Objective
• C o m m o n my t h s a b o u t d e p re s s i o n
• C a u s e s o f d e p re s s i o n , b o t h c l i n i c a l a n d
s i t u a t i o n a l
• W h a t t h e s y m p t o m s l o o k l i ke i n d i f f e re n t
g e n d e r s a n d a g e g ro u p s
• Tre a t m e n t o p t i o n s
• Way s t o c a re : S e l f , Pe e r, & Pa s t o ra l
PHQ-9: On a scale of 0 (not at all) to 3 (nearly
every day) how often have you been
bothered by: 1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleep too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself, or that you are a failure or have let
yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or
watching television
8. Moving or speaking so slowly that other people could have noticed.
Or the opposite – being fidgety or restless that you have been
moving around a lot more than usual
9. Thoughts that you would be better off dead, or of hurting yourself in
some way
Scoring & Recommendations
0-4 Minimal Depression
❑ Practice good self-care
5-9 Mild Depression
❑ Practice good self-care and consider talking to someone (faith
leader/mentor/professional therapist)
10-14 Moderate Depression
❑ Seek professional help, brief therapy (8 to 12 sessions)
15-19 Moderately-Severe Depression
❑ Seek professional help and consider medication management
for a few months
20-27 Severe Depression
❑ Seek intensive treatment (inpatient/partial inpatient), seek
medication for stabilization, and long term therapy for post
intensive treatment
Common myths about Depression….
HARD WORK BEATS DEPRESSION
• Depression affects nearly one in six people at some point in their lives, so folk remedies and half-truths about this common illness abound.
• One such idea: throw yourself into work and you'll feel better. For a mild case of the blues, this may indeed help, but depression is a different animal.
• Overworking can actually be a sign of clinical depression, especially in men.
IT'S NOT A REAL ILLNESS
• Depression is a serious medical condition and the top cause of disability in American adults. But it's still confused with ordinary sadness.
• Biological evidence of the illness can be seen in brain scans, which show abnormal activity levels.
• Key brain chemicals that carry signals between nerves also appear to be out of balance in depressed people.
Major Depression (MD)
is an illness that impacts the body,
your mood, and your thoughts.
It affects the way a person eats and
sleeps, the way one feels about
oneself, and the way one thinks
about things.
Common myths about Depression….
DEPRESSION IS JUST SELF-PITY
• Our culture admires will power and mental toughness and is quick to label anyone who falls back as a whiner.
• But people who have clinical depression are not lazy or simply feeling sorry for them selves. Nor can they "will" depression to go away.
• Depression is a medical illness -- a health problem related to changes in the brain.
• Like other illnesses, it usually improves with appropriate treatment.
Reflection Question
What are some uninformed
adjectives that have been used
historically to describe depressed
individuals?
People with MD CANNOT
merely "pull themselves together"
and get better.
Without treatment, symptoms can
last for weeks, months, or years.
major depression is manifested by a combination of
symptoms that
interfere with the ability to work,
study, sleep, eat, and enjoy once
pleasurable activities
• decreased energy or fatigue• decreased motivation• difficulty concentrating/
remembering• changes in appetite/weight• changes in sleep patterns• sad, anxious or empty mood• hopelessness/pessimism• loss of interest/ isolation • loss of sex drive• restlessness/irritability• insomnia • thoughts of death/suicide• Thoughts to hurt others• guilt/worthlessness• Hallucinations
Many medical illnesses like Stroke, Heart attack, Cancer
Stressful change in life patterns can trigger a
depressive episodeInformation provided by Dr. Al Masterson,Head of Inpatient Psychiatric Programs Cleveland Clinic
Financial Problem: Loss of stock,
Inheritance loss, Low SES
Relationship difficulties: Divorce,
Separation, Argument
A serious loss: Loss of job, Loss of house,
Loss heir loom, Significant other
GeneticsStress
Hormones Substance abuse
What causes
depression?
Clinical/Chemical
Depression
Genetic, psychological, physical and environmental factors all seem to be involved in the onset of a depressive disorder.
• Is depression inherited?depression can occur generation after generation in some families, but it can also occur in people who have no family history of depression.
• Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.
SEROTONIN NOREPINEPHRINEN DOPAMINE
Brain chemicals get low = Symptoms of Depression/Anxiety etc.
