Transcript Major Depressive Disorder Jennifer Kurbel

What is Depression?
Jennifer Kurbel
Common Depression Definitions
• A condition of general emotional dejection and withdrawal;
sadness greater and more prolonged than that warranted by
any objective reason
• A common mental disorder that presents with depressed
mood, loss of interest or pleasure, feelings of guilt or low
self-worth, disturbed sleep or appetite, low energy, and poor
concentration.
• A condition that involves the body, mood, and thoughts, that
affects the way a person eats and sleeps, the way one feels
about oneself, and the way one thinks about things.
Depression versus Sadness
• Everyone occasionally feels blue or sad, but these feelings
are usually fleeting and pass within a couple of days
• Depression interferes with daily life, normal functioning, and
causes pain for both the person with the disorder and those
who care about the individual
• Depression is a common but serious illness, and most who
experience it need treatment to get better
Major Depressive Episode Definition
According to the DSM-IV-TR
• A period lasting for at least two weeks during which there is
either depressed mood or the loss of interest or pleasure in
nearly all activities.
• A symptom must be either newly present or must have
clearly worsened compared to the person’s preepisode
status.
• Symptoms must persist for most of the day, nearly every
day, for at least two consecutive weeks.
• The episode must be accompanied by clinically significant
distress or impairment in occupational, social, or other
important areas of functioning.
Diagnostic Criteria For Major Depressive Episode
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A.
Five (or more) of the following symptoms have been present during the same 2week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
* Do not include symptoms that are clearly due to a general medical condition,
or mood-incongruent delusions or hallucinations.
(1) depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others
(e.g., appears tearful). *In children and adolescents, can be irritable mood
(2) markedly diminished interest or pleasure in all, or almost all, activities most
of the day, nearly every day (as indicated by either subjective account or
observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite
nearly every day . *In children, consider failure to make expected weight
gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others,
not merely subjective feelings of restlessness or being slowed down)
Diagnostic Criteria For Major Depressive Episode
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may
be delusional) nearly every day (not merely self-reproach or guilt about
being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every
day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal
ideation without a specific plan, or a suicide attempt or specific plan for
committing suicide
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B.
The symptoms do not meet criteria for a Mixed Episode.
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C.
The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
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D.
The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medial
condition (e.g., hypothyroidism).
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E.
The symptoms are not better accounted for by Bereavement, i.e., after
the loss of a loved one, the symptoms persist for longer than 2 months
or are characterized by marked functional impairment, morbid
preoccupation with worthlessness, suicidal ideation, psychotic
symptoms, or psychomotor retardation.
Diagnostic criteria for Major Depressive Disorder, Single Episode
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Presence of a single Major Depressive Episode
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B.
The Major Depressive Episode is not better accounted for by Schizoaffective
Disorder and is not superimposed on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified
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C.
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic
Episode. *This exclusion does not apply if all of the manic-like, mixedlike, or hypomanic-like episodes are substance or treatment induced or are
due to the direct physiological effects of a general medical condition.
If the full criteria are currently met for a Major Depressive Episode, specify its
current clinical status and/or features:
* Mild, Moderate, Severe Without Psychotic Features/Severe With
Psychotic Features
* Chronic
* With Catatonic Features
* With Melancholic Features
* With Atypical Features
* With Postpartum Onset
Diagnostic criteria for Major Depressive Disorder, Single Episode cont’d
If the full criteria are not met for a Major Depressive Episode, specify the current
clinical status of the Major Depressive Disorder or features of the most recent
episode:
* In Partial Remission, In Full Remission
* Chronic
* With Catatonic Features
* With Melancholic Features
* With Atypical Features
* With Postpartum Onset
Diagnostic Criteria for Major Depressive Disorder, Recurrent
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A.
Presence of two or more Major Depressive Episodes
* To be considered separate episodes, there must be an interval of at least
2 consecutive months in which criteria are not met for a Major Depressive
Episode
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B.
The Major Depressive Episodes are not better accounted for by
Schizoaffective Disorder and are not superimposed on Schizophrenia,
Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not
Otherwise Specified.
