Depression - ttiinc.orgclinical depression Common but serious mood disorder Alters thoughts, feelings, and behaviors Affects the ability to cope with the stressors involved with activities

T r a i n i n g a n d T r e a t m e n t I n n o v a t i o n s , I n c

2 0 2 0

DEPRESSION

DEPRESSION DEFINED

Training and Treatment

Innovations, Inc. 2020

Also known as major depressive disorder or

clinical depression

Common but serious mood disorder

Alters thoughts, feelings, and behaviors

Affects the ability to cope with the stressors involved with activities

of daily living like sleeping, eating, or

maintaining hygiene

Symptoms need to be present for at least two

weeks to be diagnosable

Affect: observable behaviors that express a feeling

(emotion)

Blunted: reduced intensity in expression

Flat: little to no sign of any expression

Anhedonia : lack of enjoyment from, engagement in, or

energy for life’s experiences

Dysthymia : while depressed, two or more of the following:

poor appetite or binging, insomnia/hypersomnia, fatigue, low self esteem, poor concentration, or feelings of hopelessness

Dysphoric mood : an unpleasant mood, like

sadness/anxiety or irritability

COMMON TERMS RELATED TO

DEPRESSION



KINDS OF DEPRESSIVE DISORDERS ( D S M - V )



Disruptive mood dysregulation disorder

Major depressive disorder

Persistent depressive disorder (dysthymia)

Premenstrual dysphoric disorder

Substance/medication induced depressive disorder

Depressive disorder due to another medical condition

Other unspecified or specified depressive disorders

Unspecified depressive disorder

COMMON SYMPTOMS AMONG ALL

VARIATIONS

Significant weight loss/gain

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation

Fatigue or loss of energy nearly every day

Feelings of worthlessness/inappropriate guilt

Diminished ability to think or concentrate

Recurrent thoughts of death/suicide and or suicide attempt

Recently added to the DSM; used for children 12 and younger Used to reduce the potential for misdiagnosis of bipolar disorder

Age of onset of symptoms (10 years and younger historically)

Presentation in children with persistent irritability and frequent episodes of behavioral dyscontrol present Severe recurrent tempter outbursts that are not appropriate for the

situation

Inconsistent with developmental level

Happens on average, 3 or more times per week

Mood in between outbursts/episodes is persistently irritable or angry

DISRUPTIVE MOOD DYSREGULATION

DISORDER

Diagnosis should not be made on any individual age 6 or younger Training and Treatment


Major depressive disorder is characterized by one or more depressive episodes

Has to include either depressed mood most of the day/nearly every day, or, lost of interest in pleasurable activities (anhedonia)

Some individuals will report having no feelings, feeling ‘blah’ or anxious

While others may emphasize somatic symptoms like bodily aches and pains

In children and adolescents, irritable/cranky mood may manifest as opposed to a sad or dejected mood

MAJOR DEPRESSIVE DISORDER MDD



MDD VS. GRIEF



Major Depressive Disorder:

• Mood and thought Patterns are almost constantly negative

• Feelings of worthlessness and self-loathing are common

Grief:

• -Painful feelings come in waves, often with positive memories of the deceased/or loss are mixed in

• Self-Esteem will remain in tact

Chronic form of depression that is consistently present over the course of at least two years in adults, 1 year in children

Can refer to a low level symptoms of depression for extended periods of time

“Down in the Dumps” most of the time

Also known as Dysthymia

PERSISTENT DEPRESSIVE DISORDER



BIPOLAR DISORDER



Recognized on the list due to the extreme ‘low’

moods reported by those diagnosed

Meets criteria for depression

Mood: sadness, general discontent, guilt/hopelessness, loss

of interest or pleasure in activities

Behavioral: disorganized, crying spells, agitation, fatigued

speech

Cognitive: unwanted thoughts, slowness in activity, delusion

Psychological: depression, agitated depression

Sleep: insomnia/hypersomnia

SEASONAL DEPRESSION



Seasonal affective disorder Characterized by the onset of depression during cooler months

Less natural sunlight

Generally is relieved during Spring and Summer

Winter depression symptoms include: Social withdrawal

Increased sleep

Weight gain

& predictability it will return next season

DEPRESSION IN PSYCHOTIC DISORDERS



Depressive symptoms are a common feature

Disturbing false fixed beliefs (delusions)

Or, hearing/seeing upsetting things that others cannot hear or see

(hallucinations)

Psychotic Symptoms usually have a depressive

“theme”

Delusions of guilt, poverty, or illness

Include the same criteria of a combination

of depressed mood or diminished interest or

pleasure in all or almost all activities

Depressive symptoms are only present either

during intoxication, withdrawal, or after

exposure to medication

SUBSTANCE/MEDICATION INDUCED



Drawing our Depression:

https://www.youtube.com/watch?v=coSbBsTGs_A&t=7s

DIFFERENT REPRESENTATIONS



https://www.youtube.com/watch?v=coSbBsTGs_A&t=7s

Not all symptoms present the same, be on the look out for the following:

Frequent, varied, and vague complaints that have all been examined but ruled out of any medical cause

Interpersonal struggles

Barriers to upholding responsibilities like job roles/family roles

Struggle to maintain medication adherence or compliance with recommended treatment

Change in affect

Complaints of fatigue or pain

Exhibiting violent or impulsive behaviors

ATYPICAL SYMPTOMS TO BE ASSESSING



ASSESSMENTS



•Contains 9 questions

•High reliability and validity

•Available in numerous languages and at no cost

•Valuable tool to gauge progress if used at periodic visits

Patient Health Questionaire-9

(PHQ-9)

•Contains 21 questions scored on a scale from 0-3

•Higher scores indicate more severe symptoms

•Takes 10 minutes to complete on average

•Used on ages 13 - 80

Beck’s Depression

Inventory – (BDI)

ILLNESSES THAT INVOLVE SIMILAR

SYMPTOMS TO DEPRESSION

Neurological disorders (dementia, Parkinson’s, etc.)

