Depression More Than The Blues
Rachel: Welcome to today’s webinar titled Depression More Than the Blues! We are very fortunate to have Marjorie Nichols as our presenter.
Ms. Nichols is a licensed clinical social worker and has provided behavioral healthcare for over 30 years. She graduated from Eastern Illinois University with an undergraduate major in Psychology and Health Education. She holds a Master’s degree in Social Work from the University of Illinois and has served as a field instructor for the University of Texas at Arlington for social work interns.
In her capacity as an Employee Assistance Program Counselor, Corporate Director of EAP Systems and Director of Provider Networks, she has written and facilitated seminars and workshops for numerous organizations.
And without further delay, Marjorie, I will turn things over to you.
Marjorie Nichols: Thank you Rachel! This is a topic that I am quite passionate about in that for the last 30-plus years I have worked with people struggling with the illness of depression.
So let me begin by talking with you all about what I will cover today. It’s initial particularly when we are talking about mental illness or mental decease to very clearly define what that illness is about.
Begin with talking with you about the definition of depression from the World Health Organization and then I’ll move in to assisting you and recognizing the signs and the symptoms of depression, and explain in pretty good detail what some of the causes and risk factors are for developing depression and describe the treatment options and discuss steps to take to help yourself or someone else who you believe is struggling with depression.
So let’s move to that very rich definition from the World Health Organization which says that depression is 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. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities.
You see depression is the word that is often used in a common lexicon and it can fit in saying something like, oh my goodness, I had a flat tire on my way to work yesterday, and it was just so depressing to have to deal with that.
Depression is far more than just feeling down, disappointed or blues some days. You might say that you're depressed if you get angry at someone or a police officer pulls you over for a speeding ticket the depression is far more than that, it’s worst than having a bad day.
When depression hangs on for a long time and includes symptoms in addition to low mood we call it a disease or a disorder, and I am going to get into greater detail about that just a couple of slides from now. So what distinguishes clinical depression from normal feelings of sadness? Well! As a therapist what I look for is the degree with which the intensity and severity of symptoms that a client is presenting with, interferes with their normal daily functioning. In addition, unlike ordinary sadness or grief experience, as a result of a personal loss, clinical depression does not necessarily grow from a clearly identified life crisis or stressful event, nor does it respond to positive change in life circumstances or good news or the passing of time. It’s almost as though it has a life of its own. I explain to patients that sometimes the feeling is they are being taken hostage by the depression.
Now, to that point in particular, depression is a serious and often disabling mental condition. It is more than simply a case of the blues in contrast to depression, periodic mood fluctuation, temporary sadness related to life events and periods of grieving due to loss are normal aspects of anyone's life.
Depression on the other hand involves persistent physical, behavioral, mental and emotional symptoms that can interfere significantly within individual’s ability to function.
I want to lead us into a better understanding about very relevant facts regarding depression. You might say that depression is an equal opportunity disease, by that I mean it affects all segments of society, and current literature, research from 2014 for the National Institute of Mental Illness cites that major depressive disorder affects 14.8 million Americans each year.
Now those Americans that are affected most likely are women than men, and I am going to get into specifics about gender differences in just a minute. Men are less likely to be diagnosed or seek health, and often depression as a whole goes undetected, and I want to speak to the particulars about that in a minute as well, and again, equal opportunity disease, it affects people of all age; social, racial, and ethnic groups, but very relevant, it is a highly treatable disorder.
Individuals who have a family history of depression runs a higher risk of experiencing depression in their lifetimes compared to the general population. People who had traumatic experience of growing up such as physical, emotional, or sexual abuse have a significant risk of experiencing depression as adults.
Divorced people have a higher rate of depression than married individuals. In addition, depression commonly co-occurs with anxiety and substance-abuse disorders further complicating its effect on lives of those that are struggling with depression.
So as you see in this slide, the header is causes and risk factors for depression, and I want to refer to this slide as chicken and egg. We sometimes don’t know what comes first, the chicken or the egg. So let me address some of the causes and the risk factors by beginning with a biochemical piece. There are many ideas about what causes sadness that is bad enough to be called an illness or a disorder.
