THE MANY FACES OF DEPRESSION

Dr. Michela M. David, Ph.D., C. Psych.

Unit Psychologist, Mood Disorders Research and Treatment Service, Providence Care, Mental Health Services,

Adjunct Assistant Professor of Psychology and Psychiatry, Queen’s University

Ashley Judd

Joan Rivers

Winona Ryder

Damon Wayans

Winston Churchill, British Prime MinisterSir Isaac Newton, Scientist

Jim Carrey

Drew CareyTennessee Williams, Playright

Darryl Strawberry

Ted Turner - CNN

Sigmund Freud, Psychiatrist

Sheyl Crow

Diana, Princess of Wales

Charles Darwin

Mark Twain

Charles Dickens, Author

Elton John

Alanis Morissette

Peter Gabriel, Artist

Patty Duke, Actress

Charles DickensJimmy Piersall, Boston Red Socks

Vivien Leigh, Gone With The Wind

Vivien Leigh, Gone With The Wind

Michelangelo, Artist

Vincent Van Gogh, Artist

Sylvia Plath, Poet

Ernest Hemmingway, Novelist

Larry King`

Edgar Alan Poe, Author

John Keats, Poet

Vaslov Niginsky, Dancer

Leo Tolstoy, Author Warn and Peace

Ludwig von Beethoven, Composer

Virginia Woolf, Novelist

Richard Dreyfuss, Actor

Abraham Lincoln, American President

Robert Schumann, Poet

Gaetano Donizetti, Opera Singer

Eugene O’Neill, Playwright

Lionel Aldridge, Green Bay Packers

Emperor Joshua Norton

Sophie AndersoEugene O’Neill, Playwrightn, Model

Adam Ant, Musician

Frank Bruno, BoxerFrank Bruno, Boxer

Kurt Cobain, MusicianDick Cavett, Television JournalistEugene O’Neill, Playwright

Maz Bemis. Musician

Lord Byron, Poet

Jeff Buckley, Musician

Jeremy Brett, Actor

Adrian Borland, Musician

Ross “Dutch” Boyd, Poker Player

Thomas Lovell Beddoes

Charles Baudelaire

Andy Behrman

Georg Cantor

Iris Chang, Historian

Samuel Taylor Coleridge

Robert S Corrington, Theologist

Ralph Waldo Emerson, Writer

Carrie Fisher, Actress

Francis Scott Key Fitzgerald, Writer

William Faulkner, Writer

Stephen Foster, Songwriter

Connie Francis, Singer

Stephen Fry, Actor

Matthew Good, Canadian Musician

Philip Graham, Businessman

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People With Mental Illness Enrich Our Lives

A Mood Disorder is… a common illness which affects

emotional AND physical wellbeing NOT a character flaw or a

weakness treatable treated most effectively when

treatment is started early on potentially very destructive if left

untreated

Two Most Common Types of

Mood Disorder:

Major Depressive Disorder

(depression only)

Bipolar Disorder (Depression + Hypomania or Mania)

Incidence:

1 in 5 people will experience symptoms of a mood disorder in their lifetime

Twice as many women than men are affected

The incidence of mood disorders is increasing

Less than 30% of sufferers seek treatment Less than 10% receive adequate treatment Severe depression has a suicide rate of

15%

The Cost of Depression: expected to become the world’s leading health

problem within the next decade second leading cause of time confined to bed Financial (7.3 billion Cdn $ a year in health costs

and lost revenue; about 15% of business revenues)

fastest rising cause of disability claims families and relationships: the personal cost susceptibility to physical health problems (back

pain, repetitive strain, colorectal cancer)

Yet despite the high incidence and huge costs…

There is tremendous stigma associated with mental illnesses in general, and a lack of knowledge about how to recognize symptoms and what treatments are available.

Many sufferers of depression do not seek help, and many are undertreated.

Why do people not seek help?

They think they are just not coping

Lack of knowledge Anti-medications Fear of the unknown They decide to wait and see

whether things improve They don’t have the energy They can’t make a decision

about seeking help They don’t know where to

turn STIGMA

What is “Stigma”?

StereotypingDiscrimination

Labelling

Causes of Mood Disorders:

Genetic predisposition Chemical imbalance in the brain Certain medications Some physical illnesses Substance abuse

Losses Stressful life events ?

