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Depressive Disorders

Depression has been recognized by mankind for millennia. The term melancholia (which means black bile in Greek) was first used by Hippocrates to describe the condition around 400 B.C. Most of the major symptoms of depression observed today were known in ancient times. Our modern understanding of depression was heavily influenced by the German psychiatrist Karl Leonhard, who after observing that some of his patients had histories of both depression and mania, while others had histories of depression only, proposed a distinction between unipolar and bipolar depression. Prior to this, depression was not seen as a separate diagnosis but rather, listed as a part of other disorders such as manic-depression and psychosis.



Characteristic Symptoms

The characteristic symptom of the depressive disorders is a persistently depressed and empty mood. A period of sadness or melancholy that occurs in reaction to a personal loss or trauma is often referred to as a reactive depression. While in some instances a reactive depression may be severe enough to require treatment, it is normally of short duration and self-correcting. In the depressive disorders, however, the depressed mood arises spontaneously and is long lasting, the symptoms are severe, and the individual is unable to function normally.

A major depressive episode is characterized by either a persistent depressed mood or loss of interest or pleasure in daily activities over at least a two-week period. Four or more of the following symptoms must also be present: Significant weight change or change in appetite, sleeping too much or not being able to sleep, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, an inability to concentrate or indecisiveness, and recurrent suicidal thoughts.

Types of Depressive Disorders

Major Depressive Disorder

Major Depressive Disorder is characterized by a major depressive episode that lasts at least two weeks and is severe enough to cause marked impairment in the individual’s ability to function in their daily life. A person may experience a major depressive episode only once, but more commonly episodes occur several times in a lifetime.

Persistent Depressive Disorder

Persistent Depressive Disorder (Dysthymia) is a less severe form of depression that is characterized by a chronically depressed mood for at least two years. The symptoms of dysthymia, while not seriously disabling, keep the individual from functioning well or feeling good. Many people with dysthymia experience major depressive episodes during their lives.


Prevalence and Age of Onset

The lifetime prevalence of the depressive disorders in the United States is estimated to be 16.6% for major depressive disorder and 2.5% for persistent depressive disorder. The depressive disorders occur more commonly in women than men. The age of onset for the first major depressive episode is usually late adolescence / early adulthood although the first episode can occur at any age. A family history of depression increases the likelihood that a child will also have a depressive disorder. The risk of suicide in people with major depressive disorder is about 20 times that of the general population. The rate of successful suicide in men is four times that of women, though women make more suicide attempts. Major depressive disorder is the leading cause of disability in the United States and the second leading cause of disability worldwide.




Treatment & Support

While depression is a dark and painful disorder, a number of effective treatments have been developed that can bring significant relief to those who are suffering. More than 80% of people with a depressive disorder will show improvement in their symptoms within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments. Treatment usually lasts for about a year. After that time, there is usually a discussion regarding the continuation of medication or psychotherapy with the mental health professional. There are a small percentage of individuals who have recurrent depression and require ongoing treatment to maintain recovery.

Antidepressants

Antidepressant medications are given to alter the levels of the neurotransmitters serotonin (5-HT) and/or norepinephrine (NE) in the brain. While some improvement in the symptoms of depression may be seen in just a few weeks, antidepressant medications generally have to be taken for three to eight weeks before the full therapeutic effect is realized. Because of the variability of response, a patient may have to try several antidepressants at different doses over a period of time before an effective treatment is found.

Antidepressants medications are grouped into five classes based on their structure and/or action in the brain. Monoamine Oxidase Inhibitors (MAOIs) are the oldest class of antidepressants. MAOIs inhibit an enzyme (monoamine oxidase) in the brain’s cells that breaks down neurotransmitters (including 5-HT and NE) making them inactive. Dietary restrictions are necessary when taking MAOIs to minimize dangerous side effects. Drugs in this class include phenelzine (Nardal), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (Emsam). Tricyclic Antidepressants (TCAs) work by inhibiting the brain’s reuptake of 5-HT and NE. They also partially inhibit the reabsorption of the neurotransmitter dopamine (DA). TCAs tend to have more side effects than other antidepressants. Side effects include weight gain, drowsiness, dizziness, nausea, dry mouth, constipation and increased heart rate. Drugs in this class include amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), nortriptyline (Pamelor), and imipramine (Tofranil). Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. This class of medications, as the name implies, blocks the reabsorption of 5-HT into the nerve cells. Drugs in this class include fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), and citalopram (Celexa). The Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are one of the newest types of antidepressant. These medications block the reabsorption of both 5-HT and NE into the nerve cells. Drugs in this class include duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Khedezla), levomilnacipran (Fetzima), and desvenlafaxine (Pristiq). The Atypical Antidepressants are a class of mostly newer medications that target neurotransmitters other than 5-HT and NE or have unique actions in the brain. Drugs in this class include bupropion (Wellbutrin), trazodone (Oleptro), mitazapine (Remeron), and Vortioxetine (Brintellix).

