What is
Depression?
A serious medical condition
in which a person feels very sad, hopeless, and unimportant and often is unable
to live in a normal way.
Depression is a
medical illness that causes a persistent feeling of sadness and loss of interest.
Clinical
depression is a mood disorder in which feelings of sadness, loss, anger, or
frustration
interfere
with everyday life for a longer period of time.
Symptoms of depression include:
• Low or irritable mood most of the
time
• A loss of pleasure in usual
activities
• Trouble sleeping or sleeping too
much
• A big change in appetite, often
with weight gain or loss
• Tiredness and lack of energy
• Feelings of worthlessness,
self-hate, and guilt
• Difficulty concentrating
• Slow or fast movements
• Lack of activity and avoiding
usual activities
• Feeling hopeless or helpless
• Repeated thoughts of death or
suicide
Causes of
Depression
The key understanding about depression causes — and, in fact, causes for
any mental disorder — is that we still do not know what causes these mental
disorders. It is generally believed that all mental disorders are caused by a
complex interaction and combination of biological, psychological and social
factors. This theory is called the bio-psycho-social model of causation and is
the most generally accepted theory of the cause of disorders such as depression
by professionals.
Some types of depression run in families, suggesting that a biological
vulnerability can be inherited. This seems to be the case with
bipolar disorder. Studies of families in which members of
each generation develop bipolar disorder found that those with the illness have
a somewhat different genetic makeup than those who do not get ill. However, the
reverse is not true: Not everybody with the genetic makeup that causes
vulnerability to bipolar disorder will have the illness. Apparently additional
factors, possibly stresses at home, work, or school, are involved in its onset.
In some families, major depression also seems to occur generation after
generation. However, it can also occur in people who have no family history of
depression. Whether inherited or not, major
depressive disorder is often associated with changes in
brain structures or brain function.
People who have low self-esteem, who consistently view themselves and the
world with pessimism or who are readily overwhelmed by stress, are prone to
depression. Whether this represents a psychological predisposition or an early
form of the illness is not clear.
In recent years, researchers have
shown that physical changes in the body can be accompanied by mental changes as
well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson’s disease, and hormonal
disorders can cause depressive illness, making the sick person apathetic and
unwilling to care for his or her physical needs, thus prolonging the recovery
period. Also, a serious loss, difficult relationship, financial problem, or any
stressful (unwelcome or even desired) change in life patterns can trigger a
depressive episode. Very often, a combination of genetic, psychological, and
environmental factors is involved in the onset of a depressive disorder.
·
Biological differences. People with
depression appear to have physical changes in their brains. The significance of
these changes is still uncertain, but may eventually help pinpoint causes.
- Neurotransmitters. These naturally occurring brain chemicals linked
to mood are thought to play a direct role in depression.
- Hormones. Changes in the body's balance of hormones may be involved
in causing or triggering depression. Hormone changes can result from
thyroid problems, menopause or a number of other conditions.
- Inherited traits. Depression is more common in people whose
biological family members also have this condition. Researchers are trying
to find genes that may be involved in causing depression.
- Life events. Certain events, such as the death or loss of a loved
one, financial problems, and high stress, can trigger depression in some
people.
- Early childhood trauma. Traumatic events during childhood, such as
abuse or loss of a parent, may cause permanent changes in the brain that
make you more susceptible to depression.
Depression
Disorders
Major Depressive Disorder
Major Depressive Disorder is a serious form of depression. For an
individual to be diagnosed with this Depressive Disorder they must have experienced at least one Major Depressive Episode, but no Manic, Hypomanic, or Mixed Episodes. Major Depressive
Disorder is cyclic, which means that the person experiences severe depression
for a time and then will return to normal and then go through another major
depressive episode.
Major Depressive Episode
A person who suffers from a major depressive episode must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A major depressive episode is also characterized by the presence of 5 or more of these symptoms:
- Depressed mood most of the
day, nearly every day, as indicated by either subjective report (e.g.,
feeling sad or empty) or observation made by others (e.g., appears
tearful). (In children and adolescents, this may be characterized as an
irritable mood.)
- Markedly diminished interest
or pleasure in all, or almost all, activities most of the day, nearly
every day
- 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.
- Insomnia (inability to sleep)
or hypersomnia (sleeping too much) nearly every day
- Psychomotor agitation or
retardation nearly every day
- Fatigue or loss of energy
nearly every day
- Feelings of worthlessness or
excessive or inappropriate guilt nearly every day
- Diminished ability to think
or concentrate, or indecisiveness, nearly every day
- 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
Dysthymia
Dysthymia is another mood disorder. In Dysthymia symptoms are not as severe as MDD, but they are chronic. It is not a cycle of being severely depressed and then returning to normal. A person with dysthymia always feels pretty low. Symptoms are not as severe but they are always there.
DSM
IV criteria for Dysthymic disorder
- Depressed mood for most of the day, for more days than
not, as indicated either by subjective account or observation by others,
for at least 2 years. Note: In children and adolescents, mood can
be irritable and duration must be at least 1 year.
