About This Course

Course Instructor

Professor Rudolf Klimes, PhD, welcomes you to this online course.

START the course here. TAKE the exam at the end. 

Introductory Exercise

(Answers do NOT need to be submitted to the instructor)

1. List the types of depression and their symptoms.

Depression

Being clinically depressed is very different from the down type of feeling that all people experience from time to time. Occasional feelings of sadness are a normal part of life, and it is that such feelings are often colloquially referred to as “depression.” In clinical depression, such feelings are out of proportion to any external causes. There are things in everyone’s life that are possible causes of sadness, but people who are not depressed manage to cope with these things without becoming incapacitated. As one might expect, depression can present itself as feeling sad or “having the blues”. However, sadness may not always be the dominant feeling of a depressed person. Depression can also be experienced as a numb or empty feeling, or perhaps no awareness of feeling at all. A depressed person may experience a noticeable loss in their ability to feel pleasure about anything. Depression, as viewed by psychiatrists, is an illness in which a person experiences a marked change in their mood and in the way they view themselves and the world. Depression as a significant depressive disorder ranges from short in duration and mild to long term and very severe, even life threatening. Depressive disorders come in different forms, just as do other illnesses such as heart disease. The three most prevalent forms are major depression, dysthymia, and bipolar disorder. The average duration of all depressive disorders is 20 weeks.

Depression is the world’s most common mental illness. About half of all depressive episodes may be triggered by stressful events. Depression is treatable.

General symptoms: 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 you once enjoyed, including sex; insomnia, early-morning awakening, or oversleeping, appetite and/or weight loss or overeating and weight gain; decreased energy. fatigue, being “slowed down”; thoughts of death or suicide, suicide attempts; restlessness, irritability, difficulty concentrating, remembering, making decisions; persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

1.1 Major depression

Major depression is a sadness that does not end. It is manifested by a combination of symptoms that interfere with the ability to work, sleep, eat; and enjoy once-pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime. The first onset is usually between ages 25 and 29.

1.2 Dysthymia

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at “full steam” or from feeling good. It is a chronic mild depression that usually develops in childhood and is more common in women. It is usually treated with medication and  psychotherapy. Aerobic exercise also seems to be often very helpful.

1.3 Bipolar depression (manic-depressive illness)

Another type of depressive disorder is manic-depressive illness, also called bipolar depression. Not nearly as prevalent as other forms of depressive disorders, manic depressive illness involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when in a manic phase.

 An official definition of depression…..

• Two weeks of abnormal depressed mood
• Loss of interest and decreased energy
• Loss of confidence
• Excessive guilt
• Recurrent thoughts of death
• Poor concentration
• Agitation or retardation
• Sleep disturbance
• Change in appetite

Includes the first two symptoms and at least one other.

Severe depression is the first two symptoms and at least five others.

2.  Describe the causes of depression

The exact cause of depression is not known. Doctors think it may be caused by a chemical imbalance in the brain. The imbalance could be caused by your genes or by events in your life. Sometimes there aren’t enough chemical messengers (called neurotransmitters) in the brain. These neurotransmitters carry messages (nerve impulses) from one nerve cell to another. When there aren’t enough, certain messages don’t get carried to some areas of the brain. Two primary messengers, called serotonin (say “seer-o-tone-in”) and norepinephrine (say “nor-ep-in-nef-rin”), are responsible for your moods (how you feel).

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.

Depression in Women

Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women-particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient “blues” are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention.

Depression in Men

Although men are less likely to suffer from depression than women, three to four million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men’s suicide rises, reaching a peak after age 85.

 Men’s depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged; hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

Depression in the Elderly

Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, most older people feel satisfied with their lives. Sometimes, though, when depression develops, it may be dismissed as a normal part of aging. Depression in the elderly, undiagnosed and untreated, causes needless suffering for the family and for the individual who could otherwise live a fruitful life. When he or she does go to the doctor, the symptoms described are usually physical, for the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.

Recognizing how depressive symptoms in older people are often missed, many health care professionals are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication the older person is taking for a physical problem, or they may be caused by a co-occurring illness. If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. Recent research suggests that brief psychotherapy (talk therapies that help a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression) is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication. Efficacy studies show that late-life depression can be treated with psychotherapy.

