Importance Of Diagnosing Depression

1. Importance Of Diagnosing Depression Up to 15% of individuals with severe depression die by suicide Fourfold increase in death of individuals with depression over age 55. In general, serious depression predicts more pain and physical illness Age of onset decreasing for those born more recently

2. Importance Of Diagnosing Depression • Depression is the most common mental health disorder in the United States • Each year it affects 17 million people • About 20% of people will experience a depressive illness at some point in their life

3. Facts: • As many as 1 in 33 children may have depression (5%) • In teens the number may be as high as 1 in 8 (10% -20%) • Depression in adults often has its’ origin in adolescence • 70% to 80% of depressed adolescents do not receive treatment • Equal gender distribution of MDD in childhood. In adolescence MDD occurs twice as frequently in girls

4. Symptoms Of Depression Not everyone who is depressed experiences every symptom. Some people experience a few symptoms, some many. The severity of symptoms varies person to person and also varies over time.

5. Overview of Symptoms • Persistent sad, anxious, or "empty" mood. • Feelings of hopelessness, pessimism. • Feelings of guilt, worthlessness, helplessness. • Loss of interest or pleasure in hobbies, people and activities that were once enjoyed, including sex. • Decreased energy, fatigue, being "slowed down." • Difficulty concentrating, remembering, making decisions. • Insomnia, early-morning awakening, or oversleeping. • Appetite and/or weight loss or overeating and weight gain. • Thoughts of death or suicide/suicide attempts. • Restlessness, irritability. • Chronic pain, illness, digestive disorders

6. Types of depression:Major Depression • Manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. • 50%-60% of people suffering from MDD can be expected to have a 2nd episode; • Those with 2 have 70% chance of a third, those with 3 have 90% chance of having a fourth

7. MDD – Associated features • In general MDD predicts more pain and physical illness • “Affluenza” : higher rate of depression in adolescents from high income families • Age of onset decreasing for those born more recently • Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next five years • Suicide is the third leading cause of death for 15-24 year olds.

8. Dysthymia A less severe type of depression, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives. Early diagnosis and treatment of dysthymia is crucial since it serves as a major pathway to recurrent depression in children

9. Causes • Evidence indicates that depression runs in families (genetics) • Not everybody with the genetic makeup that causes vulnerability to mood disorders will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset. • Biochemical abnormalities in mood regulating neurotransmitters may cause depression (endogenous depression) • Sometimes the onset of depression is associated with acute or chronic physical illness (reactive depression)

10. continued • Negative life events such as the loss of a loved one, a break-up, family conflict, divorce, a move, abuse, bullying at school a major financial upheaval or other loss may cause depression (reactive depression) • Certain personality traits such as low self-esteem, shyness, anxiety, and perfectionism may increase the likelihood of developing depression • People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression.

11. Summary In summary, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

12. Symptoms in Children specifically • Change in school performance such as frequent complaints from teachers, loss of usual work effort, loss of usual interest in nonacademic school activities • Diminished socialization such as decreased group participation, social withdrawal, decreased friendliness • Change in attitude toward school such as decreased enjoyment in school activities or refusal to attend school • Somatic complaints such as non-migraine headaches, abdominal pain, and muscles aches or pains • Loss of energy • Unusual change in appetite and/or weight

13. Continued…. • Dysphoric mood statements or appearance of sadness, loneliness, unhappiness, hopelessness and/or pessimism • Mood swings, irritability, hypersensitivity and negativity • Feelings of being worthless, useless, dumb, stupid, ugly • Desire to run away or leave home • Suicidal thoughts or attempts • Aggressive behavior such as excessive fighting or sudden angry outbursts, disrespect towards authority, belligerence, difficulty getting along with others • Sleep disturbances such as insomnia, restless sleep and difficulty waking

14. Reasons for under-diagnosis in children • Differing manifestation of depressive symptoms in childhood- e.g. Irritability and duration • Children not always able to accurately express how they feel • Co-morbid disorders can mask affective symptoms • Clinicians often view mood disorders as adult syndromes

15. Parental Depression • Children with at least one depressed parent are approximately three times more likely to have a lifetime episode of MDD than children of nondepressed parents. • The lifetime risk for MDD in children of depressed parents has been estimated to range from 15% to 60% • Offspring of depressed parents are not only at risk for affective disorders, but they also are at increased risk for general psychopathology, including anxiety and disruptive disorders

16. Depressed Mothers’ Interactions with kids • Mother appears withdrawn, uninterested • Mother does not provide adequate stimulation for child (touch, play, affection) • Tends to interpret child’s facial expressions as negative • Alternates between hostile, over-involved and unresponsive inattentive. • Mothers perceive children as hard to parent

17. Continued… • Depressed parents tend to be more irritable and emotional • Children are more likely to develop behavioral problems when their parents rely heavily on yelling and criticism when dealing with poor behavior • Depressed parents tend to focus on the negative and ignore the positive • Child is prone to “give up” on trying to improve if efforts at behaving are ignored • Child of depressed parent learns that the way to get parent out of depressed mood is to misbehave

18. Cognitive Styles and Temperment • Children who have negative attributional styles for interpreting and coping with stress and negative life events tend to become hopeless and dysphoric and appear to be at higher risk of developing MDD • It appears that a negative cognitive style becomes more fixed during adolescence emphasizing the need for early intervention.

19. Finding Help… • The process of finding a therapist can be highly anxiety producing - cut yourself some slack. • A sweet personality is no guarantee of ethical or effective skills, • One size does not fit all! A therapist who is just perfect for one person may not be a good fit for the next. • Word of mouth is a good starting place. Get referrals. • Before interviewing a therapist, be familiar with the various options available

20. Continued • Ask yourself…….. “What do I hope to gain from therapy? Can this therapist help me do that?” • Interview perspective therapists…. Many of them. • Trust your instinct - Ask yourself “Am I comfortable with THIS therapist?” • Ask about membership in professional organizations, specialization and licensure, and how long they have been in practice • Ask what it is that the therapist does that is supposed to be helpful. How is this different from how other therapists work? What should you expect?

21. The Helping Professionals: Who They Are – What They Do Helping professionals work in many settings, such as schools, mental health centers, clinics, employee assistance programs, private and group practice, hospitals, nursing homes, residential centers, partial care organizations, family or social service agencies, and university medical centers or teaching hospitals. The promotion and enhancement of healthy, satisfying lifestyles are the goals of all helping professional regardless of where services are provided. (SEE HANDOUT)