Psychotherapy

Research has found that two psychotherapeutic (talk therapy) approaches are effective in treating the depressive disorders, interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT). The foundational idea of IPT is that depression can be treated by improving how a person relates to others. IPT puts an emphasis on the way symptoms of depression are related to a person’s relationships. The goals of IPT are symptom reduction, improved interpersonal functioning, and increased social support. The major aim of cognitive-behavioral therapy (CBT) is to help the client eliminate negative beliefs and/or behaviors and replace them with positive ones.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT, also known as “shock treatment”, may seem like a frightening prospect for a patient seeking relief from depressive symptoms. In recent years, however, the ECT procedure has greatly improved, and clinical research clearly shows it to be an effective treatment for major depression. Prior to the procedure, the patient is given a muscle relaxant, and the procedure itself is performed under mild anesthesia. Electrodes are placed at precise locations on the head to deliver a low-level electrical current. The electrical stimulation causes a brief seizure in the brain, lasting about thirty seconds. It is not fully understood how ECT is effective in treating depression, although it is theorized that like antidepressants ECT alters the levels of certain neurotransmitters in the brain. For the full therapeutic effect, repeated sessions are usually required over several weeks.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. During the procedure, a large electromagnetic coil is placed against the patient’s scalp near the forehead. The electromagnet creates electric currents that stimulate nerve cells in the prefrontal cortex thought to be involved in mood control and depression. The procedure is painless, has no reported side effects, and is usually done as an outpatient procedure in a psychiatrist’s office or clinic. Daily sessions are usually required for four to six weeks to obtain the full therapeutic benefit. Each session last approximately 40 minutes.

 

A Spiritual Perspective

The depressive disorders share a core spiritual feature, hopelessness. We can clearly see that hopelessness in the Old Testament character Job as he cries out in his suffering, “My days are swifter than a weaver’s shuttle, and come to an end without hope” (Job 7:6) and “Where now is my hope?” (Job 17:15). As Job’s focus turned more toward his circumstances and away from his relationship with God, he lost sight of his hope and sank deeper and deeper into despair. Ultimately, Job recognized that true hope comes only through faith in the Redeemer (Job 19:25–26). Faith and hope are intimately connected.

The Scriptures teach us that “faith is the assurance of things hoped for, the conviction of things not seen” (Hebrews 11:1). If you are ministering to someone with a depressive disorder, a hope that transcends circumstances is what you have to offer them. The Scriptures were written to encourage us and to give us hope. Use God’s Word to rebuild their hope. Show them that heroes of faith like David (Psalm 13), Job (Job 3), and Jeremiah (Lamentations 3) struggled with times of intense hopelessness. Remind them that while deep despair and hopelessness can occur in believers, God is faithful. Demonstrate to them how focusing on that single truth brought hope to the prophet Jeremiah at his lowest point: “This I recall to my mind, therefore I have hope. The Lord’s loving kindnesses indeed never cease, for His compassions never fail. They are new every morning; great is Your faithfulness” (Lamentations 3:21–23).


Finding Care

Mental Health Care Providers

When assisting an individual it is important to help them find the right type of mental health care provider. These links will assist you in beginning your provider search. Knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment, as well as, being able to better support them once they begin receiving professional treatment.

An individual struggling with a depressive disorder will most likely need to see both a clinical psychologist / therapist for psychotherapy (talk therapy) and a psychiatrist for medication.

By providing your zip code the following search engines will give you information about local mental health care providers.

Clinical Psychologists / Therapists Psychiatrists


Treatment Facilities

In some people, depressive disorders become so severe that a hospital stay is needed. This may be necessary if the individuals seeking your care can’t take care of themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric treatment at a hospital can help keep them calm and safe until their mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

By providing your zip code the following search engine will give you information about mental health treatment facilities in your area.

Substance Abuse and Mental Health Services Administration American Residential Treatment Association


Support Groups

Recognizing that community is one of the factors necessary for successful recovery, attending support groups can be a powerful and meaningful way to connect with others facing similar challenges. Support group experiences allow people affected by mental health difficulties and disorders to connect in a safe and supportive environment. Support groups are led by trained facilitators and teach coping skills, help reduce anxiety, build resiliency and provide a place for people to share common concerns and receive emotional support.

These links will give you information on support groups for depressive disorders in your area.

Depression and  Bipolar Support Alliance National Alliance on Mental Illness Grace Alliance  Fresh Hope for Mental Health


Supporting the Family

Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers. Many times the caregiver needs as much support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with depressive disorders.

These links will give you information on caregiver (family) support groups in your area.

Anxiety and Depression Association of America National Alliance on Mental Illness – Family Support Group National Alliance on Mental Illness – Family to Family Support GroupGrace Alliance  Fresh Hope for Mental Health



Educational Resources

Here are some links to aid you in learning more about bipolar disorders. The more knowledge you have, the better you are able to help those seeking your guidance.

National Institute of Mental Health Mental Health America


Downloadable Resources 

First Step – What to do once a diagnosis has been made.

Daily Steps – Developing a holistic mental health care plan.

Difficult Steps – Navigating destructive behavior and legal issues.

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