Depression and Other Mood Disturbances

1. Depression and Other Mood Disturbances Dr. Manasi Kumar, Ph.D., CPsychol. Psychotherapist Lecturer in Clinical Psychology Department of Psychiatry University of Nairobi, Kenya Email:manni_3in@hotmail.com Phone: 0717 379 687

2. What is Depression? Needs to be understood on a spectrum Disturbance of mood- feelings, affects, emotions Persistent and chronic gloom (feeling empty, dark and low constantly) Chronic unhappiness, loss of energy and motivation Feeling low, gloomy and low motivation

3. Why do people get Depressed? Several factors work in tandem 2. Physiological processes, neurotransmitter functioning that contributes to dysfunction 3. Stressors in life and ones mental capacities to deal with it 1. Individual personality shaped by early experiences and interpersonal relationships

4. Parts of the Brain implicated in Depression Receives most sensory information and relays it to the appropriate part of the cerebral cortex part of the limbic system and has a central role in processing long-term memory and recollection- ‘emotionally colours experience/ memory Directs high-level functions such as speech, behavioural reactions, movement, thinking, and learning part of the limbic system, a group of structures deep in the brain that’s associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal, also emotionally charged memories Source: Harvard Depression review. 2012

5. How do we know it is depression? 1. Emotions or feelings • Feeling sad, guilty, upset, numb or despairing • Losing interest or enjoyment in things • Crying a lot or unable to cry when a truly sad event occurs • Feeling alone even if you are in company • Feeling angry and irritable about the slightest things Source: Synopsis of Psychiatry. Kaplan and Saddock, Kluwer Press, 2009 4th revision & NHS Camden & Islington Booklet on Depression 2011

6. Signs of depression 2. Physical or bodily signs • Tiredness • Restlessness • Sleep problems • Feeling worse at a particular time of day – usually mornings • Changes in weight, appetite and eating • Loss of interest in sex.

7. Signs of depression 3. Thoughts • Losing confidence in yourself • Expecting the worst and having negative thoughts • Thinking you hate yourself/feeling worthless • Poor memory or concentration • Thinking that life is not worth living. 4. Behaviour • Having difficulty in making decisions • Can’t be bothered to do everyday tasks • Putting things off • Not doing things one enjoyed or did earlier

8. Extending an understanding of Depression : Melancholia • Freud (1918) in an interesting comparison talked about how melancholia (depression) was like mourning (death of someone) • A real or imaginary loss of ‘someone’ or ‘something’ within us died and we are mourning its loss (Derrida) • Knowing this ‘someone’ or ‘something’ is the key objective of a psychotherapeutic process In Depression, it is important to know ‘who’ and ‘what’ we are mourning for!

9. Aaron Beck’s Cognitive Triad Depression stems from this cycle of helplessness and hopelessness. It is our thinking patterns & emotions underlying that need to change Negative view of oneself Negative view of others/world Negative view of future

10. On the same continuum..... • Manic-Depressive illness (Bipolar) • Cyclic vacillation between bouts of extreme happiness, euphoric (frenzy) and extremely high levels of activity and energy • Varying periods of depression and mania- form subtypes of mood disorder • Post partum Depression Common in both men and women after arrival of a new baby. Often in instances of first baby. Women more vulnerable/susceptible to it (baby blues) - Seasonal Affective Disorder

11. Global Mental Health Research Facts on Depression • 14% of global burden of diseases attributable to neuropsychiatric problems (Price et al. 2007, 2009, Lancet) – mostly unipolar, bipolar & substance use • The WHO deems bipolar the sixth main cause of disability for people aged 15-44. In children, the diagnosis has increased by over 400% • Social support is an effect modifier in case of many neuropsychiatric problems (Kleinman, Lancet, 2012)

12. Battling it out!: Treatment Options • Psychotherapy (medium intensity) • Drug intervention/ pharmacological –SSRI, Tricyclics, SNRI, MAOI’s • Combined drug and therapy or counselling • Support or self help groups • Active participation in other socio-cultural forums or in creative arts • Self-study and care

13. Psychotherapy • Different types: -Focus on different zones of experience and different management styles Intensity/more vs. less behavioural/group vs. Individual -Evidence based finding says that it is the quality of the therapeutic relationship that matters more than orientation of the therapist - Mild to moderate depression minimum 25 sessions (upto 50) of psychotherapy helps – UK govt. NICE report , endorsed by APA & BPS

14. Some creative resources.... • 5 films • The Hour (based on Virginia Woolf’s life) • Sylvia (based on Sylvia Plath’s The bell jar) • Helen • Prozac Nation • It’s all about my mother (Almodavar) • Short film viewing for 11.25 mins • http://www.youtube.com/watch?v=YJmNosceZWg • Directed by Shane Abbess, Director of Photography Peter Holland, and Edited by Enzo Tedeschi. Starring Emily Stewart and Dwaine Stevenson. 2006. Sutherland country awareness programme.

15. Any questions? Please feel free to contact me on manni_3in@hotmail.com Or m.kumar@ucl.ac.uk