DEPRESSIONDEPRESSIONIts Symptoms, Causes Its Symptoms, Causes

and Treatmentand Treatment

Presentation by Presentation by

Dr Adelbert ScholtzDr Adelbert Scholtz

A REAL ILLNESSA REAL ILLNESS The World Health Organisation The World Health Organisation

recognises the various forms of recognises the various forms of depression as real illnessesdepression as real illnesses

Depression is not Depression is not weakness of character weakness of character or imagination or imagination

It’s impossible to just It’s impossible to just shake your depression shake your depression off off

THE DEPRESSED BRAINTHE DEPRESSED BRAIN

Decreased brain activity with Decreased brain activity with depressiondepression

OVERVIEW OVERVIEW

1. Symptoms1. Symptoms

2. Causes2. Causes

3. Treatment3. Treatment

1. SYMPTOMS1. SYMPTOMS

““Recession is Recession is when a neighbor when a neighbor loses his job. loses his job. Depression is Depression is when you lose when you lose yours.”yours.”Ronald ReaganRonald Reagan

ICD-10: F32 Depressive ICD-10: F32 Depressive Episode (1)Episode (1)

In typical mild, moderate, or severe In typical mild, moderate, or severe depressive episodes, the patient suffers depressive episodes, the patient suffers from lowering of mood, reduction of from lowering of mood, reduction of energy, and decrease in activity. Capacity energy, and decrease in activity. Capacity for enjoyment, interest, and concentration for enjoyment, interest, and concentration is reduced, and marked tiredness after is reduced, and marked tiredness after even minimum effort is common. Sleep is even minimum effort is common. Sleep is usually disturbed and appetite diminished. usually disturbed and appetite diminished. Self-esteem and self-confidence are almost Self-esteem and self-confidence are almost always reduced and, even in the mild form, always reduced and, even in the mild form, some ideas of guilt or worthlessness are some ideas of guilt or worthlessness are often present. often present.

ICD-10: F32 Depressive ICD-10: F32 Depressive Episode (2)Episode (2)

The lowered mood varies little from day to The lowered mood varies little from day to day, is unresponsive to circumstances and day, is unresponsive to circumstances and may be accompanied by so-called "somatic" may be accompanied by so-called "somatic" symptoms, such as loss of interest and symptoms, such as loss of interest and pleasurable feelings, waking in the pleasurable feelings, waking in the morning several hours before the usual morning several hours before the usual time, depression worst in the morning, time, depression worst in the morning, marked psychomotor retardation, marked psychomotor retardation, agitation, loss of appetite, weight loss, and agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number loss of libido. Depending upon the number and severity of the symptoms, a depressive and severity of the symptoms, a depressive episode may be specified as mild, moderate episode may be specified as mild, moderate or severe. or severe.

ICD-10: VARIOUS TYPES ICD-10: VARIOUS TYPES OF DEPRESSIONOF DEPRESSION

F32.0 Mild depressive episode F32.0 Mild depressive episode F32.1 Moderate depressive F32.1 Moderate depressive

episode episode F32.2 Severe depressive episode F32.2 Severe depressive episode

without psychotic symptoms without psychotic symptoms F32.3 Severe depressive episode F32.3 Severe depressive episode

with psychotic symptoms with psychotic symptoms F32.8 Other depressive episodes F32.8 Other depressive episodes F32.9 Depressive episode, F32.9 Depressive episode,

unspecifiedunspecified

BI-POLAR DISORDERBI-POLAR DISORDER

People suffering People suffering from this disorder from this disorder fluctuate between fluctuate between manic and manic and depressive phasesdepressive phases

It is a distinct It is a distinct disorder, not to be disorder, not to be confused with confused with “ordinary” “ordinary” depressiondepression

SYMPTOMSSYMPTOMS

The symptoms of The symptoms of depression are depression are characterised by certain – characterised by certain – Behaviours; Behaviours; Thoughts; Thoughts; Feelings; and Feelings; and Physical signs Physical signs

Evaluate yourself Evaluate yourself according to the checklist according to the checklist that followsthat follows

SYMPTOMSSYMPTOMS

For more than two weeks, For more than two weeks, have you –have you –

Felt sad, down or miserable Felt sad, down or miserable most of the time?most of the time?