One idea is that depression is caused by chemical imbalance, and I think many of you are probably familiar with this theory. Now, think about it, as we are made of chemicals this clearly as a relevant working theory. There are many ways the chemicals can become uneven. There is the genetic piece as I mentioned just earlier, those people whose family members were depressed are far more likely to struggle with depression as an adult. Scientists have shown that you are far more likely to get depression if a parent, brother, or a sister has had a serious depression. Some people are born with traits that cause brain cells under many kinds of stress to have problem. These kinds of problems can lower the levels of vital brain neurotransmitters, and those neurotransmitters -- and as I say these neurotransmitters to you, probably many of you are familiar or at least with serotonin and you probably know that anti-depression medication such as Prozac is a selective serotonin re-uptake inhibitor. The other two neurotransmitters are norepinephrine and dopamine, and all three are main regulators of mood.
Research findings also points the biochemical role in that. The brain chemistry actually changes when a person is clinically depressed, chicken or the egg again. Likewise, the serious life crisis, stressful event, physical illness, personal loss can trigger or exacerbate a depressed mood or a depression episode. Even an anniversary of a loss or a traumatic life event can worsen depressive symptoms, and then drug and alcohol abuse also can trigger and/or deepen depression due to the effects on the central nervous system.
Think about it this way, alcohol is in itself a depressant. In short, some depressions are clearly psychological in nature, triggered by stressful life events. Other depressions clearly have a biological basis such as hormonal changes leading to postpartum depression; still others have a combination of biological, psychological and environmental factors.
Depression is a complex bio-cycle social, medical condition, which means that it involves the physical, the psychological and the social factors. It is a whole body element, in that it affects the way a person feels, thinks and acts.
Now I want to speak to those points on the facts, the slide before this one. I want to talk first about gender differences and then move on to depression in children and elderly and the stigma of depression.
Now women are 70% more likely than men to experience depression in their life time. Again, this statistic comes from the NIMH 2014 research. This is primarily due to hormonal influences associated with menstrual cycle changes, pregnancy postpartum and menopause. The prevalence of depression in men may be under-reported, under-diagnosed, and under-treated as evidenced by the fact that the rate of suicide in men is four times that of women, and that statistic comes to you from the American Foundation for Suicide Prevention.
In addition, studies have shown that men are less likely than women to admit to or recognize depression in themselves, and physicians therefore are less likely to diagnose it in their male patients. Also men tend to exhibit anger, irritability, and agitation at a greater rate than women do as associated symptoms of depression. So it may not look like depression to people who love this man that is struggling with depression or to his internist or primary care physician. Research into gender differences and depression reveals that while both men and women can develop the same depressive illnesses, it is often expressed with different symptomatology. So as I begin to talk about signs and symptoms of depression, please listen carefully to what fits for you and know that it may be quite different from your counterpart.
All right! It's important for me to talk albeit briefly about depression in children and elderly. A child with depression may pretend to be sick, refuse to go to school, cling to a parent or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable and feel misunderstood; because these signs may be viewed as normal mood swings typical of children as they do move through developmental stages, it may be difficult to accurately diagnose a young person win depression. Early detection and intervention of childhood depression is critical because if it's left greeted, there is a high risk that the depression will persist into adulthood or worse may result in a suicide attempt. Likewise, depression in the elderly can easily be overlooked, sometimes when depression develops in an older person, it maybe dismissed as a normal part of aging. Depression is not a normal part of aging, on the contrary the majority of older people report feeling satisfied with their lives, despite having to face the normal losses and challenges associated with the stage of life, persistent depressive symptoms that interferes significantly with the ability to function are not healthy or normal, in addition depression in the elderly can mimic other medical conditions to include thyroid conditions and other physical ailments and dementia.
No conversation about depression is complete until that conversation includes the stigma of depression, because less than one-third of adults and only one-half of children with diagnosable mental disorder receive any mental health services.