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C.
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic
Episode. *This exclusion does not apply if all of the manic-like, mixed-like,
or hypomanic-like episodes are substance or treatment induced or are due
to the direct physiological effects of a general medical condition.
Diagnostic Criteria for Major Depressive Disorder, Recurrent
If the full criteria are currently met for a Major Depressive Episode, specify its current
clinical status and/or features:
* Mild, Moderate, Severe Without Psychotic Features/Severe With
Psychotic Features
* Chronic
* With Catatonic Features
* With Melancholic Features
* With Atypical Features
* With Postpartum Onset
If the full criteria are not currently met for a Major Depressive Episode, specify the
current clinical status of the Major Depressive Disorder or features of the most recent
episode:
* In Partial Remission, In Full Remission
* Chronic
* With Catatonic Features
* With Melancholic Features
* With Atypical Features
* With Postpartum Onset
Specify:
* Longitudinal Course Specifiers (With and Without Interepisode Recovery)
* With Seasonal Pattern
Misconceptions About Depression
• An individual can just “snap out of it” or just get over feeling
depressed
• Children do not have any reason to be depressed because
they’re too young
• It's normal for teenagers to be moody. Teens don't suffer
from "real" depression
• Telling an adult that a friend might be depressed is betraying
a trust. If someone wants help, he or she will get it
• Talking about depression only makes it worse
• Medication is not necessary to help with depression.
Common Signs of Depression
• Irritability or anger
• Temper tantrums
• Physical complaints (such as stomachaches, headaches) that
do not respond to treatment
• Difficulty in thinking, concentrating and making decisions
• Continuous feelings of guilt, sadness, and hopelessness
• Vocal outbursts or crying
• Changes in sleep -- sleeplessness or excessive sleep
• Changes in eating habits that lead to weight gain or loss or
not making expected weight gains
Common Signs of Depression
• Low self-esteem
• Reduced ability to function during events and activities at
home or with friends, in school, at work, extracurricular
activities, and in other hobbies or interests.
• Constant tiredness or lack of energy
• Social withdrawal
• Frequent absences from school or work
• Poor performance in the work place or at school
• Talk of or efforts to run away from home
• Increased sensitivity to rejection
• Recurrent thoughts of death or suicidal ideation
Risks For Depression
• Having a parent or immediate family member who is depressed. Children
or teens who have a parent with depression are 3 times more likely to
develop depression.
• Having been depressed before, especially if depression first occurred at
an early age.
• Having a long-term medical condition such as diabetes or epilepsy.
• Having another mental disorder, such as conduct disorder or an anxiety
disorder.
• Having a family member or close friend die.
• Being physically or sexually abused.
• Having problems with alcohol or drug abuse
• Being exposed to family conflict.
• Not having good social relationships with peers.
• Being a bully or a victim of bullying.
Some Causes of Depression in Children & Teens
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Family history of depression
Grief over the loss of a loved on through death, divorce, or separation
Stress and pressure to excel in school, sports and other activities
Puberty, especially in females
Physical, sexual or emotional abuse
Major life events such as moving, or graduating to a new grade
Long term or serious medical conditions
Substance abuse
Being socially isolated or excluded from family, friends, or other social
groups
• Being picked on or bullied in school
Some Causes of Depression in Adults
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Medical condition – Illnesses or traumatic experiences that are far too difficult to
handle. This might include cancer, cardiovascular disease, hypothyroidism,
hepatitis, and major injuries.
Poverty
Being a single parent
Prolonged unemployment
Career frustrations
Multiple personal failures
Drug and alcohol addiction
Gambling addiction
Financial problems
Loss of family members (spouse, child or relatives)
A breakup within a committed relationship
Some Causes of Depression in Adults
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Early life experiences – Childhood trauma like rejection or abandonment, chronic
illness, neglect, death of loved one, sexual abuse, incest, psychological trauma,
and other accidents that may not appear to be harmful during the early years but
which can manifest later in life.