Cardiovascular Disease

HIV

Cancer

Fibromyalgia

Chronic Fatigue

Sleep Disorders

Infectious Diseases (Lyme Disease)

Traumatic Brain Injury

Mineral and Vitamin Deficiencies



Although there are no blood tests

to determine depression, a blood test can

rule out the following illnesses

COMMONLY PRESCRIBED MEDICATIONS



Cognitive Therapy Assists in recognizing and combating negative thinking that

contributes to depressive episodes

Changing maladaptive thought patterns to rational, accurate, and

helpful ones

Behavioral Activation Implementing into schedule specific activities with high potential for

positive reinforcement

Interpersonal Psychotherapy Time limited approach

Addresses interpersonal stresses and improving social functioning

Interpersonal issues are the main focus of treatment

OTHER MODALITIES OF TREATMENT



DIVERSE REPRESENTATIONS



Women:

• biological, lifecycle, and hormonal factors unique to women can be linked to higher rates.

• Symptoms include: sadness, worthlessness, and guilt

Men:

• typical affect is tired, irritable, and sometimes angry.

• Lack of interest in activities, sleep disturbances, reckless/maladaptive behaviors.

DIVERSE REPRESENTATIONS



Younger children:

depression looks like pretending to be sick, refusing to attend school, attachment

issues to parent or anxiety about the death of a parent

Adolescents:

behavioral issues, get into trouble at school, irritable. Co-morbid conditions

like anxiety, eating disorders, or substance use/abuse

Older adults:

less apparent symptoms, less likely to admit to feelings of sadness or grief. More likely to

be linked to medical conditions like heart disease

DEPRESSION IN THE U.S

• Feelings of numbness, disbelief, anxiety or fear

• Changes in appetite, energy level, and activity

• Difficultly concentrating

• Change in sleep patterns/ insomnia or nightmares

• Physical reactions like gestational issues or skin rashes

• Worsening of present health problems

• Increased anger or outbursts

• Substance misuse / maladaptive coping mechanisms

Even though you may not be diagnosed with depression, the uncertainty of the current health climate could possibly be making you feel:

COPING WITH COVID-19



Open Communication: Talking openly and

honestly can help lessen children’s

confusion and ease their fears

Help by labeling feelings so connections are

made to better express and manage the strong

emotions

Non-Verbal Communication: Observing

behavior can help you understand their

needs.

This goes for anyone struggling to communicate

their feelings

HELPING CHILDREN COPE

Rosita the Grouch: https://www.youtube.com/watch?v=Akx0o0Mg2zg

Seasme Street Communities Website: https://sesamestreetincommunities.org/

https://www.youtube.com/watch?v=Akx0o0Mg2zg

https://sesamestreetincommunities.org/

Practice Self-Care Eat healthy, exercise regularly, drink fluids, and maintain a sleep

routine; avoid substance misuse

Stay connected with others Through various outlets like phone calls, letters, make cards, use social

media platforms, or organize drive-by’s to celebrate birthdays/holidays/showers/graduations

Take breaks Physical and mental breaks; meditate, take deep breaths

Stay informed/monitor the amount of news intake Be aware there might be rumors; watch, listen to, or read the news for

updates from officials

Seek professional help as necessary There are a lot of outlets to seek help during this time, virtual therapists

are available

MAINTAINING YOUR EMOTIONAL HEALTH



PREVENTATIVE FACTORS



Some form of activity or exercise

Delegate tasks or break tasks up into smaller ones

Prioritize, think SMART

Implement high quality relaxation activities into daily routine

Postpone big life decisions until mental health is recharged

Avoid self medication/maladaptive behaviors

https://www.nimh.nih.gov/health/publications/depression/index.shtml#pub1

https://adaa.org/understanding-anxiety/depression

https://adaa.org/understanding-anxiety/co-occurring-disorders

https://www.healthline.com/health/depression/facts -statistics-infographic#3

https://emergency.cdc.gov/coping/selfcare.asp

Diagnostic and Statistical Manual of Mental Disorders - 5 th Edition ( DSM-V )

https://www.integration.samhsa.gov/clinical -practice/screening-tools

seasmestreetcommunities.org

https://www.ismanet.org/doctoryourspirit/pdfs/Beck -Depression-Inventory -BDI.pdf

tti inc.org

REFERENCES & RESOURCES



https://www.nimh.nih.gov/health/publications/depression/index.shtml

https://www.nimh.nih.gov/health/publications/depression/index.shtml











https://www.healthline.com/health/depression/facts-statistics-infographic





https://emergency.cdc.gov/coping/selfcare.asp

https://www.integration.samhsa.gov/clinical-practice/screening-tools





https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf








Documents

Depression - ttiinc.orgclinical depression Common but serious mood disorder Alters thoughts, feelings, and behaviors Affects the ability to cope with the stressors involved with activities