Download Depression

DEPRESSION
Chris Ferry, KidsPeace
Objectives
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Depression 101
Types of depression
Risk factors
Common symptoms
Sad vs. Depressed
Impact on body
Self-help
Professional help
Conclusion
Depression 101
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Depression is a very dark place.
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It clouds the depressed person’s mind.
It throws the past in their face (“Look at what you were before
depression!”).
It steals all that is good from the present (“There is nothing wrong
but everything is wrong!”).
Then it threatens the future (“This is how it’s going to be forever.”).
Depression tells the individual they are a disappointment
and a burden to their loved ones, which makes the darker
thoughts easy to believe, that their family would be better
off without them.
Depression 101
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Depression can literally reverse the instinct for selfpreservation, causing the person to consider acts that
would end their own life.
In 2014, an estimated 15.7 million adults aged 18 or
older in the United States had at least one major
depressive episode in the past year.
This number represented 6.7% of all U.S. adults.
 11% of adolescents have a depressive disorder by the age
of 18
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350 million people globally are affected by some form
of depression.
Depression 101
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While major depressive disorder can develop at any
age, the median age at onset is 32.
Women are 70% more likely than men to experience
depression in their lifetime.
$80 billion is the estimated annual cost of depression
in the U.S. due to lost productivity and health care.
50% of Americans with major depression don’t seek
treatment for the illness.
Depression 101
Different Types of Depression
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Major Depression
Persistent Depressive Disorder
Postpartum Depression
Seasonal Affective Disorder
Atypical Depression
Psychotic Depression
Premenstrual Dysphoric Disorder
Bipolar Disorder
Situational Depression
Major Depression
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Extreme sadness, hopelessness, lack of energy, irritability,
trouble concentrating, changes in sleep or eating habits,
feelings of guilt, physical pain, and thoughts of death or
suicide which last for more than two weeks.
A person might only experience one episode of major
depression, but the condition tends to recur throughout a
person's life.
 7% of the adult U.S. population has this debilitating mental
health condition at any given time.
 The best treatment is usually with antidepressant medications
and talk therapy with an estimated 80 to 90 percent of people
responding well to treatment.
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Persistent Depressive Disorder
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Also called dysthymia, this is a depressed mood that
lasts for at least two years. A person may have
episodes of major depression along with periods of
less severe symptom that include sadness, trouble
concentrating, fatigue, and changes in sleep habits
and appetite.
 About
2% of the American population has this form of
depression.
 People can function adequately, but not optimally.
 Usually responds better to talk therapy than to
medications.
Postpartum Depression
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Feelings of extreme sadness, fatigue, loneliness,
hopelessness, suicidal thoughts, fears about hurting the
baby, and feelings of disconnect from the child.
 85%
of new moms feel some sadness after their baby is
born, but for up to 16% of women, that sadness is serious
enough to be diagnosable.
 Can occur anywhere from weeks to months after childbirth.
 Postpartum depression needs prompt and experienced
medical care that may include a combination of talk and
drug therapy.
Seasonal Affective Disorder
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Characterized by the onset of depression during the
winter months, when there is less natural sunlight. This
depression generally lifts during spring and summer
and is typically accompanied by social withdrawal,
anxiety, increased irritability, increased sleep, and
weight gain.
 6%
of people in the United States have seasonal affective
disorder.
 Can be treated with light therapy or artificial light
treatment; exposing patients to bright lights of specific
wavelengths in timed intervals.
Atypical Depression
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Shares many of the typical symptoms of major
depression or dysthymia but is characterized by
improved mood in response to positive events.
Symptoms include increased appetite, sleeping too
much, feeling that arms and legs are heavy, and
feeling rejected.
 Your
depressed mood can brighten in response to positive
events.
 Treatment includes medication, talk therapy and lifestyle
changes.
Psychotic Depression
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Occurs when a person has severe depression plus
some form of psychosis; false fixed beliefs (delusions)
or hearing/seeing upsetting things (hallucinations). The
psychotic symptoms typically have a depressive
“theme,” such as delusions of guilt, poverty, or illness.
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20% of people with depression have episodes so
severe that they see or hear things.
 People may become catatonic, not speaking or leaving
their bed.
 Treatment may require a combination of antidepressant
and antipsychotic medications.