- Presence, while depressed, of two (or more) of the
following:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness
- During the 2-year period (1 year for children or
adolescents) of the disturbance, the person has never been without the
symptoms in Criteria A and B for more than 2 months at a time.
- No Major Depressive Episode (see Criteria for Major
Depressive Episode)
has been present during the first 2 years of the disturbance (1 year for
children and adolescents); i.e., the disturbance is not better accounted
for by chronic Major Depressive Disorder, or Major Depressive Disorder, In
Partial Remission.
- Note:
There may have been a previous Major Depressive Episode provided there was
a full remission (no significant signs or symptoms for 2 months) before
development of the Dysthymic Disorder. In addition, after the initial 2
years (1 year in children or adolescents) of Dysthymic Disorder, there may
be superimposed episodes of Major Depressive Disorder, in which case both
diagnoses may be given when the criteria are met for a Major Depressive
Episode.
- There has never been a Manic Episode (see Criteria for Manic
Episode), a
Mixed Episode (see Criteria for Mixed
Episode), or
a Hypomanic Episode (see Criteria for Hypomanic
Episode),
and criteria have never been met for Cyclothymic Disorder.
- The disturbance does not occur exclusively during the
course of a chronic Psychotic Disorder, such as Schizophrenia or
Delusional Disorder.
- The symptoms are not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication) or a general
medical condition (e.g., hypothyroidism).
- The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
Double depression is where a person has
dysthymia and Major Depressive Disorder. It is cyclic like MDD, but instead of
returning to normal they just go back to dysthymia. This can be an especially
inflicting disorder because the patient never experiences relief from the
symptoms. They are generally in a low mood, and then they will have major
depressive episodes where their symptoms become even more severe.
Bipolar
There are multiple disorders that fall
under that of Bipolar. The most common are Bipolar I and Bipolar II. The
differences are that Bipolar I requires a full manic episode with either
dysthymic or major depressive episode. Where as Bipolar II is hypomania with
full major depressive episode.
Bipolar I Disorder
Diagnostic criteria for 296.0x Bipolar I
Disorder, Single Manic Episode
- Presence of only one Manic
Episode (see Criteria for Manic Episode) and no
past Major Depressive Episodes.
- Note: Recurrence is defined
as either a change in polarity from depression or an interval of at least
2 months without manic symptoms.
- The Manic Episode is not
better accounted for by Schizoaffective Disorder and is not superimposed
on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
Psychotic Disorder Not Otherwise Specified.
Bipolar II Disorder
· Presence
(or history) of one or more Major Depressive Episodes (see Criteria
for Major Depressive Episode).
- Presence (or history) of at
least one Hypomanic Episode (see Criteria for Hypomanic Episode).
- There has never been a Manic
Episode (see Criteria for Manic Episode) or a
Mixed Episode (see Criteria for Mixed Episode).
- The mood symptoms in Criteria
A and B are not better accounted for by Schizoaffective Disorder and are
not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
- The symptoms cause clinically
significant distress or impairment in social, occupational, or other
important areas of functioning.
Manic Episode
A manic episode is characterized by period of time where an
elevated, expansive or notably irritable mood is present, lasting for at least
one week. These feelings must be sufficiently severe to cause difficulty or
impairment in occupational, social, educational or other important functioning
and can not be better explained by a mixed episode. Symptoms also can not be the result of substance use or abuse
(e.g., alcohol, drugs, medications) or caused by a general medical condition.
Three or more of the following symptoms must be present:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., one feels rested after
only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts
are racing
- Attention is easily drawn to unimportant or irrelevant
items
- Increase in goal-directed activity (either socially, at
work or school, or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that
have a high potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish business
investments)
Cyclothymic Disorder
Cyclothymia is like bipolar disorder but the symptoms are not as severe. It is a cycling between hypomania and depressive symptoms.
Diagnostic criteria for 301.13 Cyclothymic Disorder
- For at least 2 years, the
presence of numerous periods with hypomanic symptoms (see Criteria for Hypomanic Episode) and
numerous periods with depressive symptoms that do not meet criteria for a
Major Depressive Episode. Note: In children and adolescents, the duration
must be at least 1 year.
- During the above 2-year
period (1 year in children and adolescents), the person has not been
without the symptoms in Criterion A for more than 2 months at a time.
- No Major Depressive Episode (Criteria for Major Depressive Episode), Manic
Episode (Criteria for Manic Episode), or Mixed Episode (see Criteria for Mixed Episode) has been
present during the first 2 years of the disturbance.
- Note: After the initial 2
years (1 year in children and adolescents) of Cyclothymic Disorder, there
may be superimposed Manic or Mixed Episodes (in which case both Bipolar I
Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive
Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder
may be diagnosed).
- The symptoms in Criterion A
are not better accounted for by Schizoaffective Disorder and are not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
- The symptoms are not due to
the direct physiological effects of a substance (e.g., a drug of abuse, a
medication) or a general medical condition (e.g., hyperthyroidism).