Stigma still discourages people from getting help despite advances in education and research. By learning the truth about mental illness and encouraging others to do the same you can help lessen the stigma. Depression can be devastating to an individual’s health, family relationships, friendships, and the ability to function at work or in the community. Even so many people still believe that the painful and disabling symptoms caused by depression are not real, and that a person should be able the shake off the symptoms and stop feeling so sorry for themselves. Because of the inaccurate beliefs, unchallenged myths and stereotypes and misguided intentions, there is still a great deal of shame, ridicule, and misinformation associated with depressive illness. Sadly too often untreated or inadequately treated depression leads to unnecessary suffering, wrecked marriages, broken families, lost jobs, violence and even suicide.
I want to move now into talking about the signs and symptoms of depression, and again, something that we look at as mental health providers is to determine the intensity and severity of the symptoms as it affects daily life functioning and the longevity or how long have these symptoms been present in someone’s life. So as I move through a discussion of signs and symptoms, please consider that if you have intermittent insomnia once a quarter or your appetite changes, this is probably not depression. We are looking at duration of symptoms, intensity and severity. So symptoms may vary from individual to individual, as I mentioned earlier, and particularly between a gender, depending on the type of depression as well as other factors, such as someone’s physical health.
If we are struggling with chronic pain or chronic illness or we lack a healthy social support system or have other pre-disposing variables, we may be at greater risk of depression. Not everyone who is depressed will experience all the symptoms that I am going to address with you all. Some people experience a few symptoms and some many; severity of the symptoms vary with individuals and also varies over time.
For instance, depression that is caused by grieving the death of a loved one can take years to overcome. Ways of grief can worsen depressive symptoms. When reminders of the loss occurs such as an anniversary date or of the death rather or a holiday that reminds you of the fact that you are missing this dear loved one. Again, keep in mind that occasional blue moods do not require treatments and such experiences are a normal part of the human condition, with symptoms usually being fleeting and often subsiding within a short period of time on their own. However, more serious and prolonged periods of depression, including severe grief reaction are reasons for concern since untreated depression can cause intense emotional pain and suffering, can lead to serious difficulty in functioning, and can lead to a decreased resistance to disease and physical illness. In essence, depression can make you sick, by that I mean it can make you physically sick. In some extreme incidences it can lead to thoughts of suicide.
I had a client in my office the other day who is severely depressed or what we would call a major depressive episode and it’s a recurrent major depressive episode, and each week that I work with her, I ask her on a scale of 1 to 10, 1 being most severely depressed with thoughts of suicide and 10 feeling happy, joyous and free on top of your life, managing your life, feeling a great sense of personal competency and confidence in your life, where would you rate yourself? And it was just last week that she indicated she really understood she got why people thought about ending their lives which was a very strong alarm mechanism for me to step up intensity of care and I am going to get into treatments of depression in just a bit of time.
Now you will notice on this slide we are very much coaching you to understand to always take talk of suicide, or thoughts of suicide that are shared with someone that this person trust, please take it seriously and assist in getting help for them. We are providing you a great deal of resources. At the end of this webinar to take advantage of that if you feel that those individuals are in crisis, call 911 or 800-273-TALK or 8255, we want to make sure that this individual gets help immediately.
So to continue with the signs and the symptoms of depression often people that come into see me will begin to tell me that they are concerned that they are losing their mind, they can’t focus, they can't concentrate, they can't recall information, they don’t even recall people’s names anymore. Well, this in fact maybe clearly related to depression. Depression begins to depress neural pathways in the brain and so our retrieval is impaired, our ability to focus can be impaired.
Some of the hallmarks of depressive symptoms are feelings of helplessness, hopelessness, guilt or uselessness and despair. So if you see on that last slide, the first slide or this one that you have more symptoms than not and these symptoms have been around for greater than two weeks, I would very much encourage you to pick up the phone and call ValueOptions Employee Assistance Program and begin to be assessed by a professional.
