Depression - TUP TUTORS



Depression

Outline

I-Introduction

II-Definition of depression

III-Depression in adults, adolescents and children

A-Symptoms

B-Consequences

IV-Types of depression

A-Depressive disorders

B-Bipolar depressive disorders

V-Genetic causes

VI-Treatment

A-Medication

B-Electroconvulsive therapy

C-Cognitive therapy

D-Psychological therapies

VII-Conclusion

Introduction

It is very common to hear people complaining that they are suffering a depression, hopefully one that will disappear in a few hours or even days. Depression has been considered as a major psychological problem in modern communities. However, what most people believe to be a depression is in fact nothing but the consequence of stress. Depression as psychologists view it and define it is much more dangerous, complicated and persistent. Depression is by all means on of the major health problems identified in the twentieth century.

Definition

In adults depression is defined as a mood disorder in which an individual feels deeply unhappy, self-degragatory, and bored (Santrock, p. 527). Psychiatrists define depression as a psychiatric disorder characterized by feelings of worthlessness, guilt, sadness, helplessness, and hopelessness. Depression has also been defined as that state in which one feels sad and hopeless, but to such an extent and over a long time that it interferes in one’s daily life (Arbetter, p.7).

In contrast to normal sadness or the grief accompanying the loss of a loved one, clinical depression is persistent and severe. It is accompanied by a variety of related symptoms, including disturbances in sleep and eating, loss of initiative, self-punishment, withdrawal and inactivity, and loss of pleasure.

Community surveys show that as many as 20 in 100 people suffer from significant depressive symptoms at any one time. Furthermore, some 25% of the population may suffer from a depression over the course of a lifetime. The disorder strikes men and women of all ages, in all segments of society, but most studies indicate that women are more often afflicted.

Depression in Children

For many years, it was believed that only adults suffered from depression, excluding both children and adolescents. However, studies that started in the early 1970s proved that both children and adolescents suffered from depression just as adults do.

In fact, depression, is reported be one of the major symptoms accompanying cases or attempts of suicide among adolescents (Zanden, p.409). Psychologists have detected continuous depressions to be apparent in many cases of suicide among adolescents in the age of 14 to 21.

Hence, it has been agreed among scientists that depression might even lead more destructive consequences among children and adolescents than among adults, especially that these children and adolescents involved in anti-social, aggressive and anxious behaviors (Santrock, p.527). The most prevalent type of depression among children and adolescents is psychotic depression. To relieve children of the impact of depression, scientists have tried discover a cure. Curing depression in children and adolescents depends on two important steps; pharmacotherapy and psychotherapy.

After years of research, findings showed that depression in children was the number one risk factor for suicide. Erroneously, depression was believed to be a sign of weakness, but scientific evidence shows that depression is in reality caused by three major factors: genetic make-up which a person has inherited from parents; chemical balance in the brain; and life experiences which depend on the environmental circumstances and events which happen in daily life (Arbetter, p.7). Erik Erikson was a leading scientist in identifying depression in children and adolescents, as he considered depression to be the result of the heavy responsibility that these individuals have to satisfy; that is, establishing their own identity, thoughts, feelings, interests and values, as well as their independence from parents and others (Arbetter, p.7).

Although adolescents are naturally moody, depression is serious when it is persistent for a long period of time, ranging between six to seven months, and sometimes to two or three years. For, depression prohibits normal development during a critical period of one’s life, and the consequences last for a life time (Arbetter, p.7).

Types of Depression

In psychiatry, two major forms of depressive disorders are recognized. In both, the predominant symptom is a disturbance in mood. One form of the disorder, depressive disorder, is marked only by episodes of depression. The other, bipolar or manic depressive illness, is characterized by alternating depressed and manic episodes.

