and treatable eating disorder.
-newest eating disorder formally recognize in the DSM-5.
-symptoms: eating much more rapidly than normal, eating a
large amounts w/o feeling hungry and eating until uncomfortably
full.
Avoidant- restrictive food intake disorder
-ARFID starts at a younger age than other eating disorder.
-picky eating and general lack of interest in foods are the main features of ARFID.
-may not feel hungry or turned off by the smell, taste, texture of color of the food.

Pica
-is a compulsive eating disorder in which people eat nonfood items.(ex. Dirt, clay
and tiles).
- more common on children, affecting 20 to 30 % of young children ages 1-6 years
old. It can also occur in children and adults with intellectual and development disabilities.
-symptoms: stomach upset, stomach pain, blood in the stool, bowel problems.
Rumination Disorder
-aka rumination syndrome or merycism
- is a feeding and eating disorder in which undigested food comes back
up from a person’s stomach into his or her mouth (Regurgitation).
- it is always characterized by repeated regurgitation of food over a
period of time.
- children and adult with high level of anxiety or stress may be at higher
risk for rumination syndrome.
- symptoms: abdominal pain, effortless regurgitation (every 10
mins.), Feeling of fullness, bad breath, nausea, and unintentional weight
loss.
 DIAGNOSIS OF EATING DISORDER:
Physical examination:
-the doctor/ physician will examine you to rule out other medical causes for your eating issues. They
will also check your weight, height and BMI if it is normal or not. He or she may also request for lab test.

Mental health questionnaire:

-Since metal health coexist with an eating disorder, the healthcare provider may ask you to fill out
questionnaires particularly to your mental health for over the past few weeks.

Lab tests:
- Blood test to check for blood count (CBC), electrolytes, liver function, kidney and thyroid function.
This test will determine if you have anemia, dehydration, malnutrition and electrolytes abnormalities in you blood
that also a cause to weakens your body.
-
Electrocardiogram ( ECG)
- this is done to check the rhythm of the heart. People with eating disorder is prone for having a heart
that doesn’t beat with a regular rhythm.
 Treatment of Eating Disorder
The treatment for depend on the specific type of eating disorder you have. It involves nutrition
education, psychotherapy and medication.

Psychotherapy:
It involves seeing a psychologist or another mental professionals to guide you and help you to normalize
your eating patterns and achieve a healthy weight, change unhealthy habits to healthy one, learn to monitor your
eating and moods, develop problem solving skills. Psychologist plays avital role in the successful treatment of
eating disorder it works with the physician which rules out medical illness and determine if the patient is in
danger or not.
 Family based therapy (FBT)
-is an evidenced based treatment for children and teenagers with eating disorder. The family
is involve in making sure that the child or other family member follows healthy-eating patterns and
maintains a healthy weight.

 Cognitive behavioral therapy (CBT)

- commonly used in eating disorder treatment, especially for bulimia and binge- eating
disorder. It is talking therapy that can help to manage your problems by changing the way you think and
behave.
Medication:
Antidepressants can help to reduce the risk and symptoms of depression and anxiety which
frequently occur along with eating disorder.

Olanzapine (Zyprexa)
-has been an effective in “reducing psychological distress particularly in the refeeding phase
of anorexia nervosa treatment. It as successfully used in patients with severe anorexia nervosa for
stimulating appetite and weight gain.
Selective serotonin reuptake inhibitor(SSRIs)
- a class of antidepressant, are sometimes used to treat binge eating disorder. SSRI increases
the amount of serotonin in the brain which it helps to boost mood. Prozac (fluoxetine) has proven to
reduce episodes of binge-purge cycles in bulimia.
-ex: Fluoxetine, paroxetine, sertraline
Topiramate
- is an anti-seizure medication that has been found to treat BED. It has been found to be
“significantly superior placebo in reducing binge frequency, as well as obsessive- compulsive features
of binge eating symptoms
Nutrition education:
Registered dietitian/ nutritionist is a big help too for the management of
eating disorder. They’re the one who guides your everyday meal plan to bring
back your good eating habit and improve health. This would not just help the
patients to reduce eating disorder but also to build strong relationship with the
food and their bodies.

Hospitalization
-you may be admitted to hospitals if you have a serious health
complication because of eating disorder and if your health and life is in danger.
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