DEPRESSION: Understanding it and getting help

* General Information

* How to recognize Depression

* Treatment Options

* Special Populations

Who suffers from Depression?

• Depression can effect anyone but there is a significantly higher rate of depression among women than men.

• 17 million Americans develop depression each year.

• 8.6% of adults over 18 have a mental health problem for at least 2 weeks a year.

Who suffers from depression?

• 2% of Children get depressed

• 6-8% of Teenagers– 1999 survey- reported that1 of every 10

American high school students reported making a suicide attempt the year before.

– Teenage boys are more likely than girls to kill themselves.

– Look for a change in behavior or performance in school

What is Depression?

• Depression is an illness that involves the body, mood and thoughts

• It impacts the way a person functions socially, at work, and in relationships.

• It is more than feeling blue, down in the dumps or sad about a particular issue or situation.

• It is a medical condition that requires diagnosis and treatment

What Depression is NOT:• It is not something to be ashamed of.

• It is NOT a character flaw or sign of weakness.

• No one with depression can just “Snap Out of It”.

• You can’t “Pull yourself up by your bootstraps”.

What Depression IS:

• TREATABLE

• No matter what the cause of a persons depression, there is treatment and it is widely available!!

• Some symptoms (e.g. appetite, attention) seem to be mediated more by one neurotransmitter than the other.

• Some other symptoms (e.g. anxiety) seem to be mediated by either. There are other symptoms (e.g. aches and pain) that seem to be mediated more consistently by a combination of both the neurotransmitters.

There are at least two sides to the neurotransmitter story

The neurotransmitter pathway story

Adapted from References:

1. Stahl SM. J. Clin Psych. 2002;63:203-220.

2. Verma S, et al. Int Rev Psychiatry. 2000;12:103-114.

3. Blier P, et al. J Psychiatry Neurosci. 2001;26(1):37-43.

• Dysregulation of Serotonin (5HT) and Norepinephrine (NE) in the brain are strongly associated with depression

• Dysregulation of 5HT and NE in the spinal cord may explain an increased pain perception among depressed patients1-3

• Imbalances of 5HT and NE may explain the presence of both emotional and physical symptoms of depression.

It’s not all in your head

Descending Pathway

Ascending Pathway

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Symptoms of Depression

• FIVE OR MORE OF THE FOLLOWING FOR AT LEAST TWO WEEKS:

• Feelings of sadness, depressed mood and/or irritability

• Loss of interest or pleasure in activities• Changes in weight or appetite• Changes in sleep pattern-not enough or too

much

Symptoms of Depression

• Feelings of guilt, hopelessness or worthlessness

• Inability to concentrate, remember things or make decisions

• Constant fatigue or loss of energy• Restlessness or decreased activity• Recurrent thoughts of suicide or death

Treatment for Depression:

• Approximately 80% of people who receive treatment for Depression improve.

• There are three types of treatment:– Psychotherapy– Medication– Electroconvulsive Therapy (ECT)

Psychotherapy: What is it?

• Psychotherapy is a form of “talking therapy” that works by helping a person gain an understanding or insight into their problems and work on solving them.

• Behavioral psychotherapy is a type of therapy that looks at patterns of behavior that may contribute to depression.

Medication for Depression:

• Antidepressant Medication helps by affecting the brain chemistry.

• Often take 3-5 weeks to become fully effective, but improvement is often experienced within the first week.

• Work well and are safe

• They are Non-habit forming!

ECT: How is it done?

• ECT is a painless procedure• A person is put to sleep with general anesthesia• Muscle relaxers are used to prevent any injury

from the procedure• Oxygen is given by mask during ECT• The whole treatment takes 5 minutes• You are awake, up walking and eating breakfast

with one hour. Home within two!

Depression in women• Women are at a much greater increased

risk of Depression:– At times of hormone swings-premenstrual

• 3%-8% of women have Premenstrual Dysphoric Disorder during reproductive years

– Postpartum period• 15-20% of women have depression after delivery

– Menopause– Going into puberty– Following a miscarriage (within one month)

Postpartum Depression

• 15% of women report depression within three months of delivery

• Women with a prior history of depression are at greater risk

• Postpartum “blues” or “baby blues” is normal– mild feeling of being down, tearful– lasts for only a day or so

Postpartum Psychosis

• A complication of either a Postpartum Depression or Bipolar disorder that has a sudden onset and is a psychiatric emergency

• Characterized by hallucinations or delusional beliefs about the infant.

• The infant and mother must be protected and treated immediately!

• Increased risk in subsequent pregnancies

Treatment for Postpartum Depression

• Psychotherapy is very important

• Medication

• Breastfeeding is not contraindicated!

What should SHE do:

• Rest, rest and more rest! Tiredness can lead to exhaustion which in turn can cause worsening depression

• Resist the temptation for rush around and catch up with housework while the baby is asleep…. ….take a nap yourself!

• Eat regularly…..gentle exercise…talk about your worries

• Avoid major stresses at this time• Don’t be too hard on yourself

What should She do Cont.:

• GET TREATMENT!!!!!!!– Medications and psychotherapy

• Do not be discouraged…every woman who suffers from postnatal illness DOES RECOVER IN TIME!!

What can HE do?

• BE PATIENT!• Don’t try to reason…depression defies logic.• Let her express her true feelings and treat them

with sympathy• Don’t force her to do anything she isn’t ready for• Try to go out as a couple without the children.• Don’t ignore your own feelings- Ask for help too!

What can a loved one do for someone who is depressed?

• Listen and provide support– Be patient, understanding and encouraging– Don’t dismiss the symptoms but you can offer

hope– Try to understand the negative feelings the person

may be feeling– Remember that depression is a medical condition

What you can do Continued:• Take care of the “little things”• Remind your loved one to keep doctor’s

appointments and to take their medication!• Help to support healthy habits: good sleeping

habits, eating well, trying to get exercise• Urge your loved one to postpone major life

decisions such as changing jobs, divorce, marriage or moving until his or her depression is better

What you can do Continued:

• Suicide threats are to be taken seriously!• Take care of your self• Remember:

– Depression is a very treatable illness, and you or your loved one can get better with appropriate medical treatment and support!

Other special populations:

• Elderly- Our Senior Citizens!– Increased feelings of isolation & support

• Medically Ill- Depression is often either a symptom or as a result of a serious or chronic medical problem– treatment improves quality of life!

• Those persons with Addictions-– If the depression is treated, the addiction can

be treated also.