PATCHS PROGRAM PUBLIC HEALTH NURSING ADVOCATES TEACHING CHILD HEALTH AND SAFETY HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC)
Volume 1, Issue 23		APRIL 2006

Medical Information Fact Sheet

Depression:

Depression is a disorder that affects your thoughts, moods, feelings, behavior and even your physical health. It used to be thought that it was “all in your head” and that if a person tried, they could just “snap out of it” or just “get over it.” It is now known that depression is not a weakness, and it is not something you can treat on your own. Depression is a medical disorder with a biological and chemical basis.

Sometimes a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Depression is much more than grieving or a bout of the blues.

Depression may only occur once in a person’s life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime.

People of all ages and races suffer from depression. Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.

Signs and Symptoms:

Two hallmarks of depression ─ symptoms key to establishing a diagnosis ─ are:

• Loss of interest in normal daily activities. You lose interest in or pleasure from activities that they used to enjoy.
• Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.

In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present for at least two weeks.

• Sleep disturbances. Sleeping too much or having problems sleeping can be a sign a person is depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
• Impaired thinking or concentration. You may have trouble concentrating or making decisions and have problems with memory.
• Changes in weight. An increased or decreased appetite and unexplained weight gain or loss may indicate depression.
• Agitation. You may seem restless, agitated, irritable and easily annoyed.
• Fatigue or slowing of body movements. You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before. You may feel like you are doing everything in slow motion, or you may speak in a slow, monotonous tone.
• Low self-esteem. You feel worthless and excessive guilt.
• Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
• Thoughts of death. You have persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.

Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety.

Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions.

Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, refuse to go to school, or exhibit behavioral problems. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties.

Types of Depression:

The main types of depression include:

• Major Depression. This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness and guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
• Dysthymia. Dysthymia (dis-thi-me-uh) is a less severe but more chronic form of depression. Signs and symptoms usually are not disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression
• Adjustment Disorders. If a loved one dies, you lose a job or you receive a diagnosis of cancer, it is perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some do not. This is what is known as an adjustment disorder ─ when your responses to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.
• Bipolar Disorder. Having recurrent episodes of depression and elation (mania) is a characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it is called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase or vice versa.
• Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.

Causes:

There is no single known cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters ─ serotonin, norepinephrine and dopamine ─ seemed to be linked to depression.

Scientists do not fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It is not certain whether changes in neurotransmitters are a cause or a result of depression.
Factors that contribute to depression include:

• Heredity. Researchers have identified several genes that may be involved in bipolar disorder, and they are looking for genes linked to other types of depression. Not everyone with a family history of depression develops the disorder, and conversely, people with no family history of the disorder can become depressed.
• Stress. Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger depression.
• Medications. Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills or, occasionally, birth control pills, may cause symptoms of depression in some people.
• Illnesses. Having a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer’s disease, puts you at a higher risk of developing depression. Having an underactive thyroid (hypothyroidism), even mildly, also can cause depression.
• Personality. Certain personality traits, such as having low self-esteem and being overly dependent, self-critical, pessimist and easily overwhelmed by stress, can make you more vulnerable to depression.
• Postpartum depression. It is common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time you may have feelings of sadness, anger, anxiety, irritability and incompetence. A more severe form of the baby blues, called postpartum depression, also can affect new mothers.
• Hormones. Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.
• Alcohol, nicotine and drug abuse. Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. It is now believed that using these substances may actually contribute to depression and anxiety disorders.

Screening and diagnosis:

To diagnose depression, the doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.

If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a medical doctor who specializes in mental illness (psychiatrist) or even recommend immediate hospitalization.

Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.

Complications:

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Women attempt suicide more often than men do, but men are much more likely to succeed in killing themselves.  The rate of suicide is four times greater for men. Men over 70 are the most likely to commit suicide.
           
Treatment:

The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you have severe depression, initial treatment is usually with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for four to nine months to prevent relapse.

It is important to keep taking the medication even if you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment greatly reduces the risk of a rapid relapse. If you have had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications:

• Selective serotonin reuptake inhibitors (SSRIs). These are usually the first-line treatment for depression because they have fewer serious side effects. SSRIs include Prozac, Zoloft, Paxil, Celexa and Lexapro. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Desyrel and Effexor, and dopamine reuptake inhibitors, such as Wellbutrin.
• Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters, but by a different mechanism than SSRIs.
• Monoamine oxidase inhibitors (MAOIs). These drugs prevent the breakdown of neurotransmitters. These drugs have serious side effects if combined with certain other medications or food products.
• Stimulants. Stimulants such as Ritalin and Concerta may be prescribed if you can’t take antidepressants because they are contraindicated due to another medical condition.
• Lithium and mood-stabilizing medications. Lithium, Depakote and Tegretol are used to treat Bipolar disorder. Medications called atypical antipsychotics such as Zyprexa, Risperdal and Seroquel were initially developed to treat psychotic disorder but doctors sometimes use them to treat bipolar disorder. According to the American Diabetes Association (ADA), certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure. The ADA recommends that doctors screen and monitor anyone taking Risperdal, Seroquel and Zyprexa.

* It can take up to eight to 12 weeks before you feel the full effects of an antidepressant. If your response to medication has not resulted in a satisfactory progress after that time, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.

Mayo Clinic. (2006). Depression. Retrieved on April 10, 2006 from the World Wide Web: http://www.mayoclinic.com/health/depression/DS00175

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HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!   We would like to welcome our newest public health nurse Aizzel Trieu! She will be working out of the Hole Ave CPS Office.

 

Editor: Kristen Thompson, PHN
Contributors: Nicole Boyd, PHN, Assistant Nurse Manager, and Judy Earp, MHA, Director of Public Health Nursing.