1

Under st andi ng & Managi ng

DEPRESSI ON
Depr essi on
Depr essi on St at i st i c s
Li f et i me pr eval enc e Maj or -17%
Mi nor -17%
Women : Men r at i o i s 2:1(19 mi l l i on )
25% of dr ug and al c ohol pr obl ems
r el at ed t o depr essi on
30-40% of depr essed i ndi vi dual s have
sudden bout s of anger
Onl y 20% of depr essed r ec ei vi ng
adequat e Tx .
Causes of Depr essi on
Genet i c s : Fami l y hi st or y c oul d
i nc r ease l i k el i hood si x -f ol d
Bi ol ogi c al Fac t or s:
Neur ot r ansmi t t er s-
Ser ot oni n, Nor -epi nephr i ne, Dopami ne
Sl eep di sor der s
Li ght depr i vat i on
Repr oduc t i ve Hor mones:
Sudden f l uc t uat i ons of est r ogen &
pr ogest er one
Emot i onal & Physi c al
Si gns of Depr essi on
Depr essi on c an r ange f r om mi l d t o
sever e and t r ansi t or y t o c hr oni c ;
Onset c an oc c ur at any age;
Can be t r i gger ed by 1 event or a
ser i es of event s;
Depr essed mood al one does not
c onst i t ut e a depr essi ve di sor der .
Sadness
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Emot i onal Sympt oms of
Depr essi on
Sadness, t ear f ul ness, l ow sel f -
est eem, obsessi ve sel f -c r i t i c al
t hought s, i nabi l i t y t o ex per i enc e
pl easur e, l oss of ambi t i on, l oss of
i nt er est , i nabi l i t y t o f oc us on t ask s;
I r r i t abi l i t y, anger , pessi mi sm, gui l t ,
hel pl essness, l oss of hope, or
f eel i ngs of despai r , i nc l udi ng
t hought s of sui c i de.
Physi c al Si gns of
Depr essi on
I n t he sl eep r eal m: pr obl ems f al l i ng
asl eep, st ayi ng asl eep or ear l y A.M.
w ak eni ng;
Appet i t e c hanges i nc l udi ng c hanges
i n body w ei ght ;
Soc i al w i t hdr aw al /i sol at i on;
I nc r eased somat i c c ompl ai nt s,
i nc l udi ng anx i et y about i l l ness, and
havi ng many vague body c ompl ai nt s.
Chi l d & Adol esc ent
Depr essi on Sympt oms
Epi sodes l ast avg. 7-9 mont hs;
Sadness, l oss of i nt er est i n f r i ends or
ac t i vi t i es, f eel t hey ar e not
l i k ed/l oved by ot her s;
Feel pessi mi st i c about t he f ut ur e, ar e
i ndec i si ve, have t r oubl e
c onc ent r at i ng i n sc hool & may l ac k
ener gy & mot i vat i on.
Usual l y pr esent w i t h mor e anx i et y,
and ar e r eac t i ve t o f ami l y c hanges
(di vor c e, abandonment or deat h).
Types of Depr essi ve
Di sor der s
Adj ust ment Di sor der ;
Dyst hymi c Di sor der ;
Bi pol ar Di sor der ;
Cyc l ot hymi c Di sor der ;
Maj or Depr essi ve Di sor der
Adj ust ment Di sor der s
Usual l y i n r esponse t o an i dent i f i abl e
st r essor ;
I n men & w omen, pr eval enc e i s 5-
20%, c ondi t i on i s shor t -t er m &
gener al l y t r eat ed w i t h t al k i ng
t her apy;
Cont i nui ng st r essor s may l engt hen
t he per si st enc e of t he adj ust ment
di sor der .
Dyst hymi c Di sor der
Chr oni c al l y depr essed mood t hat i s
pr esent most of t he t i me f or at l east
2 yr s i n adul t s and 1 yr i n c hi l dr en;
Dyst hymi a af f ec t s 6% of t he
popul at i on, esp. w omen;
Depr essed f eel i ng i s ex per i enc ed as
nor mal
Unt r eat ed dyst hymi a and i t s
st r essor s may pr ec i pi t at e an epi sode
of maj or depr essi on.
3
Bi Pol ar Di sor der
Mood i nst abi l i t y w hi c h al t er nat es
bet w een bout s of depr essi on and
epi sodes of mani a;
Condi t i on of t en begi ns i n
adol esc enc e;
Mani c epi sode: r ac i ng t hought s,
over c onf i denc e, t al k s ex c essi vel y,
spendi ng bi nges, ex agger at ed or
del usi onal i deas about abi l i t i es.
Peopl e of t en ex per i enc e a mani c
epi sode as a r el i ef f r om depr essi on.
Cyc l ot hymi c Di sor der
A mi l d f or m of bi -pol ar di sor der ;
Does not i nc l ude psyc hot i c
t hought pr oc esses;
Tr eat ment may i nc l ude
psyc hot her apy and medi c at i on.
Maj or Depr essi on
A ser i ous heal t h pr obl em
c har ac t er i zed by 1+ maj or depr essi ve
epi sodes;
Femal es c ar r y mor e r i sk f ac t or s f or
depr essi on & w or r y mor e about body
i mage, r ej ec t i on & r el at i onshi p
di f f i c ul t i es; f emal es ar e al so
vul ner abl e t o hor monal l y r el at ed
mood f l uc t uat i ons t hr oughout t he
r epr oduc t i ve l i f e c yc l e f or w hi c h
t her e i s gr eat st i gma.