In major depression, a depressed mood predominates, although the patient may not be aware of feeling sad. Typically, he or she loses all interest in and withdraws from usual activities. Symptoms include sleep disturbances such as early-morning awakening; loss of appetite or greatly increased appetite; inability to concentrate or to make decisions; slowed thinking and decreased energy; feelings of worthlessness, guilt, hopelessness, and helplessness; diminished sexual interest; and recurrent thoughts of suicide and death, sometimes leading to actual suicide.

In the manic phase of bipolar illness, the patient's mood can be elevated, expansive, or irritable. Behavior is bizarre and sometimes obnoxious. Other symptoms include excessive talkativeness, racing thoughts, and grandiose ideas; greatly increased social, sexual, and work activity; distractability; loss of judgment; and a decreased need for sleep.

Genetic Causes

Both depressive and bipolar disorders run in families. Almost certainly a predisposition to these disorders is genetically transmitted. Thus, the risk of a depressive disorder is greater in the families of depressive patients than in the population at large. The higher proportion of depression in women may be biologically induced, or it may be that women learn social roles that favor feelings of helplessness. Because women in trouble are more likely to seek help than men, statistics reporting a higher incidence of depression among women than among men may be explained, at least in part, by an underdiagnosis of depression in men.

Studies have suggested that genetic predisposition to depression may be linked with an abnormal sensitivity to the neurotransmitter acetylcholine. Receptors for acetylcholine have been found to occur in excessive numbers in the skin of a number of patients suffering from depressive disorders.

In most cases, the adolescent will not identify himself or herself as a depressed person, specifically that depression is usually considered a negative stereotype. Therefore, much of the burden to identify the symptoms falls upon parents at home or teachers in school. These symptoms may be obvious in a way if the adolescent’s grades start dropping, or if their behavior changes in a negative manner. Once depression has been identified, therapy should immediately follow, especially if the depressed individual shows severe signs of withdrawal, or loss of interest in life, because in such a case, suicide could be an imminent threat.

Treatment

At first, medications such as monoamine oxidase, inhibitors and tricylics were used with adolescents on the hope that they would reflect improvement as they have done with adults. Nevertheless, the results were not encouraging (Lamarine, p.391). Another medication was used, mainly fluoxetine (Prozac) which showed much better improvement in two thirds of depressed children and adolescents (Lamarine, p. 391). Likewise, treatment with imipramine HCl (Tofranil) also showed noticeable improvement in depressed children and adolescents (Burford 87).

The depressive disorders are among the most treatable in psychiatry. The usual treatment in modern practice involves administration of a drug plus supportive psychotherapy. Two major classes of drugs are used to treat depressive disorders: the tricyclic/tetracyclic antidepressants and the monoamine oxidase (MAO) inhibitors. The latter require following a special diet because they interact with tryamine, which is found in cheeses, beer, wine, chicken livers, and other foods, and causes elevation of blood pressure. The tricyclic antidepressants require no special diet; common generic drugs in this class are amitriptyline, desipramine, doxepin, and imipramine. Lithium carbonate, a common mineral, is used to control the manic phase of manic-depressive illness. In smaller doses, it is also used to regulate the mood fluctuations of this bipolar disorder.

Electroconvulsive therapy, or ECT, is considered most effective for depressions not responsive to drug therapy. Although controversial, ECT brings rapid relief from severe depression and can often prevent suicide.

To curb the negative psychological and social impacts of depression, various methods have been devised. The main methods used with child and adolescent depression were medical or psychological. However, research showed later on that it was better to use both types at the same time, to ensure positive results and therapy. However, it is in order here to identify depression to point out the problem before solving it. Adolescents continue to perceive depression as a weakness, and this is why they continue to conceal it. This makes it almost impossible for parents, teachers or peers to identify the problem. It is therefore important to educate children and adolescents to seek help whenever they feel depressed.

