|
|
Help in Depression:
Symptoms & Treatment
| Course Number |
LW03-4263-05003
|
| Objectives |
At the end of this course, you will
1. list the types of depression and their
symptoms.
2. describe the causes of depression.
3. discuss the various treatments of depression.
4. suggest help for four case-studies in depression.
|
| Credit Hours and Fee |
3.0 CE Credit Hours with a fee of $24.00 |
| Instructor |
Rudolf Klimes, PhD (Indiana University), MPH
(Johns Hopkins University); Adjunct Professor, Folsom Lake College,
Folsom, CA |
Welcome
to this
3-contact-hour Continuing Education course with instant online processing
and certification 24/7. Study the course below, take the 12-question
multiple-choice
TEST, register and pay online. If
you score 75% or above, you may print your CE certificate on your printer as
soon as you finish.
If you have difficulty printing your certificate,
click here..
You may retake the test once.
3 Types?
Causes? Treatment?
4 Case-studies?
Course
Description: This is a short course that examines
the types, symptoms, causes and treatments for depression. The
course prepares participants to analyze cases of depression, to refer
individuals to the most helpful professional, and to suggest self-help treatment
options, where appropriate.
Questions
for Self-study: Study the below page in
depth and submit only the quiz.
Take some self-assessments:
Online Depression Tests,
Depression
Assessments,
Depression Scale.
Dysthymia is a very severe type of depression.
The official definition of depression includes 2
weeks of abnormal depressed mood.
Men experience depression about twice as often as women.
Depression is an emotion.
1. List the types of depression and
their symptoms.
Depression
Being clinically depressed is very different from the down type of feeling that
all people experience from time to time. Occasional feelings of sadness are a
normal part of life, and it is that such feelings are often colloquially
referred to as "depression." In clinical depression, such feelings are out of
proportion to any external causes. There are things in everyone's life that are
possible causes of sadness, but people who are not depressed manage to cope with
these things without becoming incapacitated. As one might expect, depression can
present itself as feeling sad or "having the blues". However, sadness may not
always be the dominant feeling of a depressed person. Depression can also be
experienced as a numb or empty feeling, or perhaps no awareness of feeling at
all. A depressed person may experience a noticeable loss in their ability to
feel pleasure about anything. Depression, as viewed by psychiatrists, is an
illness in which a person experiences a marked change in their mood and in the
way they view themselves and the world. Depression as a significant depressive
disorder ranges from short in duration and mild to long term and very severe,
even life threatening. Depressive disorders come in different forms, just as do
other illnesses such as heart disease. The three most prevalent forms are major
depression, dysthymia, and bipolar disorder. The average duration of all
depressive disorders is 20 weeks.
Depression is the world's most common mental illness. About
half of all depressive episodes may be triggered by stressful events. Depression
is treatable.
General symptoms: persistent sad, anxious, or "empty" mood, feelings of hopelessness, pessimism;
feelings of guilt, worthlessness, helplessness; loss of interest or pleasure in
hobbies and activities that you once enjoyed, including sex; insomnia,
early-morning awakening, or oversleeping, appetite and/or weight loss or
overeating and weight gain; decreased energy. fatigue, being "slowed down";
thoughts of death or suicide, suicide attempts; restlessness, irritability,
difficulty concentrating, remembering, making decisions; persistent physical
symptoms that do not respond to treatment, such as headaches, digestive
disorders, and chronic pain
1.1 Major depression
Major depression is a sadness that does not end. It is manifested by a
combination of symptoms that interfere with the ability to work, sleep, eat; and
enjoy once-pleasurable activities. These disabling episodes of depression can
occur once, twice, or several times in a lifetime. The first onset is usually
between ages 25 and 29.
1.2 Dysthymia
A less severe type of depression, dysthymia, involves long-term, chronic
symptoms that do not disable, but keep you from functioning at "full steam" or
from feeling good. It is a chronic mild depression that usually develops in
childhood and is more common in women. It is usually treated with medication and
psychotherapy. Aerobic exercise also seems to be often very helpful.
1.3 Bipolar depression (manic-depressive illness)
Another type of depressive disorder is manic-depressive illness, also called
bipolar depression. Not nearly as prevalent as other forms of depressive
disorders, manic depressive illness involves cycles of depression and elation or
mania. Sometimes the mood switches are dramatic and rapid, but most often they
are gradual. When in the depressed cycle, you can have any or all of the
symptoms of a depressive disorder. When in the manic cycle, any or all symptoms
listed under mania may be experienced. Mania often affects thinking, judgment,
and social behavior in ways that cause serious problems and embarrassment. For
example, unwise business or financial decisions may be made when in a manic
phase.
An official
definition of depression.....
Source: World Health Organization's International Classification of
Disease
2. Describe the causes of
depression.
The exact cause of depression is not known. Doctors think it
may be caused by a chemical imbalance in the brain. The imbalance could be
caused by your genes or by events in your life. Sometimes there aren't enough
chemical messengers (called neurotransmitters) in the brain. These
neurotransmitters carry messages (nerve impulses) from one nerve cell to
another. When there aren't enough, certain messages don't get carried to some
areas of the brain. Two primary messengers, called serotonin (say
"seer-o-tone-in") and norepinephrine (say "nor-ep-in-nef-rin"), are responsible
for your moods (how you feel).
