Generally Speaking: What is a Depressive
disorder is an illness that involves the body, mood & thoughts. It affects the way a person eats & sleeps,
the way one feels about oneself & the way one thinks about things.
disorder isn't the same as a passing blue mood. It isn't a sign of personal weakness or a condition that can be willed
or wished away. People w/a depressive illness can't merely "pull themselves together" &
Without treatment, symptoms
can last for weeks, months or years. Appropriate treatment, however, can help most people who suffer from depression.
Types of Depression
disorders come in different forms, just as is the case w/other illnesses such as heart disease. This pamphlet briefly
describes 3 of the most common types of depressive disorders. However, within these types
there are variations in the number of symptoms, their severity & persistence.
depression is manifested by a combination of symptoms (see symptom list) that interfere
w/the ability to work, study, sleep, eat & enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.
A less severe type of depression, dysthymia, involves long-term,
chronic symptoms that don't disable, but keep one from functioning well or from feeling good.
Many people w/dysthymia also experience major depressive episodes
at some time in their lives.
Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive
disorders, bipolar disorder is characterized by cycling mood changes: severe
highs (mania) & lows (depression). Sometimes the mood
switches are dramatic & rapid, but most often they're gradual.
When in the depressed cycle, an individual can have any or all of the symptoms of a depressive
When in the manic cycle, the individual may be overactive, overtalkative & have a great deal of energy.
Mania often affects thinking,
judgment & social behavior in ways that cause serious problems & embarrassment.
i.e., the individual in a
manic phase may feel elated, full of grand schemes that might range from unwise business
decisions to romantic sprees. Mania, left untreated, may
worsen to a psychotic state.
Symptoms of Depression
Not everyone who is depressed or manic experiences every symptom. Some people experience
a few symptoms, some many. Severity of symptoms varies w/individuals & also varies over time.
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies 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
- Persistent physical symptoms that do not respond to treatment,
such as headaches, digestive disorders, and chronic pain
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
CAUSES OF DEPRESSION
Some types of depression run in families, suggesting that a
biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members
of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than
those who do not get ill.
However, the reverse is not true: Not everybody with the genetic
makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses
at home, work, or school, are involved in its onset.
In some families, major depression also seems to occur generation
after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not,
major depressive disorder is often associated with changes in brain structures or brain function.
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. Whether this represents a
psychological predisposition or an early form of the illness is not clear.
In recent years, researchers have shown that physical changes
in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's
disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his
or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem,
or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, 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.
DIAGNOSTIC EVALUATION & TREATMENT
The first step to getting
appropriate treatment for depression is a physical examination by a physician. Certain medications
as well as some medical conditions such as a viral infection can cause the same symptoms as depression
& the physician should rule out these possibilities thru examination, interview & lab tests.
If a physical cause for the
depression is ruled out, a psychological evaluation should be done, by the physician or
by referral to a psychiatrist or psychologist.
A good diagnostic evaluation
will include a complete history of symptoms, i.e.,
- when they started
- how long they've lasted
- how severe they are
- whether the patient had them before &, if so
- whether the symptoms were treated
- what treatment was given
The doctor should ask about
alcohol & drug use & if the patient has thoughts about death or suicide. Further, a history should include questions
about whether other family members have had a depressive illness & if treated, what
treatments they may have received & which were effective.
Last, a diagnostic evaluation
should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes
happens in the case of a depressive or manic-depressive illness.
Treatment choice will depend
on the outcome of the evaluation. There are a variety of antidepressant medications & psychotherapies that can be used
to treat depressive disorders.
Some people with milder forms
may do well with psychotherapy alone. People with moderate to severe depression most often
benefit from antidepressants.
Most do best with combined
treatment: medication to gain relatively quick symptom relief & psychotherapy to learn more effective ways to deal with
life's problems, including depression.
Depending on the patient's
diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy
that have proven effective for depression.
(ECT) is useful, particularly for individuals whose depression is severe or life threatening or who can't take antidepressant
ECT often is effective in cases where antidepressant medications
do not provide sufficient relief of symptoms. In recent years, ECT has been much improved.
A muscle relaxant is given before treatment, which is done under
brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses.
The stimulation causes a brief (about 30 seconds) seizure within
the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit,
at least several sessions of ECT, typically given at the rate of three per week, are required.
