CACHE Level 2 Cert in Awareness of Mental Health Problems Unit 5 - Understanding Depression

Unit 5 – Understanding Depression Section 1 – The meaning of depression Q1 Define the term 'depression'. (1.1) Depression is a persistent state of low mood and aversion to activity. It can be long term or short term depending on the severity of the condition and is characterised by a range of symptoms affecting the emotional, cognitive, behavioural and physical aspects of a person’s well-being. Q2 Differentiate between feeling low and clinical depression. (1.2) Everyone feels low at some point in their life as day to day events affect us. Low mood is generally a short term problem, usually lasting no longer than 2 weeks. When suffering from low mood, an individual may experience sadness, worry, anxiety, frustration, tiredness anger and low self-esteem. Clinical depression is more severe than low mood, it is characterised by symptoms including a low mood lasting 2 weeks or more; a loss of enjoyment in life; feelings of hopelessness, apathy and isolation; an inability to concentrate on everyday things; comfort eating or losing your appetite; disrupted sleep patterns and having suicidal thoughts or thoughts of self-harm. Depression will often require treatment which can involve a combination of lifestyle changes, talking therapies and medication. Q3 Describe the factors associated with psychotic depression. (1.3) Psychotic depression is when an individual suffering with depression also experiences symptoms of psychosis and is estimated to affect 10-15% of people who have clinical depression. Individuals with psychotic depression with suffer delusion and hallucination which are negative, self-critical, self-blaming and self-punishing in nature and almost always reflect the individual’s deeply depressed mood. They may experience psychomotor agitation, where they are unable to relax or stay still, often demonstrated by rocking, fidgeting or rapid leg movement. Psychotic depression can cause a person to be detached from reality and suffer paranoia where they may feel their thoughts are being controlled or listened to. Other symptoms of psychotic depression are acute anxiety and agitation, a disturbance in their thought patterns, insomnia and thoughts of suicide. Section2 – Possible causes of depression. Q4 Describe possible causes of depression. (2.1) There is no definitive cause for depression but experts think that several factors such as brain chemistry, genetic inheritance, environmental or social influences, physical illness and lifestyle choices may be responsible. BRAIN CHEMISTRY - when people experience depression there is a change in the chemistry of their brain. Chemicals within the brain are important in regulating mood and thought processes - it is unsure if the change in the chemistry causes the depression of the depression causes the chemical imbalance itself. GENETIC INHERITANCE has a part to play however, the inheritance of a gene which predisposes someone to a depressive illness does not necessarily mean an individual is destined to develop that illness. "Research on the heredity of depression within families’ shows that some individuals are more likely to develop the illness than others. If you have a parent or sibling that has had major depression, you may be 1.5 to 3 times more likely to develop the condition than those who do not have a close relative with the condition." "Much of what we know about the genetic influence of clinical depression is based upon research that has been done with identical twins. Identical twins are very helpful to researchers since they both have the exact same genetic code. It has been found that when one identical twin becomes depressed the other will also develop clinical depression approximately 76% of the time. When identical twins are raised apart from each other, they will both become depressed about 67% of the time. Because both twins become depressed at such a high rate, the implication is that there is a strong genetic influence. If it happened that when one twin becomes clinically depressed the other always develops depression, then clinical depression would likely be entirely genetic. However because the rate of both identical twins developing depression is not closer to 100% this tells us that there are other things that influence a person's vulnerability to depression." "Research has also been done with fraternal twins. Unlike identical twins who have the same genetic code, these siblings share only about 50% of their genetic makeup and do not necessarily look alike. Studies have shown that when one fraternal twin becomes depressed, the other also develops depression about 19% of the time. This is still a higher rate of depression when compared to overall rates for the general public, again pointing towards a genetic influence in the development of clinical depression." (source: allaboutdepression.com) ENVIRONMENTAL OR SOCIAL - These are the things that happen in the course of our everyday lives. They might include situations such as prolonged stress at home or work, coping with the loss of a loved one, or traumatic events which can all lead to low self-esteem and negative thought patterns. While these events are often negative and cause great stress for many people, stress can also occur as the result of a more positive event such as getting married, moving to a new city, or starting a new job. Events like these can take away a sense of control and cause great emotional upheaval which can in turn lead to depression. PHYSICAL ILLNESS can increase an individual’s risk of depression. An individual suffering with a serious illness such as HIV, heart disease, stroke or cancer can become depressed as they struggle with the medical condition. The physical effects of depression are very real and often debilitating, but only around 10-18% of