Understanding Depression

Depression is a medical condition that is marked by sadness, hopelessness, helplessness, pessimism, and a loss of interest in life day after day. Depression is the fourth leading cause of disability worldwide.

Overview of Depression

 Facts about Depression

1. More than just feeling blue or sad
2. A medical illness of the brain
3. Affects 1 out of 7 Americans in their lifetime
4. Affects many other body systems (ex. – adrenal glands)
5. Causes more sick days than diabetes or heart disease
6. Treatment is effective 75-85% of the time 

Myths about Depression

1.  A sign of personal weakness
2.  Solely a spiritual problem
3. Nothing can be done about it
4. Not that important:  Ignore it or snap out of it
5. The treatment is worse than the disease

A Statistical View of Depression

1. Affects approximately 5% of U.S. population at any given time
2. Lifetime Risk:  7-12% in men; 20-25% in women
3. Present in 12-16% of general medical patients
4. Responsible for  more than 60% of suicides
5. Costs $44 billion a year in the U.S.
6. 40% of depressed patients seek treatment – usually in primary care
7. Misdiagnosis rate in primary care is 50%.  Usually don’t spend enough time with patient to determine. Also, primary care personnel are focused on physical not mental health.

Why Depressed People Don’t Seek Treatment

1. Social stigma
2. Privacy issue
3. Lack of access
4. Pride
5. Hopelessness
6. No insurance or high deductible
7. Too busy to get help

Types of Depression

1. Major Depression (severe life impairment)
2. Dysthymic Disorder – Chronic low-grade low
3. Bipolar Disorder – Highs and lows.  Salt levels in body are out of balance
4. Organic Mood disorder – Caused by problems with thyroid, anemia, medications, pre-menstrual, post-stroke, post-menopausal, etc.

Symptoms of Depression

1. Feelings of sadness, depressed mood, irritability/anger.
2. Loss of interest and pleasure in hobbies and interests.  “Nothing is fun anymore”
3. Changes in weight and appetite – increase or decrease.
4. Changes in sleep – too much sleep, can’t fall asleep, can’t stay asleep, nightmares.
5. Anxiety – i.e., nervous – stressed out, fears.
6. Fatigue – tired even when had 10 – 12 hours sleep
7.  Inability to concentrate or remember – easily distracted.
8. Thoughts of suicide or dead wishes; wish I could disappear.
9. Decreased libido (sex drive).
10. Social avoidance – avoid people – takes too much effort to be social.
11. Hopelessness/helplessness.
12. Crying spells.
13. Physical symptoms – pain, gastro-intestinal, fatigue, headache, PMS.

Complications of Untreated Depression

1. Drug and Alcohol Abuse – people try to fix themselves and make depression worse.
2. Job and School Problems – late, forget things, angry with peers or authority.
3. Suicide – self-mutilation (cutting, burning), attempted in effort to get help.
4. Worsening of Medical Conditions (diabetes, stroke, heart attacks).
5. Other Psychiatric Problems (OCD, Panic Disorder, ADHD).

Physiology of Depression

1. Defects in serotonin/norepinephrine/dopamine activity.  Brain not producing the above chemicals in the right amounts for normal brain activity
2. Receptor / Second Messenger System Problems.  Like a lamp with a short in the on/off switch.  The brain doesn’t allow one to be on an even keel.
3. Genetics: Risk in the general population = 7-8%. If one parent has depression, risk =16%

 Natural Lesson of Depression

1. Develops slowly with a waxing and waning lesson.  Comes on so slowly it’s not noticed until it’s to the point of incapacitating.
2. A reoccurring disease state – average of 6 episodes / lifetime.

Influence of Depression on Relationships

1. Helplessness.…Self-Focused / Lack of Empathy.  No energy or interest for family/friends.
2. Depression….Emotional Withdrawal / Communication Problems.
3. Despair….Anger / Spiritual Withdrawal.
4. Suicidal Thoughts….Increased risk-taking (affairs, money, addiction).
5. Anxiety….Overly sensitive, Irritable, Anger Outbursts.
6. Loss of Pleasure Drives….Sexual Problems, Social Withdrawal.
7. Hopelessness….Negative / Defeatist Attitude (divorce risks).

Influence of Co-Existing Conditions

Mania (Bipolar) – Bills

1. Intimacy (sexual excess)
2. Paranoid / Irritable 
3. Over committed (neglect of family) 
4. Legal (usually financial or driving of vehicle) 
5. A Mile a Minute Behavior - talk fast, thoughts race 
6. Roller Coaster Relationship

ADHD

1. Poor Impulse Control (Temper Problems, Money, Affairs)

2. Poor Attention (Listening)
3.  Hyperactivity (Can’t sit still / impatient)
4.  Anxiety – leads to depression
5.  Drug / Alcohol Abuse - Codependency (sick care-taking)
6.  Grief
7.  Domestic Violence

Help (Therapy Options)

1. Cognitive Behavioral Psychotherapy
2. Hypnosis
3. Antidepressant Therapy
4. Old Drugs – Elavil, Tofranil, Pamelor, Sinequan, Norpramin
5. Newer – Prozac, Zoloft, Paxil, Celexa, Effexor, Serzone, Wellbutrin, Remeron, Luvox
6. St. John’s Wort
7. Exercise / Diet
8. Light Therapy
9. Sleep Hygiene
10. Electroconvulsive Therapy (ECT 90 – 95% effective)
11. Lithium and Anticonvulsants (Bipolar) 

 The Role of a Counselor

1. Early Identification
2. Explaining the Symptoms
3. Responsible Referral
4. Continued Follow-up and Monitoring