Fact-sheet
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. Later episodes of
illness typically are precipitated by only mild stresses, or none at all.
Depression in Women:
Women experience depression about twice as often as men. Many
hormonal factors may contribute to the increased rate of depression in
women-particularly such factors as menstrual cycle changes, pregnancy,
miscarriage, postpartum period, pre-menopause, and menopause. Many women also
face additional stresses such as responsibilities both at work and home, single
parenthood, and caring for children and for aging parents.
A recent NIMH study showed that in the case of severe
premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS
experienced relief from mood and physical symptoms when their sex hormones were
suppressed. Shortly after the hormones were re-introduced, they again developed
symptoms of PMS. Women without a history of PMS reported no effects of the
hormonal manipulation.
Many women are also particularly vulnerable after the birth of a
baby. The hormonal and physical changes, as well as the added responsibility of
a new life, can be factors that lead to postpartum depression in some women.
While transient "blues" are common in new mothers, a full-blown depressive
episode is not a normal occurrence and requires active intervention.
Depression in Men
Although men are less likely to suffer from depression than
women, three to four million men in the United States are affected by the
illness. Men are less likely to admit to depression, and doctors are less likely
to suspect it. The rate of suicide in men is four times that of women, though
more women attempt it. In fact, after age 70, the rate of men's suicide rises,
reaching a peak after age 85.
Men's depression is often masked by alcohol or drugs, or by the
socially acceptable habit of working excessively long hours. Depression
typically shows up in men not as feeling hopeless and helpless, but as being
irritable, angry, and discouraged; hence, depression may be difficult to
recognize as such in men. Even if a man realizes that he is depressed, he may be
less willing than a woman to seek help. Encouragement and support from concerned
family members can make a difference. In the workplace, employee assistance
professionals or worksite mental health programs can be of assistance in helping
men understand and accept depression as a real illness that needs treatment.
Depression in the Elderly
Some people have the mistaken idea that it is normal for the
elderly to feel depressed. On the contrary, most older people feel satisfied
with their lives. Sometimes, though, when depression develops, it may be
dismissed as a normal part of aging. Depression in the elderly, undiagnosed and
untreated, causes needless suffering for the family and for the individual who
could otherwise live a fruitful life. When he or she does go to the doctor, the
symptoms described are usually physical, for the older person is often reluctant
to discuss feelings of hopelessness, sadness, loss of interest in normally
pleasurable activities, or extremely prolonged grief after a loss.
Recognizing how depressive symptoms in older people are often
missed, many health care professionals are learning to identify and treat the
underlying depression. They recognize that some symptoms may be side effects of
medication the older person is taking for a physical problem, or they may be
caused by a co-occurring illness. If a diagnosis of depression is made,
treatment with medication and/or psychotherapy will help the depressed person
return to a happier, more fulfilling life. Recent research suggests that brief
psychotherapy (talk therapies that help a person in day-to-day relationships or
in learning to counter the distorted negative thinking that commonly accompanies
depression) is effective in reducing symptoms in short-term depression in older
persons who are medically ill. Psychotherapy is also useful in older patients
who cannot or will not take medication. Efficacy studies show that late-life
depression can be treated with psychotherapy.
Depression in Children
Only in the past two decades has depression in children been
taken very seriously. The depressed child may pretend to be sick, refuse to go
to school, cling to a parent, or worry that the parent may die. Older children
may sulk, get into trouble at school, be negative, grouchy, and feel
misunderstood. Because normal behaviors vary from one childhood stage to
another, it can be difficult to tell whether a child is just going through a
temporary "phase" or is suffering from depression. Sometimes the parents become
worried about how the child's behavior has changed, or a teacher mentions that
"your child doesn't seem to be himself." In such a case, if a visit to the
child's pediatrician rules out physical symptoms, the doctor will probably
suggest that the child be evaluated, preferably by a psychiatrist who
specializes in the treatment of children. If treatment is needed, the doctor may
suggest that another therapist, usually a social worker or a psychologist,
provide therapy while the psychiatrist will oversee medication if it is needed.
Parents should not be afraid to ask questions: What are the therapist's
qualifications? What kind of therapy will the child have? Will the family as a
whole participate in therapy? Will my child's therapy include an antidepressant?
If so, what might the side effects be?
Source
3. Discuss the various treatments of
depression.
Antidepressant medications are widely used, effective treatments
for depression. Existing antidepressant drugs are known to influence the
functioning of certain neurotransmitters (chemicals used by brain cells to
communicate), primarily serotonin, norepinephrine, and dopamine, known as
monoamines. Older medications - tricyclic antidepressants (TCAs) and monoamine
oxidase inhibitors (MAOIs) - affect the activity of both of these
neurotransmitters simultaneously. Their disadvantage is that they can be
difficult to tolerate due to side effects or, in the case of MAOIs, dietary and
medication restrictions. Newer medications, such as the selective serotonin
reuptake inhibitors (SSRIs), have fewer side effects than the older drugs,
making it easier for patients to adhere to treatment. Both generations of
medications are effective in relieving depression, although some people will
respond to one type of drug, but not another. Medications that take entirely
different approaches to treating depression are now in development.
