Depression: Lifting the Veil

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After completion of this course you will receive 1 Continuing Education Unit
Is this course for me? This course is for RNs, LVNs, Psych Techs, Administrators & Workers for Adult Residential Facilities, Residential Facilities for the Elderly & Group Homes
Course Synopsis:

We all face ups and downs from time to time. It’s a normal part of life. Most of us can relate when someone we know goes through a down period after experiencing some type of loss or other distressing event. Even when we personally have to ride out an occasional wave of sadness, we usually don’t panic because we know that in time-maybe in just a matter of hours or days, at the most we’ll bounce back and the sad feelings will gradually fade.

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Sample CEU Certificate

Course Objectives: 

Upon completion of this course you will be able to:

  • Define and understand the complexities of depression
  • Understand the common signs and symptoms of depression
  • Gain knowledge about the physiological processes of depression
  • Identify and assess individuals who may be at risk or currently suffering from depression
  • Comprehend the ramifications that depression has on health, the individual, family, friends and society
  • Develop and utilize strategies, tools and resources to help those suffering from depression
  • Gain knowledge about various treatment options for depression

Course Instructor Profile:

 Donn Kropp founded CLiCKPLAY Continuing Education University out of a desire to bring others to greater levels of health and wellness. With over ten years of emergency and trauma room experience, Donn brings a seasoned, yet fresh approach to continuing education.

Course Approvals

This course is approved by the following governing boards & organizations:

  • CA Board of Registered Nursing: CA Provider # CEP 15849
  • District of Columbia Board of Nursing: CE Provider #50-14108
  • California Board of Vocational Nursing Provider # V10810
  • Psychiatric Technicians Provider # V10806
  • DSS/CCL Division for Adult Residential Facilities (ARF) Vendor Approval # 2000149-735-2: Course Approval #149-0112-26421
  • DSS/CCL Division for Residential Facilities for the Elderly (RCFE) Vendor Approval # 2000149-740-2: Course Approval #149-0106-26481
  • DSS/CCL Division for Group Homes (GH) Vendor Approval # 2000149-730-2: Course Approval #149-0106-26480
  • Far Northern Regional Center

Transcript

Depression: Lifting the Veil

1. INTRODUCTION
Hi, my name is Donn Kropp. Welcome to our course entitled, Depression-Lifting the Veil. Depression can shake you to the core, corrode your confidence, self-esteem, your ability to think straight and make decisions. The feelings of sadness can be overwhelming not just to the sufferer but to those around them. We all face ups and downs from time to time. It’s a normal part of life. Most of us can relate when someone we know goes through a down period after experiencing some type of loss or other distressing event. Even when we personally have to ride out an occasional wave of sadness, we usually don’t panic because we know that in time-maybe in just a matter of hours or days, at the most we’ll bounce back and the sad feelings will gradually fade.

But, for a person suffering from severe depression, the waves of sadness, hopelessness and anxiety can seem to be unending. It’s a staggering statistic- experts tell us that one in ten people will experience some type of major depressive disorder during their lifetime. Depression has become one of the leading causes of disability worldwide. Unfortunately, in our culture, and even within the healthcare and human services community, depression is a loaded word. Sadly, even to this day there is still stigma surrounding depression and this causes thousands of people who suffer from depression to avoid seeking the help they need. Unfortunately, because of this stigma individuals may be ashamed and worry about the reaction of their friends, families or coworkers. Those who are experiencing depression often times feel like they are the only ones suffering from this illness. Sufferers might even have to deal with people who dismiss their symptoms or make them feel ashamed and embarrassed that they’re not able to just “snap out of it”.

It’s important for us as healthcare professionals and human service workers to understand the seriousness of major depressive disorders since they’re one of the most common medical and mental conditions globally. Without treatment, depression can quickly become life-threatening. Our health care system is so vast and complicated that it often overlooks all of the cracks that a person with mental illness can fall into. Because of this, we need to be aware of the early warning signs in ourselves, in the people we work with, as well as in the patients or clients we treat and provide care to. We want to iterate that depression has nothing to do with a character defect, personal weakness or a problem that people bring on themselves. We really want to express in this course that suffers of depression are not alone and help is readily available. Also in this course we want to help you understand that depression goes far beyond a temporary mood swing or a case of “the blues”. It’s a serious and complex medical condition with a number of emotional, cognitive, physical and behavioral aspects. So join me now as we lift the veil and uncover the topic of Depression.

