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Depression A Wellness Education Centre Info Kit CONTENTS WHAT IS DEPRESSION? o HOW LONG DOES DEPRESSION LAST? o DOES DEPRESSIVE ILLNESS FOLLOW A PATTERN? o WHO GETS DEPRESSION AND WHAT CAUSES IT? o PERSONAL DESCRIPTIONS OF DEPRESSION FROM SUFFERERS WHAT CAN BE DONE ABOUT DEPRESSION? o WHAT CAN FRIENDS AND FAMILY DO? SIGNS AND SYMPTOMS OF DEPRESSION o A DEPRESSION CHECKLIST SEASONAL AFFECTIVE DISORDER (S.A.D.) BIPOLAR DISORDER SUICIDE o RISK FACTORS AND WARNING SIGNS o EFFECT OF SUICIDE ON FELLOW STUDENTS o HOW TO HELP SOMEONE AFFECTED BY SUICIDE o WHO TO CONTACT FOR HELP YOU ARE NOT ALONE: FAMOUS PEOPLE WITH DEPRESSIVE DISORDERS RESOURCES What is Depression? Depression affects both the mind and the body. Once in a while, everyone feels sad or becomes discouraged, but usually these mood changes are temporary. However, when a depressed mood begins to be ongoing and interferes with everyday living, it can be the sign of serious depression. Depression is: A serious illness that, left untreated, will continue to affect a person’s o Appetite o Sleep o Interest and pleasure in life o Mood (irritability, sadness, anxiety) o Sex life o Productivity at work or school Either episodic (occurring once or every so often) or chronic (lasting months or years at a time) No one’s fault - depressive disorders are diseases like any other, and must be treated as such. Depression is not: Something someone can just “get over” Anyone’s fault – this cannot be stressed enough. In seniors: senility, stroke, or part of the natural aging process In children: a behavioural problem Anything other than a real disease much like physical diseases How long does depression last? Not everyone experiences clinical depression the same. Severity, frequency and duration depend on the individual, lasting weeks to months. Depression can end naturally, however treatment can help speed up the process. It is important to remember that depression rarely becomes permanent. Does depressive illness follow a pattern? Unfortunately, once a person has had a clinical depression, he/she is more likely to suffer from depression again. For example, some people experience seasonal cycles of depression, particularly in winter. This is called Seasonal Affective Disorder (SAD). Source: http://www.cmha.ca/bins/content_page.asp?cid=3-86-87 Who gets depression and what causes it? Depression is thought to be caused by a biochemical imbalance in a person’s brain, causing the brain to send “depressed” signals even when the person has reason to feel content. Depression is a common problem and can strike at any age. There is no single cause of depression. Sometimes, stressful and discouraging situations overwhelm us on a continual basis and have the potential to contribute to serious depression. The onset of depression may be attributed to some of the following factors: Life changes, such as transition from high school to university o Death or illness of someone close Difficulties with one’s job, finances, or personal relationships o Unexpressed emotional burdens Poor self-esteem Genetic predisposition (family history of depression) Physical stress of surgery Physical illness or side-effects of medication Depression knows no economic, geographic, social, or cultural boundaries. It affects men, women, and children of all ages. However, depression affects women more than twice as much as men. Statistics indicate that 1 in 4 women and 1 in 10 men can expect to develop depression at some point in their life. Depression has a genetic and hereditary link; that is, someone who has relatives with depression may be at higher risk of having depression themselves. Personal descriptions of depression From Toronto Star Newspaper Special June 11-June 13 2003 o “Molasses on the mind – a total lack of energy.” o “Numb… dead inside.” o Everything seemed enveloped in a black cloud. I even saw colours differently.” o “It was like someone had put a ton of bricks on my chest and it was pressing down, going right through me. All I wanted to do was disappear.” o “When I was low, I’d have trouble functioning – just black, horrible, horrible black moods. You feel like you can’t do anything. Nothing works, nothing is right.” What can be done about depression? Knowledge is key for a person seeking treatment for depression. Depression is often stated as one of the most common and most treatable mental health problems. However, each person’s experience of depression is different and may require different methods of treatment. Many people who are seriously depressed wait too long to seek treatment or they may not seek treatment at all. They may not realize that they have a treatable illness, or they may be concerned about getting help because of the negative attitudes held by society towards this type of illness. It