There are several types of
antidepressant medications used to treat depressive disorders. These include newer medications - chiefly:
- the selective serotonin reuptake inhibitors (SSRI's)
- the tricyclics
- the monoamine oxidase inhibitors (MAOI's)
The SSRI's - & other newer
medications that affect neurotransmitters such as dopamine or norepinephrine - generally have fewer side effects than tricyclics.
Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of
medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few
weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the
full therapeutic effect occurs.
Patients often are tempted
to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication
isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects (see section
on Side Effects on page 13) may appear before antidepressant activity does.
Once the individual is feeling better, it is important to continue
the medication for at least 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped
gradually to give the body time to adjust.
Never stop taking an antidepressant
without consulting the doctor for instructions on how to safely discontinue the medication. For individuals with bipolar
disorder or chronic major depression, medication may have to be maintained indefinitely.
Antidepressant drugs aren't
habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have
to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness
For the small number of people for whom MAO inhibitors are the
best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines,
and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive
crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited
foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions.
Medications of any kind—prescribed,
over-the counter, or borrowed—should never be mixed without consulting the doctor. Other
health professionals who may prescribe a drug—such as a dentist or other medical specialist—should be told of
the medications the patient is taking. Some drugs, although safe when taken alone can, if taken with others, cause severe
and dangerous side effects. Some drugs, like alcohol or street drugs, may reduce the effectiveness of antidepressants and
should be avoided. This includes wine, beer, and hard liquor. Some people who have not had a problem with alcohol use may
be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants.
Antianxiety drugs or sedatives are not antidepressants. They
are sometimes prescribed along with antidepressants; however, they are not effective when taken alone for a depressive disorder.
Stimulants, such as amphetamines, are not effective antidepressants, but they are used occasionally under close supervision
in medically ill depressed patients.
Questions about any antidepressant prescribed, or
problems that may be related to the medication, should be discussed with the doctor.
Lithium has for many years been the treatment of choice for
bipolar disorder, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully
monitored, as the range between an effective dose and a toxic one is small. If a person has preexisting thyroid, kidney, or
heart disorders or epilepsy, lithium may not be recommended. Fortunately, other medications have been found to be of benefit
in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol®) and
valproate (Depakote®). Both of these medications have gained wide acceptance in clinical practice, and valproate
has been approved by the Food and Drug Administration for first-line treatment of acute mania. Other anticonvulsants that
are being used now include lamotrigine (Lamictal®) and gabapentin (Neurontin®): their role in the treatment
hierarchy of bipolar disorder remains under study.
Most people who have bipolar disorder take more than one medication
including, along with lithium and/or an anticonvulsant, a medication for accompanying agitation, anxiety, depression, or insomnia.
Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring
by the physician.
Antidepressants may cause mild and, usually, temporary side
effects (sometimes referred to as adverse effects) in some people. Typically these are annoying, but not serious. However,
any unusual reactions or side effects or those that interfere with functioning should be reported to the doctor immediately.
The most common side effects of tricyclic antidepressants, and ways to deal with them, are:
- Dry mouth—it is helpful to drink sips
of water; chew sugarless gum; clean teeth daily.
- Constipation—bran cereals, prunes,
fruit, and vegetables should be in the diet.
- Bladder problems—emptying the bladder
may be troublesome, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty
- Sexual problems—sexual functioning
may change; if worrisome, it should be discussed with the doctor.
- Blurred vision—this will pass soon
and will not usually necessitate new glasses.
- Dizziness—rising from the bed or chair
slowly is helpful.
- Drowsiness as a daytime problem—this
usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants
are generally taken at bedtime to help sleep and minimize daytime drowsiness.
The newer antidepressants have different types of side effects:
- Headache—this will usually go away.
- Nausea—this is also temporary, but
even when it occurs, it is transient after each dose.
- Nervousness and insomnia (trouble falling asleep
or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually
- Agitation (feeling jittery)—if this
happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
- Sexual problems—the doctor should
be consulted if the problem is persistent or worrisome.
In the past few years, much interest has risen in the use of
herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively
in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John's
wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk
and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant.
However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.