2. OBJECTIVES
By the end of this course, you will be able to :
1. Define and understand the complexities of depression
2. You’ll also learn about the common signs and symptoms of Depression
3. We’ll help you understand the physiological processes of Depression.
4. You’ll also learn today about how to identify and assess individuals who may be at risk or currently suffering from depression.
5. We’ll also delve into the ramifications that depression has on health, the individual, family, friends and society at large.
6. Also today we’ll help you develop and utilize strategies, tools and resources to help those suffering from depression.
Finally we’ll look at various treatment options for depression.
Well, as you can see we have a lot to cover in this course….So, let’s get started!

3. DEFINING DEPRESSION
As we’ve already mentioned, depression goes much deeper than just occasional feelings of sadness. We all go through ups and downs in our mood and sadness is a normal reaction to life’s struggles, setbacks, and disappointments. We hear people use the word “depression” to explain these kinds of feelings, but clinical depression is a serious illness that disrupts every aspect of a person’s day-to-day life. It interferes with work, study, eating habits, sleeping patterns and social life. Physical health can start to deteriorate. Depression sufferers can experience the intense waves of sadness for weeks, months, and years at a time. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, and the person gets very little to no relief.

Individuals who suffer from clinical depression often describe it as living in a “black hole of despair” where they face overwhelming feelings of impending doom. Other people who are depressed don’t feel sad at all—they may feel lifeless, empty, and apathetic. Men in particular report feeling angry, aggressive, or restless. A person in the midst of a major depressive episode may experience a number of these emotions and without help they’ll often worry that there’s no light for them at the end of the tunnel. Clinical depression can take several different forms. The first step in helping someone to find the best treatment approach for their illness is determining what type of depression they have.

This course will focus on major depression and we’ll spend most of our time exploring this illness. However, in a little bit we’ll briefly discuss some other types of depression. Major Depression is diagnosed if a person’s symptoms are severe enough to interfere with their day-to-day functioning and if the symptoms persist for extended periods of time. According to the Diagnostic and Statistical Manual of mental disorders published by the American Psychiatric Association a diagnosis of major depression is made when the sufferer has five or more of the following symptoms over a two-week period. Symptoms can be based on the feelings the individual suffering from depression has or can be based on observations made by someone else. The following are the typical symptoms of major depression:

1. Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful.
2. Diminished interest or feeling, having no pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting, weight gain, decrease or increase in appetite nearly every day.
4. Insomnia or increased desire to sleep nearly every day.
5. Either restlessness or slowed behavior that can be observed by others.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness, or excessive or inappropriate guilt nearly every day.
8. Trouble making decisions, or trouble thinking or concentrating nearly every day.
9. Recurrent thoughts of death or suicide, or a suicide attempt.

It’s important to note here that to be considered as suffering from major depression the symptoms must not be due to a mixed episode of simultaneous mania and depression that can occur in bipolar disorder. Also, symptoms must be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others.A diagnosis of major depression is not made if symptoms are due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism. Also, if symptoms are caused by grieving, such as temporary sadness after the loss of a loved one- major depression is ruled out as a diagnosis.

Do you know anyone who meets the criteria just mentioned? Do you yourself meet the criteria? If so, it’s time to reach out and help yourself or the individual suffering from depression to get help. Remember, it’s important to note here that there are a few other types of depression. It’s key to be able to differentiate between the types of depression so that an accurate diagnosis and treatment plan can be made. Today we’ll just briefly highlight the different types of depression. The first one we’ll mention is called. Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life such as the ending of a relationship or marriage. Death of a loved one. Undergoing a major life change such as moving, getting married or having a baby. This type of stress-related mental illness may affect your feelings, thoughts and behavior. A sufferer of adjustment disorder may feel anxious or depressed, or even have thoughts of suicide. The normal daily routines may feel overwhelming. Or you may make reckless decisions. In essence, those who suffer from this disorder have a hard time adjusting to change in life, and it has serious consequences.