Premenstrual Dysphoric Disorder
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PMDD is a type of depression that affects women
during the second half of their menstrual cycles.
Symptoms include depression, anxiety, and mood
swings.
 Unlike
premenstrual syndrome (PMS), which affects up to
85% of women and has milder symptoms, PMDD affects
about 5% of women and is much more severe.
 PMDD can be severe enough to affect a woman's
relationships and ability to function normally when
symptoms are active.
 Treatment may include a combination of depression drugs
as well as talk and nutrition therapies.
Bipolar Disorder
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Different from depression, but included because
someone with bipolar experiences episodes of
extremely low moods that meet the criteria for major
depression. A person with bipolar also experiences
extreme high euphoric or irritable moods called
“mania” or a less severe form called “hypomania.”
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Symptoms may cycle between depression and mania a
few times per year or much more rapidly.
Affects 2 to 3% of the population and has one of the
highest risks for suicide.
Typically treated with mood stabilizers and talk therapy.
Situational Depression
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Clinically termed adjustment disorder, it is triggered
by a stressful or life changing event, such as a job loss,
death of a loved one, or even a bad breakup.
Symptoms of situational depression may include
excessive sadness, worry, or nervousness.
 Situational
depression is about three times more common
than major depression, and medications are rarely
needed because it tends to clear up over time once the
event has ended.
Risk Factors
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Current research suggests that depression is caused by a
combination of genetic, biological, environmental, and
psychological factors.
Personal or family history of depression
 Major life changes, trauma, or stress
 Certain physical illnesses and medication
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Risk Factors
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Depression often co-occurs with other medical conditions.
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25% of cancer patients experience depression.
10-27% of post-stroke patients experience depression.
1 in 3 heart attack survivors experience depression.
1 in 3 HIV patients experience depression.
50% of Parkinson's disease patients experience depression.
50-75 % of eating disorder patients (anorexia and bulimia)
experience depression.
27% of individuals with substance abuse disorders (both alcohol
and other substances) experience depression.
8.5-27% of persons with diabetes experience depression.
Common Symptoms
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Persistent sad, anxious, or
“empty” mood
Feelings of hopelessness
Irritability, feeling restless or
having trouble sitting still
Feelings of guilt, worthlessness,
or helplessness
Loss of interest or pleasure in
hobbies and activities
Decreased energy or fatigue
Moving or talking more slowly
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Difficulty concentrating,
remembering, or making
decisions
Difficulty sleeping, earlymorning awakening, or
oversleeping
Appetite or weight changes
Suicidal ideations or attempts
Aches or pains, headaches,
cramps, or digestive problems
without a clear physical cause
Sad vs. Depressed
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Feeling sadness, loneliness, or grief when you go through
a difficult life experience is part of being human. And
most of the time, you can continue to function.
But what if you don’t bounce back?
 What if your feelings of sadness interfere with your work,
sleep, or recreation?
 What if you’re feeling fatigue or worthlessness along with
your sadness?
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People with depression cannot simply “pull themselves
together” and get better.
Sad vs. Depressed
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Being sad is a part of being human and is a natural
reaction to painful circumstances. All of us will
experience sadness at some point in our lives.
People commonly say they were “depressed” after losing a
job, a breakup, or having a baby. However, they are
experiencing a period of sadness that typically will lift over
time.
 Since it is caused by something, when the something changes
or fades into the past, the sadness follows.
 It’s real. It’s emotional. It’s normal.
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Sad vs. Depressed
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Having depression is a medical condition and can
happen to people for seemingly no reason. It is
generally not in response to trauma or major life
changes.
People often see the symptoms of depression and assume
they are the depressed person’s problem. These are indeed
symptoms of a problem, but not the cause.
 Depressed people are often seen as lazy. People think that if
they just got up and did their job they would feel better.
 Depressed people would love nothing more than to be
able to get up and do their job.
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Sad vs. Depressed
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Sadness is a transient feeling that passes as a person
comes to terms with their troubles. Depression can linger
for weeks, months or even years.
A sad person feels bad, but continues to cope with living.
 A person with clinical depression feels overwhelmed and
hopeless.
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Impact on Body
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Research suggests that depression doesn't spring from
simply having too much or too little of certain brain
chemicals.
