Depression Panel

My notes from the depression panel I participated in at the Casual Bloggers Conference:

-Depression is a common disorder and is different from the normal “feeling down” or “blues” that we all feel at certain times.
-5 to 10% of population suffers from clinical depression.
-Only 1 to 3% are currently getting treatment.
-Women suffer from depression at a rate of 3 to 1 compared to men.
-Men more likely to suffer in silence – they cope by overworking or by self medicating (i.e. men have 2x the rate of women for alcoholism)
-Depression is diagnosed when the symptoms cause certain levels of disability (i.e. unable to maintain relationships, unable to fulfill daily responsibilities at work or home, unable to relax or enjoy recreation, etc.).
-10 to 25% of women will suffer from depression at some point of their lives.
-5 to 12% of men…
-At least 5 of the following symptoms need to be present for at least 2 weeks: depressed mood/irritability; loss of interest/pleasure (including sex drive); inappropriate guilt; low self-worth or self-hate present; disturbed sleep or appetite; low energy/fatigue; poor concentration/memory; sluggishness (i.e. speech and movement); aches and pains; hopelessness; suicidal thoughts or plans
-Depression can come from 4 different sources (or a combination of these): 1. Situational- something happens that causes depressed feelings (usually diagnosed as an adjustment disorder), 2. Biological- genetic foundation and vulnerabilities, 3. Developmental- from unmet needs at important developmental stages, and 4. Spiritual- from sin, perception of sin, challenges in ones faith, etc. All four manifest with depleted levels of neurotransmitters to the brain.
-All diseases have biochemical components. Brain is a physical organ and not immune to this.
-The lymbic system is the center of emotion in the brain. It controls feelings having to do with anger, joy, eating behaviors, sleep and sexuality.
-A depressed brain actually looks different from a “normal” brain in brain imaging studies. Key cells become less able to produce chemicals like serotonin, norepinephrine, and dopamine. These are called neurotransmitters and they are responsible for maintaining positive mood and optimism.
-A common denominator for treatment should include the medical model.

Types of depression diagnoses:
-Adjustment Disorder
-Major Depression (5 of 9 symptoms) – mild, moderate or severe
-Psychosis involved – psychotic symptoms present (i.e. loss of contact with reality, paranoid delusions or hallucinations). Immediate hospitalization should be sought. ECT (electroconvulsive treatment) has proven helpful in these cases. Make sure this psychosis is not drug induced (especially when in regards to adolescents or young adults who are more likely to be using drugs).
-SAD – Seasonal Affective Disorder which is linked to sunlight exposure. Symptoms need to be present for 2 consecutive years and symptoms should resolve when season changes.
-Postpartum – Can be life endangering for both mother and child.
-Bipolar – Cyclical between manic episodes and depressed episodes. Definitely a biological component. Antidepressants do not work for this disorder – they can actually cause a manic episode. Mood stabilizers are effective instead and are the most effective form of treatment for this disorder. It is important when diagnosing depression to always ask if there has been a history of mania so that an antidepressant is not prescribed.
-Dysthymia – A chronic form of depression but usually lower in severity.

Resources that address the multifaceted effects of depression:
-Ecclesiastical leader that can help address spiritual component.
-Doctor/Psychiatrist that can help address the biological component.
-Counselor/Therapist that can help address the emotional component.

Research is continually in agreement that the most effective form of treatment is a combination of medication and talk therapy (60-80% report significant progress).

Non medical things that help alleviate symptoms:
-diet
-exercise
-correct amount of sleep
-spiritual tools (i.e. meditation, prayer, scripture study, etc.)
-journal writing
-supportive connections

The problem with only taking the non-medical route is that often the person who is depressed lacks the energy and initiative to do the things that can help.

Research on the “placebo effect” shows that it wears off after a few weeks. Whereas those on the actual medication show continued progress over a longer period of time.

Resistance to medication is common due to:
-stories that cause fear but are not the “norm”
-misdiagnosis
-dependency fears
-religious beliefs
-lack of information
-feeling that medication is “overprescribed”

Depression can resolve itself without medicine – it just usually takes a lot longer and one is also taking the risk that it will not resolve itself. This is also where suicide risk needs to be evaluated as well as the effects the depression has on the entire family system – not just the individual in question.

Depression will also not resolve itself only with medicine. These are not wonder or magical pills. The reason why therapy is helpful is to be able to assess past history of bad decisions, vulnerabilities, skills, coping skills and problem solving tendencies.

Estrogen therapy can help in postpartum depression.

Myths about depression:
– people are trying to get attention
– you can beat it with willpower (increases guilt and furthers depression)
– due to unconfessed sins or weak faith (again increases guilt and can be very debilitating)
– just another word for grief
– fellow church members, family or friends will be supportive and understanding (fear, ignorance and the desire to “fix things” often gets in the way of understanding)
– it is a waste of time (an indulgence)
– comes from repressed anger (sometimes, but not always)

Getting Help
– enlist a constructive support network (including family, friends, professionals and church leaders that are SUPPORTIVE)
– allow for relaxation
– volunteer opportunities/service can be beneficial
– keep a journal

Be wary of:
-alternative meds and therapies (make sure treatments are backed up by research – many “herbal” remedies are still chemicals interacting in your body, can have serious side effects and do not have the backing of the FDA to ensure that you are buying what the label says you are buying)
-overworking
-self medicating by soothing through unhealthy behaviors (i.e. drinking, pornography viewing, gambling, overspending, smoking, etc.)
-false intimacy
-easy fixes
-developing physical complaints
-feeling like you have to do this on your own

How to encourage a loved one going through depression:
– listen and express concern
– offer to go to the doctor’s office with them
– telephone often or reach out in other ways (i.e. written notes)
– invite to a movie (comedy please – no drama) or bring over a video to watch and laugh together
– do something fun with them
– have realistic expectations – be patient
– don’t parent

There are gifts that come with depression – the opposition factor:
-greater sensitivity and empathy
-possibility for change and growth
-channel for creativity
-dependence on a higher power
-understanding of grace or mercy
-deeper faith or redefining faith through a spiritual journey

The Beck Depression Inventory is a great assessment tool.

New Light on Depression: Help, Hope & Answers for the Depressed & Those Who Love Them by David B Biebel, DMin & Harold G Koenig, MD is a valuable resource that is written from a Christian perspective.

On a side note: Maybe the fact that Utah is the #1 state for women on antidepressants is actually a positive where women of the LDS faith are willing to take control and show self-initiative for self-care and self-sufficiency. Yes, the LDS culture comes packed with pressure and high expectations. However, most LDS women I know are creative, forward thinking and willing to do whatever it takes to progress personally and care for their loved ones. If this includes the use of anti-depressants and therapy then more power to them!

Again, the women who spoke on this panel with me were amazing. Their stories spoke true, raw and honest. I was so impressed with the level of self disclosure and confidence that was palpable under the depression itself. Wow!

I welcome comments and discussion on this amazingly important topic. What have you found useful or not?