Bipolar disorder is talked about a lot in our society and has been highlighted in several movies and television shows over the years. This type of depression used to be called manic depressive disorder. Bipolar disorder causes people to have emotional extremes that swing between intense hyperactivity and devastating lows. The third type of depression we’ll mention is Cyclothymia. Cyclothymia, also called cyclothymic disorder, is a milder form of bipolar disorder. With cyclothymia, a person may experience periods when their mood noticeably shifts up and down from your their normal state. Cyclothymia causes someone to feel on top of the world for a time, followed by a low period. Between these cyclothymic highs and lows, an individual may totally feel stable and fine.

Another type of depression is Dysthymia. Dysthymia is not as disabling as major depression but it causes depressive symptoms that make it difficult for the person to function as well as they normally would. Some people with dysthymia may also experience intermittent periods of major depression. Another type of depression we hear talked about is Postpartum depression. Often times we hear mothers having the baby blues that send moms into to unprovoked crying spells that seem to resolve quickly. However, postpartum depression is severe and long lasting and if left unnoticed or untreated the welfare and safety of the mother and new child may be at risk.

Psychotic depression is another type of depression. Those who suffer from this type struggle with bouts of severe depression accompanied by psychotic symptoms, such as delusions or hallucinations. Delusions can come in the form of intense feelings of failure, worthlessness or having committed some-kind of a sin. Hallucinations can be auditory or visual such as hearing voices or seeing objects, ghosts or people. Those who have psychotic depression may become angry for no reason, may neglect their personal hygiene or say random and illogical things. It’s important to note here that psychotic depression is different from schizophrenia in that the theme of an individuals psychosis is depression coupled with feelings of worthlessness or failure.

Let’s talk a little bit about Seasonal affective disorder. This type of depression is related to changes in seasons and has been associated with diminished exposure to sunlight. If you get depressed at the same time every year when the seasons are changing, usually in the fall or winter, then there’s a pretty good chance you’re suffering from Seasonal Affective Disorder. This disorder manifests with the same symptoms of depression but resolve when the seasons change back. If one of these disorders strikes it can have profound and devastating effects on the individual sufferer, their family, friends and society at large. So let’s make sure to remember the symptoms of these disorders and be vigilant and aware so that we can do our part to help someone in need. It can be devastating if depression is misdiagnosed. Imagine if someone is suffering from Seasonal Affective Disorder- would it be appropriate for them to receive treatment aimed at helping psychotic depression? No, there isn’t a one size fits all treatment for the different types of depression. Treatment should be tailored and customized to meet the needs of the individual and their specific symptomology. In our day and age it’s easy to just recommend or prescribe an antidepressant or anti-psychotic medication. But, the human body and mind is very complex. We must really be cautious and focus in on what the sufferer is experiencing and tailor treatment and support accordingly.

4. SIGNS & SYMPTOMS
Surprisingly, depression is one of America’s most common illnesses but it’s also one of the least understood. It can be hard to recognize. But depression is an illness, not a weakness, so no amount of “cheering up”, or exercise, vitamin supplements or vacation can make it go away. It’s important that everyone, the person who is depressed as well as each of the healthcare and human service workers involved, acknowledge that when biochemical factors are at play, depression can’t simply be willed away with a positive outlook. The dark moods of this illness are beyond the sufferer’s control. A depressed person will need your empathy and support. The sufferer will probably be just as baffled by their condition as their family members and friends are.

Since depression can strike a person of any age or background, depression has a lot of different faces. It doesn’t always appear the same in men as it does in women, and it looks different in young people than it does in older adults. Being aware of how depression affects different individuals, gender and age groups can help healthcare professionals and human services workers to recognize depression early on and help the sufferer benefit from the enormous relief that comes from an early diagnosis and proper treatment. Let’s break depression down by gender and see how women are specifically effected. Studies show that women are twice as likely to suffer from depression as men. This is partly due to hormonal factors that can influence a person’s brain chemistry. During life phases when hormones go through drastic fluctuations, for instance in the case of premenstrual syndrome, pregnancy and postpartum, or menopause, it’s more likely that women will experience a serious depressive episode. Women who suffer from depression are more likely than men to have feelings of guilt, and to sleep excessively, overeat, and gain weight.

