Final ExamTopic 1: Mental Health: Depression Program Clips from “Out of the Shadows” 1. Introduction-depression takes many forms; illness of loneliness; feelings of being isolated; - can strike early in life or later- trauma, loss, or neglect can lead to depression; genetics also plays a role (having a family history)- treatment=ongoing process of trial and error; - over 20 million Americans are living with depressive disorders - In some cases, the loss of a loved one can be a tipping point into depression - Depression is a biological disorder (not all in your head)- Triggers of depression (whether you have an episode or when you have an episode) are an onset probably related to environmental factors (ex. Loss of attachments and stress and loss in your life)2. Andrew- Expert and best-selling author; began having depression in his 30’s; - Opposite of depression is vitality; feeling that you can’t do anything and life is completely terrifying- his first major episode of depression came suddenly when he was publishing his first major novel;- Anxiety; he was terrified all of the time, but he didn’t know what he was scared of 24 hours a day; - Desperate for help, he moved in with his father, who took care of him- He thought that the loss of mother to cancer 3 years earlier contributed to his depression- His mother ended her life on her own terms; Sometimes, the Vulnerabilities: Genetic and environmental; we all have a vulnerability and the vulnerability is determine by 2 major factors: on genetic and environmental- Genetic-accounts for about 1/3 of risks for depression- Environmental vulnerabilities-early life trauma, child abuse and neglect, experiencing traumatic events as a child, poverty3. Sherwin “Shep” Newman-thought that child trauma played a role in his depression- Immigrant parents who couldn’t read or write in English and Sherwin just wanted to be an American- father with a temper and epitome who seemed worthless to the rest of his world- lost his mother at age 11- attended college, then Harvard medical school (experienced depression during this time, but managed it with therapy sessions)4. Phillip-low grade depression; mild distant from physical body, but the effects on his physical body are obvious; functioned with low level depression for several years; youngest CEO of a fortune 500 company- for 16 years, he ignored his symptoms and buried himself in work; - collapsed in his office from severe panic attack, then admitted himself into mentalinstitution because he could no longer take it any longer- 100% convinced that his wife and 2 children would be better off without him - Safe in the hospital, a patient in the hospital encouraged him to speak out about his illness in order to help other people- Philip took his story public in Houston in front on a group of business - The consequences of untreated depression can be severe: 650,000 reported suicide attempts in the U.S each year- The act of encouraging others to seek treatment helped in his own recovery5. Treatment: Andrew-Medications, talk therapy, and exercise- Most cases of depression are treatable, but only about 50% of people experiencing depression seek help; - complex mix of medications is 1 component of his treatment- Remeron- atypical antidepressant- Zoloft-primary anti-depressant; SSRI- Wellbutrin-stimulating anti-depressant (while others are sedating)- Zyprexa-atypical anti-spychotic and helps control anxiety associated with - Namenda-actually an Alzheimer’s drug, but has mild anti-depressant effect;helps with the cognitive slow down you get from Remeron an Zyprexa- Remantidine-Counteracts the weight gain effects associated with the Remron and Zyprexa- Fish oil (he takes two kinds)- Anti-depressant medications have been around for over 50 years ; 25 approved drug-all of which targeting mood influencing chemicals in the brain- Healthy brain=release neurotransmitter that communicate with adjacent cellls work together like a circuit board- In the depressed brain-some neurotransmitters (serotonin, norepinephrine, and dopamine) stop working properly and communication breaks down- It took Andrew nearly 6 years to find medications that work best for him; finding the right drug is a trial and error process- Relative seratonin deficiency in depressed brain; dopamine (ability to experience pleasure) affected in depressed brain- Andrew makes weekly visits to a talk therapist (70-80% effective when combined with medication)- Frontal area and hippocampus, which is associated with memory and learning; early intervention is critical to the treatment process- Talk therapy is a primary way of reducing stress, a major risk factor in depression- The stress hormone cortisol (adrenal hormone hyper secreted during depression)may cause nerve cell death or shrinkage or neurons- Prefrontal cortex and hippocampus–smaller in some patients with depression - Anti-depressant treatments may reverse the damage because they increase the rate at which neurons are born and grow; viable hypothesis, just not yet proven- Proven: Exercise stimulates nerve cell growth in the hippocampus- Exercise can dramatically reduce the symptoms of depression in mild cases- Exercise is an essential part of Andrew’s treatment (along with medications and talk therapy)- What are Andrew’s treatments? Medications, talk therapy, and exercise6. Sherwin “Shep”-medication and talk therapy did not help him; ECT effective for him- he checked himself into a psychiatric hospital- his two children became his lifeline; when he looked at the picture of his children,he knew that he had to get better for them- frontal lobotomy suggested, but he knew that the majority of people who have lobotomy become passive in their intellects for the rest of their lives- ECT shock therapy tried first; ECT procedure worked!- began to feel better at 10th or 11th treatment; he knew that the bad stuff was over;7. ECT (electroshock therapy)-highly safe and effective treatment, especially for severe depression; - works particularly well among the elderly whose aging brains and bodies can be less responsive to medications and therapy - ECT creates a seizure in the brain and may alter the brain’s chemical balance- ECT works more rapidly than medications, but may cause short term memory loss and possibility of a relapse - Older people relapse at really high rates; chances of a younger person having another depression is about 50% in younger people; an older person