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Slide 1 - Depression and Anxiety Lauren Ellis Exercise for Special Populations PEP 4370
Slide 2 - 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
Slide 3 - Epidemiology Depression Fourth highest cause of disability worldwide 6.7% 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 distress Women are affected twice as often as men $83+ billion per year which exceeds the costs of the war in Afghanistan. Anxiety 18.1% 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
Slide 4 - What are the types depression and anxiety? Depression Dysthymia(chronic) Minor Psychotic Postpartum Seasonal affective disorder (SAD) Bipolar disorder Anxiety Generalized Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Panic Disorder Post-Traumatic Stress Disorder (PTSD) Social Phobia
Slide 5 - Video Depression http://www.youtube.com/watch?v=IeZCmqePLzM
Slide 6 - Signs and Symptoms of Clinical Depression Physical: Sleep disturbances-insomnia, oversleeping, waking up early Changes in appetite or eating: much more or much less Decreased energy, fatigue Headaches, stomachaches, digestive problems unexplained Behavioral/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 decisions Neglecting responsibilities or personal appearance Emotional: Persistent sad or "empty" mood, lasting two or more weeks Crying "for no reason" Feeling hopeless, helpless, guilty or worthless Feeling irritable, agitated or anxious Thoughts of death or suicide
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Slide 9 - Video Anxiety http://www.youtube.com/watch?v=dRmBJhtys9g&feature=relmfu
Slide 10 - Signs and Symptoms of Anxiety Feelings of panic, fear, and uneasiness Uncontrollable, obsessive thoughts Repeated thoughts or flashbacks of traumatic experiences Nightmares Ritualistic behaviors, such as repeated hand washing Problems sleeping Cold or sweaty hands and/or feet Shortness of breath Palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension Dizziness Anything where the reaction is inappropriate to the situation.
Slide 11 - Diagnosis, tests and evaluation Depression See a doctor Rule out all other possibilities Physical examination, interview, and/or lab tests can be used Complete history of symptoms http://www.depressedtest.com/ Anxiety See a doctor Interview 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
Slide 12 - Complications Depression Alcohol abuse Substance abuse Anxiety Work or school problems Family conflicts Relationship difficulties Social isolation Suicide Self-mutilation, such as cutting Premature death from other medical conditions Anxiety Depression Substance abuse Trouble sleeping (insomnia) Digestive or bowel problems Headaches Teeth grinding (bruxism) Substance use disorders
Slide 13 - Depression Treatments/medications The newest and most popular types of antidepressant medications include: Fluoxetine (Prozac) Citalopram(Celexa) Sertraline (Zoloft) Paroxetine (Paxil) Escitalopram (Lexapro) Fluvoxamine (Luvox) Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include: Venlafaxine (Effexor) Duloxetine (Cymbalta) Everyone reacts differently. There is no one-size-fits-all approach to medication
Slide 14 - 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 US A 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.
Slide 15 - 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
Slide 16 - 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….
Slide 17 - 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).
Slide 18 - 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
Slide 19 - 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.
Slide 20 - Effects of training on disease or patient with disease… Improved mood Improved self-concept Improved work behavior Decreased depression and anxiety Improved social networks
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Slide 22 - 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. -
Slide 23 - 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.
Slide 24 - 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.
Slide 25 - Resources Retrieved 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-disorders Retrieved April 2012, from Best Practice: http://bestpractice.bmj.com/best-practice/monograph/55/basics/epidemiology.html Retrieved 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.shtml Retrieved April 2012, from Depressed Test: http://www.depression-primarycare.org/images/pdf/phq_9_eng.pdf All about depression.. Retrieved April 2012, from http://www.allaboutdepression.com/cau_02.html
Slide 26 - Questions?