Depression Print

Symptoms of Depression An In Service Activity By Christopher Skinner

Aims of In Service At the end of this session the learner will have an understanding of the symptoms and signs of Clinical Depression, together with a basic understanding of how Depression is treated both pharmaceutically and behaviourally.

Symptoms of Depression If a person is clinically depressed they would have at least two (2) of the following symptoms for at least two weeks. An unusually sad mood that does not go away Loss of enjoyment and interest in activities that used to be enjoyable Lack of energy and tiredness

Symptoms of Depression As well, people who are depressed have other symptoms such as:Loss of confidence in themselves, or poor self esteem Feeling guilty when they are not at fault Wishing they were dead Difficulty concentrating, or making decisions Moving more slowly or, sometimes, becoming agitated and unable to settle Difficulty in sleeping or, sleeping too much Loss of interest in food or, eating too much, changes in dietary habits can lead to weight changes.

Symptoms of Depression Appearance of the depressed person. The person usually looks sad and depressed, and is often anxious, irritable and easily moved to tears. A depressed person is usually slow in thinking and moving, though agitation and restlessness, as well as irritability, can occur. The Affect is Flat. Emotions may be blunted. Speech can be slow and monotonous. There may be a lack of interest in one’s own grooming and personal hygiene.

Symptoms and Signs of Depression Thought content is often negative, with ideas of helplessness, hopelessness and failure and views of despondency. Speech content may be limited, mono-syllabic and there may be poverty of speech which identifies underlying poverty of thought. Examples of Speech content are:- “It’s all my fault, I am a failure, life is not worth living, there is no point in going on, things will never get better, no one cares about me, no one loves me, I’d be better off dead.

Treatments There are three main ways of treating depression

Pharmaceutical Treatment Behavioural Change (Psycho-Social) ECT (Electro-Convulsive Therapy)

Pharmaceutical Treatments The main stay of Pharmaceuticals are the anti depressants, these drugs are effective in over 70% of cases. (WHO 2005) There are two main classes of anti depressants in use today – the Tricyclic Antidepressants, and the Selective Serotonin Re-uptake Inhibitors (SSRI’s) There are also some other antidepressants, such as Venlafaxine.

Tricyclic Antidepressants: These are the most effective, but have fallen out of favour lately as they are known to have cardio-toxic (heart damaging) effects when used over long periods. Examples are Amitriptyline and Imipramine

SSRI’s

These are the newer anti-depressants Examples are Citalopram, Fluoxetine and Paroxetine. Common trade names are Cipramil, Zoloft and Aropax They work by altering brain chemistry They are generally given once a day

Treatments All antidepressants take between 5 and 10 days to reach a therapeutic level in the blood stream. During this time the patient may undergo some adjustment experiences such as blurred vision and a dry mouth. They need to be re-assured that these symptoms will soon pass.

Treatments Drug Treatment usually carries on for 3 – 6 months depending on the severity of the symptoms – the drug is withdrawn by gradually reducing the dosage, to see whether or not depression returns. Some patients will remain drug free and symptom free, others will require occasional intervention. Some require life long treatment. (About a third in each case)

Behavioural change: Cognitive Behavioural Therapy Takes between 3-6 months of weekly one hour sessions Changes the way the patient thinks about themselves and the world around them, teaching them to use tools of positive rather than negative thinking

Lifestyle coaching and change Exercise is an important tool in helping people with depression get better, often depressed people are unfit, obese and feel tired due to their poor physical stamina. Exercise routines improve cardiac output and general organ functioning and may help “lift” the depression.

Lifestyle coaching and change Diet can play a large part in people being depressed, fast foods, fatty foods and processed foods such as McDonalds and Hungry Jocks, Coca Cola, Fat Burgers and Sausages are examples of unhealthy, semi toxic foods that de-energise the body and the brain. These should be substituted with fresh whole foods such as Cereals, Fruit, Vegetables, Nuts, Fresh Fish and small portions of Red Meat as well as Fresh Water and 100% Fruit Juice. Tea is also good.

Electro Convulsive Therapy This is an empirical treatment, no one knows why or how it works, but it is often effective in people who are resistant to drug treatment. Generally, there are a course of 7 to 20 treatments, usually a week apart. After effects can include confusion, short term memory loss and tiredness, but these effects pass after 1-2 days. Older patients are usually convulsed with a uni-lateral placement of electrodes, to reduce after effects of short term memory loss and confusion. The treatments are administered by passing an electric current through the brain, creating a seizure in the patient – the severity of the seizures are clinically controlled by the administration of a short acting anaesthetic and by regulation of the current voltage. Properly administered ECT is a safe procedure.

Treatments Treatments are usually integrated so that both an anti-depressant and a behavioural strategy are employed. Hospitalisation may occur where the person is so depressed that they are at risk of Suicide. Other recommendations revolve around altering unhealthy habits such as drinking too much, cigarette smoking and sedentary habits.

Getting Better The patient reports better sleep, improved mood and concentration and returning zest for life. They become more active and feel happier – they often can’t believe the way they felt and are often grateful to their therapist for the improvement.

Questions Not all at once please!

Ordering advice If you wish to order copies of this presentation you may do so by emailing me at chrisskinner.bermuda.com, copies are $1.00 a sheet of which .50C will be donated to Beyond Blue     Christopher Skinner All Rights Reserved 2008   reproduction of this document in any form, whether electronic or hard copy is an infringement of the author's copyright. The author's permission must be sought BEFORE copying