is important to understand that depression is not something that someone should feel guilty about. Depression is not always something that can be controlled. There are things that a person can do to help him/herself or a loved one recover from depression. Some approaches that may be helpful include: Counseling or therapy Exercise Acupuncture Meditation Maintaining good nutrition Support from people who are understanding Medication What can friends and family do? It can be difficult to be with and to help someone who is seriously depressed. Some people who are depressed keep to themselves, while others may not want to be alone. They may react strongly to the things you say or do. It is important that you let them know that it is okay to talk about their feelings and thoughts. Listen and offer support rather than trying to contradict them or talk them out of it. Let them know you care. Support them as they try to determine the type of help/support the need or are willing to pursue (e.g., calling their family doctor or a mental health professional, looking into local self-help groups and attend a meeting with them). Try to be patient and non-judgmental. Most of all don't do it alone - get other people to provide help and support too. Signs and Symptoms of Depression Symptoms according to the DSM-IV (Diagnostic and Statistical Manual IV*) 1. Depressed mood most of the day, nearly every day. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day 3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day 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 nearly every day (not merely self-reproach or guilt about being sick) 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation* without a specific plan, or a suicide attempt or a specific plan for committing suicide A checklist for depression o Have you lost interest in your favourite hobbies and sports? o Do you feel sad, or start crying, often for no reason at all? o Have you lost enjoyment in spending time with family and friends? o Have you lost your appetite or been overeating? o Is it hard to get to sleep and your sleep is restless and broken OR are you feeling so tired you want to sleep all the time? o Have you lost interest in sex when you were previously interested? o Are you thinking a lot about death, suicide, or hurting yourself? o Do you feel worthless, guilty, or like you are a burden to others? o Do you have trouble concentrating or making decisions? * What do all these technical words mean? What is the DSM-IV? A manual used by psychiatrists to diagnose mental illness. Insomnia is getting too little sleep; hypersomnia is sleeping excessively Psychomotor agitation: restlessness, pacing, tapping fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around, and more. Psychomotor retardation: real physical difficulty performing activities that normally would require little thought or effort, such as walking upstairs, simply getting out of bed, clearing dishes from the table, doing laundry. Suicidal ideation: thoughts of taking one’s life If these feelings describe you, and have been persistent for two weeks or more, you may have depression. Please call a support centre or a doctor for help. There’s hope, there’s help, and there’s effective treatment. Seasonal Affective Disorder (S.A.D.) Source: http://www.cmha.ca/bins/content_page.asp?cid=3-86-93 Fall and winter are the SAD seasons. Winter is filled with gray skies and cold rain and snow. The SAD season births its symptoms around the time when we set our clocks to “fall back” an hour for Daylight Savings Time. This change in time results in our shorter daylight hours appearing even shorter. As a result, many people experience the symptoms of clinical depression during the winter months. A mild form of SAD, often referred to as the “winter blues," causes discomfort, but is not incapacitating. However, the term “winter blues” can be misleading; some people have a rarer form of SAD which is summer depression. This condition usually begins in late spring or early summer. What are the Symptoms? SAD can be difficult to diagnose, since many of the symptoms are similar to those of other types of depression or bipolar disorder. Generally, symptoms that recur for at least 2 consecutive winters, without any other explanation for the changes in mood and behaviour, indicate the presence of SAD. They may include: o o o o o o o o o o change in appetite, in particular a craving for sweet or starchy foods weight gain decreased energy fatigue tendency to oversleep without feeling refreshed difficulty getting out of bed difficulty concentrating irritability avoidance of social situations feelings of anxiety and despair The symptoms of SAD generally disappear when spring arrives. For some people, this happens suddenly with a short time of heightened activity. For others, the