Lost interest or pleasure in Lost interest or pleasure in most of your usual most of your usual activities?activities?If you have answered YES to If you have answered YES to either of the questions, either of the questions, evaluate yourself according evaluate yourself according the following checklist and the following checklist and count how many times you count how many times you answered YESanswered YES

SYMPTOMS SYMPTOMS (BEHAVIOURS)(BEHAVIOURS)

Stopped going outStopped going out Not getting things Not getting things

done done Withdrawn from Withdrawn from

family & friends family & friends Relying on sedatives Relying on sedatives

or alcohol or alcohol Stopped doing things Stopped doing things

you enjoy you enjoy Unable to concentrateUnable to concentrate

SYMPTOMS SYMPTOMS (THOUGHTS)(THOUGHTS)

““I’m a failure”I’m a failure” ““It’s my fault”It’s my fault” ““Nothing good ever Nothing good ever

happens to me”happens to me” ““I’m worthless”I’m worthless” ““Life is not worth Life is not worth

living”living” ““Nothing makes Nothing makes

sense anymore”sense anymore”

SYMPTOMS (FEELINGS)SYMPTOMS (FEELINGS) OverwhelmedOverwhelmed UnhappyUnhappy IrritableIrritable FrustratedFrustrated No confidenceNo confidence GuiltyGuilty IndecisiveIndecisive MiserableMiserable SadSad

PHYSICAL SYMPTOMSPHYSICAL SYMPTOMS Tired all the timeTired all the time Sick and run downSick and run down Headaches and Headaches and

muscle painsmuscle pains Churning gutChurning gut Cry easilyCry easily Can’t sleepCan’t sleep Poor appetite / Poor appetite /

weight lossweight loss

YOUR SCOREYOUR SCORE

If you answered If you answered YES to 3 or more YES to 3 or more of the symptoms of the symptoms on the checklist, on the checklist, you most you most probably may be probably may be diagnosed with a diagnosed with a depressive illnessdepressive illness

DEGREES OF DEGREES OF DEPRESSIONDEPRESSION

One can have mild, moderate One can have mild, moderate or serious depression. or serious depression.

Moderate chronic depression Moderate chronic depression is sometimes called dysthemia. is sometimes called dysthemia.

It may also be a single episode, It may also be a single episode, it may be a series of separate it may be a series of separate episodes or the depression episodes or the depression could be a chronic condition could be a chronic condition over a number of years. over a number of years.

All the variations, though, All the variations, though, exhibit the same symptoms. exhibit the same symptoms.

THE PRIME CAUSE OF THE PRIME CAUSE OF SUICIDESUICIDE

About 90% of About 90% of persons who persons who commit suicide are commit suicide are suffering from suffering from severe depression.severe depression.

Depression is, Depression is, therefore, a serious therefore, a serious condition that condition that cannot be ignored cannot be ignored or wished awayor wished away

QUOTESQUOTES

It's hard to answer the question It's hard to answer the question “what‘ s wrong” when nothing’s right.“what‘ s wrong” when nothing’s right.

I'm tired of trying, sick of crying, I I'm tired of trying, sick of crying, I know I've been smiling, but inside I'm know I've been smiling, but inside I'm dying.dying.

Tired of living and scared of dying.Tired of living and scared of dying. I'm just learning how to smile, I'm just learning how to smile,

and that's not easy to do. and that's not easy to do. The hardest years in life The hardest years in life

are those between ten and are those between ten and seventy. seventy.

2. CAUSES2. CAUSES

TYPES OF DEPRESSIONTYPES OF DEPRESSION

There are There are basically 2 basically 2

forms of forms of depression:depression:

Reactive Reactive depression depression

Endogenous Endogenous depression depression

REACTIVE DEPRESSIONREACTIVE DEPRESSION

An individual’s reaction to An individual’s reaction to some or other disaster or some or other disaster or serious loss, e g death of a serious loss, e g death of a beloved one, loss of beloved one, loss of income, loss of health income, loss of health or cessation of an important or cessation of an important relationshiprelationship

Nobody can stay untouched Nobody can stay untouched in these circumstances in these circumstances

Depression is a normal Depression is a normal reaction after such a blow or reaction after such a blow or lossloss

AGGREVATING AGGREVATING FACTORSFACTORS

Social isolationSocial isolation Inadequate dietInadequate diet Weak self-imageWeak self-image PessimismPessimism Chronic pain & bad healthChronic pain & bad health Dependency on alcohol & Dependency on alcohol &

other drugsother drugs

OVERDOSE OF STRESSOVERDOSE OF STRESS A certain amount of stress is A certain amount of stress is

beneficial beneficial An overdose of stress may be An overdose of stress may be

overwhelming and lead to overwhelming and lead to depressiondepression

Examples: Examples: Family strifeFamily strifeWork overloadWork overloadSocial demandsSocial demandsDeadlinesDeadlines