 Rather,
depression has many possible causes, including
faulty mood regulation by the brain, genetic vulnerability,
stressful life events, medications, and medical problems. It's
believed that several of these forces interact to bring on
depression.
Impact on Body
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Brain Function in Depression – The brain is the
"command center" of the human body. It controls the
basic functions of our bodies, our movements, and our
thoughts and emotions.
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Researchers studying clinical depression tend to look at
several aspects of brain function including the structures of
the limbic system and the function of neurotransmitters
within neurons.
Impact on Body
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Limbic System – Area of the brain that regulates activities
such as emotions, physical and sexual drives, and the stress
response.
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Disturbances in any part of the limbic system, including how
neurotransmitters function, can affect your mood and behavior.
Amygdala – Part of the limbic system that's associated
with emotions such as anger, pleasure, sorrow, fear, and
sexual arousal. Activated when a person recalls
emotionally charged memories, such as a frightening
situation.
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Activity in the amygdala is higher when a person is clinically
depressed and continues even after recovery from depression.
Impact on Body
Thalamus
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Directs high-level functions
such as speech, behavioral
reactions, movement,
thinking, and learning.
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Some research suggests that
bipolar disorder may result
from problems in the
thalamus, which helps link
sensory input to pleasant
and unpleasant feelings.
Hippocampus
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Registers fear, processes
long-term memory and
recollection.
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The hippocampus is smaller
in some depressed people,
and research suggests that
ongoing exposure to stress
hormone impairs the
growth of nerve cells in this
part of the brain.
Impact on Body
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Neurotransmitters – Of the 30 or so neurotransmitters
that have been identified, researchers have
discovered associations between clinical depression
and the function of three primary ones: serotonin,
norepinephrine, and dopamine.
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three neurotransmitters function within structures of
the brain that regulate emotions, reactions to stress, and
the physical drives of sleep, appetite, and sexuality.
Impact on Body
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Endocrine System –Made up of small glands that create
hormones and release them into the blood. The
endocrine system usually keeps the hormonal levels from
becoming excessive through an intricate process of
feedback, much like a thermostat in a home.
Hormonal levels are constantly monitored and when a
specific hormone rises to particular level the gland stops
producing and releasing the hormone.
 When depressed this feedback process doesn’t function as it
should and abnormal levels of some hormones are found
despite having healthy glands.
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Impact on Body
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Cortisol – About one-half of clinically depressed
individuals will have an excess of the hormone cortisol
which assist us in our reactions to stressful events.
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This hormone is believed to be related to clinical depression
since the high levels usually reduce to a normal level once
the depression disappears.
People who are not depressed tend to have secretions of
cortisol at certain times of the day. Highest at approximately
8:00 a.m. and 4:00 p.m., and then lowest during the night.
This normal cycling of cortisol levels does not occur in some
people who are depressed.
Self-Help
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Try to be active and exercise.
While doctors recommend exercise to all people suffering
from depression, it appears to have the greatest effect on
milder cases. Research has shown that getting regular
moderate to high-intensity exercise can dramatically reduce
symptoms.
 This is a natural treatment that has no down side.
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Dietary interventions
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Boost your intake of omega-3 fatty acids, reduce caffeine
intake, and follow a high-protein diet. Healthy fats have
been shown to boost serotonin levels, while caffeine reduces
them.
Self-Help
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Meditation
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An ancient art that involves using concentration techniques to
calm down brain activity. Theoretically, it helps practitioners
achieve an elevated state of tranquility, which can be a
benefit to people suffering from chronic mood disorders.
Quit smoking
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While research is still trying to uncover the specific links
between quitting smoking and relieving depression, studies
show a positive correlation between the two. If you’ve been
diagnosed with depression and you’re a smoker, you may
experience significant symptom relief by quitting.
Self-Help
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Set realistic goals for yourself.
Try to spend time with other people and confide in a
trusted friend or relative.
Try not to isolate yourself, and let others help you.
Expect your mood to improve gradually, not
immediately.
Continue to educate yourself about depression.
Professional Help
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Depression, even the most severe cases, can be treated.
The earlier that treatment can begin, the more effective
it is.
Depression is usually treated with medications,
psychotherapy, or a combination of the two. If these
treatments do not reduce symptoms, electroconvulsive
therapy (ECT) and other brain stimulation therapies may
be options to explore.