Now you see the last bullet on this last slide that deal for signs and symptoms or personal hygiene, for those of you that are in any type of leadership role in a company and you become aware of someone sliding personal hygiene, this may be an indicator that they are struggling with depression, of course it's not your role to diagnose the depression, but it maybe an opportunity or an open door for you to discuss the fact that there are many wonderful resources that your company does offer to the Employee Assistance Program, if they should need to talk with someone they might find that to be helpful.
Now the good news that in most cases treatment is effective and either completely resolving the depression or significantly relieving the associated symptoms, enabling people to return to a satisfying and functioning life. Also as with most health conditions the earlier the depression is detected and treated, and treatment rather is initiated, the shorter duration of the episode of depression, and that is one of the goals of your Employee Assistance Program is to get the word out and begin to encourage people to better understand where they maybe on a depression continuum, if you will, and reach out and get professional assistance at an earlier stage of problem development. Therefore they are not in pain and emotional agony any longer than they need to, because again, treatment helps, it results about 90% of the depressive cases that we work with.
Now the treatment choices from the gamut from self-help approaches, reading or what I refer to bibliotherapy and I often provide a list of books and articles to patients that I work with to supplement the work that we are doing in talk therapy. I also want to make you aware that there are rich resources of articles on your Achieve Solutions website. Building of support systems, community support systems often encourages a helpful tone, it also gives one a sense that they are not alone and loneliness is again one of the hallmark symptoms of feeling depressed.
Journaling, writing down your feelings, meditation and exercise are all included in the self-help approaches. Added to professional intervention, which is what I do in my private practice through talk therapy and group therapy, meditation which is prescribed by a psychiatrist or at times a more intense level of care through hospitalization either an intensive outpatient program, a partial day program or an impatient program.
The nature and severity of the depression will dictate what type of treatment is best in each case. The first step towards getting appropriate treatment is seeking a thorough evaluation by a qualified medical and/or mental health professional, because certain medications and medical conditions can cause the same symptoms as depression such as hyperthyroidism, sleep apnea, and I could list more.
It's a good idea to be examined by your personal physician first, that physician should be able to rule out the possibilities that there is a medical basis for the depressive symptoms through examination, interview and lab test.
If a medical cause for the depression is ruled out an evaluation by a trained mental health professional should occur.
This could be a qualified licensed psychologist, psychiatrist or clinical social worker. Often my clients don’t understand the difference between these three professions. And I explained to them that a psychiatrist is a medical physician who is licensed to be able to prescribe psychotropic medication, medication that assists in resolving the biochemical problems associated with depression, a licensed psychologist or a Psy.D., has a Ph.D. in Psychology, and in clinical social workers such as myself has a master’s or a Ph.D. in Social Work all with a strong concentration of clinical intervention practices.
A good diagnostic evaluation should include a complete history of past and current symptoms, previous treatment, relevant, social, occupational, medical and family history, drug and alcohol use, and a family history of depression. Treatment choice will depend upon the outcome of the evaluation, a variety of psychotherapies and/or antidepressant medications can be used effectively to treat depressive disorders. Some people with milder forms do very well with psychotherapy or talk therapy alone and they don’t need the medication.
I always start my clients off with evaluating their nutrition intake as well as their exercise, because we know with an increase in exercise which does promote more generation of serotonin in the body as well as healthy eating, they may find more mood stabilization with that along with talk therapy. The addition of self-help approaches as I mentioned as well as resolving whatever medical conditions may also be triggering or causing the mood fluctuation can very much help in building new skills which will reduce the symptoms of self-depression.
People with moderate to severe depression most often benefit from antidepressant medications. The ideal treatment regimen is a combination of medication and psychotherapy. Medication to gain relatively quick symptom relief so the person can return to functioning in his or her daily activities in psychotherapy to learn more effective ways to deal with life’s problems for the long haul.
Now some people in my practice have a notion that they can become addicted to an antidepressant medication and I explained them that they are reluctant to consider taking an antidepressant because of the addictive qualities is unfounded. Antidepressant medications are not habit for me.
So therapies for depression include healthy lifestyle changes, as I have mentioned, cognitive behavioral therapy, which is a method of teaching people to think and act more positively to be able to harness the healthier parts of their thinking, which will override the negativity and the pessimism and talk with themselves differently to promote healing and restorative care.
