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Prozac Medication: The Benefits, Side Effects and Dosages




Prozac Medication: An Overview

Prozac is a medication used to treat depression, obsessive-compulsive disorder, bulimia, and frequently severe symptoms of premenstrual syndrome. Prozac is within the drug classification referred to as selective serotonin reuptake inhibitors (SSRI’s), which is believed to help maintain a elevated level of the neurotransmitter serotonin in the brain.

Serotonin is a neurotransmitter in the brain which is believed to affect moods. This neurotransmitter is usually quickly reabsorbed after its initial release from neurons in the brain. It is believed that excess serotonin between the neurons is blocked by medications such as Prozac from being taken back up into the releasing neurons resulting in increased levels of serotonin in the brain.

Prozac is most often prescribed to treat depression of the moderate to severe variety which interferes with daily functioning and most often is referred to as major depression. The symptoms of major depression include low mood and low energy, changes in sleeping habits and appetite, decreased sex drive, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts. However, Prozac can be taken for a variety of other mental health disorders including obsessive-compulsive disorder, premenstrual dysphoric disorder as well as others. It is most often prescribed for adolescents, adults and the elderly but may occasionally be prescribed for children.

Prozac Medication for Obsessive- Compulsive Disorders:

In addition to being used for the treatment of depression, Prozac is also used to treat obsessive-compulsive disorder. Obsessions are thoughts that won’t go away, and compulsions are repetitive behaviors and actions which are done to relieve anxiety often associated with the obsessions. Prozac is used at times to also treat bulimia which is a binge eating disorder which involves deliberate vomiting and has also been used to treat other eating disorders including obesity.

Premenstrual Dysphoric Disorder:

Under the brand name Serafem which includes the active ingredients in Prozac, this depression medication is sometimes prescribed for premenstrual dysphoric disorder (PMDD), which is often referred to as premenstrual syndrome (PMS) including mood changes such as anxiety, depression, persistent anger, irritability, and mood swings. There are various physical problems associated with PMDD, including bloating, breast tenderness, headache and joint muscle pain. Symptoms usually tend to begin about 1 to 2 weeks before a woman’s premenstrual period. They are frequently severe enough to interfere with a woman’s daily activities, functioning and relationships.

Prozac Medication: Precautions

You should always be open and honest with your doctor when your taking Prozac. Always give a complete medical history, including liver problems, kidney disease, seizures, heart problems, allergies and history of diabetes. This depression medication has been known to make individuals dizzy or drowsy, making it necessary to be cautious when engaging in activities that require alertness such as driving or using heavy machinery. Alcohol should be limited when on this medication. Caution is also advised if you have diabetes, alcohol dependence or liver disease. Also, caution should be taken when this medication is being used by the elderly as they are more sensitive to the effects of the drug. This drug should only be used if necessary if an individual is pregnant as the medication passes into the breast milk. Because of the possible risk to the infant, breast-feeding while on this medication is not recommended. Consultation with your physician about the benefits and risks of Prozac used during pregnancy and breast-feeding is imperative. Obviously, you should never share your Prozac with others.




Important Facts About This Depression Medication

It has been noted that there can be some very serious and at times even fatal reactions to occur when Prozac is taken at the same time as some other antidepressants such as the MAO inhibitors. Also, you need to be careful when taking high doses of Prozac over a prolonged period of time. If you are taking any other medications for depression or any other prescription or nonprescription drugs you need to notify your physician before beginning on Prozac.

Prozac Side Effects:

Although the Prozac side effects seem to be less than some of the earlier generation antidepressant medications such as desipramine, amitriptyline and nortriptyline, there are still side effects that you need to be aware of. Some of the more common side effects of Prozac are sweating, dry mouth, drowsiness, headache, insomnia and nausea. Some of the side effects that are less likely but at times even more severe are loss of appetite and unusual weight loss, uncontrollable movements such as tremors, decreased interest in sex, flu-like symptoms, and either unusual or severe mood changes. Even less likely but even more potentially serious Prozac side effects include trouble swallowing, vision changes, white spots and swelling on the mouth and tongue, painful and/or prolonged erection and changes in sexual ability. The most severe side effects associated with Prozac are irregular and fast heartbeat, and fainting. Allergic reactions to Prozac are relatively rare but may include itching, rash, swelling, trouble breathing and dizziness. If you notice any reactions after beginning treatment with Prozac, you need to notify your pharmacist or physician immediately. A more complete listing of Prozac side effects follows.

The Most Common Prozac Side Effects:

Abnormal vision, abnormal ejaculation, abnormal dreams, increased anxiety, reduced sex drive, dry mouth, dizziness, flushing, flulike symptoms, headache, gas, impotence, itching, insomnia, loss of appetite, nervousness, nausea, sinusitis, rash, sleepiness, sweating, sore throat, upset stomach, tremors, yawning, vomiting, weakness

Less Common Prozac Side Effects:

Agitation, abnormal taste, weight gain, sleep disorders, bleeding problems, confusion, chills, weight gain, ringing in the ears, palpitations, loss of memory, increased appetite, high blood pressure, frequent urination, ear pain, emotional instability

There have been other very rare side effects reported while taking Prozac. If you develop any unexplained or new symptoms after initiating treatment with this depression medication you need to contact your physician immediately.