One way of asking for help is to contact school counselors and psychologists, because these have a lot of experience of identifying depression symptoms, and consequently, they are able to look for solutions. Another source of help is mental health agencies that also have professionals who can identify depression and guide the adolescent to seek therapy. Finally, private therapists such as social workers and psychologists can help adolescents identify the problem and seek help in appropriate ways (Lamarine, p.391).

The remarkable improvement with pharmcotherapy, however, was not enough. The real burden of treatment was placed on psychotherapy. The approaches used in this context are the cognitive therapy, family therapy, behavior therapy and psychodynamic therapies (Lamarine, p.392).

Cognitive therapy enables the depressed individual to use logic and rational methods of thinking and dealing with problems, and to get over irrational patterns that may interfere in his or her development. The use of rationality in solving problems instead of emotions helps the depressed get over depression (Lamarine, p. 392).

Family therapy requires the parents to play a positive role in observing the problem and communicating with their child. Besides, involving the family in the therapy is important because having a depressed child or adolescent in the family tends to create disturbances and stress in the family (Lamarine, p. 393).

In addition to family therapy, behavioral therapy is very important because it helps the depressed individual get rid of the negative behaviors that have been learned before and during depression, and instead, reinforces positive behaviors that are related to rationality and logic in dealing with daily life problems and situations. For example, the depressed person might be taught how to evaluate choices and options in dealing with situations rather than panicking (Lamarine, p. 392).

Finally, psychodynamic therapy depends on the Freudian understanding of conflicts that underlie mental illnesses such as depression. This therapy helps the depressed individual face and resolve these conflicts by revealing them to the conscious mind (Lamarine, p. 392).

The role of school is considered to be important in curing depression in children and adolescent. The presence of the depressed individual in group depression-treatment programs provides the depressed individual with opportunities to meet with positive role models which will help him or her modify behavior positively (Lamarine, p. 393). Besides, school treatment-programs help raise self-esteem with the help of social support groups and peers that can help improve the social skills of the depressed individual (Lamarine, p. 393). The role of professionals at school, such as counselors and social workers is also important since they provide the depressed child or adolescents with advice and ways to cope with disappointments, disabilities and abusive situations (Arbetter, p. 8).

Finally, the treatment of depression in children and adolescents is one that is still undergoing scientific research. Both pharmacotherapy and psychotherapy have been used with a certain degree of success with psychotic depression, but it is obvious that the use of both at the same time can be more helpful and effective. This shows that scientists are now taking child and adolescent depression seriously.

Conclusion

Many young people take a lot of Prozac and other medicaments to deal with what they consider to be depressions. The major myth among adolescents and adults alike today is that any mood disorder that might make them feel sad or unhappy must be a depression. Some of the symptoms of depression are indeed very prevalent among people, mostly resulting from stress, disappointment and episodes of low self-esteem, but these do not qualify to be identified as depression. A depression is a persistent psychological situation that has its roots traced to alterations in the biochemistry of the body. Depressions are also genetically inherited and are on many occasions treated as a mental and psychiatric disorder. Recently, scientific research has started studying the social and psychological factors that upon persistence may eventually lead to elongated episodes of depression. This is specifically the result of certain findings that show the high relationship between depression and a number of disorders such as anorexia and bulimia nervosa, as well as child and adolescent suicide. Although the symptoms of depression are very widely spread, it is nonetheless a fact that scientists do not enough about depression yet. In fact, many of the treatment methods devised for dealing with depression are still in the experimental phases, and ultimately, the treatment of depression requires commitment and will by the depressed person to improve.

References

Arbetter, Sandra. "Am I normal? Those teen years." Current Health 2, April

1995, pp. 6-12.

Burford, Sandra. "What's wrong with this 12-year-old boy?" Patient Care,

March 30, 1995. pp. 85-87.

Lamarine, Roland. "Child and adolescent depression." Journal of School

Health, November 1995, pp. 390-393.

Santrock, John. Adolescence. New York: Brown & Benchmark, 1995.

Zanden, James. Human Development. New York: McGraw Hill, 1995.

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