Electroconvulsive therapy (ECT), although not generally used as a first-line
treatment, is one of the effective treatments for severe depression.
Psychotherapy is also effective for treating depression. Certain types of
psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT),
have been shown to be particularly useful. More than 80 percent of people with
depression improve when they receive appropriate treatment with medication,
psychotherapy, or the combination. Psychotherapy helps individuals identify the
life problems that contribute to their depression, pinpoint negative and
distorted thinking, and gain a sense of control and joy of life.
Recently there has been enormous interest in herbal remedies for various
medical conditions including depression. One herbal supplement, St. Johns Wort, has been promoted as having antidepressant properties.
However, no carefully designed studies have determined the antidepressant
efficacy of the supplement. NIMH is currently enrolling patients in the first
large-scale, multi-site, controlled study of St. John's wort as a potential
treatment for depression.
Recent Research Findings
Modern brain imaging technologies are revealing that in depression, neural
circuits responsible for moods, thinking, sleep, appetite, and behavior fail to
function properly, and that the regulation of critical neurotransmitters is
impaired. Genetics research indicates that vulnerability to depression results
from the influence of multiple genes acting together with environmental factors.
Studies of brain chemistry, mechanisms of action of antidepressant medications,
and the cognitive distortions and disturbed interpersonal relationships commonly
associated with depression, continue to inform the development of new and better
treatments. The hormonal system that regulates the body's response to stress -
the hypothalamic-pituitary-adrenal (HPA) axis - is overactive in many patients
with depression. The hypothalamus, the brain region responsible for managing
hormone release from glands throughout the body, increases production of a
substance called corticotropin releasing factor (CRF) when a threat to physical
or psychological well-being is detected. Elevated levels and effects of CRF lead
to increased hormone secretion by the pituitary and adrenal glands which
prepares the body for defensive action. The body's responses include reduced
appetite, decreased sex drive, and heightened alertness. Research suggests that
persistent overactivation of this hormonal system may lay the groundwork for
depression. The elevated CRF levels detectable in depressed patients are reduced
by treatment with antidepressant drugs, and this reduction corresponds to
improvement in depressive symptoms. www.nih.gov
ERIC_NO:
EJ612641,
TITLE:
Countering Depression with the Five Building
Blocks of Resilience.
AUTHOR:
Grotberg, Edith H.,
1999
ABSTRACT:
Provides strategies for reducing the risk of youth
retreating into depression when faced with adversities in life, by helping them
develop the building blocks of resilience (trust, autonomy, initiative,
industry, identity). Reports that these building blocks have proven effective in
fostering and strengthening resilience.
Core Beliefs Of
Depression Self-help:
-
Depression is a disease, but like heart disease or diabetes, self-care is
essential to recovery.
-
Depression is not an emotion. Emotions are self-limiting.
-
Depression affects every aspect of ourselves - our thinking, behavior,
emotions, self-esteem, and relationships with others - but we can identify and
control or accept those effects.
Principles for Recovery: The group borrows from Alcoholics Anonymous
in adopting a set of principles, discussion and application of which become the
guidelines for recovery. These principles are from Richard O'Connor, Undoing
Depression (Little, Brown, 1997):
-
Feel Your Feelings
-
Nothing Comes Out of the Blue
-
Challenge Depressed Thinking
>
-
Establish Priorities
-
Communicate Directly
-
Take Care of Your Self
-
Take, and Expect, Responsibility
>
-
Look for Heroes
-
Be Generous
-
Cultivate Intimacy
-
Practice Detachment
-
Get Help When You Need It
A combination
prayer and affirmation that may be read during repressive episodes.
-
I accept the fact that I am
going through a dark night of the soul. I am dying to the me that I have
known.
-
I embrace my pain fully and
accept my present condition. I understand that on some level my soul needs
this experience.
-
Although I feel alone, I know
God is with me.
-
I realize that this experience
has a purpose and teaching, and I ask God to reveal it to me.
-
Although I am in pain, I know
that my travail will end, and that love, inspiration and direction will
reenter my life.
-
I ask God to give me strength,
courage and guidance to see my way to my rebirth.
-
I give thanks for my situation
just the way it is. Adapted from
Source
4. Suggest help for four case-studies in depression.
Four Depression Case
Studies.
For self-study, review the above four cases.
Analyze the four cases of depression, suggest ways to refer individuals to the
most helpful professional, and suggest self-help treatment options, where
appropriate. Do not submit this to the instructor.
Depression Library: Psychological
Self-Help
Depression
Brochure Depression Research
Depression Information
Center
Depression in Primary
Care Andrew's
Depression Page
Understanding and
Treating Depression www.bpdworld.org
Now take the
TEST
Study this web-site for 3 hours for an
approved 3-hours Continuing Education Certificate (0.3 CEUs)
Click
here for the self-correcting test.
|
|