Drug Interactions:

In addition to the Prozac side effects mentioned above, there are also concerns for negative food and drug interactions when taking this antidepressant medication. As mentioned previously, Prozac should never be taken at the same time as you are taking MAO inhibitors. This can cause a very serious medication interaction. Also, when Prozac is taken with other medications the effect may be increased, decreased or altered in other ways. You should always check with your doctor when Prozac is taken with the following medications:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Tryptophan
Vinblastine (Velban)
Warfarin (Coumadin)

Special Warnings if You are Pregnant or Breast-feeding:

Prozac has not been adequately studied for its effects on pregnancy. If you are pregnant or plan to become pregnant in the near future, you need to talk with your physician as soon as possible to determine whether you should continue taking this depression medication. Prozac is known to appear in breast milk, so breast-feeding is obviously discouraged when taking this drug.

Prozac Dosage:

It is most common for your Prozac dosage to be taken once or twice a day and should be taken exactly as prescribed by your physician. It needs to be taken regularly to be effective. If it is possible, you should take your Prozac dosage at the same time every day.

Some patients have found that it can take as much as four weeks to feel any significant effects and get some relief from their depression. Doctors will also commonly maintain the treatment regimen for about nine months after the first initial three-month treatment trial. Some individuals who experience obsessive-compulsive disorder may not feel the full effects for as much as five weeks.

The Recommended Prozac Dosage:

The most common starting dosage of Prozac is 20 mg daily taken in the morning. Your physician may increase your dose after several weeks if there has been no improvement in symptoms. Elderly people with kidney and liver disease, and any other individual taking other medications may have their dosage adjusted by their doctor.

When taking a dosage of Prozac over 20 mg, the doctor may ask you to take it once a day in the morning or may ask that you to take two smaller doses in the morning and also at noontime.

The usual Prozac dosage for depression ranges between 20 mg and 60 mg. For obsessive-compulsive disorder, the usual dosage of Prozac ranges from 20 mg to 60 mg per day, although at times a maximum of 80 mg may be prescribed. The usual dosage of Prozac for bulimia nervosa is 60 mg taken in the morning. As with other disorders, the doctor may start at a lower dosage and increase to this level over a period of time. The most common Prozac dosage for premenstrual dysphoric disorder is 20 mg per day.

For some individuals who have been treated successfully with the daily form of Prozac, their doctor may switch them to a long acting form sometimes referred to as Prozac weekly. Your physician may ask you to skip your daily doses for seven days and then take your first weekly capsule.

If you miss your dose of Prozac you should take it as soon as you remember. If a significant time has passed however, you should skip that dosage and resume your normal dosage schedule.

Over dosage of Prozac:

Prozac like all medications, needs to be taken as recommended. Dosages more than the recommended amount can be dangerous and even fatal. Also, combining Prozac with certain other medications or drugs may cause symptoms of over dosage. If you suspect an overdose, you need to contact your doctor or go to an emergency room immediately.

The most common symptoms of Prozac over dosage include rapid heartbeat, nausea, seizures, vomiting and sleepiness. Some of the less common symptoms of Prozac over dosage include stupor, sweating, rigid muscles, low blood pressure, mania, coma, delirium, fainting, high fever and irregular heartbeat.

By Paul Susic Ph.D. Licensed Psychologist


Treatment for Depression: Psychotherapy and Psychological Treatments





Treatment for Depression: An Introduction

Treatments for depression have come a long way in the last couple of decades with many advancements in psychotherapy and psychological treatments that have been empirically supported by research. Research into cognitive behavioral therapy, behavior therapy and interpersonal therapy have now been conclusively found to be effective. Evidence has also been found to support the use of cognitive therapy and reminiscence therapy among senior adults. A review of each of the main specific therapeutic modalities follows below.

Treatment for Depression: Cognitive Behavioral Therapy

Cognitive behavioral therapy was originally developed by Aaron Beck M.D. in the late 1960’s. It has easily become the most popular treatment modality for depression, anxiety disorders and a multitude of other mental health conditions. Cognitive behavioral therapy focuses on the connection between thoughts, moods and behaviors and utilizes primarily the thoughts as the main intervention point to modify moods and ultimately behaviors. It recognizes the negative bias that many people develop that results in biased information processing and dysfunctional beliefs that lead to and maintain depression. The main goal is to identify and change the dysfunctional or maladaptive thinking which is believed to then consequently change the individual’s affect and behaviors.




Cognitive behavioral therapy is traditionally provided within a structured format that facilitates learning experiences, monitoring thoughts, development of more adaptive coping skills and Socratic questioning of maladaptive thinking. A full course of cognitive behavioral therapy may involve 14 to 16 sessions along with booster sessions whenever necessary. There has been significant evidence over the last several decades recognizing the effectiveness of cognitive behavioral therapy in treating depression. Various outcome studies have found it to be at least as effective as pharmacotherapy and may be more effective than depression medications alone in assisting with preventing relapse of depressive symptoms. A more recent field of cognitive behavioral therapy has also had an increased interest and attention in that it has integrated the concept of mindfulness as well into the traditional cognitive behavioral model, in an attempt to reduce the incidence of relapse.