- The symptoms cause clinically
significant distress or impairment in social, occupational, or other
important areas of functioning.
Postpartum
Depression
DSM-IV does not recognize postpartum
depression as a separate diagnosis; rather, patients must meet the criteria for
a major depressive episode and the criteria for the postpartum-onset specifier.
The definition is therefore a major depressive episode with an onset within 4
weeks of delivery.
Seasonal Affective Disorder (SAD)
Commonly known as winter depression. One
of the depressed disorders but is specific to a season.
SAD, or the seasonal pattern of major
depressive episodes, is most simply defined as recurring depression with
seasonal onset and remission. It is not considered a separate mood disorder.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) describes
it as a "specifier" or a subtype that can occur within any of the
following major mood disorders [3]:
- Major Depressive Disorder,
recurrent (characterized by recurring major depressive episodes)
- Bipolar I Disorder
(characterized by a manic or mixed episode(s) with or without a major
depressive episode(s))
- Bipolar II Disorder
(characterized by a hypomanic episode(s) with a major depressive
episode(s))
Two seasonal patterns of SAD have been
described: the fall-onset SAD and the summer-onset SAD. The fall-onset type,
also known as "winter depression," is most recognized. In this
subtype, major depressive episodes begin in late fall to early winter and remit
during summer months. Although less documented in the literature, a
spring-onset pattern has also been described [4].
The following criteria must be met for a
diagnosis of seasonal affective disorder:
- You've experienced depression
and other symptoms for at least two consecutive years, during the same
season every year.
- The periods of depression
have been followed by periods without depression.
- There are no other
explanations for the changes in your mood or behavior.
Medication
and Treatment
Psychotherapy
Psychotherapy -- also called talk therapy, therapy, or counseling -- is a process focused on helping you heal and learn more constructive ways to deal with the problems or issues within your life. It can also be a supportive process when going through a difficult period or under increased stress, such as starting a new career or going through a divorce.
Generally psychotherapy is recommended
whenever a person is grappling with a life, relationship or work issue or a
specific mental health concern, and these issues are causing the individual a
great deal of pain or upset for longer than a few days. There are exceptions to
this general rule, but for the most part, there is no harm in going into
therapy even if you're not entirely certain you would benefit from it.
Modern psychotherapy differs significantly
from the Hollywood version. Typically, most people see their therapist once a
week for 50 minutes. For medication-only appointments, sessions will be with a
psychiatric nurse or psychiatrist and tend to last only 15 to 20 minutes. These
medication appointments tend to be scheduled once per month or once every six
weeks.
Psychotherapy is usually time-limited
and focuses on specific goals you want to accomplish.
Most psychotherapy tends to focus on
problem solving and is goal-oriented. That means at the onset of treatment, you
and your therapist decide upon which specific changes you would like to make in
your life. These goals will often be broken down into smaller attainable
objectives and put into a formal treatment plan. Most psychotherapists today
work on and focus on helping you to achieve those goals. This is done simply
through talking and discussing techniques that the therapist can suggest that
may help you better navigate those difficult areas within your life. Often
psychotherapy will help teach people about their disorder, too, and suggest
additional coping mechanisms that the person may find more effective.
Most psychotherapy today is short-term
and lasts less than a year. Most common mental disorders can often be
successfully treated in this time frame, often with a combination of
psychotherapy and medications.
Cognitive
Behavioral Therapy (CBT)
Cognitive behavior therapy (CBT) is a
type of psychotherapeutic treatment that helps patients understand the thoughts
and feelings that influence behaviors. CBT is commonly used to treat a wide
range of disorders including phobias,
addiction, depression and anxiety.
Cognitive behavior therapy is generally
short-term and focused on helping clients deal with a very specific problem.
During the course of treatment, people learn how to identify and change
destructive or disturbing thought patterns that have a negative influence on
behavior.
SSRIS
An SSRI, or selective serotonin reuptake
inhibitor, is a medication designed to help increase the amount of serotonin in
the synapse by blocking its reabsorption.
Most common SSRI is Prozac. Some side
effects of Prozac are Physical agitation, sexual dysfunction, low sexual
desire-50%-75% prevalence, insomnia, gastro-intestinal upset.
List of anti-depressants:
Abilify
(ariprazole), Adapin
(doxepin), Anafranil
(clomipramine), Aplenzin
(bupropion), Asendin
(amoxapine), Aventyl HCI
(nortriptyline), Celexa
(citalopram), Cymbalta
(duloxetine), Desyrel
(trazodone), Effexor XR
(venlafaxine), Emsam
(selegiline), Etrafon
(perphenazine and amitriptyline),
Elavil
(amitriptyline), Endep
(amitriptyline), Lexapro
(escitalopram), Limbitrol
(amitriptyline and chlordiazepoxide),
Marplan
(isocarboxazid), Nardil
(phenelzine), Norpramin
(desipramine), Oleptro
(trazodone), Pamelor
(nortriptyline), Parnate
(tranylcypromine), Paxil
(paroxetine), Pexeva
(paroxetine), Prozac
(fluoxetine), Pristiq (desvenlafaxine), Remeron
(mirtazapine), Sarafem
(fluoxetine), Seroquel XR
(quetiapine), Serzone
(nefazodone), Sinequan
(doxepin), Surmontil
(trimipramine), Symbyax
(fluoxetine and olanzapine),
Tofranil
(imipramine), Triavil (perphenazine
and amitriptyline), Viibryd
(vilazodone), Vivactil
(protriptyline), Wellbutrin
(bupropion), Zoloft
(sertraline)
Lithium
Studies show that lithium can
significantly reduce suicide risk. Lithium also helps prevent future manic and
depressive episodes. As a result, it may be prescribed for long periods of time
(even between episodes) as maintenance therapy.