Major Depressive Disorder

formerly known as “clinical depression” “depression” is an overused term a clinical syndrome causing impairment of

functioning ranges in severity from mild to very severe,

even life threatening 29%-41% heritability; 8-9% lifetime

incidence (up to 20% for women)

MDD Symptoms: (5+ in 2-week period) Depressed mood most of nearly every day Markedly reduced interest or pleasure in all/nearly

all activities Significant weight loss or gain (5%) Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every

day Fatigue or loss of energy nearly every day Feelings of worthlessness or inappropriate guilt Diminished ability to concentrate Recurrent thoughts of death/suicide

What you might notice if a person is suffering from depression:

They seem distant, aloof or disinterested They socialize less They are uncharacteristically lacking in motivation They have difficulty concentrating and remembering

things They don’t seem to enjoy things the way they used to;

they may not react to positive things They are uncharacteristically late, tired, unkempt or

unreliable They are often very hard on themselves They seem unusually emotional, and may cry a lot They make indirect or direct references to suicide They function very differently from their usual self

When to seek help

A change in functioning from your “usual” is noticeable and/or prolonged

Other people start noticing or commenting on the changes, or you notice these changes in someone

The “barometer”: are the mood changes affecting many areas of life? Do you feel like you don’t care?

Crying often for no clear reason, or uncharacteristic inability to cope

Uncharacteristic lateness, unreliability Feeling that life is not worth living, or considering suicide

(always check this out if you suspect it in someone else) Err on the side of caution! Mood disorders are most

treatable early on

Challenges in helping a depressed person:

Interpersonal cues may be different (e.g. poor eye contact)

Irritability/anger are often present (and may seem like personality issues)

They may lack insight (i.e. not recognize the changes in themselves)

They are full of self-blame; guilt (e.g. “It’s my fault”) They lack hope (e.g. “nothing will help”) They lack internal resources (i.e. they don’t try or

know how to help themselves)

Where to seek help?

Family doctor / Psychiatrist Mood Disorders specialty programs (e.g. HDH Psychiatry;

FCMHS; Providence Care, MHS) Employee Assistance Program / Employee Health /

Student Health Services / Health Unit Counsellor / therapist Support or crisis line (e.g. FCMHS Crisis line; TALK) Online: e.g. Mood Disorders Association of Ontario

www.mooddisorders.on.ca Peer support groups and organizations (e.g. MDAO; Peers

of the Round Table; Queen’s Mental Health Awareness; Family Resource Centre; Bereavement groups through Funeral Homes)

A trusted adult (family, friend, coworker, manager, someone with lived experience)

Evidence-Based Treatments for Major Depressive Disorder

BIOLOGICALAntidepressant MedicationsElectroconvulsive Therapy (ECT)Transcranial Magnetic Stimulation (TMS)Deep Brain Stimulation (DBS)Light Therapy

PSYCHOLOGICAL PsychotherapyPsychoeducationBibliotherapyYoga and

meditation

Peer Support

Major Depressive Disorder Variations:

Single episode or recurrent Severity (mild, moderate or severe) Psychotic features Post-partum onset Seasonal variation

Seasonal Affective Disorder (SAD)

a form of Major Depressive Disorder atypical features, such as hypersomnolence,

weight gain and carbohydrate cravings recurrent with seasonal pattern (typically fall/winter) treated with pharmacotherapy and/or light

therapy

Bipolar Disorder

depression + hypomania or mania alternating or “mixed” mood states” may alternate rapidly between

depressed and manic phases: “rapid cycling”

formerly known as “manic-depression”

Incidence of Bipolar Disorder:

1.2% of general population 15-25% heritability when a sibling has bipolar

disorder 15-30% heritability when one parent has

bipolar disorder Up to 75% heritability when both parents

have bipolar disorder Postpartum depression increases risk of

Bipolar Disorder

Treatments for Bipolar Disorder:

Primarily medications (especially mood stabilizers, or “atypical antipsychotics”)

For depressed phase: antidepressant medications, ECT, or TMS (usually under the cover of a mood stabilizer)

Adjunctive Psychotherapy (i.e. with medications):

○ Interpersonal and Social Rhythm Therapy (emphasis on regularity of daily routine with an interpersonal focus)

○ Cognitive Behavioural Therapy○ Family therapy

Reasons for Under-Diagnosis of Bipolar Disorder:

Individuals may not seek help; often it is others around them who see a problem

Manic symptoms may appear later than depression (misdiagnosed as MDD)

Symptoms are missed, or are seen as being characterological

Decreased sleep need is the most reliable sign of bipolar disorder

Conclusions Depression is becoming a problem of

astounding proportions in today’s world Demographics will make the problem worse Each one of us can make a difference by

watching for it in ourselves, our friends and our families, and accessing help

Depression is very treatable, and yet many never seek treatment

Each one of us can help by recognizing and spreading the word that depression is a treatable illness and NOT a weakness

Resources and Information Mood Disorders Association of Ontario

www.mooddisorders.on.ca Check-Up from the Neck Up

www.checkupfromtheneckup.ca Policy on Accommodation of Mental

Illness (from www.chrc-ccdp.ca ) Healthy Living Moods Magazine

www.moodsmag.com

Please:

HELP THE STIGMA