So how does depression manifest in men? Unfortunately, depression in men is often portrayed by the entertainment world and society as a sign of weakness. When a man expresses strong emotions of fear or sadness, they are easily labeled as “out of control” or wimpy. Depressed men are less likely than women to express or admit their true feelings of self-loathing and hopelessness. Instead, they’ll tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and other activities they used to enjoy. Men who are dealing with depression often show signs of anger, aggression, violent and reckless behavior, or substance abuse. It’s important to note that anger is almost always a secondary emotion. Meaning that the anger is covering up some other primary emotion or feeling. So, it’s really important to understand when interacting with a man who is angry that there are other feelings below the tough angry edifice. Although the depression rates for women is twice as high as it is in men, males who suffer from depression are at a much higher risk of suicide, especially as they get older.

Let’s talk a little bit about teens. Remember being a teenager? It’s a hard time of life, isn’t it? Did you just put a picture up of me when I was a teen? You better not. Stop it. I mean it. Is it still there? I’ll just ignore it. Getting back to our topic at hand. The teenager is trying on adulthood for size to see if it fits and often times the teen is confused, scared, hormonal, ruled by social interactions and not to mention acne and the awkwardness. What a tough time? When interacting with teenagers you have to have a whole different set of eyes. Sadly, teenage depression is on the rise. It can be easy to miss because depressed teens don’t always appear to be sad, but instead may be hostile, moody, or short-tempered. They may also complain of dull aches and pains. These symptoms can be mistaken by parents or caregivers as “normal” teenage behavior. In fact, irritability is actually the most predominant symptom in depressed adolescents and teens. If it’s not caught early enough, teenage depression can easily escalate into problems at home and school, or even go so far as leading the person into substance abuse, violence or suicide. But the good news is that with professional help and a supportive family and friends, teenage depression is highly treatable. Do you know a teenager who has been acting out? Rather then dismissing the teen as just being a teenager let’s try to communicate and really find out what is happening in their mind and heart.

Let’s shift our focus from teenagers and talk a little bit about the aging population. Many older individuals are bombarded with enormous challenges – the loss of their mate, health problems and having to give up independence. Because of these and other types of stressors, it’s common for older adults to suffer from depression, especially if they don’t have a strong support system of friends and family. However, this doesn’t mean that depression has to be just a normal part of aging. When caring for an aging population, it’s more common that we hear them complain about their physical pain and symptoms than it is to hear them express their emotional issues that may indicate depression. Depression in older adults is associated with a noticeable decline in health, a higher mortality rate, and an increased risk of suicide. As healthcare and human service workers, we can help by having a listening ear and when we notice the signs, tactfully ask if the person feels like they’re getting the help that they need. In our next section we’ll talk about the physiological process of depression and will answer the question about what is going on in the body and brain of those suffering from depression?

5. THE PHYSIOLOGICAL PROCESS
In spite of all the research and advances we’ve made in healthcare and mental health, there’s no clear answer to the question: what causes clinical depression? In some cases there seems to be a strong genetic link, but in most instances life experiences appear to play an even more important role. And although we’ve mentioned that depression is diagnosed in twice as many women as men, this doesn’t mean that men are unaffected. The numbers show that between five and twelve percent of men will become clinically depressed at some point in life. A person’s unique brain chemistry can also put them at increased risk of serious depression. Within the brain we know that there are literally billions of neurons that communicate electrochemically. Each of these nerve fibers branches out at the ends with tiny gaps in between them called synapses. The job of the chemical neurotransmitters is to transfer messages across the synaptic gap.

Most researchers feel that an imbalance of these naturally occurring chemicals can cause depression. One of the most important neurotransmitters is serotonin, which researchers believe influences a person’s biological vulnerability to suicide. The book Inside the Brain says: “A low serotonin level . . . can dry up the wellsprings of life’s happiness, withering a person’s interest in his existence and increasing the risk of depression and suicide.” Norepinephrine and dopamine are other important neurotransmitters that can trigger symptoms of depression when there is an imbalance, since they’re thought to be associated with brain functions like mood, pain sensation, appetite, loss of pleasure, energy and motivation. There are a number of reasons why healthcare professionals and human service workers need to be alert to the danger of depression in our client population:

Depression is a very widespread illness. Certain portions of the population are more susceptible than others, especially those with chronic illnesses, regardless of their age or background. According to the World Health Organization, by the year 2020 depression will be the second leading cause of disability worldwide, coming close behind heart disease in the number of people it affects. Researchers are also discovering more and more evidence that depression can’t be considered a strictly psychological illness. Neuro-endocrinologists have found that it’s one of the only systemic diseases we know of that can aggravate other seemingly unrelated illnesses. Experts also suspect that depression can trigger conditions like heart disease, diabetes, osteoporosis and cancer. How does this happen? Studies show that the hearts of depressed individuals can become more rigid over time, making the heart less able to respond to the body’s ever-changing demands for blood and oxygen. And a brain that is depressed increases its demands for energy, which can trigger the body to produce more cortisol known as the body’s stress hormone, which in turn raises blood sugar levels, ultimately increasing the person’s risk of developing diabetes. Scientists are now interested in finding out if treating a patient’s depression can improve the outcome of other serious medical disorders they suffer from.

