Depression

Depression Digging Deeper into the Heart of the Matter. Heart Centre Nursing Education DayJune 10 2016

Colleen Cannon, PhD, R.Psych.

4 key messages to convey:Depression is a real illness.Depression affects people in different ways.Depression is treatable.If you have depression, you are not alone.

National Institute of Mental Health

OriginsOriginally referred to as melancholiaHippocrates an excess in the bodily fluid of black bileOther fluids included blood, yellow bile, and phlegm

Other theories included demonic possession

Demons depicted in a 14th century arabic manuscript4

DSM-IV criteria for Depressive EpisodeDepressed mood, or feeling sad or empty for 2 weeks.

AndDiminished interest or pleasure in nearly all activities.Significant weight loss or gain, or change in appetite.Insomnia or hypersomnia.Psychomotor agitation or retardation.Fatigue/loss of energy (not due to a medical condition).Feelings of worthlessness, or excessive guilt.Diminished ability to concentrate, or indecisiveness.Recurrent thoughts of death or suicide.

At least 5 of these, most days, most of the time, for 2 weeks.

What percentage of Canadians will personally experience a mental illness in their lifetime?5%10%15%20%

Canadian Mental Health Association 2016

What percentage of Canadians will personally experience a mental illness in their lifetime?5%10%15%20%

Canadian Mental Health Association 2016

What percentage of Canadians will experience major depression at some time in their lives?4%8%12%

Canadian Mental Health Association 2016

What percentage of Canadians will experience major depression at some time in their lives?4%8%12%

Canadian Mental Health Association 2016

The mentally ill are not amongst us. They are us.Andre Picard, Globe and MailPublic Health Reporter

4 key messages to convey:Depression is a real illness.Depression affects people in different ways.Depression is treatable.If you have depression, you are not alone.

National Institute of Mental Health

Caution!Dont assume you can tell if someone is depressedNo sig correlation between BDI scores and health care provider (nurses, med students, cardiologists) assessmentsFalse pos = 30%; False neg = 75%.

Psychosomatic Medicine 67:393-397(2005)

DirectDepression can lead to:Increase in cortisol Increase platelet activationAltered autonomic function Increase inflammatory markers

Charlson et al 2013 Pooled relative risk of developing IHD in those with major depr was 1.56 (95% CI 1,30 to 1.87)Globally almost 4 million estimated IHD disability-adjusted life years attributed to depr3.5 million years of life lost attributed to depr

BMC Medicine, 2013, vol 11:250

Clinical Cardiac AnecdotesIf I cant provide for my family any more, what good am I as a man?I did everything right and was a health nut- for THIS?? I cant sit still. Ive NEVER been able to sit still. And I may never run again??Im overwhelmed everyone else needs me theres no time to focus on myselfTaking medications means Im a sick person.

4 key messages to convey:Depression is a real illness.Depression affects people in different ways.Depression is treatable.If you have depression, you are not alone.

National Institute of Mental Health

Treatments includedTreatment was consistent with current beliefsBloodlettingBathingExercising(get that excess black bile out!)

Treatments includedTreatment was consistent with current beliefsdrowningexorcismsburningstarvation(Demons need to be driven out of the body for THEIR wellbeing)

Treatments included18th and 19th centuries, beliefs shifted to depression and mental illness as a weakness in temperment & unchangeableshunned and locked up for OUR wellbeing

Facing the past

Research and practice now indicate that depr is caused by a number of factorsBiologicalInherited traitsBrain chemistry, hormonesCertain medicationsPsychologicalHow we learn to think about ourselves & the worldEnvironmentalGrief, loss, trauma, high stress, health conditions

BehavioursThoughtsEmotions

Physiology

As I recall Im threading all or nothing thinking through this exampleCBT in a nutshell.A very simple model for making sense of very complex situations. I use this model daily personally and professionally to help explain what unfolded, and how to make changes. How did I get myself in this pickle, and what do I do to get out of it?Be utterly transparent about this model- draw it on a scrap piece of paper or on a whiteboard in your office, or even simply on a sticky note. I always explain to clients that unlike my colleagues I cant take a blood test or monitor their heart rate, to understand whats going on for them thinking about yourself and your response to a situation is an ABSTRACT experience, and having a model to fold can help guide you in figuring things out, alone and together.

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BehavioursThoughtsEmotionsPhysiology-Several possible IHD changes-medications, med side effects-pain, fatigue, BG-poor diet, limited exerciseDiabetes & Angina

As I recall Im threading all or nothing thinking through this exampleCBT in a nutshell.A very simple model for making sense of very complex situations. I use this model daily personally and professionally to help explain what unfolded, and how to make changes. How did I get myself in this pickle, and what do I do to get out of it?Be utterly transparent about this model- draw it on a scrap piece of paper or on a whiteboard in your office, or even simply on a sticky note. I always explain to clients that unlike my colleagues I cant take a blood test or monitor their heart rate, to understand whats going on for them thinking about yourself and your response to a situation is an ABSTRACT experience, and having a model to fold can help guide you in figuring things out, alone and together.

