depression [Compatibility Mode].pdf

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“Understanding & Managing DEPRESSION”

Depression

Depression Statistics• Lifetime prevalence Major-17%• Minor-17%• Women : Men ratio is 2:1(19 million )• 25% of drug and alcohol problems

related to depression• 30-40% of depressed individuals have

sudden bouts of anger• Only 20% of depressed receiving

adequate Tx.

Causes of Depression• Genetics : Family history could

increase likelihood six-fold• Biological Factors:

Neurotransmitters-Serotonin, Nor-epinephrine, Dopamine

Sleep disordersLight deprivation

• Reproductive Hormones:Sudden fluctuations of estrogen & progesterone

Emotional & Physical Signs of Depression

• Depression can range from mild to severe and transitory to chronic;

• Onset can occur at any age;• Can be triggered by 1 event or a

series of events;• Depressed mood alone does not

constitute a depressive disorder.

Sadness

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Emotional Symptoms of Depression

• Sadness, tearfulness, low self-esteem, obsessive self-critical thoughts, inability to experience pleasure, loss of ambition, loss of interest, inability to focus on tasks;

• Irritability, anger, pessimism, guilt, helplessness, loss of hope, or feelings of despair, including thoughts of suicide.

Physical Signs of Depression• In the sleep realm: problems falling

asleep, staying asleep or early A.M. wakening;

• Appetite changes including changes in body weight;

• Social withdrawal/isolation;• Increased somatic complaints,

including anxiety about illness, and having many vague body complaints.

Child & Adolescent Depression Symptoms• Episodes last avg. 7-9 months;• Sadness, loss of interest in friends or

activities, feel they are not liked/loved by others;

• Feel pessimistic about the future, are indecisive, have trouble concentrating in school & may lack energy & motivation.

• Usually present with more anxiety, and are reactive to family changes (divorce, abandonment or death).

Types of Depressive Disorders

• Adjustment Disorder;• Dysthymic Disorder;• Bipolar Disorder;• Cyclothymic Disorder;• Major Depressive Disorder

Adjustment Disorders

• Usually in response to an identifiable stressor;

• In men & women, prevalence is 5-20%, condition is short-term & generally treated with talking therapy;

• Continuing stressors may lengthen the persistence of the adjustment disorder.

Dysthymic Disorder• Chronically depressed mood that is

present most of the time for at least 2 yrs in adults and 1 yr in children;

• Dysthymia affects 6% of the population, esp. women;

• Depressed feeling is experienced as “normal”

• Untreated dysthymia and its stressors may precipitate an episode of major depression.

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BiPolar Disorder • Mood instability which alternates

between bouts of depression and episodes of mania;

• Condition often begins in adolescence;

• Manic episode: racing thoughts, overconfidence, talks excessively, spending binges, exaggerated or delusional ideas about abilities.

• People often experience a manic episode as a relief from depression.

Cyclothymic Disorder

• A mild form of bi-polar disorder;• Does not include psychotic

thought processes;• Treatment may include

psychotherapy and medication.

Major Depression• A serious health problem

characterized by 1+ major depressive episodes;

• Females carry more risk factors for depression & worry more about body image, rejection & relationship difficulties; females are also vulnerable to hormonally related mood fluctuations throughout the reproductive life cycle for which there is great stigma.

Depression in womenMajor Depression in Women

• Twice as many woman as men• During extreme hormonal shifts• Early puberty• 22% incidence in ages 20-45• Perimenopausal symptom• Pregnancy –especially around wk 32• Post partum ; 2wks- 3 months

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Menopause Depression in Men

Major Depression in Men• Commonly occurs with attempts to

self-medicate with alcohol, drugs, food, gambling or sex;

• Men often do not experience these behaviors as signs of depression and have more reluctance to ask for professional help.

• Depression may be precipitated by loss of ability to function in an impt or especially valued area of life.

Depression & Life Changes

• Even happy & eagerly anticipated events (birth of a baby, retirement, new job, etc.) can precipitate a mild depression;

• The chronicity of other stressors can have a profound impact on a at-risk individual (caring for an aging parent, aftermath of divorce, job lay-off, problematic family issues)

Depression & Aging Issues• Increased weight gain and changes

in body image;• Poor sleep habits, including

undiagnosed sleep disorders;• More medications to take & MD visits

to monitor meds;• Loss of friends or relatives to illness,

relocation, or death;• Fears of crippling diseases, concerns

for adult children, financial worries about retirement.

Depression & Medical Issues• Do you know that, in some at- risk

people, there is a link between depression & undiagnosed diabetes?

• Post-operative cardiac patients are at high risk for depression & their cardiac prognosis improves with anti-depressant use.

• Untreated long term depression has an adverse effect on our immune response.

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What About S.A.D.?

• Seasonal affective disorder (SAD) affects only 1.4% of pop living in the South; and 9.7% of people living in the North. Person may crave carbohydrates (serotonin sub.)

• Is a response to decreases in daylight, starting as early as August and lasting through February.

• Treatment can include use of medication, increasing amount of direct sunlight, use of a lightbox, or a combination of the above.

A Changing Landscape

• JAMA Study, 2002: N=32,000• Kinds of Treatment Received:

1987 1997Antedepressants 37% 75%

alonePsychotherapy 71% 60%

alone

MedicationsMedications to Treat Depression• Depression is highly treatable, but

some people may become impatient with the process (high expectations, intolerance of side effects, inability to keep med monitoring appts.)

• Different “generations” of anti-depressant medications may be used

• Individual variability from person-to-person;

• Psychiatrist strives to use the tx dose, while minimizing side effects.

“Chronic” Depression• Affects a small # of those diagnosed• Usually maintained on a daily dose of

meds that is monitored regularly by MD in order to reduce kindling effect;

• Person needs to become aware of “buildup” pattern (rejection, overwork, poor sleep, family stress) and take active steps to intervene with MD help;

• Important to develop a supportive psychotherapy relationship to minimize stress & prevent relapse.

Stress reduction

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Choice of Professional

• Family doctor• Psychiatrist• Psychotherapist (PhD, MSW, etc.)

can’t prescribe meds• Most common source of lack of

response in major depression is the administration of inadequate doses, or the use of psychotherapy alone.

Psychotherapy

The issue of suicide• No verbal threats (vague or

otherwise) should be dismissed or treated lightly!

• Depressed females may think about it, but depressed males have more follow-through.

• Suicide more likely after former depressed person shows small improvement but now has the energy to follow-through on previous suicidal thinking.

Your BNL EAPYour BNL EAP Manager: Nancy

Losinno avail Mon-Fri. Call X4567 to make appt.

24/7 crisis coverage provided by Magellan Behavioral health at 1-800-327-2182 or go to www.magellanhealth.com/member

Employees and their household members are covered for 5 free visits to a Magellan-network provider. Call EAP Manager for referrals