Another reason why healthcare professionals and human service workers need to be alert to the signs of depression is that when left untreated, it can spiral out of control and potentially lead to suicide. People who feel depressed are usually able to cope as long as there is some hope to hold on to and a reason to believe that things will eventually improve. So being that source of hope to a person with depression is one of the most important roles we can play in our patient’s and client’s lives. The opposite is also true: if a person’s feelings of despair start to pile up day after day, the pain can become so unbearable that their ability to control suicidal impulses starts to weaken. It’s a lot like brakes on a car that are worn thin by constant stress. So you can see how vital it is that we first of all, help people to find positive ways to get relief from the pain, and secondly to reassure them that the hopelessness they feel will get better as they receive the support and the treatment they need.

6. ASSESSING DEPRESSION
I like this quote by Dr. David Fassler. “Sadness is a normal, healthy emotion; depression is a disease. The challenge lies in understanding and recognizing the difference.” The First Step we must take in assessing depression is to recognize the Warning Signs. Like most other disorders, depression can be assessed and diagnosed by a discerning healthcare professional who notices some of the telltale symptoms. But often the signs are overlooked or misdiagnosed. Why does this happen? One reason is because so many people experience dark moods or episodes throughout their life, especially if they’re hospitalized or coping with another chronic illness. Without making the effort to investigate further, it can be hard to differentiate between a case of the blues and clinical depression. Even a relatively brief bout can be what experts refer to as a depressive episode. As we’ve mentioned earlier, there are two determining factors that specialists use to pinpoint what type of depression a person is suffering from–intensity and duration. Intensity describes how deeply the negative feelings affect the life of the depressed individual. When a person’s condition becomes an all-consuming emotional illness that seriously impairs their ability to function at home, at work or at school, clinical depression is often the diagnosis. One doctor describes the severity or intensity of depression this way: “Imagine the worst physical pain you’ve ever had—a broken bone, a toothache, or labor pain—multiply it tenfold and take away the cause; then you can possibly approximate the pain of depression.”

The second determining factor clinicians use to pinpoint the specific type of depression is to look at duration. Duration refers to the length of time the feelings and physical symptoms continue without relief. When diagnosing depression, a physician or primary health care provider will want to know whether the person’s symptoms tend to last for the entire day, every day for long periods of time, or whether they tend to be more sporadic in nature. Motivating a depressed person to take the step of consulting with their doctor or primary care provider can be a huge obstacle. It may take a lot of encouragement, but it’s an essential and critical step on the road to recovery.

During an initial consultation, a clinician, physician, psychiatrist or other primary care provider will most likely start with a thorough diagnostic evaluation of the individual’s physical health history, psychosocial status, especially the quality of their social and interpersonal relationships, and an assessment of any history of mental health conditions. The clinician will also take note of any previous treatments given for mood disorders and whether or not these were effective. A complete patient history will help to guide the healthcare team in providing the most suitable treatment options or a combination of therapies. The physician may also wish to speak to close relatives about the person’s condition and behavior to ensure they have a complete picture of the symptoms and quality of life.