Behavior Therapy Treatment of Depression:

Behavior therapy focuses on the use of reinforcement and extinction of behaviors that are found to be either positive or negative. Behavior therapies focus on increasing the quality as well as the frequency of pleasant experiences which are then expected to result in improvements in an individual’s mood. A structured treatment program that was developed utilizing this theoretical perspective is the Coping With Depression course. This course uses the format of a psychoeducational group which usually consists of 12 sessions over approximately eight weeks, and then uses skills training to improve social skills. The objective is then to increase activities that are pleasant as well as to teach individuals how to relax. Some recent evidence has found that the use of this Coping With Depression course is at least as effective as antidepressant medications in treating depression in the short-term and possibly even over the long-term.

Interpersonal Therapy for Depression:

An interpersonal therapy model for depression was developed by Klarman, Wiseman and Associates in the 1980’s. The basis for Interpersonal therapy is the Interpersonal model of depression which considers depression to be the result of or to be exacerbated by interpersonal difficulties between people. As a result, interpersonal therapy focuses on remediating these interpersonal problems. Interventions may focus on role transitions, or disputes, interpersonal deficits and skills and even grief issues which have been denied, delayed or may be inadequately completed.

Interpersonal therapy is also provided within a structured format and utilizes a progression through three phases: (1) the diagnosis and identification of specific areas of interpersonal difficulties as well as an explanation of the course of therapy; (2) focus on resolution of the specific problematic areas or difficulties and (3) termination of therapy. This type of therapy has been utilized in a modified format among several specific populations such as adolescents and the elderly and has been used for other mental health disorders as well. Interpersonal therapy has been demonstrated to be effective for both the acute and maintenance phases of depression.

Learned Helplessness Treatment Model for Depression:

Significant research has also recognized the importance of the learned helplessness model for the development and maintenance of depression. Learned helplessness is based upon a model by Martin Seligman Ph.D. in the early 1960’s in which he recognized that there was a connection between an individual’s sense of control over their environment and depression. He found that an individual’s inability to have a sense of control over adverse circumstances in their environment resulted in a sense of helplessness and ultimately depression. He believed this perspective and consequent depressed mood was basically a learned experience. This model recognizes the need for increasing an individual’s sense of control over their environment, reducing feelings of helplessness, hopelessness and depression.

Treatment for Depression: Conclusion

Research and my (Paul Susic Ph.D. Licensed Psychologist) clinical experience has found over the last several decades that optimal treatment for depression may include both psychotherapy and/or psychological treatments along with medications for the most effective treatment of major depressive disorder. Although medications frequently are prescribed as a front-line treatment for depression, this physiological focus is often not ideal. Medications alone have been found to have higher relapse risks of additional episodes than psychotherapy alone. In most cases it seems that the most effective approach may be to attempt to remediate the depression with psychotherapy and then add medication as necessary rather than trying medication and then adding psychotherapy as an adjunct treatment.

By Paul Susic Ph.D. Licensed Psychologist





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Lexapro Medication: Side Effects, Dosages and Indications




Lexapro Medication: Side Effects and Dosages: Overview

Lexapro medication side effects and dosages are absolutely essential to know before you begin taking this antidepressant medication. Lexapro is a medication usually prescribed for major depression which is a low mood that persists for at least several weeks duration, and interferes with daily functioning. Major depression must occur nearly every day for at least two weeks, and must include either (1) low mood or (2) loss of interest in your usual activities and interests, as well as at least five of the following symptoms of depression: significant changes in weight or appetite, changes in your pattern of sleep, lethargy or agitation, feelings of guilt or worthlessness, fatigue, difficulty concentrating and slowed thinking and thoughts of suicide. If the symptoms of depression persist over a period of several weeks you may have major depressive disorder, which may make Lexapro a good choice for an antidepressant. If that is the case, it is essential to understand Lexapro medication, side effects, dosages, indications and contraindications.

Lexapro is a medication that increases the levels of serotonin in the brain. Serotonin is a necessary chemical in the brain referred to as a neurotransmitter, which is involved in things such as establishing biological processes associated with sleeping and eating. Lexapro is also a close cousin of Celexa, which is also a medication used to treat depression. There are several medications that focus on increasing the level of serotonin in the brain including Zoloft, Prozac and Paxil.




Lexapro Medication Important Information:

Lexapro is an effective and very popular medication. However, this is a medication in which you could possibly get a very bad reaction if you have been taking some other medications, such as those of the medication classification of monoamine oxidase inhibitors (MAOI’s). Some of the MAOI’s include Parnate, Marplan and Nardil. Many psychiatrists recommend that you never take Lexapro within two weeks of having taken these medications. When combined with Lexapro, these medications can cause some very serious and even fatal reactions. These negative symptoms include twitching and agitation, fever, and rigidity, which have been known at times to even lead to delirium and even coma.

