The Invisible War Among the Depressed

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.

Appropriate treatment, however,

CAN help most people who suffer

from depression.

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.

Reflection Question

What are unique ways

faith leaders mask their

experience with

depression?

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.

Famous people who live(d) with depression and got treatment

Questions