Depression in Children

Only in the past two 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, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through 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 is needed. Parents should not 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?

3. Discuss the various treatments of depression

Antidepressant medications are widely used, effective treatments for depression. Existing antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications – tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) – affect the activity of both of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development.

Electroconvulsive therapy (ECT), although not generally used as a first-line treatment, is one of the effective treatments for severe depression.

Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination. Psychotherapy helps individuals identify the life problems  that contribute to their depression, pinpoint negative and distorted thinking, and gain a sense of control and joy of life.

Recently there has been enormous interest in herbal remedies for various medical conditions including depression. One herbal supplement, St. Johns Wort, has been promoted as having antidepressant properties. However, no carefully designed studies have determined the antidepressant efficacy of the supplement. NIMH is currently enrolling patients in the first large-scale, multi-site, controlled study of St. John’s wort as a potential treatment for depression.

Recent Research Findings

Modern brain imaging technologies are revealing that in depression, neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly, and that the regulation of critical neurotransmitters is impaired. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry, mechanisms of action of antidepressant medications, and the cognitive distortions and disturbed interpersonal relationships commonly associated with depression, continue to inform the development of new and better treatments. The hormonal system that regulates the body’s response to stress – the hypothalamic-pituitary-adrenal (HPA) axis – is overactive in many patients with depression. The hypothalamus, the brain region responsible for managing hormone release from glands throughout the body, increases production of a substance called corticotropin releasing factor (CRF) when a threat to physical or psychological well-being is detected. Elevated levels and effects of CRF lead to increased hormone secretion by the pituitary and adrenal glands which prepares the body for defensive action. The body’s responses include reduced appetite, decreased sex drive, and heightened alertness. Research suggests that persistent overactivation of this hormonal system may lay the groundwork for depression. The elevated CRF levels detectable in depressed patients are reduced by treatment with antidepressant drugs, and this reduction corresponds to improvement in depressive symptoms. www.nih.gov

ERIC_NO: EJ612641, TITLE: Countering Depression with the Five Building Blocks of Resilience.
AUTHOR: Grotberg, Edith H., 1999

ABSTRACT: Provides strategies for reducing the risk of youth retreating into depression when faced with adversities in life, by helping them develop the building blocks of resilience (trust, autonomy, initiative, industry, identity). Reports that these building blocks have proven effective in fostering and strengthening resilience.

Core Beliefs Of Depression Self-help:

 

• Depression is a disease, but like heart disease or diabetes, self-care is essential to recovery.
• Depression is not an emotion. Emotions are self-limiting.
• Depression affects every aspect of ourselves – our thinking, behavior, emotions, self-esteem, and relationships with others – but we can identify and control or accept those effects.

Principles for Recovery:

The group borrows from Alcoholics Anonymous in adopting a set of principles, discussion and application of which become the guidelines for recovery. These principles are from Richard O’Connor, Undoing Depression (Little, Brown, 1997):

Feel Your Feelings

1. Challenge Depressed Thinking
2. Nothing Comes Out of the Blue

• Establish Priorities
• Communicate Directly
• Take Care of Your Self
• Take, and Expect, Responsibility

1. Look for Heroes
2. Be Generous
3. Cultivate Intimacy
4. Practice Detachment
5. Get Help When You Need It

A combination prayer and affirmation that may be read during repressive episodes:

 

1. I accept the fact that I am going through a dark night of the soul. I am dying to the me that I have known.
2. I embrace my pain fully and accept my present condition. I understand that on some level my soul needs this experience.

Although I feel alone, I know God is with me.

• I realize that this experience has a purpose and teaching, and I ask God to reveal it to me.
• Although I am in pain, I know that my travail will end, and that love, inspiration and direction will reenter my life.
• I ask God to give me strength, courage and guidance to see my way to my rebirth.
• I give thanks for my situation just the way it is.

Adapted from Source

4. Suggest help for a case-study in depression

Depression Library:

TEST

Recommendations for you: Visit our Ethical Dilemma course (https://cecourses.org/ethics/ethical-dilemmas/) To learn how to define dilemmas, select relevant values, principles and personal issues in the dilemmas, and how to propose solutions. Many have found this course very valuable and have recommended it to their colleagues.