Psychological conditions – Lack of self-confidence and low self-esteem can trigger
depression.
Physical conditions – Weight issues and physical deformities or disabilities can
cause an adult to become depressed.
Living with a depressed person – Acquiring negative energy from someone who is
depressed can increase the chances of depression.
Heredity – It is believed that there are depressive genes. If the parents have
these kinds of genes, the offspring is likely to become depressed as well.
Postnatal depression or postpartum depression – Mood changes after giving
birth. This is often seen within 3 months after the delivery and would last for a
number of months.
Some Causes of Depression in the Elderly
• Loneliness and isolation – Living alone; a dwindling social circle due to
deaths or relocation; decreased mobility due to illness or loss of driving
privileges.
• Reduced sense of purpose - Feelings of purposelessness or loss of
identity due to retirement or physical limitations on activities.
• Health problems – Illness and disability; chronic or severe pain; cognitive
decline; damage to body image due to surgery or disease.
• Medications – Many prescription medications can trigger or exacerbate
depression.
• Fears – Fear of death or dying; anxiety over financial problems or health
issues.
• Recent bereavement - The death of friends, family members, and pets;
the loss of a spouse or partner
Assessments
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Laboratory tests are primarily used to rule out other diagnoses:
* Complete blood count (CBC)
* Electrolytes, including calcium, phosphate, and
magnesium
* Calcium
* Serum toxicology screen
* Thyroid function tests
* Thyroid-stimulating hormone (TSH) level
Imaging Studies:
* CT scan or MRI of brain
Other Tests:
* Zung Self-Rating Depression Scale
* Beck Depression Inventory (BDI)
* Children's Depression Inventory (CDI)
* Yesavage Geriatric Depression Scale
Types of Treatment
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The most common treatments for depression are psychotherapy and medication
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Cognitive-behavioral therapy (CBT) - Cognitive approaches utilize specific
strategies designed to alter negatively-based cognitions. Depressed patients are
trained to recognize the connections between their thoughts, feelings, and
behavior; to monitor their negative thoughts; to challenge their negative
thoughts with evidence; to substitute more reality-based interpretations for their
usual interpretations; and to focus on new behaviors outside treatment.
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Behavioral - Behavioral approaches designed to increase pleasant activities
include several components such as self-monitoring of activities and mood;
identifying positively reinforcing activities that are associated with positive
feelings; increasing positive activities; and decreasing negative activities.
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Interpersonal therapy (IPT) - Interpersonal approaches focus on relationships,
social adjustment, and mastery of social roles. Treatment usually includes nonjudgmental exploration of feelings, elicitation and active questioning on the part
of the therapist, reflective listening, development of insight, exploration and
discussion of emotionally laden issues, and direct advice.
Types of Treatment
• Medications that help balance chemicals in the brain are called
neurotransmitters. Types of antidepressant medications that help keep
the neurotransmitters at the correct levels are:
* SSRIs (selective serotonin reuptake inhibitors)
* SNRIs (serotonin and norepinephrine reuptake inhibitors)
* MAOIs (monoamine oxidase inhibitors)
* Tricyclics.
• For teens, a combination of medication and psychotherapy may work the
best to treat major depression and help keep the depression from
happening again
• Antidepressant medication for children is a controversial topic. There are
no long-term studies that show what kind of impact this medication will
have on a child's future development
Other Therapies
• Electroconvulsive Therapy (ECT) - treatment where electrodes are
put on the patient's scalp and a finely controlled electric current is
applied. The current causes a brief seizure in the brain.
• St. John's Wort - St. John's wort is a wild yellow flower considered to
be a weed throughout most of the United States. There is some scientific
evidence that St. John's wort is helpful in treating mild to moderate
depression. However, two large studies, one sponsored by the National
Center for Complementary and Alternative Medicine (NCCAM), showed
that the herb was no more effective than placebo in treating major
depression of moderate severity.
Ways to Prevent Depression
• Eating a balanced diet.
• Getting regular exercise.