Lithium acts on a person's central
nervous system (brain and spinal cord). Doctors don't know exactly how lithium
works to stabilize a person's mood, but it is thought to help strengthen nerve
cell connections in brain regions that are involved in regulating mood,
thinking and behavior.
Electroconvulsive shock therapy
Electroconvulsive therapy (ECT) is a
procedure in which electric currents are passed through the brain,
intentionally triggering a brief seizure. ECT seems to cause changes in brain
chemistry that can quickly reverse symptoms of certain mental illnesses. It
often works when other treatments are unsuccessful.
Phototherapy
Light therapy is a way to treat seasonal affective disorder (SAD) by exposure to artificial light. Seasonal affective disorder is a type of depression that occurs at a certain time each year, usually in the fall or winter.
During light therapy, you sit or work
near a device called a light therapy box. The box gives off bright light that
mimics natural outdoor light.
Light therapy is thought to affect brain
chemicals linked to mood, easing SAD symptoms. Using a light therapy box may
also help with other types of depression, sleep disorders and other conditions.
Light therapy is also known as bright light therapy or phototherapy.
Depression
Testing
Depression
Screening Test
You should not take this as a diagnosis or recommendation for treatment in any way, though. - See more at: http://psychcentral.com/cgi-bin/depression-quiz.cgi#sthash.Cnf98WA1.dpuf
1. I do things slowly.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
2. My future seems hopeless.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
3. It is hard for me to concentrate on reading.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
4. The pleasure and joy has gone out of my life.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
5. I have difficulty making decisions.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
6. I have lost interest in aspects of life that
used to be important to me.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
7. I feel sad, blue, and unhappy.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
8. I am agitated and keep moving around.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
9. I feel fatigued.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
10. It takes great effort for me to do simple
things.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
11. I feel that I am a guilty person who deserves
to be punished.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
12. I feel like a failure.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
13. I feel lifeless -- more dead than alive.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
14. My sleep has been disturbed -- too little,
too much, or broken sleep.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
15. I spend time thinking about HOW I
might kill myself.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
16. I feel trapped or caught.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
17. I feel depressed even when good things happen
to me.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
18. Without trying to diet, I have lost, or
gained, weight.
Not at all
Just a little
Somewhat
Moderately
Quite a lot
Very much
Scoring:
• 0 points Not at all
• 1 point Just a little
• 2 points Somewhat
• 3 points Moderately
• 4 points Quite a lot
5 points Very much
Screening test scoring ranges:
• 0-9 No Depression Likely
• 10-17, Possibly Mildly Depressed
• 18-21, Borderline Depression
• 22-35, Mild-Moderate Depression
• 36-53, Moderate-Severe Depression
54 and up, Severely
Depressed
Statistics/Facts
on depression
- At any point in time, 3 to 5 percent of
people suffer from major depression; the lifetime risk is about 17 percent.
-Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15 to 44.3
-Major Depressive Disorder Affects approximately
14.8 million American adults, or about 6.7 percent of the U.S. population age
18 and older in a given year.
-While major depressive disorder can develop at any age, the median age at onset is 32.5
-Major Depressive Disorder is More prevalent in women than in men.
-For dysthymia, Symptoms must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis.
-Dysthymia Affects approximately 1.5 percent of the U.S. population age 18 and older in a given year. (about 3.3 million American adults).
-The median age of onset for dysthymia is 31.1
-Depression is a condition that
affects 1 in 10 americans at one point or another.
-Over 80% of people who are experiencing symptoms of depression are not receiving any specific treatment for their depression
-The number of patients diagnosed with depression increases by 20% every year
-The states with the highest rates for adults meeting the criterias of depression are; OK, AR, LA, MS, AL, TN, and WV.
-states with higher rates of depression also have high rates of obesity, heart disease, stroke, sleep disorders, lack of education, less access to medical insurance
-Individuals are more likely to suffer from depression if they are unemployed and/or recently divorced.
-Depression is most prevalent in people ages 45-64
-Woman have higher rates of depression than men
-1 in 10 women experiences symptoms
of depression in the weeks after having a baby
-60%-80% of all depression cases can be effectively treated with psychotherapy and medication.
