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Depression 1
Depression
Outline
I-Introduction
II-Definition of depression
III-Depression in adults, adolescents and children
A-Symptoms
B-Consequences
IV-Types of depression
A-Depressive disorders
B-Bipolar depressive disorders
V-Genetic causes
VI-Treatment
A-Medication
B-Electroconvulsive therapy
C-Cognitive therapy
D-Psychological therapies
VII-Conclusion
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Introduction
It is very common to hear people complaining that they are suffering a
depression, hopefully one that will disappear in a few hours or even days. Depression
has been considered as a major psychological problem in modern communities.
However, what most people believe to be a depression is in fact nothing but the
consequence of stress. Depression as psychologists view it and define it is much more
dangerous, complicated and persistent. Depression is by all means on of the major
health problems identified in the twentieth century.
Definition
In adults depression is defined as a mood disorder in which an individual feels
deeply unhappy, self-degragatory, and bored (Santrock, p. 527). Psychiatrists define
depression as a psychiatric disorder characterized by feelings of worthlessness, guilt,
sadness, helplessness, and hopelessness. Depression has also been defined as that state
in which one feels sad and hopeless, but to such an extent and over a long time that it
interferes in one’s daily life (Arbetter, p.7).
In contrast to normal sadness or the grief accompanying the loss of a loved
one, clinical depression is persistent and severe. It is accompanied by a variety of
related symptoms, including disturbances in sleep and eating, loss of initiative, selfpunishment, withdrawal and inactivity, and loss of pleasure.
Community surveys show that as many as 20 in 100 people suffer from
significant depressive symptoms at any one time. Furthermore, some 25% of the
population may suffer from a depression over the course of a lifetime. The disorder
strikes men and women of all ages, in all segments of society, but most studies
indicate that women are more often afflicted.
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Depression in Children
For many years, it was believed that only adults suffered from depression,
excluding both children and adolescents. However, studies that started in the early
1970s proved that both children and adolescents suffered from depression just as adults
do.
In fact, depression, is reported be one of the major symptoms accompanying
cases or attempts of suicide among adolescents (Zanden, p.409). Psychologists have
detected continuous depressions to be apparent in many cases of suicide among
adolescents in the age of 14 to 21.
Hence, it has been agreed among scientists that depression might even lead more
destructive consequences among children and adolescents than among adults, especially
that these children and adolescents involved in anti-social, aggressive and anxious
behaviors (Santrock, p.527). The most prevalent type of depression among children and
adolescents is psychotic depression. To relieve children of the impact of depression,
scientists have tried discover a cure. Curing depression in children and adolescents
depends on two important steps; pharmacotherapy and psychotherapy.
After years of research, findings showed that depression in children was the
number one risk factor for suicide. Erroneously, depression was believed to be a sign of
weakness, but scientific evidence shows that depression is in reality caused by three
major factors: genetic make-up which a person has inherited from parents; chemical
balance in the brain; and life experiences which depend on the environmental
circumstances and events which happen in daily life (Arbetter, p.7). Erik Erikson was a
leading scientist in identifying depression in children and adolescents, as he considered
depression to be the result of the heavy responsibility that these individuals have to
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satisfy; that is, establishing their own identity, thoughts, feelings, interests and values, as
well as their independence from parents and others (Arbetter, p.7).
Although adolescents are naturally moody, depression is serious when it is
persistent for a long period of time, ranging between six to seven months, and
sometimes to two or three years. For, depression prohibits normal development during a
critical period of one’s life, and the consequences last for a life time (Arbetter, p.7).
Types of Depression
In psychiatry, two major forms of depressive disorders are recognized. In both,
the predominant symptom is a disturbance in mood. One form of the disorder,
depressive disorder, is marked only by episodes of depression. The other, bipolar or
manic depressive illness, is characterized by alternating depressed and manic episodes.
