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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 PhD Licensed Psychologist



Major Depressive Disorder Diagnosis and Symptoms




Major Depressive Disorder Diagnosis

Major depressive disorder is diagnosed as major disorder, single episode or having recurrent episodes and is also rated in terms of severity such as mild, moderate or severe. It has been part of the DSM diagnostic system used by mental health professionals for many years. It is probably the most often diagnosed disorder by mental health clinicians. The National Institute of Mental Health estimates that 6.7% of the population in the United States suffer from major depressive disorder in any given year. Unfortunately, as reported by the Substance Abuse and Mental Health Services Administration in 2008 only about 64.5% of individuals experiencing major depressive disorder seek treatment.

In order to receive a major depressive disorder diagnosis, you must experience nearly every day (usually all day) either a low mood or lack of interest in your daily activities and interests or both. Additionally, you may experience a loss of appetite, fatigue, problems with sleeping, suicidal ideation, agitation, trouble concentrating, and feelings of excessive guilt. Major depressive disorder can lead to a variety of physical and emotional problems and can be a chronic illness requiring long-term psychotherapy, and/or medical and biological treatments.

Major Depressive Disorder Diagnosis and the Bereavement Exclusion:

An exclusion for bereavement was removed from the DSM-5. Previous editions of the DSM had an exclusion for individuals who experience depression for up to two months after the death of someone of significance. Some individuals criticized the removal of the exclusion stating that the existence of bereavement could pathologize the normal grieving process. However, the American Psychiatric Association concluded that normal grieving frequently occurs without a diagnosis of major depressive disorder.

Basic Features of a Major Depressive Disorder Diagnosis:

A major depressive disorder diagnosis can be given at any age although the prevalence seems to increase often after an individual gets to the age of puberty. First episodes can occur in middle age or even for senior citizens although it seems to peak when individuals are in their early twenties. As previously stated, major depressive disorder can be diagnosed to consist of either a single or recurrent episode. It must consist of at least five of the nine criteria below. It is also important to recognize that these criteria must define a change from the individual’s previously normal level of functioning. The symptoms must continue for at least a two-week period of time. Mental health clinicians need to be very considerate that they do not include symptoms related to another medical condition when diagnosing major depressive disorder.

There are very high mortality rates associated with major depressive disorder. Some estimates have found that as many as 40.3% individuals diagnosed with major depressive disorder have suicidal ideation within a given year and approximate 10.4% actually make an attempt.

Psychologists and mental health clinicians frequently use depression screening and suicide assessment instruments to closely monitor clients with moderate to severe depression symptoms. Occasionally, an individual may require a higher level of care such as hospitalization.

Major Depressive Disorder Diagnosis: Cultural Considerations

It is also very important to understand that there are cultural considerations related to major depressive disorder. It has been found that Latinos may be more susceptible to major depressive disorder especially if they are recent immigrants or they have had trouble acclimating to the new culture. Native Americans seem to have relatively the highest risk of prevalence for major depressive disorder over their entire lifetime. Some studies have found rates as high as 19.17%. The second highest cultural group of individuals with diagnosed major depressive disorder are Caucasian Americans with a rate of approximately 14.58% followed by Latinos at 9.64%, African-Americans at 8.93% and Asian Americans and Pacific Islanders at 8.77%.

It is important to understand that culture affects not only the prevalence rates of the different ethnic groups but also influences their experience of the symptoms, the language that they use to report the symptoms as well as influences their decision whether to seek treatment or not. It may affect every aspect of their diagnosis and care.

Treatment for Major Depressive Disorder:

Most of treatments for major depressive disorder fall within the categories of either psychotherapy or depression medication or in many cases both. Clinical experience seems to indicate that in many cases the optimum treatment may require both psychotherapy and medication management of depression symptoms.

Coding for Major Depressive Disorder:

Major depressive disorder is diagnosed as having either single or recurrent episodes. Also, the severity level such as mild, moderate, severe and with psychotic features are also specified to note the unique aspects of the course of the disorder. Major depressive disorder specific codes can be found on the previous page.
Please see below for specific symptoms for major depressive disorder.




Major Depressive Disorder diagnostic criteria:

A. Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., A change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear dying), recurrent suicidal ideation without a specific plan, or suicide attempt or specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note: Criteria A-C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in criteria a, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of major depressive episode in addition to normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on individual’s history and cultural norms for the expression of distress in the context of loss.