effects of SAD gradually dissipate. Symptoms of summer depression may include poor appetite, weight loss, and trouble sleeping. If you feel depressed for long periods during autumn and winter, if your sleep and appetite patterns change dramatically, or if you find yourself thinking about suicide, you should seek professional help - for example, from your family doctor. What Causes SAD? As yet, there is no confirmed cause of SAD. However, SAD is thought to be related to seasonal variations in light. A “biological internal clock” in the brain regulates our circadian (daily) rhythms. The relatively recent introduction of electricity has relieved us of the need to be active mostly in the daylight hours, but our biological clocks may still be telling our bodies to sleep as the days shorten. This puts us out of step with our daily schedules, which no longer change according to the seasons. Other research shows that neurotransmitters, chemical messengers in the brain that help regulate sleep, mood, and appetite, may be disturbed in SAD. Who is at Risk of SAD? o Research in Ontario suggests that between 2% and 3% of the population may have SAD. Another 15% have a less severe experience described as the “winter blues". o SAD tends to begin in people over the age of 20. The risk of SAD decreases with age. The condition is more common in women than in men. o Recent studies suggest that SAD is more common in northern countries, where the winter day is shorter. Deprivation from natural sources of light is also of particular concern for shift workers and urban dwellers. How is SAD Treated? There is effective treatment for SAD. Even people with severe symptoms can get rapid relief once they begin treatment. o Spend more time in the light. People with mild symptoms can benefit from spending more time outdoors during the day and by arranging their environments so that they receive maximum sunlight. Keep curtains open during the day, move furniture so that you sit near a window, and add more lamplight to your room! o Exercise. Exercise relieves stress, builds energy and increases your mental and physical well-being. If you exercise indoors, position yourself near a window. Make a habit of taking a daily noon-hour walk. o Eat less refined sugar and flour. People with SAD often crave high-sugar foods. Work at resisting the carbohydrate and sleep cravings that come with SAD. o Go on vacation. A winter vacation in a sunny destination can also temporarily relieve SAD symptoms, although symptoms usually recur after returning home. o Light therapy. Many people with SAD respond well to exposure to bright, artificial light. "Light therapy" involves sitting beside a special light box for several minutes per day. Consult your doctor before beginning light therapy. o Medication and counseling. For people who are more severely affected by SAD, antidepressant medications are safe and effective in relieving symptoms. Counseling and therapy, especially short-term treatments such as cognitivebehavioural therapy, may also be helpful. SAD Symptoms 1. Change in Sleep Patterns o oversleeping but not refreshed o o cannot or reluctantly get out of bed require afternoon naps 2. Depression o o o o o o o feelings of despair, misery, guilt, anxiety, hopelessness, etc. normal tasks become frustratingly difficult withdrawal from friends and family avoiding company crankiness or irritability lack of feeling/emotion constant state of sadness 3. Lethargy o decreased energy o everything an effort o decreased productivity 4. Physical Ailments o o o o o joint pain stomach problems lowered resistance to infection weight gain premenstrual syndrome (worsens or only occurs in winter) 5. Behavioural Problems o o o o appetite changes (usually increased appetite) carbohydrate craving loss of interest in sex difficulty concentrating o not accomplishing tasks SAD Treatments Low fat diet, without too much protein Daily vitamin with magnesium, B complex, and minerals Elimination of caffeine Reduce Stress Elimination of refined sugars and flours o Walking or aerobic exercise Saint John's Wort Mustard Flower Essences o Herbal remedies Thirty minutes each day in the fresh air (in the sunlight if the weather permits, don't forget sunscreen!) Light therapy (Light, whether it is natural or artificial is essential in your life) Bipolar Disorder From: The National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/bipolardisorder/complete-index.shtml People with bipolar disorder, or manic depressive disorder, experience alternating mood swings, from emotional highs (mania) to lows (depression). These mood swings are not necessarily related to events in the person’s life, and are not caused by recreational drug use. The condition can range from mild to severe. Bipolar disorder affects approximately 1% of the population; it typically starts in