“Facing the Blues”

1. “Facing the Blues” DEPRESSION

2. Depression Is Not New • King Saul of the Old Testament • Psalm 88 • Hippocrates (400 B.C.) - “melancholia” • Among the most common mental problems affecting adults, teens, and children • Is the most serious of the mood disorders; rivals heart disease in its debilitating effects • Is the most treatable; 90% get better

3. Being Human • Palm = Spiritual • 5 Fingers = • Physical • Mental • Emotional • Social • Moral

4. Clinical Depression: A Mood Disorder • Sadness (emotion) is passing and dependent upon circumstances. • Clinical depression is a low mood that is less dependent upon one’s circumstances. • CD is the most treatable of the mental illnesses; untreated it can lead to suicide. • With CD, one has a negative view of the self, the world, and the future.

5. Why Treat Depression? • Negative view of self, world, & future can prevent one from being able to glorify and enjoy God. • Untreated and unabated, it can lead to death (suicide): a permanent solution to a temporary problem.

6. Bipolar Disorder: 2 Poles • Manic phase: cheerful, talkative, energetic, spending sprees, grandiose, indiscriminate sexual advances. Recklessness may lead to accidents. • Depression: often changes from manic to irritability, rage, & paranoia. May lead to suicide. • Bipolar versus unipolar depression.

7. DSM-IV Diagnostic Criteria • Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either: (1) depressed mood or (2) loss of interest or pleasure. • NOTE: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

8. Symptoms of Depression • 1) Feelings of sadness • 2) Diminished interest or pleasure in usual activities • 3) Losing or gaining weight • 4) Sleep disturbances (sleeping too much or too little; disrupted sleep) • 5) Observable slowed or agitated physical and/or spoken responses • 6) Lack of energy or feeling tired all the time • 7) Feelings of guilt or worthlessness • 8) Problems concentrating or making decisions • 9) Suicidal thoughts

9. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. • The symptoms are not better accounted for by bereavement (i.e., if the symptoms persist for longer than 2 months).

10. Biochemical Changes in CD • One biochemical change observed in CD is reduced levels of brain chemicals called neurotransmitters, namely serotonin (ø) or norepinephrine. Treat via SSRIs. • Nerve Synapse <ø <<ø <<ø <<<XøX<< ø << ø << ø <<<<<< ø ø ø < ø ø <ø ø ø ø<<<<<<<<<<<<

11. Treatment for Depression • Standard of care is counseling, plus medication (only if warranted). • Medications have no immediate effect on mood and no effect on people whose mood is normal. They only bring disturbed brain chemistry back into balance. • Antidepressants are not physiologically addictive.

12. Medications usually serve to speed up the recovery process. Usually begin to see improvement within 7-10 days. Become fully effective within 3-6 weeks. • Prevent relapse by staying on meds for several months. Some may require longer, even permanent, medication if recurrent depression appears. • Untreated episode: 6-13 months vs. 3 months. • Cognitive therapy/counseling is the most effective form of counseling. Change the negative thoughts, assumptions, & behaviors.

13. ECT or electroconvulsive therapy is used in cases where the person cannot take medications due to heart conditions, old age, or severe malnourishment, and for patients who are suicidal or unresponsive to antidepressant medications. In ECT, a small electrical impulse is administered to the brain. No long term memory loss. While the mechanism of its effectiveness is not understood, ECT is quite effective. Very costly ($9-18,000/series of treatment)

14. Cognitive Therapy Based on the premise that thoughts (cognitions) produce feelings. Therefore, to change the feelings, one first changes the thoughts that give rise to those feelings: Five column method of cognitive therapy: Situation -- Emotions -- Automatic Thoughts -- Rational Response -- Outcome

15. Some Spiritual Sources of Depression • Idols of the Heart (Pr. 13:12) - Physical, Emotional, Mental, Social, Moral • Unresolved anger at self, others, God

16. Resources • Prayer - especially by others (support/ encouragement) • Scripture Psalm 77 • Worship – interacting with Christ • Community of Faith - Fellowship • Medical Professionals • Internet

17. Questions or Contributions End

18. A New Medication • In 1998, Merck & Co. announced a new drug, code-named MK-869, that targets a mysterious brain chemical, a neuropeptide known as substance P. • MK-869 demonstrated fewer side effects than Paxil and does not affect the function of serotonin or norepinephrine. • MK-869 relieves depression in an entirely different way than other anti-depressants.

20. 1) depressed mood most of the day, nearly every day 2) markedly diminished interest or pleasure in all, or almost all, activities of the day 3) significant weight/appetite loss/gain 4) insomnia or hypersomnia nearly every day (sleep disturbance is most robust marker; early morning wakenings) 5) psychomotor agitation or retardation 6) fatigue or loss of energy nearly every day 7) feelings of worthlessness or excessive or inappropriate guilt 8) diminished ability to think or concentrate 9) recurrent thoughts of death; suicidal