Because of the widespread interest in St. John's wort, the National
Institutes of Health (NIH) conducted a 3-year study, sponsored by three NIH components—the National Institute of Mental
Health, the National Center for Complementary and Alternative Medicine, and the Office of Dietary Supplements. The study was
designed to include 336 patients with major depression of moderate severity, randomly assigned to an 8-week trial with one-third
of patients receiving a uniform dose of St. John's wort, another third sertraline, a selective serotonin reuptake inhibitor
(SSRI) commonly prescribed for depression, and the final third a placebo (a pill that looks exactly like the SSRI and the
St. John's wort, but has no active ingredients). The study participants who responded positively were followed for an additional
18 weeks. At the end of the first phase of the study, participants were measured on two scales, one for depression and one
for overall functioning. There was no significant difference in rate of response for depression, but the scale for overall
functioning was better for the antidepressant than for either St. John's wort or placebo. While this study did not support
the use of St. John's wort in the treatment of major depression, ongoing NIH-supported research is examining a possible role
for St. John's wort in the treatment of milder forms of depression.
The Food and Drug Administration issued a Public Health Advisory
on February 10, 2000. It stated that St. John's wort appears to affect an important metabolic pathway that is used by many
drugs prescribed to treat conditions such as AIDS, heart disease, depression, seizures, certain cancers, and rejection of
transplants. Therefore, health care providers should alert their patients about these potential drug interactions.
Some other herbal supplements frequently used that have not
been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng. Any herbal supplement should
be taken only after consultation with the doctor or other health care provider.
Many forms of psychotherapy, including some short-term (10-20
week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems
through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral"
therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the
behavioral patterns that contribute to or result from their depression.
Two of the short-term psychotherapies that research has shown
helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus
on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral
therapists help patients change the negative styles of thinking and behaving often associated with depression.
Psychodynamic therapies, which are sometimes used to treat depressed
persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms
are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication
(or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.
Preschool Depression May Mirror That of Adults
By Amy Norton
November 23, 2004
NEW YORK (Reuters Health)
- Research has shown that even preschool children can suffer from depression & now new
evidence suggests their symptoms can be divided into subtypes in a way that reflects what's seen in adults.
A study of 156 children between
the ages of 3 & about 5 1/2 found that among the 54 diagnosed w/depression, two groups
emerged. One group had characteristics similar to those of adults diagnosed w/a subtype of depression
known as "melancholic" depression.
In adults, melancholic depression is considered to be more severe than some other types of depression
& research has shown it to be distinct from a more "reactive" depression that arises
in response to a traumatic event.
From the new study findings,
it does appear that depressed preschoolers can be broken
into two groups along the lines used for adults, the study's lead author, Dr. Joan L. Luby of Washington University in St.
Louis, told Reuters Health.
The children in the study
whose depression mirrored adult melancholic depression tended
to have more severe symptoms & a strong family history of depression & all of them suffered from so-called
anhedonia - a lack of interest in the things that normally occupy young children, including
These children also appeared
to be "slowed down" or "restless" more often than the other depressed children in the study.
57% of the depressed children in the study fell into the group with anhedonia.
The second group -- which
Luby & her colleagues refer to as "hedonic" -- was distinct in that the children's moods
did brighten at times & they were able to take pleasure in things like play. They also had a higher rate of stressful life events, which is consistent w/the "nonmelancholic" type of depression seen in adults, Luby &
her colleagues note in the report.
It's possible, Luby said,
that some young children may suffer from depression in reaction to a stressful situation, while for others -- those w/anhedonia -- symptoms are biologically
Research in adults has suggested
that anhedonia may have genetic underpinnings & possibly be related to dysfunction in
the brain's "reward system."
If it's the case that preschoolers
can be separated into melancholic & nonmelancholic
groups, it's important to make the distinction, according to Luby. Adults w/melancholic depression
have been shown to respond to therapy differently than those w/other types of depression,
she pointed out.
Currently, young children
w/depression are treated w/forms of psychotherapy geared for their age group, such as "play"
therapy, but more research is needed to judge the effectiveness of such treatment, Luby said.
SOURCE: American Journal of Psychiatry, November 2004
Smaller Baby Girls at Risk for Depression
Girls who weigh less than about 5.5 pounds at birth
may be at significant risk for depression in their teenage years.
Duke University researchers who followed nearly 1,500 girls
and boys from 9 years old through 16 found nearly 40 percent of girls with low birth weights were affected by depression at
some point between ages 13 and 16. That compares to just more than 8 percent of girls who were born with higher birth weights.
No increase in depression was found for boys -- about 5 percent
of boys in both the low birth weight and normal birth weight groups ended up with depression. Other psychiatric disorders
were similar in both girls and boys, including anxiety disorders.