D. The occurrence of the major depressive episode is not better explained by seasonal affective disorder, schizophrenia, schizophrenic form disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic episode or hypomanic episode.

Note: This exclusion does not apply if all the manic -like or hypomanic-like episodes are substance -induced or are attributable to the physiological effects of another medical condition.

Severity/Course Specifier, Single Episode, Recurrent Episode

Mild 296. 21 (F32.0) 296. 31 (F33.0)
Moderate 296. 22 (F32.1) 296. 32 (F33.1)
Severe 296. 23 (F32.2) 296. 33 (F33.2)
With psychotic features 296. 24 (F32.3) 296. 34 (F 33.3)
In partial remission 296. 25 (F 32.4) 296. 35 (F 33.41)
In full remission 296. 26 (F32.5) 296. 36 (F 33.42)
Unspecified 296.20 (F 32.9) 296.30 (F 33.9)

Specify:

With anxious distress
With mixed features
With melancholic features
With atypical features
With mood congruent psychotic features
With mood-incongruent psychotic features
With catatonia Coding note: Use additional code 293.89 (F06.1).
With peripartum onset
With seasonal pattern

Diagnostic Criterion for Major Depressive Disorder from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association



Major Depressive Disorder: Important Information and Treatment







Major Depressive Disorder Overview:

Major Depressive Disorder is the most commonly diagnosed mental health disorder among adults in the United States. Some studies have found lifetime prevalence rates for men at 9% – 12% and about 20% to 25% for women. According to the American Psychiatric Association, point prevalence rates (the amount of the general population who may have this diagnosis at any given point in time) are 3% for men and 6% for women. These rates have been found to be relatively consistent throughout the lives of both women and men.




The effects of Major Depressive Disorder:

Depression is known to have severe individual and societal effects. Individual suffering includes the emotional aspects of sadness, fatigue, and impaired physical and psychological functioning which may undermine every aspect of an individual’s personal and professional life. Societal burdens are also imposed as individuals have increased utilization of social and medical services and may incur enormous financial expenses for treatment and have a severe impact upon an individual’s productivity at work, school and social responsibilities.

How do I know if I have Major Depressive Disorder?

In order to receive a diagnosis of Major Depressive Disorder you must experience a significant feeling of personal distress and have a reduction in functioning in your normal activities of daily living. Also, the two weeks prior to an assessment by a mental health clinician, you must experience on a relatively daily basis a feeling of low mood (tearful, empty, sad) and/or a significant reduced interest in your normal activities and interests.
The diagnostic manual used by psychologists, psychiatrists and other treatment professionals is the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association in 2013. According to the DSM-5 Major Depressive Disorder “represents the classic condition in this group of disorders. It is characterized by discrete episodes of at least two weeks duration (although most episodes last considerably longer) involving clear-cut changes in affect, cognition, and neurogenerative functions and an inter-episode remissions”. This depressive disorder can be diagnosed after only one episode but is usually recurrent in nature. An important consideration is to separate normal reactions to life experiences such as sadness after loss from a Major Depressive episode. Grief after loss may entail significant suffering but doesn’t necessarily indicate Major Depressive Disorder. When both are experienced simultaneously, the depressive episode seems to be more severe than if it were not occurring at the same time. Grief related depression usually seems to occur in individuals with some vulnerability to depression and treatment may include psychotherapy or antidepressant medication or a combination of both. For more specific criteria to determine whether you have major depressive disorder please see the specific criteria on this website.




In general, some of the main symptoms of major depressive disorder include significant weight loss, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, decreased concentration or indecisiveness, and/or suicidal ideation, plans, or attempts.

Major Depressive Disorder treatment:

There have been major improvements in treatment for depression over the last three or four decades. Some of the current treatments now include somatic interventions which include antidepressant medications and electroconvulsive shock treatment (ECT), as well as a number of psychological treatments such as cognitive behavioral therapy, behavioral therapy and interpersonal psychotherapy. The treatments discussed on this website will only include treatments that have had at least two comparative outcome trials with patients between the ages of 18 and 65 years old. Psychological treatments for Major Depressive Disorder have been studied extensively and have been found to have approximately the same level of effectiveness as antidepressants, although they are frequently combined at times for more efficacious treatment.

By Paul Susic Ph.D. Licensed Psychologist

See Related:

Depressive Disorders and Related DSM-5 Diagnostic Codes
What are the depression medications and how do they work?