In major depression, a depressed mood predominates, although the patient may
not be aware of feeling sad. Typically, he or she loses all interest in and withdraws
from usual activities. Symptoms include sleep disturbances such as early-morning
awakening; loss of appetite or greatly increased appetite; inability to concentrate or to
make decisions; slowed thinking and decreased energy; feelings of worthlessness,
guilt, hopelessness, and helplessness; diminished sexual interest; and recurrent
thoughts of suicide and death, sometimes leading to actual suicide.
In the manic phase of bipolar illness, the patient's mood can be elevated,
expansive, or irritable. Behavior is bizarre and sometimes obnoxious. Other symptoms
include excessive talkativeness, racing thoughts, and grandiose ideas; greatly
increased social, sexual, and work activity; distractability; loss of judgment; and a
decreased need for sleep.
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Genetic Causes
Both depressive and bipolar disorders run in families. Almost certainly a
predisposition to these disorders is genetically transmitted. Thus, the risk of a
depressive disorder is greater in the families of depressive patients than in the
population at large. The higher proportion of depression in women may be
biologically induced, or it may be that women learn social roles that favor feelings of
helplessness. Because women in trouble are more likely to seek help than men,
statistics reporting a higher incidence of depression among women than among men
may be explained, at least in part, by an underdiagnosis of depression in men.
Studies have suggested that genetic predisposition to depression may be linked
with an abnormal sensitivity to the neurotransmitter acetylcholine. Receptors for
acetylcholine have been found to occur in excessive numbers in the skin of a number
of patients suffering from depressive disorders.
In most cases, the adolescent will not identify himself or herself as a depressed
person, specifically that depression is usually considered a negative stereotype.
Therefore, much of the burden to identify the symptoms falls upon parents at home or
teachers in school. These symptoms may be obvious in a way if the adolescent’s grades
start dropping, or if their behavior changes in a negative manner. Once depression has
been identified, therapy should immediately follow, especially if the depressed
individual shows severe signs of withdrawal, or loss of interest in life, because in such a
case, suicide could be an imminent threat.
Treatment
At first, medications such as monoamine oxidase, inhibitors and tricylics were
used with adolescents on the hope that they would reflect improvement as they have
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done with adults. Nevertheless, the results were not encouraging (Lamarine, p.391).
Another medication was used, mainly fluoxetine (Prozac) which showed much better
improvement in two thirds of depressed children and adolescents (Lamarine, p. 391).
Likewise, treatment with imipramine HCl (Tofranil) also showed noticeable
improvement in depressed children and adolescents (Burford 87).
The depressive disorders are among the most treatable in psychiatry. The usual
treatment in modern practice involves administration of a drug plus supportive
psychotherapy. Two major classes of drugs are used to treat depressive disorders: the
tricyclic/tetracyclic antidepressants and the monoamine oxidase (MAO) inhibitors.
The latter require following a special diet because they interact with tryamine, which
is found in cheeses, beer, wine, chicken livers, and other foods, and causes elevation
of blood pressure. The tricyclic antidepressants require no special diet; common
generic drugs in this class are amitriptyline, desipramine, doxepin, and imipramine.
Lithium carbonate, a common mineral, is used to control the manic phase of manicdepressive illness. In smaller doses, it is also used to regulate the mood fluctuations of
this bipolar disorder.
Electroconvulsive therapy, or ECT, is considered most effective for
depressions not responsive to drug therapy. Although controversial, ECT brings rapid
relief from severe depression and can often prevent suicide.
To curb the negative psychological and social impacts of depression, various
methods have been devised. The main methods used with child and adolescent
depression were medical or psychological. However, research showed later on that it
was better to use both types at the same time, to ensure positive results and therapy.
However, it is in order here to identify depression to point out the problem before
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solving it. Adolescents continue to perceive depression as a weakness, and this is why
they continue to conceal it. This makes it almost impossible for parents, teachers or
peers to identify the problem. It is therefore important to educate children and
adolescents to seek help whenever they feel depressed.