Lexapro Medication Side Effects:

Specific Lexapro medication side effects cannot really be anticipated but if any develop or intensify, you should contact your doctor immediately. Only your physician can decide if you should continue taking this medication for depression if you experience any of the following symptoms below.

Some of the more common Lexapro side effects include:

Decreased appetite, sweating, sleepiness, sinusitis, runny nose, nausea, insomnia, indigestion, impotence, flu-like symptoms, fatigue, ejaculation disorder, dry mouth, dizziness, diarrhea, decreased sex drive, constipation

Some of the less common Lexapro side effects may also include:

Yawning, weight changes, vomiting, vertigo, urinary problems, tremors, toothache, tingling, stomachache, sinus headache, sinus congestion, ringing in the ears, rash, palpitations, pain in arms or legs, pain in the shoulder and neck, nasal congestion, muscle pain, migraine, menstrual cramps, lightheadedness, lack of orgasm, lack of energy, lack of concentration, joint pain, irritability, increased appetite, hot flashes, high blood pressure, heartburn, fever, coughing, chest pain, bronchitis, blurred vision, allergic reactions, abnormal dreaming, abdominal pain

In addition to these Lexapro side effects, others have been reported but are very rare. You should always check with your physician if you develop any new or unusual symptoms when taking this depression medication.

Lexapro side effects and additional special warnings:

This medication can make you sleepy. Until you know how you react to this drug, you should use it with caution when driving a car or operating any potentially hazardous machinery or tools. In some rare cases, Lexapro has been known to trigger manic episodes, which are unreasonably high levels of energy, that can become very risky or hazardous to your health. Also, you should let your doctor know if you have had any problems with your kidneys or liver. Your physician may need to adjust your medication accordingly.

Possible drug and food interactions when taking Lexapro:

You should never take Lexapro when taking the similar drug Celexa. Also, as referred above, you should always be careful to avoid any of the MAO inhibitor medications such as Nardil, Parnate and Marplan. Lexapro is not known to interact negatively with alcohol, but the manufacturer recommends avoiding alcoholic beverages while taking this depression medication. If Lexapro is taken with other medications, the combination may increase, decrease or otherwise alter the effects in some way. It is highly recommended that you consult your physician before taking the following medications:

• Carbamazepine (Tegretol)
• Cimetidine (Tagamet)
• Desipramine (Norpramin)
• Other drugs that act upon the brain including antidepressants, sedatives, tranquilizers and painkillers
• Ketaconazole (Nizoral)
• Lithium (Eskalith)
• Metoprolol (Lopressor)
• Narcotic painkillers
• Sumatriptan (Imitrex)

Special information if you happen to be pregnant or breast-feeding:

If you are currently pregnant or plan to become pregnant in the future, you should let your physician know before taking Lexapro. This medication should only be taken if the benefits outweigh the risks. Lexapro appears in breast milk and could possibly affect the nursing infant. In most cases it is not recommended to breast-feed while taking this medication.

Lexapro medication dosage overview:

Your Lexapro medication dosage should be taken exactly as recommended by your physician even if you begin to feel better. The correct dosage of Lexapro should result in feeling better in one to four weeks, although it is recommended that you continue with this medication for at least several months. This medication can be taken with or without food.

If you miss your usual Lexapro medication dosage…

You should take your missed dosage as soon as possible. If it is almost time for your next dosage however, you should skip the missed dose and resume your regular medication routine. You should never take more than one dose of Lexapro at a time.

Lexapro medication dosage for adults:

The recommended dosage of Lexapro is 10 mg once a day. If necessary, the doctor may increase the dosage to 20 mg after a minimum of one week. The higher dosage will probably not be recommended for senior adults and people who have liver problems.

Lexapro Overdosage:

Taking massive amounts of Lexapro can be fatal. If you suspect a Lexapro overdosage, you should seek medical attention immediately.

Typical symptoms of Lexapro medication overdosage:

Seizures, rapid heartbeat, drowsiness, vomiting, tremors, nausea, sweating, dizziness
There have also been some rare cases of Lexapro overdosage causing memory loss, confusion, breathing problems, muscle wasting, irregular heartbeat

Storage of Lexapro

This medication should be stored at room temperature.

Summary of Lexapro medication side effects and dosages:

Lexapro is a medication with well-known side effects and effective dosages. Always follow your physician’s recommendations and pay attention to the physiological changes in your body as your specific Lexapro medication side effects cannot really be anticipated and dosages may need to be adjusted accordingly.

Some information adapted from the PDR Pocket Guide to Prescription Drugs (Sixth Edition) by Paul Susic Ph.D. Licensed Psychologist




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Unspecified Depressive Disorder Symptoms and Related DSM–5 Diagnosis





Unspecified Depressive Disorder 311 (F32.9)

Information related to Unspecified Depressive Disorder as well as the specific symptoms follow below. While some of these Unspecified Depressive Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis. A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.

Unspecified Depressive Disorder 311 (F32.9) Diagnostic criteria:

This category applies to presentations in which symptoms characteristic of a depressive disorder that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The Unspecified Depressive Disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis such as in an emergency room setting.

Adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM-5: American Psychiatric Association




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Other Specified Depressive Disorder Symptoms and Related DSM-5 Diagnosis





Other Specified Depressive Disorder 311 (F32.8):

Information related to Other Specified Depressive Disorder as well as the specific symptoms follow below. While some of these Other Specified Depressive Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis. A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.




Other Specified Depressive Disorder 311 (F32.8) diagnostic criteria:

This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The Other Specified Depressive Disorder category is used in situations of when the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific depressive disorder. This is done by recording “other specified depressive disorder” followed by the specific reason such as “short-duration depressive disorder”.

Examples of presentations that can be specified using the “other specified” designation include the following:

1. Recurrent brief depression: Concurrent presence of depressed mood and at least four other symptoms of depression for 2-13 days at least once per month (not associated with the menstrual cycle) for at least 12 consecutive months in an individual whose presentation has never met criteria for any other depressive or bipolar disorder and does not currently meet active or residual criteria for any psychotic disorder.

2. Short-duration depressive disorder (4-13 days): Depressed affect and at least four of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persists for more than 4 days, but less than 14 days, in an individual whose presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for recurrent brief depression.

3. Depressive episode with insufficient symptoms: Depressed affect and at least one of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persists for at least two weeks in an individual whose presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for mixed anxiety and depressive disorders.

Adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) American Psychiatric Association


Depressive Disorder Due to Another Medical Condition Symptoms and Related DSM–5 Diagnosis





Depressive Disorder Due to Another Medical Condition:

Information related to Depressive Disorder Due to Another Medical Condition as well as the specific symptoms follow below. While some of these Depressive Disorder Due to Another Medical Condition symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis. A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.





Depressive Disorder Due to Another Medical Condition diagnostic criteria:

A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder such as adjustment disorder, with depressed mood, in which the stressor is a serious medical condition.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Coding Note: The ICD-9-CM code for Depressive Disorder Due to Another Medical Condition is 293.83, which is assigned regardless of the specifier. The ICD-10-CM code depends on the specifier (see below).

Specify if:

(F06. 31) With depressive features: Full criteria are not met for major depressive episode.
(F06. 32) With major depressive-like episode: Full criteria are met (except criterion C) for major depressive episode.
(F06. 34 With mixed features: Symptoms of mania or hypomania are also present but do not predominate in the clinical picture.

Coding Note: Include the name of the other medical condition in the name of the mental disorder such as 293. 83 [F06.31] depressive disorder due to hypothyroidism, with depressive features. The other medical condition should also be coded and listed separately immediately before the Depressive Disorder Due to the Medical Condition such as 244.9 [E03.9] hypothyroidism; 293. 83 [F06.31] depressive disorder due to hypothyroidism, with depressive features.

Adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) American Psychiatric Association



Premenstrual Dysphoric Disorder Symptoms and Related DSM–5 Diagnosis





Premenstrual Dysphoric Disorder 625.4 (N94.3)

Information related to Premenstrual Dysphoric Disorder as well as the specific symptoms follow below. While some of these Premenstrual Dysphoric Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis. A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.




Premenstrual Dysphoric Disorder 625.4 (N94.3) Diagnostic Criteria:

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

B. One (or more) of the following symptoms must be present:
1. Marked affective lability such as mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection.
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms, when combined with symptoms from criterion B above.
1. Decreased interest in usual activities such as work, school, friends and hobbies.
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite, overeating or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of being bloated or weight gain.
Note: The symptoms in criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.

D. The symptoms are associated with clinically significant distress or interference with school, work, usual social activities, or relationships with others such as avoidance of social activities; decreased productivity and efficiency at work, school or home.

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or personality disorder (although it may co-occur with any of these disorders).

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation).

G. The symptoms are not attributable to the physiological effects of a substance such as drug of abuse, a medication, other treatment or another medical condition such as hyperthyroidism.

Adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) American Psychiatric Association


Zoloft Medication Benefits, Side Effects and Dosage




Zoloft Medication Overview:

Zoloft is easily one of the most popular medications prescribed for major depressive disorder, a persistently low mood which intrudes in a senior’s daily life. Symptoms often include loss of interest in your normal activities, disturbances in sleep, appetite changes, fidgeting and/or lethargic movement, fatigue, guilt or feelings of worthlessness, and problems with thinking and concentrating. Zoloft has also been prescribed for premenstrual dysphoric disorder. This problem is often characterized by low mood, anxiety or tension, emotional instability, and anger or irritability in the two weeks prior to menstruation. Other symptoms may include loss of interest in normal activities, difficulty concentrating, lack of energy, changes in appetite or sleep patterns, and feeling out of control.

Zoloft is also effective in treating obsessive-compulsive disorder, which includes symptoms of unwanted thoughts that won’t go away (obsessions) and an irresistible urge to repeat certain actions, such as counting and hand washing (compulsions). Zoloft may also be prescribed for the treatment of panic disorder, and post-traumatic stress disorder.