Keeping the factors of intensity and duration in mind, mental health experts look for specific changes in behavior to confirm the diagnosis of major depression. We have already mentioned the process of diagnosis for major depression earlier but let’s just review them here again. If an individual has displayed more than five of the following symptoms during a 2-week period, then depression is strongly suspected:
Symptom 1: Depressed mood most of the day, nearly every day for two weeks or longer.
Symptom 2: Significant loss of interest or pleasure in previously enjoyed activities.
Symptom 3: Significant fluctuation in weight, change of more than five percent of body weight during a one month period, or change in appetite nearly every day.
Symptom 4: Inability to sleep-insomnia- or sleeping a large portion of the day-hypersomnia.
Symptom 5: Psychomotor agitation such as inability to sit still, pacing, repetitive hand-wringing, fidgeting or rubbing of the skin, clothing, or other objects. Or slowing of motor skills such as: Slowed or slurred speech and body movements; lengthy pauses before answering questions. Speech that is quieter than normal, without inflection or variety, or total muteness.
Symptom 6: Fatigue or unexplained loss of energy nearly every day.
Symptom 7: Feelings of worthlessness or excessive or inappropriate guilt, which may be delusional.
Symptom 8: Mental fogginess and a diminished ability to think or concentrate; or indecisiveness, nearly every day.
Symptom 9: Recurrent thoughts of death, not just fear of dying, or ending it all, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The primary care provider will be interested in finding out if the symptoms we’ve just mentioned have caused significant impairment in the person’s social activities, productivity at work or in any other areas of life. They’ll also be careful to rule out any symptoms that may be the result of medication, substance abuse, another medical condition or whether they’re a normal emotional response to a personal loss or tragedy that may improve on its own in time. In our next segment we’ll look at the effects of depression and its ramifications on health, family, loved ones and society at large.

7. EFFECTS & RAMIFICATIONS
The family impact of depression is complex. Coping with mental illness can be a chaotic and frightening time for the person suffering from depression as well as the people they are closest to. Family members may be afraid of where it all will lead or feel totally unprepared to provide the special kind of support that their loved one is asking of them. When close family members aren’t well informed about their loved one’s condition, relationships can become strained and the problem can easily intensify. One of the biggest challenges in dealing with depression arises when friends and relatives don’t realize that the changes they’ve observed in the person indicate a possible mood disorder.

Doctors report that even when family members agree about how the depressed person’s behavior has changed, they may have very strong and different beliefs about what’s causing them to act this way. But even more dangerous is when these signs go unnoticed by family and close friends. In the book “No One Saw My Pain”, Dr. Andrew Slaby writes that in almost every case of suicide he’s reviewed, there were clues to the depressed person’s plans that were overlooked or downplayed. Dr. Slaby observes that family members and friends don’t often understand the enormity of the changes they see in a loved one. They commonly focus on the consequences and not on the underlying problem, so what happens is the ‘family problems’ or ‘drug use’ or ‘anorexia’ become the diagnosis instead of being the symptoms stemming from depression. Sometimes the anger, the confusion, and the irritability are treated but not the core issue of depression. The underlying problem remains and continues to be agonizing and painful for all parties involved.

The prevalence of depression and suicide underscores the need for families to take any signs and symptoms extremely seriously. A recent report from the U.S. Centers for Disease Control showed that during one recent year, more young Americans died from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. Another disturbing fact is there’s been a dramatic increase in reported suicides among people between the ages of ten to fourteen. So we hope that the message is clear: Whether you’re a healthcare or human service worker, husband, wife, sibling, or just a friend with a listening ear: take any hint of depression or suicidal tendencies seriously! Don’t wait – remind the person that depression is an illness that can and should be treated and that you’ll be there to support them.

8. TREATMENT OPTIONS
If left untreated depression can be life-threatening, but with a careful balance of medication, counseling, lifestyle, diet modifications and social support, people are winning the battle. There will still be depressed days, but in time, the person will learn the coping skills necessary to regain their ability to function and enjoy life. And they’ll learn when it’s time to ask for help through medical intervention before their symptoms get to the point of being overwhelming. In this section, we’ll help familiarize you with some of the most common treatments for depression. The first line of treatment is usually medication. There are four main classes of drugs that are often prescribed for depression: serotonin reuptake inhibitors abbreviated SSRI’s. Atypical Antidepressants, Tricyclic antidepressants and Monoamine Oxidase inhibitors abbreviated MAOI’s. SSRI’s are some of the most well-known antidepressants like Prozac, Zoloft, and Paxil. They act on the neurotransmitter serotonin that we discussed earlier. Serotonin helps regulate mood and affects digestion, pain sensations, sleep habits, mental clarity, and other bodily functions. This type of drug is preferred over older classes of antidepressants such as tricyclic antidepressants and MAOI’s because the side effects are less severe. There are also new atypical antidepressants that are emerging which are able to target other specific neurotransmitters in addition to serotonin.Tricyclics are one of the oldest antidepressant medications we have. They work by inhibiting the brain’s re-uptake of serotonin and norepinephrine and they inhibit the reabsorption of dopamine. Unfortunately, since these tricyclics are so wide-acting in the brain, they also tend to cause more side effects than the other classes of antidepressants. For this reason, the SSRI’s and the atypical antidepressants are usually prescribed as a first line treatment. MAOI’s (monoamine oxidase inhibitors) are the oldest class of antidepressants. They aren’t used nearly as often as they used to, because they can have severe interactions with certain foods, drinks, and medications. Because of this danger, MAOI’s are usually only used when the other classes of drugs haven’t been successful. It’s important to note here that it can take time to find the medication that best suits the depressed individual’s needs. Most antidepressants take several weeks to take full effect and in some cases, the dosage may need to be increased, a secondary drug may have to be added, or the first drug may be replaced with another one altogether. Another treatment option is talk therapy. There are many different forms of talk therapy that have been shown to be effective for people with mood disorders. Cognitive behavioral therapy is the one of the most studied and it’s looked to as a very safe and effective treatment for depression. It can help a person to identify their negative thought patterns and correct them, which is essential for depressed people to be able to cope and adapt to the world around them. One of the biggest advantages of talk therapy is that it allows a depressed person to express their thoughts and feelings without the fear of repercussions or the risk of side effects.

