Depression

Mood

• A feeling state, an emotional experience that influences thoughts, behaviors, and overall well-being.

Time, Adaptation, Dysfunction

• Time: Mood fluctuations are normal, but persistent negative moods may indicate a deeper issue.

• Adaptation: Individuals typically adapt to changing moods, but difficulty in regulation can signal maladaptive emotional responses.

• Dysfunction: When mood disturbances impair daily functioning, they may indicate a mental health disorder such as depression.

Adaptive Emotional Responses

• Reflect a healthy awareness and expression of emotions.

• Allow individuals to process grief, stress, and emotional changes effectively.

• Example: Uncomplicated grief reaction, where sadness gradually subsides with time and support.

Maladaptive Emotional Response

• Indicate an inability to process or express emotions healthily.

• Can lead to prolonged distress, detachment, or emotional suppression.

• Examples:

  • Suppression of emotions, leading to physical and psychological stress.

  • Delayed grief reaction, where an individual postpones dealing with loss.

  • Mania and Depression, characterized by extreme emotional highs and lows.

Risks of Depression

• More common in women (29-30% risk) due to hormonal changes, societal expectations, and caregiving roles

• Men go underdiagnosed due to societal stigma around male emotional expression

• Ethical disparities:

  • Higher incidence in Whites/Hispanics compared to African-Americans.

  • More prevalent in lower socioeconomic groups, due to increased stressors, reduced access to mental health resources, and stigma.

• Common in the elderly, often linked to isolation, chronic illness, and bereavement.

• Frequently coexists with medical and psychiatric illnesses, complicating diagnosis and treatment.

Risk Factors - Psychiatric and Personal History

• Prior episodes of depression increase susceptibility to recurrence.

• Family history of depression suggests genetic predisposition.

• Prior suicide attempts indicate severe depressive symptoms.

• Personal history of sexual abuse can contribute to emotional trauma and depression.

• Current substance abuse often coexists with depression, exacerbating symptoms.

• Narcissistic abuse, leading to emotional manipulation, low self-esteem, and trauma.

Risk Factors - Demographic Factors

• Female gender: Higher risk due to hormonal fluctuations, pregnancy, and societal pressures.

• Age of onset <40 years: Early onset is linked to more severe and recurrent episodes.

• Postpartum period: Hormonal shifts and lifestyle changes contribute to postpartum depression.

Risk Factors - Medical and Social Factors

• Medical co-morbidities such as chronic pain, diabetes, and cardiovascular diseases heighten depression risk.

• Lack of social support can lead to increased feelings of loneliness and hopelessness.

• Stressful life events, including job loss, financial instability, and major life transitions, act as significant triggers.

How to treat major depression?

• Can be well managed with medications, counseling, and self-help strategies.

• However:

  • 50-80% of individuals will experience a subsequent depressive episode.

  • 20% of those affected do not fully recover within one year.

  • Some may succumb to severe depression and commit suicide.

  • Recommended to stay on antidepressants for at least 2 years to reduce relapse risk.

Postpartum Blues

• Postpartum Blues: Short-lived episodes lasting 1-4 days, affecting 50-80% of women, usually occurring within 1-5 days after delivery.

Postpartum Depression

• Postpartum Depression: Develops 2-12 months after delivery, affecting 10-15% of women.

Postpartum Psychosis

Seasonal Affective Disorder

• A type of depression linked to reduced daylight hours in fall and winter.

• Symptoms improve during spring and summer.

• Often treated with light therapy, lifestyle modifications, and medication if necessary.

Dysthymic Disorder and Symptoms

• Chronic, low-level depression lasting 2 years

• Symptoms:

  • Sadness, Dejection, Helplessness, Hopelessness

  • Flat Affect/emotions

  • Difficulty Experiencing Pleasure

  • Psychomotor Retardation:

    • Slowness to process things

    • Slow speech and thinking

  • Self-Destructive Behavior (self-harm)

  • Anorexia or Overeating

  • Insomnia or Hypersomnia:

    • Hypersomnia = sleeping too much

  • Decreased Libido

  • Feels Best Early in the Morning, becomes more sad throughout the day

3 Treatment Phases of Depression

1. Acute Treatment (6-12 weeks)

   • Goal: Eliminate symptoms

   • High risk of relapse; requires close monitoring.

2. Continuation Treatment (4-9 months)

   • Goal: Prevent relapse and promote recovery.

3. Maintenance Treatment (1+ years)

   • Goal: Prevent recurrence (new episode of illness).

Antidepressants - SSRI

SSRI’s (Selective Serotonin Reuptake Inhibitors)

• Most common antidepressants

• Block serotonin reabsorption, increasing availability for communication between neurons

• Examples:

  • Fluoxetine (Prozac)

  • Sertraline (Zoloft)

  • Paroxetine (Paxil)

  • Escitalopram (Lexapro)

  • Citalopram (Celexa)

  • Fluvoxamine (Luvox)

• Pros: Faster onset, milder side effects

• Cons: Can cause sexual dysfunction

Antidepressants - SNRI

SNRI’s (Serotonin-Norepinephrine Reuptake Inhibitors)

• Block serotonin and norepinephrine reabsorption

• Examples:

  • Duloxetine (Cymbalta)

  • Venlafaxine (Effexor)

  • Levomilnacipran (Fetzima)

• Important: Taper off gradually; do not abruptly stop

Antidepressant - TCA

Tricyclic Antidepressants (TCAs)

• Block serotonin and norepinephrine but also affect other neurotransmitters, leading to more side effects

• Examples:

  • Amitriptyline (Elavil)

  • Imipramine (Tofranil)

• Risks: Overdose can be fatal due to cardiac effects

• Less commonly used due to higher side effects

Antidepressant - MAOI

MAOI’s (Monoamine Oxidase Inhibitors)

• One of the earliest antidepressants, rarely used today due to dietary and drug interactions

• Why not commonly used?

  • Require strict dietary restrictions (avoid aged cheese, liver, fermented foods, Chianti & Sherry wine, ripe avocados/figs, deli meats)

  • Danger: Risk of hypertensive crisis if combined with foods high in tyramine or drugs like ephedrine (cold remedies, nasal decongestants, asthma meds, cocaine, amphetamines)

• Symptoms of Hypertensive Crisis: Headache, stiff neck, nausea/vomiting, diaphoresis

• Client Education is Critical!

Serotonin Syndrome

• Potentially life-threatening

• Sudden onset due to excess CNS serotonergic activity and individual sensitivity, drug interactions (prescribed or recreational), and overdose

• Symptoms: Increased heart rate, shivering, sweating, dilated pupils

Plan of Care for Depression

• Reduction and removal of maladaptive emotional responses

• Restoration of the patient’s occupational and psychosocial functioning

• Improvement in the patient’s quality of life

• Minimization of the likelihood of relapse and recurrence

• GI symptoms are normal

• Encourage showers, as they can improve well-being

• Educate patients on their condition and treatment options

Alternative Therapies for Depression

• Group Therapy: Provides a supportive environment where individuals can share their experiences, challenges, and coping strategies.

• Individual Psychotherapy: One-on-one sessions with a therapist to explore personal thoughts, emotions, and behaviors to improve mental well-being.

• Family Therapy: Involves family members to improve communication and relationships, helping to create a supportive environment for the patient.

• Light Therapy: Uses exposure to bright light to regulate mood and alleviate symptoms of seasonal affective disorder (SAD).

• Cognitive Therapy – Teaches individuals to control negative thought distortions related to expectations of the environment, self, and future. Studies suggest it may be equally or more effective than antidepressants.