Depression

Depression

Jim Katsoudas and Mary Shea

According to the Diagnostic and Statistical Manual of Mental Disorders 5^th edition (DSM-5), 8 different types of depression have been joined together under the diagnosis of Major Depressive Disorder. They are as follows: Disruptive Mood Dysregulation Disorder, Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Premenstrual Dysphoric Disorder, Substance/ Medication Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, Other Specified Depressive Disorder, and Unspecified Depressive Disorder.

What is Depression?

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Depression is also called major depressive disorder or clinical depression and it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel a sense of hopelessness and/or life isn’t worth living.

Depression is more than an occasional feeling of the blues. Feeling depressed or having been diagnosed with depression does not mean you are weak, and you can’t simply turn depression off or snap out of it. Sometimes depression may require long-term treatment. But don’t get discouraged. Once a person with depression begins to get some counseling or medication or both they begin feeling better.

Symptoms:

Although some people may only experience depression once during their life, some people can have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness
Angry outbursts, irritability or frustration, even over small matters
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports.
Sleep disturbances, including insomnia or sleeping too much.
Tiredness and lack of energy, so even small tasks take extra effort.
Reduced appetite and weight loss or increased cravings for food and weight gain.
Anxiety, agitation or restlessness.
Slowed thinking, speaking or body movements.
Feelings of worthlessness or guilt, fixating on past failures or self-blame.
Trouble thinking, concentrating, making decisions and remembering things.
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide.

There are physical problems people may experience when depressed such as: back and joint pain, muscle aches and chest pain. Headaches are very common, and if you already have had migraines they may seem worse. It may slow your digestive system down, you may become queasy or nauseated. You may have diarrhea or become constipated. Depression can exacerbate on-going health problems you already have.

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in older adults:

Depression is not a normal part of growing older, and it should never be taken lightly. However, depression in older adults may often go undiagnosed and untreated, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties and/or personality changes.
Physical aches or pain
Feeling fatigue, loss of appetite, sleep problems or loss of interest in sex, which are not caused by another medical condition or medication
Desire to stay at home, rather than going out to socialize or doing new things
Suicidal thinking or suicidal feelings, may be especially common in older men

Causes of Depression:

What actually causes depression is not exactly known. As with many mental disorders, a variety of factors may be involved, such as: biological differences, brain chemistry, hormones, and inherited traits. Biological traits: People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes. Brain chemistry: Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neuro circuits involved in maintaining mood stability may play a significant role in depression and its treatment. Hormones: Changes in the body’s balance of hormones may be involved in causing depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions. Low testosterone may also cause depression in men. Inherited traits: Depression is more common in people whose blood relatives also have this condition. Currently researchers are trying to find genes that may be involved in causing depression.

Risk factors:

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

Certain personality traits, such as low self-esteem or being too dependent, being self-critical or pessimistic
Traumatic or stressful events such as physical or sexual abuse
The death or loss of a loved one
A difficult relationship
Financial problems
Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren’t clearly male or female (intersex) in an unsupportive situation
History of other mental health disorders such as anxiety disorder, eating disorders or post-traumatic stress disorder
Abuse of alcohol or recreational drugs
Serious or chronic illness including cancer, stroke, chronic pain or heart disease
Certain medications such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications:

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn’t treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes
Pain or physical illness
Alcohol or drug misuse
Anxiety, panic disorder or social phobia
Family conflicts, relationship difficulties, and work or school problems
Social isolation
Suicidal feelings, suicide attempts or suicide
Self-mutilation, such as cutting
Premature death from medical conditions

The Chart below represents the difference in how men and women may experience depression.

Women:	Men
Blame themselves	Blame others
Feel sad, apathetic, and worthless	Feel angry and irritable, ego inflated
Feel anxious and scared	Feel suspicious and guarded
Avoid conflicts at all cost	Create conflicts
Feel slowed down and nervous	Feel restless and agitated
Having trouble setting boundaries	Needs to feel in control
Find it easy to talk about self-doubt and despair	Find it weak to admit despair
Use food, friends and love to self- medicate	Use alcohol, TV, sports to self -medicate

Depression in Children

All children have fluctuations in their affect and mood, however, childhood depression is just as significant as adult depression. If a child becomes more irritable, sad, withdrawn, noticing changes in their behavior, energy levels, sleep patterns, outbursts/tantrums, feelings of worthlessness and guilt, and academic issues for an extended period of time, they may be experiencing childhood depression. Children and adolescents who are depressed may also be less likely to engage in activities that were previously enjoyed, gain or lose weight without intention, engage in self-critical thoughts and self-talk, and have thoughts of suicide or death.

Just as in adults, children are commonly diagnosed with the following depressive disorders:

Major Depressive Disorder – symptoms (listed above) that interfere with a child’s ability to work, study, eat, enjoy activities, etc. that may occur as one episode or as several episodes in a child’s lifetime
Persistent Depressive Disorder – symptoms as listed above, but lasting for a term of 2 years or longer, with less severity.
Seasonal Affective Disorder – onset of symptoms, usually in winter months or seasons with less sunlight.

As many as 2-3% of children ages 6-12, and 6-8% of adolescents experience serious depression. Depression is more common in boys under 10, but by age 16 it manifests itself more frequently in girls (http://www.webmd.com/depression/guide/depression-children#2).