Depr essi on i n w omen
Maj or Depr essi on i n Women
Tw i c e as many w oman as men
Dur i ng ex t r eme hor monal shi f t s
Ear l y puber t y
22% i nc i denc e i n ages 20-45
Per i menopausal sympt om
Pr egnanc y espec i al l y ar ound w k 32
Post par t um ; 2w k s- 3 mont hs
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Menopause
Depr essi on i n Men
Maj or Depr essi on i n Men
Commonl y oc c ur s w i t h at t empt s t o
sel f -medi c at e w i t h al c ohol , dr ugs,
f ood, gambl i ng or sex ;
Men of t en do not ex per i enc e t hese
behavi or s as si gns of depr essi on and
have mor e r el uc t anc e t o ask f or
pr of essi onal hel p.
Depr essi on may be pr ec i pi t at ed by
l oss of abi l i t y t o f unc t i on i n an i mpt
or espec i al l y val ued ar ea of l i f e.
Depr essi on & Li f e
Changes
Even happy & eager l y ant i c i pat ed
event s (bi r t h of a baby, r et i r ement ,
new j ob, et c .) c an pr ec i pi t at e a mi l d
depr essi on;
The c hr oni c i t y of ot her st r essor s c an
have a pr of ound i mpac t on a at -r i sk
i ndi vi dual (c ar i ng f or an agi ng par ent ,
af t er mat h of di vor c e, j ob l ay-of f ,
pr obl emat i c f ami l y i ssues)
Depr essi on & Agi ng
I ssues
I nc r eased w ei ght gai n and c hanges
i n body i mage;
Poor sl eep habi t s, i nc l udi ng
undi agnosed sl eep di sor der s;
Mor e medi c at i ons t o t ak e & MD vi si t s
t o moni t or meds;
Loss of f r i ends or r el at i ves t o i l l ness,
r el oc at i on, or deat h;
Fear s of c r i ppl i ng di seases, c onc er ns
f or adul t c hi l dr en, f i nanc i al w or r i es
about r et i r ement .
Depr essi on & Medi c al
I ssues
Do you k now t hat , i n some at - r i sk
peopl e, t her e i s a l i nk bet w een
depr essi on & undi agnosed di abet es?
Post -oper at i ve c ar di ac pat i ent s ar e
at hi gh r i sk f or depr essi on & t hei r
c ar di ac pr ognosi s i mpr oves w i t h ant i -
depr essant use.
Unt r eat ed l ong t er m depr essi on has
an adver se ef f ec t on our i mmune
r esponse.
5
What About S.A.D.?
Seasonal af f ec t i ve di sor der (SAD)
af f ec t s onl y 1.4% of pop l i vi ng i n t he
Sout h; and 9.7% of peopl e l i vi ng i n
t he Nor t h. Per son may c r ave
c ar bohydr at es (ser ot oni n sub.)
I s a r esponse t o dec r eases i n
dayl i ght , st ar t i ng as ear l y as August
and l ast i ng t hr ough Febr uar y.
Tr eat ment c an i nc l ude use of
medi c at i on, i nc r easi ng amount of
di r ec t sunl i ght , use of a l i ght box , or a
c ombi nat i on of t he above.
A Changi ng Landsc ape
J AMA St udy, 2002: N=32,000
Ki nds of Tr eat ment Rec ei ved:
1987 1997
Ant edepr essant s 37% 75%
al one
Psyc hot her apy 71% 60%
al one
Medi c at i ons
Medi c at i ons t o Tr eat
Depr essi on
Depr essi on i s hi ghl y t r eat abl e, but
some peopl e may bec ome i mpat i ent
w i t h t he pr oc ess (hi gh ex pec t at i ons,
i nt ol er anc e of si de ef f ec t s, i nabi l i t y
t o k eep med moni t or i ng appt s.)
Di f f er ent gener at i ons of ant i -
depr essant medi c at i ons may be used
I ndi vi dual var i abi l i t y f r om per son-t o-
per son;
Psyc hi at r i st st r i ves t o use t he t x
dose, w hi l e mi ni mi zi ng si de ef f ec t s.
Chr oni c Depr essi on
Af f ec t s a smal l # of t hose di agnosed
Usual l y mai nt ai ned on a dai l y dose of
meds t hat i s moni t or ed r egul ar l y by
MD i n or der t o r educ e k i ndl i ng ef f ec t ;
Per son needs t o bec ome aw ar e of
bui l dup pat t er n (r ej ec t i on,
over w or k , poor sl eep, f ami l y st r ess)
and t ak e ac t i ve st eps t o i nt er vene
w i t h MD hel p;
I mpor t ant t o devel op a suppor t i ve
psyc hot her apy r el at i onshi p t o
mi ni mi ze st r ess & pr event r el apse.
St r ess r educ t i on
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Choi c e of Pr of essi onal
Fami l y doc t or
Psyc hi at r i st
Psyc hot her api st (PhD, MSW, et c .)
c ant pr esc r i be meds
Most c ommon sour c e of l ac k of
r esponse i n maj or depr essi on i s t he
admi ni st r at i on of i nadequat e doses,
or t he use of psyc hot her apy al one.
Psyc hot her apy
The i ssue of sui c i de
No ver bal t hr eat s (vague or
ot her w i se) shoul d be di smi ssed or
t r eat ed l i ght l y!
Depr essed f emal es may t hi nk about
i t , but depr essed mal es have mor e
f ol l ow -t hr ough.
Sui c i de mor e l i k el y af t er f or mer
depr essed per son show s smal l
i mpr ovement but now has t he ener gy
t o f ol l ow -t hr ough on pr evi ous sui c i dal
t hi nk i ng.
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