Why would low birth weight girls be more susceptible to depression
in their teens? The authors believe a complicated interplay of hormones and psychology may be responsible and call for more
study to tease out the causes. In the meantime, they say parents and doctors should be more vigilant in looking for signs
of depression in girls who were born weighing less than 5.5 pounds.
"For the present, the findings suggest that pediatricians and
parents of girls who were of low birth weight should pay close attention to their mental health as they enter puberty," they
This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, go
SOURCE: Archives of General Psychiatry, 2007;64:338-344
Poverty: The next
By Heather Ziegenbein, Black Hills Pioneer
/ July 14, 2006
NORTHERN HILLS - It's not easy for poor kids
to fit in with others at school. But, they can't just leave their family's financial issues behind when they step thru the
school's doors. A reminder that they're indeed different, is an ongoing cycle that continues to threaten the innocence &
youthfulness of our children.
Students visit counselors on a daily basis at area schools
because they struggle with issues at home caused by the stresses of living in poverty.
Lead-Deadwood Elementary Counselor Greg Calabro
sees 40 children on a regular basis as a direct result of parents living in poverty. Some are seen to discuss misbehavior
issues while other children discuss the onset signs of depression.
At the high school level, Spearfish High School
counselor Marcia Price said her students are mostly dealing with peer pressure.
"In some instances we hear from students who are
being made fun of because they're poor, because they have body odor or because of the car they drive," Price said of just
some of the problems her students face.
"There's a common feeling of hopelessness with these kids. I hear comments like 'What is the point? And how can I ever get out of this?' & I just try & build
a relationship with them. I'm non-judgemental & have empathy for their situation."
Calabro sums it up in one statement; "I listen." He continued by saying a substantial part of his job is giving his kids permission to be sad or angry. Usually the withdrawn little ones are reserved in expressing their own thoughts and Calabro just takes his time.
"I use Legos or tinker toys & let them play
& just talk to them while they're immersed in this diversion. I build a relationship with them & when they come back
I use a more aggressive form of communication."
Calabro said some of the toughest situations for
kids are during vacation time when school isn't in session because they're forced to stay at home where things aren't going
so well. "Thankfully this year was pretty good, but often there are times when abuse will surface.
Sometimes in the summer & on holidays kids
come in after a referral by another teacher or adult has been made. If there's tension at home, these kids have school as
a venue of escape.
They're also fed 2 meals a day (at school) & sometimes that's the most solid meals they'll have."
Sometimes others have the unrealistic impression that all poor families can qualify for the federal Food Stamps program or other government subsidies & that simply isn't
the case for all families.
Some may make a bit more than the defined poverty
levels but still not earn enough to meet daily living requirements with higher fuel costs & other pressures on family budgets. There are situations of disability or other medical crisis that can plunge families into extreme hardship
with few safety nets.
For children who are younger, these money issues
can be tough to understand. So, most kids hear fighting among adults or seldom see parents because they're working 2 jobs to support the family.
What kids do understand, Calabro says, is the fact they don't have that certain toy.
"I've had kids come in & they see what other
kids have & they don't - some can get quite aggressive. You know, it's hard to explain to them about why this is the way
it is," Calabro said.
Price said her kids are the same way. "In some
instances we probably don't see as many of the students as we should because a lot of them have a great deal of pride & they don't want people to know.
When they do, most are angry at their peers, their situation & sometimes they're shy & withdrawn."
Price noted she sees a few students who are an
exception to the rule & are pushing themselves toward a better life.
Behavior Management Caseworker Jenny Sand of Spearfish
said there's a definite cycle when it comes to poverty. She works on a daily basis with families in Lawrence County dealing
with emotional problems that are a direct result of financial anxiety.
She also sees several patients that are living
in poverty because of their mental disabilities.
Counselors see up to 225 clients per year in Lawrence County. A lot of times, caseworkers will visit the individuals at home
to make it easier & more comfortable for them.
"I think a lot of it (poverty) is passed down from generation to generation. Sometimes we see this kind of situation when someone
came from money, but most of the time families who have always struggled & pinched pennies are simply stuck in the system,"
As for the average diagnosis, most individuals
seen at Behavior Management suffer from stress, anxiety & depression.
"Many of the patients I see on a regular basis
have an overwhelming feeling of being judged & looked down upon because of circumstances that are uncontrollable," Sand said of their feelings of shame.
Price said in the end talking & listening to those struggling with these issues can be the most important. Also, she said, teaching them coping skills can be very beneficial.