Children manifest depression with symptoms that are often markedly different than adults. For example, many children complain of physical/psychosomatic symptoms (i.e. headaches, stomach aches, fatigue, lack of sleep), as well as nightmares. Older adolescents may exhibit more moodiness and decline in general functioning. However, keep in mind that most children and adolescents will display depressive symptoms at different times/settings.

Symptoms Associated with Depression in Children, but Difficult to Notice:

Frequent “bad attitude”
Frequent muscle and body aches that are nonspecific and difficult to determine the source for
Complaining of boredom
Attempts to run away from home
Substance abuse
High sensitivity, shame, and fears of rejection
Difficulty maintaining relationships and poor communication skills

In addition, due to hormonal changes during puberty, adolescents tend to exhibit symptoms similar to depression. You can distinguish moodiness and hormones from clinical depression by observing prolonged and severe differences in their normative behavior patterns. If your child/adolescent expresses suicidal thoughts, take them to the ER or their doctor immediately for a full assessment.

Warning Signs of Suicidal Thoughts:

Talking about committing suicide
Giving away significant personal items
Making amends/saying goodbye to family
Engaging in risky behaviors or becoming frequently injured
Romanticizing death/dying

Consider, also, gender differences in childhood depression: boys may exhibit increased anger/rage (externalizing symptoms) while girls tend to withdraw and become more tearful. Girls who reach puberty at earlier ages are more likely to develop depression than those who reach puberty at normative periods. Girls of depressed mothers are also at higher risk for internalizing problems (i.e. low self-esteem, anxiety, self-consciousness, sadness, and suppressing anger/emotions) which are not outwardly expressed. Girls also tend to display more worry, and fear than boys in conflict situations. In other words, a history of anxiety may lead into later depression. (See http://psych.colorado.edu/~willcutt/pdfs/zahn-waxler_2008.pdf for more information on gender differences).

Risk Factors for Depression:

Genetics/parental depression
Parental/marital conflict
Grief/loss
Child maltreatment/neglect
Peer conflict and bullying

Tips for Parents:

Do not ignore signs for depression
Do not be shy to speak about suicide – research shows no evidence that speaking about suicide increases risk of attempt, and in fact, points to evidence that risk decreases when it is addressed
Focus on listening to concerns and emotions rather than providing advice
Encourage your child’s participation in play and community with other people
Set aside quality time to spend with your child on a consistent, regular basis
Encourage physical health through providing nutritious meals which help combat depression in the brain. Encourage adequate sleep and regular physical activity

Evidence-Based Treatments for Childhood/Adolescent Depression:

Cognitive-Behavioral Therapy
Dialectical Behavioral Therapy
Play Therapy (a4pt.org)
Medications
Family Therapy

Biblical Support Pertaining to Depression:

There are numerous biblical references to depression, one of the human race’s most common and distressing afflictions. It is likely that the first humans to experience depression were Adam and Eve, after they sinned against God. The God of the Bible understands humanity’s greatest needs and He is ready to meet anyone in the midst of their depression. Below are a few of the Biblical references that speak about depression

Deuteronomy 31:8 ⁸The Lord is the one who goes ahead of you; He will be with you. He will not fail you or forsake you. Do not fear or be dismayed.”

Psalm 34:17-18… The righteous cry, and the Lord hears
And delivers them out of all their troubles.¹⁸The Lord is near to the brokenhearted and saves those who are ^[^a^]crushed in spirit.

Psalm 42:11…Why are you ^[^a^]in despair, O my soul? And why have you become disturbed within me? ^[^b^]Hope in God, for I shall yet praise Him, The ^[^c^]help of my countenance and my God.

Isaiah 61:3 to grant to those who mourn in Zion— to give them a beautiful headdress instead of ashes, the oil of gladness instead of mourning, the garment of praise instead of a faint spirit;
that they may be called oaks of righteousness, the planting of the Lord, that he may be glorified.

Isaiah 40:31 but they who wait for the Lord shall renew their strength; they shall mount up with wings like eagles; they shall run and not be weary; they shall walk and not faint.

Isaiah 43:2… When you pass through the waters, I will be with you; and through the rivers, they shall not overwhelm you; when you walk through fire you shall not be burned, and the flame shall not consume you.

Isaiah 51:11…And the ransomed of the Lord shall return and come to Zion with singing; everlasting joy shall be upon their heads; they shall obtain gladness and joy, and sorrow and sighing shall flee away.

John 16:33…These things I have spoken to you, so that in me you may have peace. In the world you have tribulation, but take courage; I have overcome the world.”

2 Corinthians 1:3-4 ³Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, ⁴who comforts us in all our affliction so that we will be able to comfort those who are in ^[^a^]any affliction with the comfort with which we ourselves are comforted by God.

Resources on Depression:

Books:

Darkness Visible By William Styron

Listening to Prozac: By Dr. Peter D. Kramer

What to Do When Someone You Love Is Depressed By Mitch Golant, PhD“

Running on Empty: Refilling Your Spirit at the Low Points of Life by: Jill Briscoe

When Someone You Love Suffers from Depression or Mental Illness by: Cecil Murphey

Finding Your Way after the Suicide of Someone You Love By: David B. Biebel, & Suzanne L. Foster

The Bumps Are What You Climb On By: Warren W. Wiersbe

Websites

Mayo Clinic http://www.mayoclinic.org/diseases-conditions/depression/home/ovc-20321449

Help Guides https://www.helpguide.org/home-pages/depression.htm