Information provided by Dr. Al Masterson,Head of Inpatient Psychiatric Programs Cleveland Clinic
ANXIETY MOOD FOCUS
Other Types of Depression
Seasonal Affective Disorder (SAD)
Postpartum Depression
•Lack of interest in your baby•Negative feelings towards your baby•Worrying about hurting your baby•Lack of concern for yourself•Loss of pleasure
•Lack of energy and motivation•Feelings of worthlessness and guilt•Changes in appetite or weight•Sleeping more or less than usual•Recurrent thoughts of death or suicide
The signs and symptoms of seasonal affective disorder are the same as those for major depression. SAD is distinguished from depression by the remission of symptoms in the spring and summer months (or winter and fall in the case of summer SAD).
SAD affects about 1% to 2% of the population, particularly women
and young people, while a milder form of winter blues may affect as many 10 to 20 percent of people.
Common myths about Depression….
DEPRESSED PEOPLE CRY A LOT
• Not always. Some people don't cry or even act terribly sad when they're depressed. Instead they are emotionally "blank" and may feel worthless or useless.
• Even without dramatic symptoms, untreated depression prevents people from living life to its fullest –and takes a toll on families.
HELP MEANS DRUGS FOR LIFE
• Despite the buzz about a "Prozac Nation," medication is only one of the tools used to lift depression.
• And asking for help does not mean you'll be pressured to take prescription drugs. In fact, studies suggest that "talk" therapy works as well as drugs for mild to moderate depression..
• Even if you do use antidepressants, it probably won’t be for life. Your doctor will help you determine the right time to stop your medication
Depression Treatment
Yes, it can and should be treated.
Research shows that the combination of medication and therapy provides the best results. Medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems (including depression).
Treatments include antidepressant medications & therapy. People with milder depression might do well with psychotherapy alone, but people with moderate to severe depression most often benefit from antidepressants
Different Types of Therapy include:Cognitive Behavioral Therapy-Restructuring your thinking patterns and recognizing how they effect your behaviors.
Mindfulness CBT- Cognitive Behavioral Therapy with a strong focus on connecting with your environment or spiritual beliefs.
Dialectal Behavioral Therapy- aims to help people validate their emotions and behaviors and make a conscious effort to bring about positive changes.
Medical TreatmentFor Depression
Rule of Seven’s 7 days 30% improvement
7 weeks 100 % filled back up7 months later ( a year total )
Stableble
Medications for MD include:
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
Some examples are: Prozac, Celexa, Zoloft, Lexapro
2. Serotonin–Norepinephrine reuptake inhibitor (SNRI’s). These neurotransmitters are known to play an important role in mood. SNRIs can be contrasted with the more widely used selective serotonin reuptake inhibitors (SSRIs), which act upon serotonin alone. Some examples are Cymbalta, Effexor, Pristiq, Wellbutrin
Sometimes doctors have to try a variety of antidepressants before finding the most effective medication or combination of medications.
Sometimes the dosage must be increased to be effective.
Although some improvements may be seen in the first few weeks, anti-depressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs!
Reflection Question
What have you noticed in
your congregations related
to depression specific to
COVID 19?
Common myths about Depression….
DEPRESSION COMES ON FAST
• Depression can creep up gradually, which makes it harder to identify than a sudden illness. A bad day turns into a rut and you start skipping work, school, or social occasions.
• One type, called dysthymia, can last for years as a chronic, low-level illness – a sickness that silently undermines your career and relationships.
• Or depression can become a severe, disabling condition. With treatment, many feel substantial relief in 4-6 weeks.
REAL MEN DON’T GET DEPRESSED
• A depressed man, his loved ones, and even his doctor may not recognize depression.
• That's because men are less likely than women to talk about their feelings -- and some depressed men don't appear sad or down.
• Instead, men may be irritable, angry, or restless. They may even lash out at others
• Some men try to cope with depression through reckless behavior, drinking, or drugs.
Women Blame themselves
Feel sad, apathetic, and worthless
Feel anxious and scared
Avoid conflicts at all costs
Feel slowed down and nervous
Have trouble setting boundaries
Find it easy to talk about self-doubt and despair
Use food, friends, and "love" to self-medicate
Women are about twice as likely as men to suffer from depression. This two-to-one difference persists across racial, ethnic, and economic divides. In fact, this gender
difference in rates of depression is found in most countries around the world.