Did you know that diet Matters. I think I’ll make a shirt that says that. Can we we make a shirt like that for this segment. [Snap Fingers] There that’s more like. I wonder if I can market this shirt? This awesome. Where were we again? Ah yes, the importance of diet. There have been a number of fascinating studies done recently on the psychological effects of nutrition. A recent study looked at the correlation of diet and depression of prison inmates, who tend to have very high rates of depression. One researcher followed 8000 teenage inmates in 9 different U.S. correctional facilities over a course of a year. The participants who’d been eating a diet that was really high in sugar and refined carbohydrates were given meals that included fresh fruits, vegetables and whole grains. During the year, the number of violent and antisocial incidents decreased by almost half. This is just one of dozens of studies that have shown a link between bad food (especially sugar and processed foods) and depression. Making the switch to a diet of fresh produce and unprocessed foods can do wonders for a person’s mind and body. Avoiding sugar and simple carbohydrates is especially important for individuals who are susceptible to depression. Let’s talk a little bit about lifestyle changes. As we mentioned at the beginning of this section, people who are dealing positively with their depression report that the key is making a number of lifestyle changes. Seemingly simple things like regular exercise, proper nutrition, and good sleep can all add up. In addition to these, limiting stress and finding effective ways of coping with stressors is so important to a person’s mental and emotional health. Whether that involves relaxation techniques, attending support groups, keeping a daily journal or self-help strategies, these treatments are worth the extra time and effort. They can boost a person’s mood during acute periods of depression and also act as a preventive and protective measure before stress levels get out of control. I want to stress to you that lifestyle changes are a relatively easy, cheap and painless investment to make that will reap positive dividends down the road. If you’re personally dealing with depression in your own life – remember that there’s hope – even when things seem their darkest. As we’ve discussed in this course, when a biochemical imbalance is involved, a person may need a combination of therapies and support to see positive results. But the most important thing is to reach out and seek help. Often times, people tend to feel ashamed about their condition, but the real shame is for a person to suffer, maybe even for years on end and not seek the help that they so desperately need and get back to enjoying the life they deserve. Remember – you aren’t alone. Others have gone before you and there are many on the journey to recovery with you. If you realize that someone: a friend, co-worker, perhaps someone in your family, or someone you provide care for, is suffering from depression, what’s the best way to be supportive? D. J. Jaffe from the National Alliance for the Mentally Ill gives this advice: “Don’t confuse the illness with the individual; instead, hate the disease but love the person.” This is one of the most important keys that I hope you take away from this class. I want you to understand how much depression can affect a person’s demeanor and behavior towards others. Making a real concerted effort to understand a person’s suffering will help you to focus on the person behind the illness. When you do this, it makes it so much easier to show empathy and be a meaningful part of an individual’s support network.

