DEPRESSION. There are a couple of kinds, or forms. The most common are major depression and dysthymic disorder.

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1 DEPRESSION OBJECTIVES: At the end of this class, you will be able to: 1.list and describe several kinds of depression, 2.discuss the signs of depression, and 3.relate the treatment of depression. INTRODUCTION Everyone feels blue or sad once in a while, but these feelings go away and pass within a couple of minutes, hours or days. Depression is when these feelings do not go away in a short period of time. It is a very common and very serious problem. It stops the person from being able to function normally. It stops them from having a normal life. It causes the person, and the people around them, to have a lot of pain unless it is treated with therapy, medications and other things. THE KINDS OF DEPRESSION There are a couple of kinds, or forms. The most common are major depression and dysthymic disorder. Major depression This type usually affects a person through out their whole life. It comes and goes. It stops the person from having a normal life and being happy. The person may have trouble eating, sleeping, working and having friends. At times it can be very severe and even lead to the person kiling themself (suicide).

2 Dysthymic disorder This form is less severe than the major form and it may only occur once during a person s life. The one episode may last two years or even longer but the person can continue to function and have an almost normal life but they are often sad. Psychotic depression This is a severe form because the person not only has the depression but they are also are out of touch with reality and they may have hallucinations and delusions. For example, the person may hear voices or they may think that they are a great person like Abe Lincoln. Postpartum depression This form happens to a new mother about a month or so after they have a baby. Some say that about 10% to 15% of new mothers get it. It is also called the baby blues. Seasonal affective disorder (SAD) This form affects people during the winter months when they is less sunlight. It also happens in places like Alaska where even days are dark as night during the winter. Special lights can be used to treat this form. Bipolar disorder This form is also known as manic-depression. The person with this form will have wide mood swings from extreme highs, or mania, to extreme lows, or depression. WHAT ARE THE SIGNS OF DEPRESSION? A person may feel: sad; helpless; hopeless; guilty; worthless; irritable; like they have no interest in anything at all; restless; tired and always sleepy; and/or like they want to kill themself The person may also not be able to think well or focus on things the way that they should. They may lose interest in the things that they used to like and enjoy. They may not be able to sleep or they may sleep all of

3 the time. Some cannot eat and may lose weight and others may over eat and gain weight. Many also have constant complaints of aches, pains, headaches and stomach problems. OTHER ILLNESSES FOUND WITH DEPRESSION Depression is very often found with other illness. Some may come before it; some may lead to it, or cause it; and still others may happen as the result of it. For example, people with a mental health problem like an obsessive compulsive disorder, a panic disorder, or a medical problem like heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease may often have depression. Alcohol and other substances may be used by the person because they think that these things will make them feel better. This is not true. These things make it worse. Some studies show that people who are depressed, in addition to another serious medical illness, tend to have the worst symptoms of both the depression and their medical illness. It is also known that treating the depression will help the treatment of the medical illness as well. It is important, therefore, to treat it. WHAT CAUSES IT? There is no one single known cause. It can come from a number of things like one s genes (it may run in families), chemical imbalance in the brain, external things like stressors and losses, and emotional problems. This mental illness is a disorder of the brain. In fact, the MRIs of people with depression show that the areas of the brain that are used for mood, thinking, sleep, appetite and behavior are not normal. Trauma, major stress and a major loss, like the death of a husband or wife, the loss of a body part like a leg, can also lead to it. HOW IT AFFECTS PEOPLE Women are more prone to it than men for a number of reasons including their hormones (PMS, menopause) and the fact that they give birth to babies ( baby blues ). Men with it tend to have more fatigue, irritability, loss of interest in activities, and sleep disturbances than women. Women tend to have more feelings of sadness, worthlessness and guilt than men with it have. Men are more likely than women to turn to alcohol or drugs when they are depressed. More women than men attempt suicide, but more men than women die by suicide in our country. Men are more successful than women. Many older people have depression. It is NOT a normal part of aging but it is often not seen by the doctor because the older person may not admit that they are sad and they may have other diseases with the same signs. For example, a person with heart disease may feel tired in just the same way that a person with depression may feel. Also, many medicines cause the same signs as depression does. Men 85 years old and older have the highest suicide rate of all. Even children can be depressed and, when it does occur, it can continue through adult years if it is not treated. This young child may: always be sick,