• Seeking treatment immediately upon first notice of symptoms of
depression, or symptoms that are getting worse - such as feelings of
hopelessness, sadness, or loss of interest or pleasure in most activities.
• Maintaining a regular sleep pattern.
• Avoiding drugs and alcohol.
• Taking more time for oneself.
• Spending time with friends and family.
• Getting involved in different activities of interest.
• Talking to clergy or spiritual advisors who may help give meaning to
painful experiences.
Economic Impact of Depression
• Major Depressive Disorder is the leading cause of disability in the U.S.
for ages 15-44.
• Depression’s annual toll on U.S. businesses amounts to about $70 billion
in medical expenditures, lost productivity and other costs.
• Depression accounts for close to $12 billion in lost workdays each year.
Additionally, more than $11 billion in other costs accrue from decreased
productivity due to symptoms that sap energy, affect work habits, cause
problems with concentration, memory, and decision-making.
• Depression ranks among the top three workplace issues, following only
family crisis and stress.
Statistics
• Major depressive disorder affects approximately 17 million American
adults annually
• Population studies show that at any point in time 10 to 15 percent of
children and adolescents have some symptoms of depression.
• As many as one in 33 children and one in eight adolescents have clinical
depression.
• By age 15, girls are twice as likely as boys to have experienced a major
depressive episode.
• 20% of children will experience a major depressive episode before
graduating from high school.
• As many as 8.3 percent of teens suffer from depression for at least a year
at a time, compared to about 5.3 percent of the general population.
Statistics
• Most teens with depression will suffer from more than one episode. 20
to 40 percent will have more than one episode within two years, and 70
percent will have more than one episode before adulthood. Episodes of
teen depression generally last about 8 months.
• Less than 33 percent of teens with depression get help, yet 80 percent of
teens with depression can be successfully treated if they seek help from
a doctor or therapist.
• More than 90 percent of people who kill themselves have a diagnosable
mental disorder, most commonly a depressive disorder or a substance
abuse disorder.
• Untreated depression is the number one risk for suicide among youth.
Suicide is the third leading cause of death in 15 to 24 year olds and the
fourth leading cause of death in 10 to 14 year olds.
Statistics
• Women are twice as likely to experience depression as men
• About 10 percent of women will experience postpartum depression in
the months following the birth of a child.
• Married women have higher rates of depression than single women,
with depression most likely during childbearing years.
• Depression in women occurs most frequently between the ages of 25
and 44
• Though women experience depression at double the rate of men,
men are three times as likely to commit suicide than women.
• Suicide is most common among men who are separated,
widowed, divorced.
• One in seven men will develop depression within 6 months of
becoming unemployed.
• Retired men are also at an increased risk for depression.
• Men recently diagnosed with depression are at double the risk of
cardiovascular problems in the next five years
Statistics
• Depression affects about 6 million elderly people.
• Elderly women experience depression more often than elderly
men.
• Older people, as a group, are most at risk for suicide.
• One quarter of all suicides are committed by the elderly.
• Depression occurs in about 15 percent of those over the age of 65.
• Depression in nursing home residents can reach as high as 25
percent.
• Only about 10 percent of the elderly experiencing depression seek
professional help.
• Caucasian men over the age of 80 are six times more likely tan any
other demographic group to commit suicide.
• Older people with depression have about 50 percent higher
healthcare costs
How Family Members Can Help
• Be aware of and learn to recognize the symptoms and signs
of depression
• Be supportive, and validate his/her experiences and their
story
• Never minimize an individuals feelings
• Reassure the individual that depression is not something to
be ashamed of, and they are not crazy for feeling that way
• Help research treatment options
• Be willing to accompany the individual to treatment
• Help monitor his/her medication
How Family Members Can Help
• Encourage him/her to lead a healthier lifestyle by doing it
yourself – eat better, avoid alcohol and drugs, and exercise
• Listen and offer hope
• Encourage participation in various activities to help prevent
isolation
• Provide opportunities for him/her to engage with others
• Be prepared for him/her to have good days and bad days.
