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
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
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
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