-121 million people in the world currently suffer with some form of depression
- Major depressive disorder affects approximately 14.8 million
American adults, or about 6.7 percent of the U.S. population age 18 and
older, in a given year. (Archives of General Psychiatry, 2005 Jun; 62(6):
617-27)
- While major depressive disorder can develop at any age, the median
age at onset is 32. (U.S. Census Bureau Population Estimates by
Demographic Characteristics, 2005)
- Major depressive disorder is more prevalent in women than in men.
(Journal of the American Medical Association, 2003; Jun 18; 289(23):
3095-105)
- As many as one in 33 children and one in eight adolescents have clinical
depression. (Center for Mental Health Services, U.S. Dept. of Health and
Human Services, 1996)
- People with depression are four times as likely to develop a heart
attack than those without a history of the illness. After a heart attack,
they are at a significantly increased risk of death or second heart
attack. (National Institute of Mental Health, 1998)
- Cancer: 25% of cancer patients experience depression. (National
Institute of Mental Health, 2002)
- Strokes: 10-27% of post-stroke patients experience depression.
(National Institute of Mental Health, 2002)
- Heart attacks: 1 in 3 heart attack survivors experience depression.
(National Institute of Mental Health, 2002)
- HIV: 1 in 3 HIV patients may experience depression. (National
Institute of Mental Health, 2002)
- Parkinson's Disease: 50% of Parkinson's disease patients may
experience depression. (National Institute of Mental Health, 2002)
- Eating disorders: 50-75% of eating disorder patients (anorexia and
bulimia) experience depression. (National Institute of Mental Health,
1999)
- Substance use: 27% of individuals with substance abuse disorders
(both alcohol and other substances) experience depression. (National
Institute of Mental Health, 1999)
- Diabetes: 8.5-27% of persons with diabetes experience depression.
(Rosen and Amador, 1996)
- About six million people are affected by late life depression, but
only 10% ever receive treatment. (Brown University Long Term Care
Quarterly, 1997)
- Fifteen to 20% of U.S. families are caring for an older relative. A
survey of these adult caregivers found that 58% showed clinically
significant depressive symptoms. (Family Caregiver Alliance, 1997)
- Women experience depression at twice the rate of men. This 2:1 ratio
exists regardless of racial or ethnic background or economic status. The
lifetime prevalence of major depression is 20-26% for women and 8-12% for
men. (Journal of the American Medical Association, 1996)
- Postpartum mood changes can range from transient "blues"
immediately following childbirth to an episode of major depression and
even to severe, incapacitating, psychotic depression. Studies suggest that
women who experience major depression after childbirth very often have had
prior depressive episodes even though they may not have been diagnosed or
treated. (National Institute of Mental Health, 1999)
- Depression may increase a woman's risk for broken bones. The hip
bone mineral density of women with a history of major depression was found
to be 10-15% lower than normal for their age--so low that their risk of
hip fracture increased by 40% over 10 years. (National Institute of Mental
Health, 1999)
- Major depressive disorder is the leading cause of disability in the
U.S. for ages 15-44. (World Health Organization, 2004)
- Major depression is the leading cause of disability worldwide among
persons five and older. (World Health Organization, "Global Burden of
Disease," 1996)
- Depression ranks among the top three workplace issues, following
only family crisis and stress. (Employee Assistance Professionals
Association Survey, 1996)
- Depression’s annual toll on U.S. businesses amounts to about $70
billion in medical expenditures, lost productivity and other costs.
Depression accounts for close to $12 billion in lost workdays each year.
Additionally, more than $11 billion in other costs accrue from decreased
productivity due to symptoms that sap energy, affect work habits, cause
problems with concentration, memory, and decision-making. (The Wall Street
Journal, 2001, National Institute of Mental Health, 1999)
- Depression is the cause of over two-thirds of the 30,000 reported
suicides in the U.S. each year. (White House Conference on Mental Health,
1999)
- For every two homicides committed in the United States, there are
three suicides. The suicide rate for older adults is more than 50% higher
than the rate for the nation as a whole. Up to two-thirds of older adult
suicides are attributed to untreated or misdiagnosed depression. (American
Society on Aging, 1998)
- Untreated depression is the number one risk for suicide among youth.
Suicide is the third leading cause of death in 15 to 24 year olds and the
fourth leading cause of death in 10 to 14 year olds. Young males age 15 to
24 are at highest risk for suicide, with a ratio of males to females at
7:1. (American Association of Suicidology, 1996)
- The death rate from suicide (11.3 per 100,000 population) remains
higher than the death rate for chronic liver disease, Alzheimer’s,
homicide, arteriosclerosis or hypertension. (Deaths: Final Data for 1998,
Center for Disease Control)
- 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. (National Institute of Health, 1998)
- Despite its high treatment success rate, nearly two out of three
people suffering with depression do not actively seek nor receive proper
treatment. (DBSA, 1996)
- An estimated 50% of unsuccessful treatment for depression is due to
medical non-compliance. Patients stop taking their 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. (DBSA, 1999)
- Participation in a DBSA patient-to-patient support group improved
treatment compliance by almost 86% and reduced in-patient hospitalization.