Zoloft is actually an antidepressant and is referred to as a selective serotonin uptake inhibitor. The neurotransmitter serotonin is believed to regulate mood. Usually, serotonin is reabsorbed after its release back into the releasing neuron (nerve cell). Zoloft, as well as other similar medications block the process of “reuptake”, allowing an increase in serotonin to be absorbed by the receiving neurons.

Important Precautions:

It is usually recommended that you don’t take Zoloft within two weeks of taking any medication classified as an MAO inhibitor. Marplan, Nardil and Parnate are drugs within this medication category. When serotonin boosters such as Zoloft are combined with these medications, serious and sometimes fatal reactions have occurred. Also, this drug should be avoided if it causes any allergic reaction.




Special precautions should be taken if you have liver disorder or have had seizures. Zoloft should always be taken under the close supervision of a doctor, and especially when you have the above conditions.
This drug has not usually been found to effect the operation of automobiles or other machinery. However, as with all medications, you should find out how you are effected by Zoloft before you attempt these operations. Also, if you have a sensitivity to latex, you may want to use precaution when you handle the dropper provided with the oral concentrate.

Zoloft: Benefits and Information:

How is Zoloft taken and what should I expect?

This drug should be taken exactly as prescribed, which most often means once a day, either in the morning or the evening.

Zoloft is available in both capsule or oral concentrate forms. You should use the dropper provided when taking the Zoloft oral concentrate. Measure out the amount of concentrate prescribed by your physician and then mix it with 4 oz. of water, ginger ale, lemon/lime soda, lemonade, or orange juice. (You should not mix the concentrate with any other type of beverage.) You should drink the mixture immediately and not save it for later use. A slight haze has been noticed at times after mixing, but is not a problem.

It usually takes several days to a few weeks to see some improvement from Zoloft. Most doctors recommend that you take it for a minimum of at least several months. It has been found to make your mouth dry at times. Many people have found that sucking on hard candy, chewing gum, or chewing on ice may provide some temporary relief.

What If I miss a dose of Zoloft?

You should take the missed dose as soon as you remember unless several hours have passed, at which time you should just skip that dose and try to get back into the usual dosing routine as soon as possible. You should never double up on your dose of Zoloft.

Zoloft storage instructions…

You should always store Zoloft at room temperature.

Zoloft – Possible food and drug interactions:

It is recommended that you not drink alcohol when taking this drug. Also, the use of over-the-counter medications should be used with caution. Although none of these over-the-counter remedies have been found to cause a negative interaction with Zoloft, interactions always remain a possibility.

If Zoloft is taken with other medications, the effects may be increased, decreased or otherwise altered. It is especially important for you to check with your doctor when combining Zoloft with any of the following:

• Cimetidine(Tagamet)
• Diazepam (Valium)
• Digitoxin (Crystodigin)
• Flecaimide (Tambocor)
• Lithium (Eskalith, Lithobid)
• MAO inhibitor drugs such as the antidepressants Nardil and Parnate
• Other serotonin-boosting drugs such as Paxil and Prozac
• Other antidepressants such as Elavil and Serzone
• Over-the-counter drugs such as cold remedies
• Propafenone (Rythmol)
• Sumatriptan (Imitrex)
• Tolbutamide (Orinase)
• Warfarin (Coumadin)

If you are using the oral concentrate form of Zoloft, do not take the medicine disulfiram (Antabuse).

If you are pregnant or breast-feeding:

Zoloft has not been adequately tested during pregnancy. If you are pregnant or plan to become pregnant in the near future, consult your doctor immediately. Zoloft should only be taken during pregnancy when you are extremely depressed and the benefits significantly outweigh the risks. It’s not presently known whether Zoloft appears in breast milk and caution is advised when using this medication during breast-feeding.

Zoloft Side Effects

Zoloft Side Effects: What do I need to know?

Zoloft side effects cannot really be anticipated but, if any develop or change in intensity, you should notify your doctor immediately. Only your physician will be able to tell you whether you should continue taking this medication.

Some of the more common Zoloft side effects may include:

Abdominal pain, agitation, anxiety, constipation, decreased sex drive, diarrhea or loose stools, difficulty with ejaculation, dizziness, dry mouth, fatigue, gas, headache, and decreased appetite are some of the more common Zoloft side effects. And, they also may include increased sweating, indigestion, insomnia, nausea, nervousness, rash, pain, sleepiness, sore throat, tingling or pins and needles, tremor, vision problems and vomiting.

Less common and much rarer Zoloft side effects may include:

Acne, allergic reaction, altered taste, back pain, blindness, breast development in males, breast pain or enlargement, breathing difficulties, bruise-like marks on the skin, cataracts, changeable emotions, chest pain, cold, clammy skin, conjunctivitis (pinkeye), coughing, difficulty breathing, difficulty swallowing, double vision, dry eyes, eye pain, fainting, feeling faint upon arising from a sitting or lying position, feeling of illness, female and male sexual problems, and fluid retention. Other less common Zoloft side effects may include blushing, frequent urination, hair loss, heart attack, hemorrhoids, hiccups, high blood pressure, high pressure within the eye (glaucoma), hearing problems, hot flushes, impotence, inability to stay seated, increased appetite, increased salivation, increased sex drive, inflamed nasal passages, inflammation of the penis, intolerance to light, irregular heartbeat, itching, joint pains, kidney failure, lack of coordination, lack of sensation, leg cramps, menstrual problems, low blood pressure, migraine, movement problems, muscle cramps or weakness, need to urinate during the night, nosebleed, pain upon urination, prolonged erection, purplish spots on the skin, racing heartbeat, rectal hemorrhage, respiratory infection/lung problems, ringing in the ears, rolling eyes, sensitivity to light, sinus inflammation, skin eruptions or inflammation, sleepwalking, sore on tongue, speech problems, stomach and intestinal inflammation, swelling of the face and throat, swollen wrist and ankles, thirst, throbbing heartbeat, twitching, vaginal inflammation, hemorrhage or discharge, and yawning.