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BehavioursThoughtsEmotionsPhysiology-Several possible IHD changes-medications, med side effects-pain, fatigue, BG-poor diet, limited exerciseDiabetes & Angina

As I recall Im threading all or nothing thinking through this exampleCBT in a nutshell.A very simple model for making sense of very complex situations. I use this model daily personally and professionally to help explain what unfolded, and how to make changes. How did I get myself in this pickle, and what do I do to get out of it?Be utterly transparent about this model- draw it on a scrap piece of paper or on a whiteboard in your office, or even simply on a sticky note. I always explain to clients that unlike my colleagues I cant take a blood test or monitor their heart rate, to understand whats going on for them thinking about yourself and your response to a situation is an ABSTRACT experience, and having a model to fold can help guide you in figuring things out, alone and together.

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Cognitve changes include:Significantly more negative beliefs about A. Your selfB. Your circumstancesC. Your future

BehavioursThoughtsEmotionsPhysiology-Several possible IHD changes-medications, med side effects-pain, fatigue, BG-poor diet, limited exerciseDiabetes & AnginaI give up - Im never getting betterId be better off deadIm a total idiot for smokingI hate my life

As I recall Im threading all or nothing thinking through this exampleCBT in a nutshell.A very simple model for making sense of very complex situations. I use this model daily personally and professionally to help explain what unfolded, and how to make changes. How did I get myself in this pickle, and what do I do to get out of it?Be utterly transparent about this model- draw it on a scrap piece of paper or on a whiteboard in your office, or even simply on a sticky note. I always explain to clients that unlike my colleagues I cant take a blood test or monitor their heart rate, to understand whats going on for them thinking about yourself and your response to a situation is an ABSTRACT experience, and having a model to fold can help guide you in figuring things out, alone and together.

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BehavioursThoughtsEmotionsPhysiology-Several possible IHD changes-medications, med side effects-pain, fatigue, BG-poor diet, limited exerciseDiabetes & AnginaI give up - Im never getting betterId be better off deadIm a total idiot for smokingI hate my lifeSocial withdrawal/isolationLow adherence meds, diet, exercise, rehabPoor sleep hygiene

As I recall Im threading all or nothing thinking through this exampleCBT in a nutshell.A very simple model for making sense of very complex situations. I use this model daily personally and professionally to help explain what unfolded, and how to make changes. How did I get myself in this pickle, and what do I do to get out of it?Be utterly transparent about this model- draw it on a scrap piece of paper or on a whiteboard in your office, or even simply on a sticky note. I always explain to clients that unlike my colleagues I cant take a blood test or monitor their heart rate, to understand whats going on for them thinking about yourself and your response to a situation is an ABSTRACT experience, and having a model to fold can help guide you in figuring things out, alone and together.

*

BehavioursThoughtsEmotionsPhysiology-Several possible IHD changes-medications, med side effects-pain, fatigue, BG-poor diet, limited exerciseDiabetes & AnginaI give up - Im never getting betterId be better off deadIm a total idiot for smokingI hate my lifeSocial withdrawal/isolationLow adherence meds, diet, exercise, rehabPoor sleep hygieneAvoidanceDepression, fearDespair, hopelessness, dread, anxious, overwhelmed, flat, empty

As I recall Im threading all or nothing thinking through this exampleCBT in a nutshell.A very simple model for making sense of very complex situations. I use this model daily personally and professionally to help explain what unfolded, and how to make changes. How did I get myself in this pickle, and what do I do to get out of it?Be utterly transparent about this model- draw it on a scrap piece of paper or on a whiteboard in your office, or even simply on a sticky note. I always explain to clients that unlike my colleagues I cant take a blood test or monitor their heart rate, to understand whats going on for them thinking about yourself and your response to a situation is an ABSTRACT experience, and having a model to fold can help guide you in figuring things out, alone and together.

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4 key messages to convey:Depression is a real illness.Depression affects people in different ways.Depression is treatable.If you have depression, you are not alone.

National Institute of Mental Health

Decreasing IsolationScreen & ReferName it. Talk about it. Normalizing it.You are not going crazySuggesting interventions as a COMMON complementary treatment in recoveryOnline resources including:Anti Depression Skills WorkbookInstagram, blogs Social Media

Positive Coping Skills: RelaxationManaging WorryActivating Your LifeSolving ProblemsManaging Depressive ThinkingManaging AngerRelationship Building

Contents

Thank you!

Colleen Cannon, R.Psych.St. Pauls Hospital, Heart Centre