Support group participants are 86% more willing to take medication and
cope with side effects. (DBSA, 1999)
TR Implications
Therapeutic recreation
treats depression in the elderly.
Source
Tulsa University, USA.
Abstract
Therapeutic
recreation can be an effective method to treat depression in elderly home care
patients. Home care is the fastest growing component in the Medicare budget.
The co-occurrence of physically limiting conditions and depression in the
elderly is well documented. Untreated depression carries an enormous risk and
cost. Therapeutic recreation is an ideal psychosocial treatment for use in the
home care setting because of its effectiveness and versatility. Certified
therapeutic recreation specialists use various interventions such as poetry,
music, and exercise as part of a treatment team. In addition to effectively
managing depression, therapeutic recreation can be beneficial in reducing the
effects of many concurrent physical conditions.
Recreational
Therapy
All of these health
benefits explain why recreational therapy can be such an essential part of a
rehabilitation program. This type of therapy involves using various recreation
or leisure activities to enhance or promote wellness. The American Therapeutic
Recreation Association shines a spotlight on some of the benefits for the
populations that commonly take advantage of the therapy including psychiatric
patients, recovering addicts, children and seniors. Some of these benefits
include faster healing from medical conditions, stress management, improved
body function and better cognitive function.
Patients are evaluated with
information from standardized assessments, observations, medical records and
discussions with medical staff and family members as well as the individual.
Recreational therapists may instruct patients in relaxation techniques,
stretching and limbering exercises, proper body mechanics for participation in
recreation activities, and pacing and energy conservation techniques.
Additionally, therapists observe and document patients' participation,
reactions and progress.
Depression
Activity Resources
|
Depression Jeopardy
submitted by Chloe Mekinc of
Fairmount Behavioral Health System on February 6, 2010
Size of Group: 4 to 12
participants
Equipment: white board, dry erase
markers, list of depression related jeopardy questions with answers
Objective: Educational game of
jeopardy meant to teach mental illness patients about depression.
Participants will learn about symptoms, medications, coping skills, causes,
and types of depression.
Description:
1. Draw a Jeopardy layout on the whiteboard by writing the
categories at the top of the board and the point amounts underneath of them.
(Ed note: you can also create a Jeopardy board on a power point and use a
projector or large screen TV)
2. Divide participants into teams depending on the total
number in the group.
3. Instruct clients to choose a category and the number of
points they want to go for.
4. Ask the team a question related to depression and tell
them to work together to come up with an answer.
5. If the team is unable to answer the question correctly the
next team can steal the question by answering it with the correct answer.
This continues until all teams have had a chance to answer the question.
6. If there is a tie between two teams at the end of the
game, provide a tie breaker question for both teams to answer.
Sample Questions:
Symptoms:
• 10
– A symptom of depression is a persistently _____ mood. ANSWER: SAD or
DEPRESSED or UNHAPPY
• 20
– The symptom of depression in which you want to end you life is known as
_______. ANSWER: SUICIDE
• 30
– This symptom occurs when you stop liking your favorite hobby/activity.
ANSWER: LACK OF INTEREST/PLEASURE
• 40
– How long do symptoms of suicide have to last in order for a person to be
diagnosed? ANSWER: 2 WEEKS
Medications:
• 10
– Give the name of one antidepressant. ANSWERS: PROZAC, ZOLOFT, PAXIL,
CELEXA, LEXAPRO, LUVOX, EFFEXOR, CYMBALTA, WELLBUTRIN, REMERON, ELAVIL,
LIMBITROL, NORPRAMIN, SINEQUAN, TOFRANIL, PAMELOR, AVENTYL, VIVACTIL, NARDIL,
MARPLAN, or PARNATE (may be others)
• 20
– What do antidepressants attempt to fix? ANSWER: THEY TRY TO CORRECT THE
IMBALANCES IN NEUROTRANSMITTERS
• 30
– When a person begins medication, what symptoms improve before the depressed
mood improves? ANWER: ENERGY LEVELS AND THE ABILITY TO TAKE ACTION (MAKE
DECISIONS)
• 40
– How long does it take for antidepressants to start having an effect?
ANSWER: 2 TO 4 WEEKS
Causes:
• 10
– A cause of depression is an imbalance in _______. ANSWER: NEUROTRANSMITTERS
• 20
– If these people have a history of depression, you are put at a higher risk
for depression. ANSWER: FAMILY MEMBERS
• 30
– Name two major life events that may cause a person to have depression. ANSWERS:
DEATH OF A LOVED ONE, MAJOR LOSS OR CHANGE, CHRONIC STRESS, SUBSTANCE ABUSE,
VICTIM OFABUSE.
• 40
– Name one of three neurotransmitters involved with depression. ANSWER:
NOREPINEPHRINE, SEROTONIN, or DOPAMINE.
Coping Skills:
• 10
– A natural way to get in shape and increase feelings of happiness is ______.