One way of asking for help is to contact school counselors and psychologists,
because these have a lot of experience of identifying depression symptoms, and
consequently, they are able to look for solutions. Another source of help is mental health
agencies that also have professionals who can identify depression and guide the
adolescent to seek therapy. Finally, private therapists such as social workers and
psychologists can help adolescents identify the problem and seek help in appropriate
ways (Lamarine, p.391).
The remarkable improvement with pharmcotherapy, however, was not enough.
The real burden of treatment was placed on psychotherapy. The approaches used in this
context are the cognitive therapy, family therapy, behavior therapy and psychodynamic
therapies (Lamarine, p.392).
Cognitive therapy enables the depressed individual to use logic and rational
methods of thinking and dealing with problems, and to get over irrational patterns that
may interfere in his or her development. The use of rationality in solving problems
instead of emotions helps the depressed get over depression (Lamarine, p. 392).
Family therapy requires the parents to play a positive role in observing the
problem and communicating with their child. Besides, involving the family in the
therapy is important because having a depressed child or adolescent in the family tends
to create disturbances and stress in the family (Lamarine, p. 393).
In addition to family therapy, behavioral therapy is very important because it
helps the depressed individual get rid of the negative behaviors that have been learned
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before and during depression, and instead, reinforces positive behaviors that are related
to rationality and logic in dealing with daily life problems and situations. For example,
the depressed person might be taught how to evaluate choices and options in dealing
with situations rather than panicking (Lamarine, p. 392).
Finally, psychodynamic therapy depends on the Freudian understanding of
conflicts that underlie mental illnesses such as depression. This therapy helps the
depressed individual face and resolve these conflicts by revealing them to the conscious
mind (Lamarine, p. 392).
The role of school is considered to be important in curing depression in children
and adolescent. The presence of the depressed individual in group depression-treatment
programs provides the depressed individual with opportunities to meet with positive role
models which will help him or her modify behavior positively (Lamarine, p. 393).
Besides, school treatment-programs help raise self-esteem with the help of social
support groups and peers that can help improve the social skills of the depressed
individual (Lamarine, p. 393). The role of professionals at school, such as counselors
and social workers is also important since they provide the depressed child or
adolescents with advice and ways to cope with disappointments, disabilities and abusive
situations (Arbetter, p. 8).
Finally, the treatment of depression in children and adolescents is one that is still
undergoing scientific research. Both pharmacotherapy and psychotherapy have been
used with a certain degree of success with psychotic depression, but it is obvious that
the use of both at the same time can be more helpful and effective. This shows that
scientists are now taking child and adolescent depression seriously.
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Conclusion
Many young people take a lot of Prozac and other medicaments to deal with
what they consider to be depressions. The major myth among adolescents and adults
alike today is that any mood disorder that might make them feel sad or unhappy must be
a depression. Some of the symptoms of depression are indeed very prevalent among
people, mostly resulting from stress, disappointment and episodes of low self-esteem,
but these do not qualify to be identified as depression. A depression is a persistent
psychological situation that has its roots traced to alterations in the biochemistry of the
body. Depressions are also genetically inherited and are on many occasions treated as a
mental and psychiatric disorder. Recently, scientific research has started studying the
social and psychological factors that upon persistence may eventually lead to elongated
episodes of depression. This is specifically the result of certain findings that show the
high relationship between depression and a number of disorders such as anorexia and
bulimia nervosa, as well as child and adolescent suicide. Although the symptoms of
depression are very widely spread, it is nonetheless a fact that scientists do not enough
about depression yet. In fact, many of the treatment methods devised for dealing with
depression are still in the experimental phases, and ultimately, the treatment of
depression requires commitment and will by the depressed person to improve.
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References
Arbetter, Sandra. "Am I normal? Those teen years." Current Health 2, April
1995, pp. 6-12.
Burford, Sandra. "What's wrong with this 12-year-old boy?" Patient Care,
March 30, 1995. pp. 85-87.
Lamarine, Roland. "Child and adolescent depression." Journal of School
Health, November 1995, pp. 390-393.
Santrock, John. Adolescence. New York: Brown & Benchmark, 1995.
Zanden, James. Human Development. New York: McGraw Hill, 1995.