"It's also very important to let them know that they can improve the quality of life & letting them know that you don't have to make 6 digits &
have a house on the hill to be happy.
The tough thing is explaining it to a young person who doesn't
have food & shelter that they can be the best that they can be," Price said. "How can you even get there if you don't
have the basics?"
Anxiety Disorders & Depression in Children
what is attention deficit hyperactivity disorder?
Attention Deficit Hyperactivity Disorder (ADHD)Attention Deficit Hyperactivity
Disorder, ADHD, is one of the most common mental disorders that develop in children. Children w/ADHD have impaired functioning
in multiple settings, including home, school & in relationships w/peers. If untreated, the disorder can have long-term
adverse effects into adolescence & adulthood.
Depression in Children
Only in the past 2 decades
has depression in children been taken very seriously.
The depressed child may:
- pretend to be sick
- refuse to go to school
- cling to a parent
- worry that the parent may die
- older children may sulk
- get into trouble at school
- be negative
- feel misunderstood
Because normal behaviors vary
from one childhood stage to another, it can be difficult to tell whether a child is just going thru a temporary "phase" or
is suffering from depression.
Sometimes the parents become
worried about how the child's behavior has changed, or a teacher mentions that "your child doesn't seem to be himself." In
such a case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the
child be evaluated, preferably by a psychiatrist who specializes in the treatment of children.
If treatment is needed, the
doctor may suggest that another therapist, usually a social worker or a psychologist, provide therapy while the psychiatrist
will oversee medication if it's needed.
Parents shouldn't be afraid
to ask questions:
- What are the therapist's qualifications?
- What kind of therapy will the child have?
- Will the family as a whole participate in therapy?
- Will my child's therapy include an antidepressant? If so, what
might the side effects be?
The National Institute of
Mental Health (NIMH) has identified the use of medications for depression in children as
an important area for research. The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs) form a network of
7 research sites where clinical studies on the effects of medications for mental disorders can be conducted in children &
Among the medications being
studied are antidepressants, some of which have been found to be effective in treating children with depression,
if properly monitored by the child's physician.8
HOW TO HELP YOURSELF IF YOU ARE DEPRESSED
Depressive disorders make one feel exhausted, worthless, helpless,
and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these
negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking
fades as treatment begins to take effect. In the meantime:
- Set realistic goals in light of the depression and assume a
reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and
do what you can as you can.
- Try to be with other people and to confide in someone; it is
usually better than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ballgame, or participating
in religious, social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling
better takes time.
- It is advisable to postpone important decisions until the depression
has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with
others who know you well and have a more objective view of your situation.
- People rarely "snap out of" a depression. But they can feel
a little better day-by-day.
- Remember, positive thinking will replace
the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
- Let your family and friends help you.
How Family and Friends Can Help the Depressed Person
The most important thing anyone can do for the depressed person
is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with
treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion,
it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether
the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the
use of alcoholic products while on medication. The second most important thing is to offer emotional support. This involves
understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do
not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them
to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities.
Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such
as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon.
The depressed person needs diversion and company, but too many demands can increase feelings of failure.
Do not accuse the depressed person of faking illness or of laziness,
or expect him or her "to snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep
reassuring the depressed person that, with time and help, he or she will feel better.
WHERE TO GET HELP
If unsure where to go for help, check the Yellow Pages under
"mental health," "health," "social services," "suicide prevention," "crisis intervention services," "hotlines," "hospitals,"
or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to
provide temporary help for an emotional problem, and will be able to tell you where and how to get further help.
Listed below are the types of people and places that will make
a referral to, or provide, diagnostic and treatment services.
- Family doctors
- Mental health specialists, such as psychiatrists, psychologists,
social workers, or mental health counselors
- Health maintenance organizations
- Community mental health centers
- Hospital psychiatry departments and outpatient clinics
- University- or medical school-affiliated programs
- State hospital outpatient clinics
- Family service, social agencies, or clergy
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies
Following is a list of organizations that may be able to provide
additional information and/or assistance about mental health topics:
Ctr. for Mental Health Services
Substance Abuse & Mental Health Services Admin.
12-105 Parklawn Building
Rockville, MD 20857
National Institute of Mental Health
Office of Communications
6001 Executive Blvd.,
Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
TollFree: 1-866-615-NIMH (6464)
American Psychiatric Assoc. (APA)
1000 Wilson Blvd., Ste. 1825
Arlington, VA 22209-3901
American Psychological Assoc.