ANSWER: EXERCISE
• 20
– Who could you talk to about your feelings of depression? ANSWERS: FAMILY,
CLOSE FRIEND, REALTIVE, COUNSELOR, SOCIAL WORKER, DOCTOR, THERAPIST, TEACHER,
ETC
• 30
– What are two ways of improving your self-esteem? ANSWER: LEARNING NEW
SKILL, NEW INTERESTS/ACTIVITIES, WRITING, SAYING GOOD THINGS ABOUT YOURSELF,
ETC.
• 40
– What are benefits of having good coping skills? ANSWER: ABILITY TO DECREASE
SYMPTOMS OF DEPRESSION, BETTER MANAGEMENT OF DEPRESSION EMOTIONS, A BETTER
MOOD or HIGHER SELF-ESTEEM, ETC.
Types of Depression:
• 10
– This type of depression involves a combination of these symptoms: depressed
mood, fatigue, appetite change, poor concentration, guilt and sometimes suicide.
ANSWER: MAJOR DEPRESSION or CLINICAL DEPRESSION or MAJOR DEPRESSIVE DISORDER
• 20
– This type of depression has episodes of extreme sadness as well as times of
extreme happiness and energy. ANSWER: BIPOLAR DISORDER or BIPOLAR DEPRESSION
or MANIC DEPRESSION
• 30
– This type of depression occurs when you have a Major Depressive episode
that lasts at least two years. ANSWER: CHRONIC DEPRESSION
• 40
– What is a long term type of depression, which has less severe symptoms?
ANSWER: DYSTHYMIA or DYSTHYMIC DISORDER
Tie Breaker Questions:
• How
many adults in the United States have depression? ANSWER: 15 million American
adults
• What
percentage of people diagnosed with depression are treated effectively and
return to their usual daily lives? ANSWER: 80% – 90%
|
By Joyce Mahoney, CTRS
I am a Recreational Therapist
(CTRS) and Psychiatric Rehabilitation Specialist (APRS) with a concentration in
Mild Cognitive Impairments (MCI) and dementia within the elderly population as
well as Cognitive Rehabilitation services.
Recently I came across an article describing the correlation between
boredom, depression, and brain stimulation. I was immediately intrigued.
According to Psychologist Stephen Vodanovich of University of West
Florida
Battling boredom, researchers say, means finding focus, living in the
moment and having something to live for.
1. Boredom, and the underpinnings of this tedious human emotion, is more
complex than commonly known.
2. Level of attention, is an aspect of conscious awareness, and that
improving a persons ability to focus may therefore decrease ennui
3. Boredom is similar to mental fatigue (a sleeplike feeling) and is caused
by repetition and lack of interest in the minute and fragmented tasks.
4. Tiresome feelings were a combination of low arousal and insufficient
motivation.
5. Psychoanalyst, Otto Fenichel identified a type of boredom that results
from the repression of a persons drives and desires and leads to apparent
aimlessness.
“When we don’t do what we want to do, or must do what we don’t want to
do.”
1. The need for NOVELTY: external stimulation, or the need for novelty,
excitement and variety. THE BRAIN IS ALWAYS SEEKING STIMULATION AND OVER
TIME IT TAKES MORE AND MORE EXCITEMENT AND NOVELTY TO ACHIEVE OPTIMAL
STIMULATION.
2. Increase their level of stimulation by changing the activity in subtle
but interesting ways.
3. People who are often bored are at greater risk for depression and
anxiety.
4. Boredom is also linked to problems with attention (its difficult to be
interested in something when you cannot concentrate on it.
5. The essential behavioral component of boredom is the struggle to maintain
attention. Boredom may also grow out of a pathological inability to focus.
6. Inability to remain attentive underlay boredom proneness as well as
depression – an illness that shares documented similarities with boredom
including a negative mood and loss of meaning of life. A chronic inability to
focus on activities may render them effectively meaningless. “Attention is
the common link between lack of meaning, boredom, and depression.”
7. Boredom in the Brain: The biological basis for this emotion (boredom)
comes from persons who have sustained damage to the frontal cortex of the
brain, rendering the individual to experience various emotional and cognitive
quirks.
§ Persons with damage to the frontal cortex also have attention deficits,
which are correlated to boredom and an inability to remain focused.
§ Disruptions in the brains networks can interfere
with a persons ability to become engaged in a task.
- Recreational Therapists
provide treatment services and recreation activities for to individuals
with disabilities or illnesses.
- Recreational Therapists help
individuals reduce depression, stress, and anxiety. They work to build
confidence; and socialize effectively so that they can enjoy greater
independence.
· Recreational Therapists help integrate people with disabilities into the
community by teaching them how to use community resources.
Resources
Depression and Bipolar Support Alliance
Depression and bipolar disorder can be isolating illnesses, but DBSA support groups can help you connect with others who have been there as well. Visit a DBSA support group and get the support that is essential to recovery.
National Institue of Mental Health
How can I help myself if I am depressed?
If you have depression, you may feel exhausted, helpless, and hopeless.
It may be extremely difficult to take any action to help yourself. But as you
begin to recognize your depression and begin treatment, you will start to feel
better.