Medications
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Antidepressants that treat depression usually take 2 to 4
weeks to work. Often symptoms such as sleep, appetite,
and concentration problems improve before mood lifts.
An estimated 50% of unsuccessful treatment for
depression is due to medical non-compliance.
Patients stop taking medication too soon due to
unacceptable side effects, financial factors, fears of
addiction and/or short-term improvement of symptoms,
leading them to believe that continuing treatment is
unnecessary.
 Support group participants are 86% more willing to take
medication and cope with side effects.
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Medications
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Selective serotonin reuptake inhibitors (SSRIs) – SSRIs
help to alleviate symptoms of depression by blocking
the reuptake of serotonin in the brain. Most commonly
prescribed, highly effective and generally cause fewer
side effects.
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Celexa, Lexapro, Prozac, Luvox, Paxil, and Zoloft.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) –
work by blocking the re-absorption of the
neurotransmitters serotonin and norepinephrine in the
brain.
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Pristiq, Cymbalta, Effexor, Savella, and Fetzima
Medications
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Tricyclic antidepressants (TCAs) –like SNRIs, TCAs work
by blocking the re-absorption of the neurotransmitters
serotonin and norepinephrine in the brain. Additionally,
they block muscarinic M1, histamine H1, and alphaadrenergic receptors.
One of the first approved antidepressants, they have
been replaced by newer antidepressants that generally
cause fewer side effects.
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Elavil, Norpramin, Sinequan, Tofranil, Pamelor, Anafranil,
Ludiomil, Surmontil, and Vivactil.
Medications
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Monoamine oxidase inhibitors (MAOIs) – blocks the
activity of monoamine oxidase, an enzyme that breaks
down norepinephrine, serotonin, and dopamine. MAOIs
have many drug and food interactions and cause
significant side effects.
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Nardil, Emsam, and Parnate.
Atypical antidepressants – “atypical” because they do not
fit into the other classes of antidepressants. Each medicine
in this category affect the levels of dopamine, serotonin,
and norepinephrine in the brain.
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Wellbutrin, Remeron, Serzone, Desyrel, Oleptro, Viibryd, and
Brintellix.
Psychotherapy
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Several types of psychotherapy can help people with
depression. Examples of evidence-based approaches
specific to the treatment of depression include cognitivebehavioral therapy (CBT), interpersonal therapy (IPT),
and problem-solving therapy.
CBT – helps patients understand the thoughts and feelings
that influence behaviors
 IPT – focuses on past and present social roles and
interpersonal interactions
 Problem-solving – a mental process that involves discovering,
analyzing and solving problems
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Brain Stimulation Therapy
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Electroconvulsive therapy (ECT) – sometimes used if
medications do not reduce the symptoms of depression.
Once strictly an inpatient procedure, today ECT is often
performed on an outpatient basis. The treatment consists of
a series of sessions, typically three times a week, for two to
four weeks.
 ECT is not painful, and you cannot feel the electrical
impulses. Before ECT begins, a patient is put under brief
anesthesia and given a muscle relaxant. Within one hour
after the treatment session, which takes only a few minutes,
the patient is awake and alert.
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Professional Help
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Up to 80% of those treated for
depression show an improvement
in their symptoms generally within
four to six weeks of beginning
medication, psychotherapy,
attending support groups or a
combination of these treatments.
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Despite its high treatment success
rate, nearly two out of three people
suffering with depression do not
actively seek nor receive proper
treatment.
Conclusion
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Depression takes a functional human being and
reduces them to an emotional mess. The brain fills their
life with negativity, horrible thoughts about
themselves, and even physical pain.
 The
disability takes away the ability to feel anything
that is positive or enjoyable.
Conclusion
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The causes of depression aren't completely
understood, but it is believed that the best
explanation is a combination of factors, such as an
underlying genetic tendency towards the condition
and certain environmental factors which can act as
triggers.
People with depression cannot simply “pull themselves
together” and get better.
Conclusion
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If you have feelings of depression the persist for
several weeks your first visit should be to your
family doctor for a thorough checkup.
 There
are several medical conditions that can cause
depression symptoms, such as vitamin and mineral
deficiencies, female hormonal changes and thyroid
conditions. In addition several medications may have
depression as a side-effect.
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If your doctor does not find any of the factors as a
cause of your depression seek a referral to a
mental health professional.