750 1st Street, NE
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Irritability in Children With Mood Disorders Has Varying Sources
By Neil Osterweil, Senior Associate Editor, MedPage Today
BETHESDA, Md., Feb. 1 -- The extreme irritability in children
with bipolar disorder appears to spring from different wells of frustration than the irritability in children with severe
mood dysregulation, NIH researchers reported.
In a study comparing children with bipolar disorder or severe
mood dysregulation with unaffected controls, extreme irritability sparked by a task designed to induce frustration revealed
distinctly different brain activity patterns, according to Brendan A. Rich, Ph.D., and colleagues here and at the University
"Our results indicate that there may be different psychophysiological
mechanisms and behavioral correlates associated with frustration between children with narrow-phenotype bipolar disorder and
those with severe mood dysregulation," the investigators wrote in the February issue of the American Journal of Psychiatry.
The findings, if borne out by further research, could lead to
better differentiation and treatment of mood disorders in children, said the study's authors.
"If future research indicates that bipolar disorder and severe
mood dysregulation are two separate disorders, this could guide parents and physicians toward the right treatments," said
Dr. Rich. "A good example is that medication prescribed for symptoms seen in severe mood dysregulation, such as stimulant
medication, might be inappropriate for a child with classically defined bipolar disorder."
To assess whether irritability could be a diagnostic indicator
for pediatric mania in bipolar disorder, the investigators looked for behavioral and psychophysiological correlates of irritability
among 21 children with severe mood dysregulation, 35 with narrow-phenotype bipolar disorder, and 26 unaffected controls.
Severe mood dysregulation was defined as non-episodic
irritability and hyperarousal without episodes of euphoric mood, and narrow-phenotype bipolar disorder was defined as a history
of at least one manic or hypomanic episode with euphoric mood.
The children were evaluated with electroencephalography
with electrodes recording signals from temporal, frontal, central and parietal sites as they performed the Posner task.
The task involved three tests in which children were asked to
press a button on a screen corresponding to the location of a target. After a baseline run, the participants were told they
could win or lose 10 cents for each correct or wrong response. On the third test run, the results were rigged so that the
children were told they would lose 10 cents on slightly more than half of their correct responses, thereby manipulating emotional
demands and inducing frustration.
After each task the children were asked to rate their responses
to that task, reward, and punishment using the Self-Assessment Manikin with line-drawings showing extremes of happy or unhappy
(to assess valence), or calm or aroused (to assess arousal).
The authors measured the children's mood response, behavior
(reaction time and accuracy), and brain activity (event-related potentials).
They found that both the children with severe mood
dysregulation and narrow-phenotype bipolar disorder reported significantly more arousal than controls when they were frustrated,
but that the arousal resulted in different behavioral and psychophysiological performance between the patient groups.
For example, when frustrated, children with bipolar disorder
had lower signal amplitude in the parietal lobe (P3 lead) than either children with severe mood dysregulation or controls.
This difference indicates that the children with bipolar disorder have impairments in executive attention, the authors wrote.
In contrast, children with severe mood dysregulation had lower
N1 (auditory evoked) event-related potential amplitude than children with narrow-phenotype bipolar disorder or controls, regardless
of the emotional context. This difference reflected impairments in the initial stages of attention in the children with severe
mood dysregulation, the investigators stated.
In post hoc analyses, the investigators determined that in the
children with severe mood dysregulation, the N1 deficits were associated with the severity of symptoms of oppositional defiant
"Whereas the deficits in the narrow-phenotype subjects indicated
impaired allocation of attention in the context of frustration, those in the severe mood dysregulation group indicated impairments
in the initial stages of attention across emotional and non-emotional tasks," the investigators wrote.
"Finally, whereas the deficits in the narrow-phenotype cohort
are consistent with those seen in mood disorders, deficits in children with severe mood dysregulation may reflect concurrent
oppositional defiant disorder. The current study is the first to provide evidence of behavioral and psychophysiological differences
between possible phenotypes of pediatric bipolar disorder," they concluded.
The investigators acknowledged that the results
were confounded by the fact that the majority of children in the study with bipolar disorder were on medication, whereas most
of the children with severe mood dysregulation were not medicated. There have been no studies showing that medication decreases
P3 amplitude, however, suggesting that medication could not have accounted for the differences they saw in children with bipolar
disorder, they wrote.