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DEPRESSION Chris Ferry, KidsPeace Objectives Depression 101 Types of depression Risk factors Common symptoms Sad vs. Depressed Impact on body Self-help Professional help Conclusion Depression 101 Depression is a very dark place. 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 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 18 350 million people globally are affected by some form of depression. Depression 101 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 1. 2. 3. 4. 5. 6. 7. 8. 9. Major Depression Persistent Depressive Disorder Postpartum Depression Seasonal Affective Disorder Atypical Depression Psychotic Depression Premenstrual Dysphoric Disorder Bipolar Disorder Situational Depression Major Depression 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. Persistent Depressive Disorder 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 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 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 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 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. About 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 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 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.” 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 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 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 Risk Factors Depression often co-occurs with other medical conditions. 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 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 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 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? People with depression cannot simply “pull themselves together” and get better. Sad vs. Depressed 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. Sad vs. Depressed 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. Sad vs. Depressed 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. Impact on Body 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 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. 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 Limbic System – Area of the brain that regulates activities such as emotions, physical and sexual drives, and the stress response. 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. Activity in the amygdala is higher when a person is clinically depressed and continues even after recovery from depression. Impact on Body Thalamus Directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. Some research suggests that bipolar disorder may result from problems in the thalamus, which helps link sensory input to pleasant and unpleasant feelings. Hippocampus Registers fear, processes long-term memory and recollection. 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 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. These 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 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. Impact on Body 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. 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 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. Dietary interventions 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 Meditation 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 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 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 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 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. Medications 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. 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. Pristiq, Cymbalta, Effexor, Savella, and Fetzima Medications 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. Elavil, Norpramin, Sinequan, Tofranil, Pamelor, Anafranil, Ludiomil, Surmontil, and Vivactil. Medications 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. 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. Wellbutrin, Remeron, Serzone, Desyrel, Oleptro, Viibryd, and Brintellix. Psychotherapy 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 Brain Stimulation Therapy 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. Professional Help 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. Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment. Conclusion 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 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 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. If your doctor does not find any of the factors as a cause of your depression seek a referral to a mental health professional.