Zoloft side effects may also include mental symptoms such as:

Abnormal dreams or thoughts, aggressiveness, exaggerated feeling of well-being, depersonalization (unreal feeling), hallucinations, impaired concentration, memory loss, paranoia, rapid mood shifts, thoughts of harming yourself, tooth grinding, and worsening depression.

It may also include the loss of several pounds for some people taking this medication. This usually doesn’t pose much of a problem, but could be a concern if your depression has already caused significant weight loss.
In a few people, Zoloft side effects may also trigger manic or hypomanic episodes which include sensations of high energy, lack of need for sleep, grandiose thoughts and feelings and generally inappropriate and out-of-control behavior.

Zoloft Dosage: What is the right amount?


General Zoloft Dosage Information

Adults

Zoloft dosage for Depressive or Obsessive Compulsive Disorder
The usual starting Zoloft dosage is 50 mg once a day, taken either in the morning or in the evening. Your doctor may increase the amount depending upon your response to the medication. The maximum Zoloft dosage is 200 mg in one day.

Zoloft dosage for Premenstrual Dysphoric Disorder

Zoloft may be prescribed throughout the menstrual cycle or limited to the two weeks preceding menstruation. The starting Zoloft dosage is 50 mg a day. If this is insufficient the doctor may increase the amount in 50 mg steps at the start of each menstrual cycle up to the maximum of 100 milligrams per day in the 2-week regimen, or 150 mg per day in the full-cycle regimen.(During the first three days of the two-week regimen, doses are always limited to 50 mg).

Zoloft dosage for Panic Disorder and Post-Traumatic Stress Disorder

The most common Zoloft dosage during the first week is 25 mg once a day. After that, the dose may be increased to 50 mg once a day. Depending upon your response, your doctor may continue to increase your Zoloft dosage up to a maximum of 200 mg a day.

Children

Zoloft dosage for Obsessive-Compulsive Disorder

The initial Zoloft dosage for children aged 6 to 12 is 25 mg, and for adolescents aged 13 to 17, is 50 mg per day. Your physician should adjust the dose as needed. The safety and effectiveness have not been established for children under the age of six.

Zoloft Overdosage

Many medications taken in excess of the recommended dosage can have serious consequences. An overdose of Zoloft can possibly be fatal. If you suspect an overdose seek medical attention immediately.

Common symptoms of Zoloft overdose include:

Agitation, dizziness, nausea, rapid heartbeat, sleepiness, tremor, and vomiting
Other less common symptoms include coma, stupor, fainting, convulsions, delirium, hallucinations, mania, high or low blood pressure, and slow, rapid, or irregular heartbeat.

Information adapted from the The PDR Pocket Guide to Prescription Drugs – Sixth Edition By Paul Susic Ph.D. Licensed Psychologist




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Disruptive Mood Dysregulation Disorder Symptoms and Related DSM–5 Diagnosis




Disruptive Mood Dysregulation Disorder 296. 99 (F34.8)

Information related to Disruptive Mood Dysregulation Disorder as well as the specific symptoms follow below. While some of these Disruptive Mood Dysregulation Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis. A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.

Disruptive Mood Dysregulation Disorder diagnostic criteria 296. 99 (F34.8):




A. Severe recurrent temper outbursts manifested verbally such as with verbal rages and/or behaviorally such as in physical aggression toward people or property that are grossly out of proportion in intensity or duration to the situation or provocation.

B. The temper outbursts are inconsistent with the developmental level.

C. The temper outbursts occur, on average, three or more times per week.

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others such as parents, teachers or peers.

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting three or more consecutive months without all of the symptoms in criteria A-D.Criteria A and D are present in at least two or three settings such as at home, at school, with peers, and are severe in at least one of these.

F. The diagnosis should not be made for the first time before age 6 years or after age 18 years.

G. By history or observation, the age of onset of criteria A-E is before 10 years.

H. There’s never been a distinct period lasting more than one day during which the full symptom criteria, except duration, for manic or hypomanic episode has been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

I. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder such as autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia].
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.

J. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.