4 not want to go to school, always want to be with or cling to a parent, and/or worry that a parent may die. As the child gets older, the child may be moody, irritable, negative, and get into trouble in school and not have any friends. Before puberty, boys and girls are just as likely to develop it. Girls are twice as likely as boys to have depression after the age of 15. Teenagers are at great risk for suicide. HOW IS IT TREATED Depression can be treated with a number of different things. The two most common things are medicines and therapy. Medicines Some medicines make the brain chemicals normal when they were not normal. These medicines are called anti-depressants. Some people do better with one medicine over another. The person often has to try different ones until they find the one that works best for them. All of these medicines have some side effects and most of them must be taken for about 3 or 4 weeks until they start to act and make the person feel better. The person has to keep taking them until their doctor stops them even if they are feeling better. Some people have to take them for life. Some of these medicines are not used for those less than 25 years of age because they may lead to suicide. All patients must be very closely followed by their doctor during the beginning of of their medication regimen. Natural treatments St. John's wort is a bushy, wild growing plant with yellow flowers. It is one of the top selling natural, plant substances in the United States. It is used very frequently to treat depression in Europe. In the US, it can be bought in a health food store or vitamin store without an order from the person s doctor. It can interfere with medications used to treat heart disease and depression so the person should ask their doctor about taking it before they start taking it. Therapy Several kinds of therapy, or "talk therapy", can help people with depression. It can be short term for some and long term for others depending on their needs. There are two forms: 1. cognitive and 2. behavioral

5 The first form helps the person to change the way they think and react to their problems. It helps to stop negative thinking and behaving. The second form aims to help the person to understand their problem and to work through it. Therapy is the best treatment for most people with mild to moderate depression. Shock treatment At times when medicines and therapy do not help the person, shock therapy (ECT) may be used. It is now only used for severe cases. The person gets a muscle relaxer and a mild anesthesia and then are then given an electrical impulse to the brain which they do not feel. The person may be confused and have some memory loss after the ECT but these things go away shortly after the treatment. Many ECT treatments are often needed. HOW TO COPE WITH STRESS AND TRAUMA After stress or trauma, the person must be helped to: grieve their loss talk to others, like their family and friends and others that they trust go to a support group, the clergy or a mental health counselor keep up their daily routine even if they do not feel like they want to take the medications that their doctor has ordered stay active and exercise. Exercise can decrease stress. NOT make major life decisions during times that they are under a lot of stress avoid drugs and alcohol continue doing the things that they used to enjoy before the stress or trauma set goals that they can reach get help as soon as they need it. Healthcare workers should: be aware of the signs of depression and stress in their patients, listen to patients. Allow them to express their own feelings. help others find ways that best help them and their own responses to stress, support the person, show understanding, patience and caring, encourage the person. Telling the person to get on with life does NOT work. report it to the supervisor if the person talks about suicide, and call 911 if you think that the person may kill themself. EXERCISE

6 Exercise can lower the signs of depression and give the person a sense of well being. It is also thought to prevent a new bout of it. The person should exercise at least 30 minutes a day at least 3 to 5 days a week, and more if they can. Research says that exercise raises some of the natural mood chemicals in the brain so it can help to make the person feel better. It also lowers muscle tension, helps the person to sleep better and it lowers the level of the stress hormone (cortisol) in the body. All of these things lower the person s sadness, stress, fatigue, anger, irritability, anxiety and feelings of hopelessness. SUMMARY Depression is a serious mental health problem. It can touch the lives of all age groups, including older adults and young children. It must be identified and treated because it can destroy the person s entire quality of life and life itself if the person takes their own life