To Help Yourself
- Do not wait too long to get
evaluated or treated. There is research showing the longer one waits, the
greater the impairment can be down the road. Try to see a professional as
soon as possible.
- Try to be active and exercise.
Go to a movie, a ballgame, or another event or activity that you once
enjoyed.
- Set realistic goals for
yourself.
- Break up large tasks into
small ones, set some priorities and do what you can as you can.
- 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. Do not expect to suddenly "snap out
of" your depression. Often during treatment for depression, sleep and
appetite will begin to improve before your depressed mood lifts.
- Postpone important decisions,
such as getting married or divorced or changing jobs, until you feel
better. Discuss decisions with others who know you well and have a more
objective view of your situation.
- Remember that positive
thinking will replace negative thoughts as your depression responds to
treatment.
- Continue to educate yourself
about depression.
1. My
Depression Connection: You didn't think I would mention
depression resources without mentioning our site did you? In all
seriousness, I do hope that anyone who has participated on our site will pass
the word along that we have a great community here for both information and
support. If you haven't done so before maybe you would like to create asharepost. Sharing your experience with others does help. Or perhaps you
would like to ask or
answer a question. Dive in! We want to
hear what you have to say.
2. Anxiety
Connection: There are many people who suffer not
only from depression but also from anxiety. I am one of these people.
According to the Anxiety Disorders Association of America: "Nearly
one-half of those diagnosed with depression are also diagnosed with an anxiety
disorder." I will be writing on Anxiety Connection starting this
month and I hope you look for me there. So if you haven't checked
out this site before please come on over.
3. Bipolar Connect: There are those of us, who, in addition to experiencing
depressive episodes will also experience what is known as mania. This
mood disorder used to be called manic depression but now is known as Bipolar
Disorder. And many people who have this mood disorder do not get
diagnosed with it until they have been suffering with it for years and
sometimes decades. John McManamy leads this site and I can tell you that
I have the utmost respect and admiration for John as he has transformed his
suffering into helping others. I visit the site periodically and it is a
wonderfully supportive community. If you have Bipolar Disorder or have a
loved one with this mood disorder, please do visit Bipolar Connect.
4. NAMI (The National
Alliance on Mental Illness): I probably give this
link to more people on this site than any other aside from Health Central
sites. If you want to find out about the latest legislation on mental illness, how to fight the stigma
of mental illness or simply find a local
support group in your area this is one of the best web
sites to find information and support for mental illness whether you are a
caregiver or suffer from mental illness yourself.
They also have an information
hotline for you to call: The Information HelpLine is an information and
referral service which can be reached by calling 1 (800) 950-NAMI (6264),
Monday through Friday, 10 am- 6 pm, Eastern time.
5. Mental Health
America: This organization was formerly known as the
National Mental Health Association. Mental Health America is the country's
leading nonprofit dedicated to helping ALL people live mentally healthier
lives. David Shern, the President of this organization often writes for My Depression
Connection to inform us of the latest legislative news on mental health or to
discuss advocacy efforts. Mental Health America works in conjunction with
other mental health organizations to promote greater awareness of mental
illness through such campaigns as National
Depression Screening Day. They also provide a comprehensive list of mental
health resources which you can find here.
6. Hotline Numbers:
There are times when you might need to talk to someone immediately because you
are having thoughts about harming yourself or even of suicide. There are
many people who suffer from depression who have felt this way. There is
no shame in calling for help. I did and was grateful for the help I
received. Here are two national hotlines for the states. If anyone
has other numbers for England, Australia, Ireland and other countries please
let me know so I can add the numbers to this post. Here is also a
list of other
hotline numbers specific to the emergency or need.
National Suicide Hopeline
Phone: 800.784.2433
National Suicide Prevention
Lifeline
Phone: 800.273.8255
This is a link to an article I had
written some months ago due to the overwhelming number of members who were
seeking help for their depression but had no insurance or money. There
are a lot of good resources within this article for either getting a therapist
or for getting medication for depression. Please do read the comment
section as members gave additional resources to check out there.
8. The National
Institute of Mental Health (NIMH): For the latest
science, research, and information about mental health issues this is the place
to search. One can also find the latest information on clinical trials.
NIMH also offers a special page of resources for getting help.
You may reach NIMH by calling:
1-866-615-6464
9. The National
Center for Complementary and Alternative Medicine Have you ever wondered what supplements can help your mental
health but you wanted a source which provided research? The information
given on this government site can help. For example one can find research
about St. John's
Wort and how it works. To reach the center to ask any
questions you can call: 1-888-644-6226
10. Wings of Madness: I have saved the best for last. Not sure if you all know
this or not but our Deborah Gray is the creator of a famous depression support
group and web site. Wings of Madness is one of the oldest depression
sites on the internet. Deborah created the site in 1995 and is still
there today to provide information and support to those suffering from clinical
depression and their loved ones. Deborah has worked tirelessly all these
years to give hope to those who need it the most. You can find Deborah's
latest writings right here on Health Central by going to her profile.
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