late adolescence or early adulthood and affects men and women equally. It is not known what causes bipolar disorder. Research suggests that people with the condition have a genetic disposition. It tends to run in families. Drug abuse and stressful or traumatic events may exacerbate to or trigger episodes. Symptoms of a manic phase include: Feelings of euphoria, extreme optimism, exaggerated selfesteem Rapid speech, racing thoughts Decreased need for sleep Extreme irritability Impulsive and potentially reckless behaviour Symptoms of the depression phase are the same as in major depression. Depression and bipolar disorder are treatable. Learning to recognize the signs and triggers enables people to work with their doctors, other health professionals, family and friends to prevent recurrences from becoming severe. Bipolar disorder is mainly treated with medication and psychotherapy. Medication helps to stabilize moods, while therapy helps people detect patterns and triggers and develop strategies for managing stress. Occasionally, electroconvulsive therapy, or ECT, is used. The majority of depressed people respond to treatment and nearly all who seek treatment will get some relief from their symptoms. Both medication and some forms of counselling or psychotherapy have been demonstrated to be effective. Suicide Who is at the highest risk? o o o o o Those with past or current psychiatric disorders of any nature, including major depression, bipolar disorder, conduct disorders or alcohol/drug abuse problems Those with a family history of a psychiatric disorder Those who have experienced previous losses of people important to them Those with personal experience with suicide, e.g. having had someone close to them commit suicide Those who have previously attempted suicide Possible warning signs indicating at-risk individuals o o o o o o o o o o o o o o o Lack of motivation and interest in school or work Extreme weight gain or loss, change of appetite Aggressiveness and violent behaviour Anxious behaviour, fretfulness, worrying about seemingly minor occurrences Increased use and abuse of drugs and alcohol Manic symptoms – excessive energy, grandiose thoughts or inflated selfesteem, high heart rate and irregular breathing, etc. Sleep difficulties – either insomnia or oversleeping (anything that is a change from the person’s usual pattern) Extreme irritability Unpredictable mood changes Inability to keep up with personal care and hygiene Loss of interest in previously enjoyed activities, friendships, and socializing Bodily complaints – stomach upset, headaches, etc. Hopelessness, talk of giving up Feelings of guilt Inability to concentrate and make decisions Serious signs to watch for o o o o o o o o Taking unusual and excessive risks (driving recklessly, unsafe sex) Preoccupation with death, dying, or suicide (includes joking about death or suicide, creative writing, poetry, artwork) A sudden elated mood following a time of depression Talking about committing suicide Making a plan for suicide Giving away valued possessions Writing a will or farewell letters Comments along the lines of: “Nothing ever goes right for me.” “Nothing matters anyway.” “I hate life.” “I can’t take it anymore.” “Everyone would be better off without me.” Effect of Suicide on Fellow Students Students do undoubtedly experience a great tragedy with the suicide of a fellow student. The psychological ramifications of a suicide on the surviving peers have far reaching implications, and the grieving process is quite different from other types of deaths. Students do not need to know the victim to be adversely affected by a suicide. Oftentimes, students who are already dealing with psychological issues, or have personal experience with suicide, will suffer adverse consequences upon the suicide of a peer. The effects of a suicide on surviving peers may last for many months regardless if they knew the victim or not. Just because a significant amount of time has passed, students will not necessarily be “over it”. Psychological consequences may take some time to develop. There is a very real possibility of contagion effects (imitative suicide), which may be more likely to occur in those that do not know the victim. Those who are close to the victim, see the effects that the suicide has on the friends and loved ones, and thus are less likely to commit suicide themselves. The danger for contagion effects lies in those who already are experiencing suicidal ideation, and something like this may give them the “push” to commit suicide themselves. It is important that your students are aware that there are others who are feeling the same way as they are. Postvention is not just needed in the days following the suicide; it is needed for a significant time after. Taken from Senior Residence Assistant Deanna Bowen’s letter to Residence