depression is triggered by another medical condition. The symptoms of depression may also signify the presence of a medical condition, which once treated may alleviate the depressive symptoms. Illnesses which can sometimes cause symptoms of depression include but are not limited to Epilepsy, Diabetes, Hypothyroidism and Hyperthyroidism, Brain trauma. LIFESTYLE CHOICES such as poor diet, lack of exercise, overwork and lack of leisure time and substance misuse can contribute to a depressive episode or drag one out. DIET - The eating of certain foods won't cause depression outright but the cycle of eating (or rather, certain patterns of eating) can trigger depression if diets are too high in certain elements (i.e., saturated and trans fatty acids) or deficient in other vital nutrients (i.e., B vitamins and Omega-3 fatty acids). Research continues to confirm that diets low in refined sweets, trans and saturated fats, and processed carbohydrates yet high in a mix of fresh fruits and veggies, lean proteins, healthy fats, and complex carbohydrates have the essential vitamins, antioxidants, and essential fats to ward off depression. https://www.activebeat.com/diet-nutrition/the-8-ways-diet-can-cause-depression/ EXERCISE - Some studies have found that exercise can be a moderately helpful treatment for mild to moderate depression in adults. Exercise should therefore be considered as an important lifestyle change that is used in addition to other treatments for depression. The benefits that can be attained from exercise depend on the amount of exercise that is undertaken. Most studies showing that exercise was helpful used aerobic exercise (such as running or walking), for at least 30 minutes, three times a week, for at least eight weeks. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/depression-and-exercise OVERWORK - A Japanese study has found that employees who work long hours and are habitually overworked are a staggering 15 times more likely than average to develop depression. Dr Takahashi Amagasa and Dr Takeo Nakayama of Kyoto University School of Public Health analysed the job and workplace factors affecting depression risk in a group of 218 Japanese clerical workers. They found that employees who worked long hours (defined as at least 60 per week) and had high job demands (defined as "usually" having too much work) were at a much higher risk of depression. https://www.management-issues.com/news/6723/depression-link-to-long-hours-and-overwork/ SUBSTANCE MISUSE - Roughly one-third of adults who have a substance use disorder also suffer from depression. Among individuals with recurring major depression, roughly 16.5 percent have an alcohol use disorder and 18 percent have a drug use disorder. Because drug use symptoms can imitate the symptoms of depression, it can be difficult to diagnose depression when a person is actively using. https://www.psycom.net/depression-substance-abuse Section 3 – The effects of depression on the individual and others Q5 Describe the feelings an individual may have when experiencing depression. (3.1) When experiencing depression an individual may suffer with feelings of guilt, worthlessness and have low self-esteem; increased or acute anxiety and they may have continual sadness, be upset and tearful. Depression can make a person seem restless, irritable or angry with others. They may demonstrate little or no interest or enjoyment in anything around them or things they previously enjoyed. They can feel despairing and hopeless, disconnected from reality and feel suicidal. Q6 Describe examples of how depression may affect the individual and their life. (3.2) Depression can have a devastating impact on a person's life. They may begin to develop problems at work, affecting their performance and ability to carry out their role and duties. Due to the lack of interest and motivation to participate in social activities the depressed individual can become socially isolated and lose touch with friends and social groups. They may develop or exacerbate physical health problems due to lack of self-care and attention - often depressed people forget or simply stop taking regular prescribed medication for physical health issues. Interpersonal relationships may become strained - if friends and family do not fully understand what the individual is going through with the depression it can be difficult to maintain normality of daily life. Relationships with children can become difficult as the individual suffers with irritability and anger - children do not understand that the person is ill and not simply being nasty with them. They may begin to develop financial problems due to taking time off work and developing risky retail habits - when depressed in the past I have personally spent thousands of pounds on material things, items which at the time I felt were necessary to make me feel better but which in reality I did not need. If the depressed individual self-medicates with drugs or alcohol this may make their depression symptoms worse and put them at risk of criminal behaviour, for example driving under the influence of drugs or alcohol. Q7 Describe how an individual’s depression may affect others. (3.3) Depression affects everyone around an individual suffering with it - it can be emotionally exhausting and difficult to deal with. Those closest to the person suffering depression will be the most affected - lack of energy, irritability, bursts of anger and sadness will all upset the family unit. Low self-esteem and negative thinking may result in arguments and a breakdown in communications. It puts extra pressure on a spouse as they shoulder more responsibility and become the caregiver. This extra burden can lead to feelings of resentment or generate a "what about me" attitude as they begin to feel ignored and put upon. Any children within the family either won't understand or