In our personal psychotherapy, this helps people evaluate and change their interpersonal relationship or approaches with significant others and their lives. Marital & Family Therapy, working directly with the intimate partners and families of depressed people to improve their functioning. Also intervening with the parents of depressed children and adolescents or the adult children of the depressed elderly person. Group therapy, working with depressed individuals or their loved ones to provide educational and emotional support and prevent relapse. Then we have alternative therapy, light therapy for as you see on the slide SAD. Well, SAD stands for Seasonal Affect Disorder, and if you live on the east coast, the Midwest or the Northwest and winter comes around, you know all about the loss of light. Some of you are affected by the grayness and find yourself having a depressed mood. What we know is often in the case of Seasonal Affect Disorder that light therapy can indeed be an effective tool.
Now, I mentioned exercise therapy before meditation but I didn't mention Yoga as a very effective therapy, because it incorporates not only exercise and stretching but a form of guided imagery and meditation; play therapy for children or the music therapy, often used in hospital settings, biofeedback, and ECT or Electroconvulsive Therapy which is used in severe depressive cases.
So how can you help yourself if you are struggling with depression? The first step in dealing with depression is learning to recognize and accept, it is a real and valid medical condition that responds favorably to appropriate treatment. Unfortunately many people do not recognize that depression is an illness, a treatable illness. If you feel that you were someone you care about at work or at home it's one of those many undiagnosed untreated depressed people in this country, there are steps you can take that may save your own or someone else's life.
Learn as much as you possibly can about depression, and in a couple of other slides from now, I will list for you, some of the resources that we have on Achieve Solutions website. Build emotional skills often that is built through the help of a psychotherapist in cognitive behavioral therapy and interpersonal therapy.
Set small realistic goals in light of the depression. Oftentimes someone that is struggling with depression becomes so overwhelmed with what they need to do because they're no longer cleaning their house, they're no longer cooking their meals. They are intermittently showering and grooming, and so the goal is not to clean up their act in a way, their goal may be to get up in a timely fashion in the morning and get a shower, and that might be their goal for the first week. Make sure that goals are realistic in light of the severity and duration of depression that you may be struggling with.
Unfortunately depression creates isolation, and remember, at the beginning I talked about how depression can keep us hostage? Well, in taking us hostage, it often isolates the person that is depressed from the very support systems that they need. Cultivate supportive relationships where you feel included and loved, and take care of yourself. I can’t stress this enough, that’s why I repeat it often, make sure that your nutritional intake is inclusive of protein, healthy fats, healthy grains and some good dairy products. Reduce or eliminate refined sugar. There seems to be some correlation between consumption of alcohol, simple sugars and simple carbohydrates and depression. Make sure that even if you don't want to you are getting out and you are exercising. It’s going to reduce your stress level, but it is going to improve your brain functioning, and evaluate and set whatever next priorities you need. Postpone any major decisions until you feel better, follow your doctor’s treatment recommendations and speak to a healthcare professional if your symptoms persist or worsen.
Now we've included in this webinar, steps to take to help a friend or a family member or a coworker recover from depression. Talk to the person about what you have noticed and what you're concerned about. People who are depressed are already immersed in a very self-critical voice, a voice inside their head that is firing off often that they're not making a cut. The voice is very critical and guilting them. So approaching them with what you've noticed in a very loving, compassionate way will help to encourage your friend or a loved one to seek assistance, to seek the resources that you may be garnering from this webinar today, and certainly invite them out for a walk. I did this with a friend of mine last year, Suzanne, who lost her lifelong partner, and everyday, I would call her and say, come on, get your shoes, we are going to go for a walk, and now she is my long-distance walking buddy, every weekend. And I know that the walking helps her a great deal for many reasons. One is she had a companion, a friend to walk with, but the other is as I have mentioned many times, exercise can solve a great many problems.
Be patient with the person. If you don't see immediate change in their affect, be patient, because recovery takes time. Again we make another reminder for all of you, never ignore talks of suicide. Call 911.