mhac depression event slides 2012
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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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Stephen Foster, Songwriter
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Stephen Foster, Songwriter
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Stephen Foster, Songwriter
Stephen Foster, SongwriterStephen Foster, Songwriter
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Stephen Foster, SongwriterStephen Foster, Songwriter
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Stephen Foster, SongwriterStephen Foster, Songwriter
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Mariette Hartley, Actress
Mariette Hartley, Actress
Mariette Hartley, Actress
Mariette Hartley, Actress
Mariette Hartley, Actress Mariette Hartley, Actress
Mariette Hartley, Actress
Mariette Hartley, Actress Mariette Hartley, Actress
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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