Assistants How you can help someone affected by a suicide o o o Talk to the person (and listen!), even if they appear to be fine; covering up the tragedy won’t help them. Remember that talking about the suicide is necessary and helpful. If you cannot answer the person’s questions, provide resources for them or direct them to someone else who can: for example a counselor, clergy member, or another trusted individual, or even one of the resources provided at the end of this info kit. 1 Let them know that : o o o o o o o o o o All of their feelings are normal, and it doesn’t mean that they’re crazy – they are in morning. The choice to commit suicide was the person’s own; it’s okay to be angry. It’s important to take one day at a time. If they are uncomfortable talking to you, they should find someone who is a good listener who they trust. Crying is okay. It’s important to get all of their questions and feelings out in the open. They should put off major decisions until they are feeling better. They should expect setbacks. Suicidal thoughts of their own are common, but they don’t need act on them. If they feel unable to cope, they should get professional help! Take care of yourself! We are not super-humans, and we need to evaluate how we are doing, too. 1 Mauk GW, Weber C (1991). Peer Survivors of Adolescent Suicide: Perspectives on Grieving and Postvention. Journal of Adolescent Research. 6: 113-131. Feeling Down? Depressed? Suicidal? Don’t be afraid to take action and ask for help. Who you can call/see immediately: Call 911 Campus Police: 519-824-4120 ext. 2000 rd Counselling Services: 3 floor UC, 519-824-4120 ext. 53244 Student Support Network: Drop-in Centre open 12pm – 10pm, Mon-Fri Located at Raithby House Here 24/7: 1-844-437-3247 A MESSAGE FROM The Wellness Education Centre https://www.uoguelph.ca/studenthealthservices/wellness nd 2 floor, J.T. Powell Building (above Student Health Services) 519.824.4120 ext. 53327 · [email protected] Open 8.30 am – 4.30 pm Monday to Friday all semesters If you have depression, you are not alone! Depression knows no economic, geographic, social, or cultural boundaries. It affects men, women, and children of all ages. Famous People with Depressive Disorders These prolific and successful writers, composers, musicians, poets, political figures and entertainers all experienced depression or bipolar disorder (formerly known as manic depression). Hans Christian Andersen, Roseanne Arnold, Honore de Balzac, James Barrie, Irving Berlin, Anton Bruckner, Robert Burns, Lord Byron, Jim Carrey, Dick Cavett, Eric Clapton, Noel Coward, Hart Crane, Richard Dadd, Charles Dickens, Emily Dickinson, Patty Duke, T.S. Eliot, William Faulkner, F. Scott Fitzgerald, Stephen Foster, Connie Francis, Peter Gabriel, Vincent Van Gogh, Oliver Goldsmith, Charles Haley, George Frederic Handel, Ernest Hemingway, Jimi Hendrix, Herman Hesse, Gerard Manley Hopkins, Victor Hugo, Samuel Johnson, John Keats, Edward Lear, Vivien Leigh, Abraham Lincoln, Jame Russell, Kristy McNichol,, Michelangelo, Edvard Munch, Edna St. Vincent Millay, Charles Mingus, Modest Mussorgsky, Georgia O’Keeffe, Eugene O'Neill, Abigail Padgett, Edgar Allen Poe, Cole Porter, Charley Pride, Sergey Rachmaninoff, Giocchino Rossini, Robert Schumann, Anne Sexton, Robert Louis Stevenson, William Styron, James Taylor, Peter Tchaikovsky, Tennyson, Mark Twain, Walt Whitman, Robin Williams, Tennessee Williams, Virginia Woolf, and more. Resources Help lines o Here 24/7: 1-844-437-3247 o Good2Talk: 1-866-925-5454 o OUTline: 519-836-4550 o Guelph-Wellington Women in Crisis: 1-800-265-7233 o Community Torchlight Crisis Line: 1-877-822-0140 On Campus Resources o Student Health Services – J.T. Powell Building Hours (Mon-Fri): 8:30-4:00 Tel: 519-824-4120 ext. 52131 o The Wellness Education Centre – 2nd floor of J.T. Powell Building Hours (Mon-Fri): 8:30am-4:30pm Tel: 519-824-4120 ext. 53327 Email: [email protected] o Counselling Services – 3rd floor of University Centre Hours (Mon-Fri): 8:15am-4:15pm Drop in hours: 12:30pm-3:30pm Tel: 519-824-4120 ext. 53244 Email: [email protected] o Student Support Network – Raithby House Hours: 12:00pm-10:00pm Websites: Mental Health Service Information Ontario: For Mental Health Services in your area - http://www.mentalhealthhelpline.ca/ Mood Disorders Society of Canada: www.MoodDisordersCanada.ca CANMAT Canadian Network for Mood and Anxiety Treatments: http://www.canmat.org/ National Institute of Mental Health: http://www.nimh.nih.gov/index.shtml Canadian Mental Health Association: http://ontario.cmha.ca/, http://www.cmha.ca/ Health Canada Mental Health Site: http://www.hc-sc.gc.ca/hl-vs/mental/index-eng.php Centre for Addiction and Mental Health: http://www.camh.ca/en/hospital/Pages/home.aspx En Français: http://www.ampq.org/, http://www.ataq.org/ , http://www.revivre.org/