• Look for drastic changes in his/her personality, which could
be a danger sign
• Always take it seriously if an individual talks about death or
says that they want to die
What NOT to Say to a Depressed Person
Sometimes, it’s more important to know what NOT to say to someone
living with depression. According to the Depression and Bipolar Support
Alliance, you should avoid saying things like:
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It’s all in your head.
We all go through times like these.
You’ll be fine. Stop worrying.
Look on the bright side.
You have so much to live for; why do you want to die?
I can’t do anything about your situation.
Just snap out of it.
Stop acting crazy.
What’s wrong with you?
Shouldn’t you be better by now?
Who Else Can Help?
• School counselors - Can conduct classroom guidance lessons on how to
identify depression and the different ways to go about treating it so
young children are informed. They can also conduct small group
counseling with at-risk students, focusing group sessions on the specific
problem (e.g., low self-esteem, social isolation) or the particular risk
factor
• Psychiatrists - Medical doctors who specialize in mental illness, and can
prescribe medication.
• Clinical Psychologists - Are skilled in human behavior, and diagnosing and
treating mental illness.
• Licensed Clinical Social Workers - Are skilled in individual therapy, group
therapy, and diagnosis
• Licensed Professional Counselors - Are also skilled in individual therapy,
group therapy and diagnosis
What if Someone I know is in Crisis?
If you know anyone who is thinking about or threatening to
harm themselves, tell someone who can help immediately.
• Call your doctor
• Call 911 or go to a hospital emergency room to get
immediate help or ask a friend or family member to help
• Call the toll-free, 24-hour hotline of the National Suicide
Prevention Lifeline at 1-800-273-TALK (8255) or
TTY: 1-800-799-4TTY (4889)
• Do not leave the suicidal person alone
Links to Resources, Pamphlets & Videos
• http://www.nimh.nih.gov/health/publications/depression/su
mmary.shtml
• http://www.mentalhealthamerica.net/go/depression
• http://www.depressionisreal.org/depressionresources.html##
• http://www.familyaware.org/teenflyer.pdf
• http://www.healthyminds.org/factsheets/LTF-Depression.pdf
• http://www.healthyminds.org/postpartumdepression.cfm
• http://www.webmd.com/video/eeg-depression
• http://www.webmd.com/video/depression-in-teens
• http://www.webmd.com/video/postpartum-depression
• http://www.webmd.com/video/elderly-depression
References
About Teen Depression. (2005). Treating Depression in Children and Teens. Retrieved July 5, 2008
from http://www.about-teen-depression.com/teen-depression.html
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders,
4th edition (DSM-IV-TR). Washington, D.C.: American Psychiatric Association.
American Psychological Association. (2008). Depression. Retrieved June 29, 2008 from
http://www.apa.org/topics/topicdepress.html
Depression and Bipolar Support Alliance. (2006). Depression Statistics. Retrieved June 29, 2008
from http://www.dbsalliance.org/site/PageServer?pagename=
about_statistics_depression
HelpGuide.Org. (2008). Depression in Older Adults and the Elderly. Retrieved July 1, 2008 from
http://www.helpguide.org/mental/depression_elderly.htm
Kapornai, K. (2008). Depression in Children. Retrieved June 30, 2008 from
http://ovidsp.tx.ovid.com/spa/ovidweb.cgi
MedicineNet.com. (2005). Depression in Children. Retrieved June 28, 2008 from
http://www.medicinenet.com/depression_in_children/article.htm
Mental Health America. (2008). Factsheet: Depression. Retrieved July 6, 2008. from
http://www.mentalhealthamerica.net/go/depression
References
National Institute of Mental Health. (2007). Depression. Retrieved June 30, 2008 from
http://www.nimh.nih.gov/health/publications/depression/summary.shtml
Schoenstadt, A. (2007). Teen Depression. Retrieved July 5, 2008 from
http://depression.emedtv.com/teen-depression/teen-depression-p2.html
WebMD. (2007). Depression in Children and Teens. Retrieved July 2, 2008 from
http://www.webmd.com/depression/tc/depression-in-childhood-andadolescence-cause