Diagnostic Information and Criterion for Disruptive Mood Dysregulation Disorders from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association

Additional information by Paul Susic Ph.D. Licensed Psychologist



Depression Symptoms and Information You Must Know




Depression Symptoms and Information:

Depression is a mood disorder that most people have some awareness of, but may not know the various symptoms and what actually defines it as a disorder. Clinical depression is a serious disorder that presents in many ways resulting in various different levels of intensity and consequences. When people refer to the term “depression” they are frequently referring to a sad mood or experience of grief. Clinical depression however is actually a syndrome of at least five symptoms that have lasted for at least two weeks. When evaluating the symptoms of depression, a mental health clinician will analyze whether there has been a change from previous functioning, and must include at least one of the first two symptoms listed below:

1. Depressed or irritated mood
2. Diminished interest or pleasure in all or almost all activities
3. Significant weight loss or weight gain, or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death, suicidal impulses or actions

The depression symptoms described above may actually form a syndrome which is referred to as Major Depressive Episode when it occurs for the first time. If it then reoccurs it is referred to as a Major Depressive Disorder. An individual may have only five of the above symptoms for a relatively short period of time while other individuals may experience many or most of the above symptoms for many years. Obviously, when someone is diagnosed as having Major Depression it is very important. Also, part of the analysis needs to include an assessment of its severity and duration.

Comorbidity of Depression:

The comorbidity of depression refers to when depression presents itself in conjunction with other psychiatric and medical disorders. Older individuals may have significant comorbidity with medical concerns such as heart disease, diabetes, stroke and various other medical concerns. They may also have significant comorbidity with anxiety disorders and other psychiatric diagnoses. Some of the most common comorbid psychological conditions include dysthymia, cyclothymia, anxiety disorders, personality disorders, eating disorders and substance abuse disorders.




Prevalence:
Major depression is easily one of the most common of all mental disorders. It is believed to annually affect about 12.9% of American women on the average and is about 1.7 times higher than the rate for males in the United States. Also, it is believed that at least 20% of adults in the United States population will experience clinical depression during their lives. Many researchers and mental health clinicians believe that the incidence of depression has increased in recent years and that could be as much as 50% higher by the year 2050 than it is presently.

Age of Onset:

The most typical pattern of the initial presentation of major depression is for it to occur for the first time in individuals in their mid to late adolescence. However, a first or recurrent episode can occur at any point in an individual’s life. It was previously believed that young children could not experience clinical depression, but this viewpoint has changed and it is now believed that it is indeed possible. In most cases however, the symptom patterns among children are somewhat different than for adults.

Course:

Major Depressive Disorder usually lasts between four months and one year if you do not seek treatment according to statistics by the American Psychiatric Association. Antidepressant medications and psychotherapy have been found to be helpful and effective in treating Major Depression, although it is commonly recognized to be chronic, recurrent and have high relapse rates. Obviously, recurrent and severe patterns of Major Depression are much more difficult to treat than an episodic and less intense depression.

Gender

As previously mentioned, American females have an incidence of depression at a rate of 1.7 times that of males. That pattern seems to begin in early to middle adolescence and continue throughout adulthood and even into the senior years. Many explanations have been proposed to account for these differences between the sexes including hormonal differences, gender roles, and various other issues related to socialization and differences in coping styles.

Impairment and Other Concerns:

Individuals actually diagnosed with clinical depression may experience significant levels of emotional, physiological, behavioral and cognitive impairment that may affect many aspects of their daily functioning. For instance, many individuals with depression experience a negative impact upon their ability to work, function well in school or cause difficulties in interpersonal relationships with friends, spouses and children.

Making a diagnosis of depression:

In order to make a formal diagnosis of depression, a mental health clinician will first assess whether an individual has a specific constellation of depressive symptoms. Then they will determine whether they are of a high enough level of severity to impair their functioning and are not attributable to the effects of substance abuse or a medical disorder. The diagnosis should not be made unless the symptoms last longer than two months following an incidence of bereavement or grief. As stated previously, some other psychological disorders also include some of the features of clinical depression such as bipolar disorder and schizoaffective disorder. These other mental health syndromes need to be ruled out and the symptoms need to be differentiated from these other disorders in order to have a diagnosis of depression.

Major Depressive Disorder in the Older Adult:

Depression and Major Depressive Disorder frequently occur among the elderly as well as among younger individuals. However, there are unique concerns related to the elderly in that older individuals with depression frequently experience impairment in their thinking or cognitive skills as part of the clinical syndrome. Depression among seniors may actually simulate dementia as individuals experience concentration difficulties, memory loss and distractibility. It is very common for dementia and Major Depressive Disorder to co-occur. Comorbidity is common. It is not very often however that findings of dementia are fully explained on the basis of depression or what is referred to as a pseudodementia.

Some studies have found that the prevalence of Major Depressive Disorder among older individuals in nursing homes may be as high as 30%. It has a tendency to frequently occur in the presence of medical conditions such as heart disease and stroke which also then complicates the treatment for both the depression and the primary medical conditions. Careful evaluation of medications is imperative which may also help explain some of these associated symptoms. When older adults have their first occurrence of depression, they must be carefully evaluated for the comorbid medical conditions such as undiagnosed cancer, cerebral ischemic events, or complications of metabolic conditions such as adult onset diabetes mellitus and thyroid dysfunction.

By Paul Susic Ph.D. Licensed Psychologist




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