MD looks different in different stages of life.It often presents differently in males and females.
Men
Blame others
Feel angry, irritable, and ego inflated
Feel suspicious and guarded
Create conflicts
Feel restless and agitated
Need to feel in control at all costs
Find it “weak” to admit self-doubt or despair
Use alcohol, TV, sports, and sex to self-medicate
Common myths about Depression….
TALKING MAKES THINGS WORSE
• People were once advised not to "dwell on" problems by talking about them.
• Today, there's evidence that guided discussions with a professional can make things much better.
• Different types of psychotherapy help treat depression by addressing negative thought patterns, unconscious feelings, or relationship troubles. The first step is to talk to a mental health professional.
TEENS ARE UNHAPPY BY NATURE
• Although many teens are moody, argumentative, and intrigued by "the dark side," prolonged sadness or irritability is not normal for teens.
• When unhappiness lasts more than two weeks, it may be a sign of depression -- which develops in about one in 11 teens. Other signs a teen may need help include: being constantly sad or irritable even with friends, taking no pleasure in favorite activities, or a sudden drop in grades.
Teens
EXTREME SENSITIVITY TO CRITICISMDepressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”
• Problems at school• Running away • Drug and alcohol abuse • Low self-esteem• Internet addiction • Reckless behavior • Violence
IRRITABLE OR ANGRY MOODIrritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated,or prone to angry outbursts.
UNEXPLAINED ACHES AND PAINS
Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.
WITHDRAWING FROM SOME, BUT NOT ALL
PEOPLEWhile adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.
Common myths about Depression….
DEPRESSION IS PART OF AGING
• Most older people navigate the challenges of aging without becoming depressed.
• Seniors may hide their sadness or have different, vague symptoms: food just doesn't taste good anymore, aches and pains worsen, or sleep patterns change.
• Medical problems can trigger depression in seniors -- and depression can slow recovery from a heart attack or surgery.
DEPRESSION IS TOUGH TO TREAT
• The reality is most people who take action to lift their depression do get better.
• In a large study by the National Institute of Mental Health, 70% of people became symptom-free through medications – though not always with the first drug.
• Other studies show combining medication and talk therapy is even more effective.
•Unexplained or aggravatedaches and pains• Feelings of hopelessness or
helplessness• Anxiety and worries• Memory problems• Lack of motivation and energy
• Slowed movement and speech• Irritability• Loss of interest in socializing
and hobbies• Neglecting personal care(skipping meals, forgetting meds, neglecting personal hygiene)
Older adults who deny feeling sad or depressed may still have major depression. Here are the clues to look for:
While depression and sadness might seem to go hand and hand, many depressed seniors claim not to feel sad at all. They may complain, instead, of low motivation, A lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.
MD looks different in different stages of life.
Elderly
Elderly
DEMENTIA VS. DEPRESSION
Never assume that a loss of mental sharpness is just a normal sign of old age. It could be a sign of either depression or dementia, both of which are common in older adults and the elderly.
Mental decline is relatively rapid Mental decline happens slowly
Knows the correct time, date, and where he or she is
Confused and disoriented; becomes lost in familiar locations
Difficulty concentrating Difficulty with short-term memory
Language and motor skills are slow, but normal
Writing, speaking, and motor skills are impaired
Notices or worries about memory problems
Doesn’t notice memory problems or seem to care
Since depression and dementia share many similar symptoms, including memory problems, sluggish speech and movements, and low motivation, it can be difficult to tell the two apart.
Coping Skills &
Prevention
AffirmationsTalk about
feelings
Problem Solving
Physical Activity/ Exercise
Religious Community
Positive Self Talk
Social Activities
Journaling
Forgiveness
Depression
Self-Care
Sleep
Diet
Exercise
Expression
Efficacy
Social Support
Stress Management
Faith Practice
Knowledge about
depression
Fun
Depression – Pastoral Care
Accept the depressive person where they are.
Allow lament.
Assure them you are with them for the long haul
if necessary.
Listen. Give them the opportunity to empty their
heart.
Emphasize the hopeful outcome of the condition.
Explain treatment options and make referrals to
medical and behavioral health professionals.
Practice faith with them.
Be patient! Set one actionable goal at a time to
set them up for success.
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