may even think they share some fault. Similar to divorce, children tend to think the problem revolves around them, even though they really have nothing to do with it. Family members may see the problems without fully understanding or knowing how to help - they care about the depressed person and want to fix the problem, even though the problem isn't "fixable" in any direct way. Co-workers may not be aware or understand that you are depressed and the fatigue and inability to enjoy interactions can be misinterpreted as disappointment in them or the job itself leading to avoidance by other workers amplifying the feelings of isolation. Section 4 - How the demands of daily life affect depression. Q8 Describe how the demands of daily life may contribute towards depression. (4.1) Daily life is stressful and demanding. Problems within relationships may contribute towards depression, if there is strain between spouses/partners it is easy to feel the lack of communication as being ignored and that you are no longer as important to that person as before - this can lead to a circle of negative thinking and low self-esteem which can cause depression. Events such as divorce, moving house and bereavement can create feelings of abandonment and isolation, sadness, irritability and anger - all symptoms of depression. Job loss or redundancy can create a spike in anxiety and worry, feelings of not being good enough will lower a person's self-image and this may lead them to distance themselves from people around them. Social and housing issues can contribute to depression - unhappiness in a housing situation can lead to stress, sadness and anger; caring for older parents or children can create stress as a person tries to "be everything to everyone". Age and hormonal changes can have a massive impact on a person’s self-image and esteem - puberty is especially stressful for young people and their sense of identity rapidly changes which can be difficult to cope with; women going through menopause can become depressed as the hormone levels within the body change from day to day and affects mood, sexuality and self-identity; older people may struggle as they reach retirement age and their lives change in relation to work, routines and providing for family. Section 5 – How depression can be managed. Q9 Describe local resources and treatments that would be available to an individual experiencing depression. (5.1) a) Local resources GPs are the first point of contact for the NHS and an important resource in recognising and treating depression. There are many self-help groups available and local ones can be found on MIND, mental health charity website - https://www.mind.org.uk/information-support/local-minds.aspx Local community mental health teams are available following referral from a GP or other service, CRHTT (Crisis Resolution and Home Treatment Teams) can help in the short term - they are often open to self-referrals and can signpost a person to the correct service for whatever they are experiencing. Talking Therapy groups are easily found on the internet, are easily accessible and open to self-referral and these provide a mixture of CBT and self-awareness. b) Treatments Local treatments for depression begin with yourself. Changing diet and exercise routines can play a huge part in managing depression (regular exercise increases the levels endorphins in the brain which promote a feeling of well-being, practicing regular relaxation techniques can be effective in reducing stress which exacerbates depression. Your GP can prescribe anti-depressant medication (which will help to balance the chemistry of the brain) if they feel you need them and using this alongside exercise, self-help groups, talking with friends and family and accessing local Talking Therapies can be effective in treating depression. Local CMHT (Community Mental Health Teams) can provide support from professionals such as psychiatrists, mental health nurses and support workers. In the event of severe depression admission to hospital can be considered for monitoring by a psychiatrist. Q10 Identify the resources and treatments that can be used to support and help a person with psychotic depression. (5.2) a) Resources Resources available for those suffering with psychotic depression are similar in many respects as those available for people with clinical depression. GPs would be the first point of contact, anti-depressant medication may be effective in the early stages but due to the complexity and complication of psychosis, anti-psychotic medication may need to be prescribed alongside (and as this cannot be prescribed by a GP and needs advice from a psychiatrist) it often results in an admission to hospital and then support from a CMHT. CRHTT would also be available for support in the short term and can be utilised to attempt to prevent a hospital admission - their intensive and daily support offers monitoring on a regular basis and they provide a fast paced service with access to crisis beds within the NHS should the need arise. Psychological support groups such as Talking Therapies can be beneficial and are easily accessible through self-referral. b) Treatments Treatment for psychotic depression usually involves a mixture of anti-depressants and anti-psychotic medication, psychological therapies can help alongside medication and is recommended by NICE (National Institute for Health and Clinical Evidence). Should urgent treatment be needed, ECT (electro-convulsive therapy) can be used but this is carried out in hospital and under general anaesthetic and consent would need to be obtained from the patient beforehand. CMHT will usually be involved in the treatment process as people generally recover from psychotic depression within a year but they may need continuous medical follow up and support. Sharon Makinson Level 2 Awareness of Mental Health