9. CONCLUSION
In the past, people were afraid and ashamed to talk about mental health and feelings of depression. And you couldn’t really blame them, since a person with any type of mental illness was often avoided by others. People with depression faced social repercussions, job discrimination and strained relationships within their own families. And of course, this only aggravated the problem and prevented people from getting the help they needed. Thankfully things have changed a lot. In the healthcare and human services field, we have better awareness about mental illness and depression. And in recent years, huge strides have been made in understanding the physiological and emotional aspects of depression. Now more people see depression as a serious disease but one that is highly treatable. As you know, however, there’s always more work to do and we as healthcare and human service workers can take the lead in lifting the veil to change people’s perceptions of depression. Like most of us, you were likely drawn to your career because you really care about people. You have a keen awareness of how precious life is. And you know that being a part of someone’s healing process is one of the most important and fulfilling things you can do with your life. But has there ever been a time when you wished that there was something more you could do to change the course of a person’s illness? One of the most challenging aspects of our work is being called on to care for someone with very little chance of recovery. Of course in that type of situation we do our best to treat the person in a way that maintains their comfort, dignity and sense of self-worth. But helping someone with depression is different. The potential for a positive outcome is so much greater than other serious illnesses and it’s where you have the opportunity to really make a difference.

To illustrate how important your role is, imagine that one day you notice someone struggling to keep their head above water as they swim through the ocean. As time ticks by you can see them getting weaker and weaker. With each wave that crashes over, they become more anxious and start to lose hope that they can keep going. So what will you do? You could stand there at the shore and shout encouragement. Tell them to just keep trying and not to give up. But at a certain point, what the person really needs is for someone to jump in with them, hand them a life preserver and guide them to safety. You can be that person. And the interpersonal skills you’ve learned today will serve as the life preserver that buoys the person up until you can help them get back to a safe place.

We hope that this course has given you an eye opening look at how many people out there are suffering from really crippling depression. And more than just the cold facts, we want you take away the knowledge that you can help restore lives. After watching this course you know how to: differentiate true depression from moodiness; be alert to suicide risks; understand what medications are most effective and spot signs of relapse. Remember too, the critically important things you can do if someone confides in you that they’re suffering from depression. Start by letting them know that you genuinely care for them, even if they’re convinced that they’re unworthy. Be willing to listen patiently as someone unburdens themselves of their fears and negative thoughts. Doing these things and then at the right time, helping the person to find a qualified psychiatrist or healthcare professional who can work with them are two of the best ways that you can help a depressed person become hopeful again.

As you develop your ability to care for depressed people in this way, you’ll see for yourself that most depressed individuals do get better. It can be a dark and difficult journey that’s full of potential pitfalls. But now you have the roadmap. You can be someone who understands what depression does to a person’s life. You can be someone they know they can trust and who will continue to be there as a beacon of hope as they find a new path for their life. Thanks so much for joining me and participating in this course. You guys did great. I’m Donn Kropp, I’ll see you next time.

Writers and References

Writer(s)Jamie Anderson & Donn Kropp, RN, BSN

References:

  • Berlinger, Norman T. Rescuing Your Teenager from Depression. 1st ed. Harper Collins, 2006. Print.
  • Depressionhurts.ca. Depression Hurts. Web. Accessed November 2012
  • “Depression—How to Treat It” Awake! (2007): 4-6. Print
  • “Depression: What is depression?” World Health Organization. http://www.who.int/mental_health/management/depression/definition/en/print.html. Web. Accessed November 2012.
  • Golant, Mitch Ph.D., Golant Susan K. What to Do When Someone You Love is Depressed. 2nd ed. Henry Holt and Company, 2007. Print.
  • “Living With a Mood Disorder” Awake! (2004): 4-7. Web. Accessed November 2012.
  • Miklowitz, David J. PhD. The Bipolar Disorder Survival Guide, What You and Your Family Need to Know. 2nd ed. Guilford Press, 2010. Print
  • “Teachers guide: information about mental illness and the brain.” National Institute of Health. http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-a.html. Web. Accessed November 2012

 

Lessons

Introduction (Preview)

We all face ups and downs from time to time. It’s a normal part of life. Most of us can relate when someone we know goes through a down period…

Objectives

Length: 1 minutes

This video highlights the objectives for this course.

Signs & Symptoms

Length: 9 minutes

In this lesson we explore the signs and symptoms of depression.

Effects & Ramifications

Length: 3 minutes

In this lesson we explore the effects and ramifications depression has on the individual, family, friends and society.

Treatment Options

Length: 7 minutes

This lesson highlights some of the treatment options available for depression.