ENDOGENOUS ENDOGENOUS DEPRESSIONDEPRESSION

An inherited An inherited condition in condition in which the person which the person has an inability has an inability to produce to produce enough of the enough of the neurotransmitteneurotransmitters rs Serotonin, Serotonin, DopamineDopamine and and NoradrenalinNoradrenalin for for use in his brainuse in his brain

DEPRESSION AND DEPRESSION AND NEUROTRANSMITTERSNEUROTRANSMITTERS

Connection between depression and Connection between depression and deficiency of deficiency of Serotonin, Dopamine, Serotonin, Dopamine, NorepinephrineNorepinephrine and and EstrogenEstrogen

Deficiency may Deficiency may cause depressioncause depression

Depression may Depression may cause deficiencycause deficiency

COMBINED TYPECOMBINED TYPE

IIn most cases, depression n most cases, depression is a combination of is a combination of inherited factors and inherited factors and environmental factorsenvironmental factors

If one has the inherited If one has the inherited tendency to become tendency to become depressed it will not depressed it will not necessarily happennecessarily happen

If enough stress and other If enough stress and other factors do occur, factors do occur, depression may resultdepression may result

OTHER MEDICAL OTHER MEDICAL CONDITIONSCONDITIONS

Certain medical conditions may Certain medical conditions may have have

symptoms similar to depression:symptoms similar to depression: AnemiaAnemia Under-active Under-active

thyroid thyroid Heart conditionsHeart conditions

POST-NATAL POST-NATAL DEPRESSIONDEPRESSION Young mothers, especially with a first Young mothers, especially with a first

babybaby Hormones thrown into confusion with Hormones thrown into confusion with

the pregnancy and breast-feedingthe pregnancy and breast-feeding If only for a few days – reasonably If only for a few days – reasonably

normal (“baby blues”)normal (“baby blues”) For a longer period – dangerousFor a longer period – dangerous Depressive mother often does Depressive mother often does

not bind with the baby and not bind with the baby and doesn’t realise the doesn’t realise the necessity of looking after necessity of looking after the baby properlythe baby properly

BIBLICAL EXAMPLESBIBLICAL EXAMPLES

1 Sam 16: 14 – 23 – King 1 Sam 16: 14 – 23 – King Saul; young David had to Saul; young David had to cheer him up with his cheer him up with his harpharp

1 Ki 19: 4 – The prophet 1 Ki 19: 4 – The prophet Elija after his encounter Elija after his encounter with the prophets of Baalwith the prophets of Baal

Lam 3: 1 – 20 – The Lam 3: 1 – 20 – The people of Jerusalem after people of Jerusalem after the destruction of the the destruction of the citycity

IS DEPRESSION A SIN?IS DEPRESSION A SIN?

One of the One of the symptoms: feelings symptoms: feelings of guiltof guilt

Question: is it Question: is it sinful to be sinful to be depressed?depressed?

Depressed persons Depressed persons often angry at Godoften angry at God

Depression: not a Depression: not a sin, but a medical sin, but a medical conditioncondition

3. TREATMENT3. TREATMENT

A CHANGE OF A CHANGE OF SCENERY?SCENERY?

Some people Some people think that a think that a change of scenery change of scenery or a holiday is all or a holiday is all that is needed to that is needed to lift a depressionlift a depression

Depression can Depression can only be treated if only be treated if the causes have the causes have been identified been identified and eliminatedand eliminated

RETAIL THERAPY?RETAIL THERAPY?

Some people try to lift their Some people try to lift their depression by going on a depression by going on a shopping spreeshopping spree

This only increases their This only increases their problemsproblems

MEDICATIONMEDICATION

Antidepressants – meant Antidepressants – meant to increase the supply of to increase the supply of serotonin to the brainserotonin to the brain

Ineffective in many casesIneffective in many cases Often unpleasant side-Often unpleasant side-

effectseffects Don’t solve any problemsDon’t solve any problems

SLEEPING PILLSSLEEPING PILLS It is necessary to get enough It is necessary to get enough

quality sleepquality sleep Sleeping pills are highly Sleeping pills are highly

addictiveaddictive Don’t provide quality sleep – Don’t provide quality sleep –

only induce a stuporonly induce a stupor Only in an Only in an

emergencyemergency

SO, WHAT DOES HELP?SO, WHAT DOES HELP?

How do you How do you put the put the smile back smile back on your on your face?face?

PSYCHOTHERAPYPSYCHOTHERAPY

A psychologist A psychologist can help you can help you identify the identify the factors affecting factors affecting your conditionyour condition

Treatment may Treatment may include include hypnosis, EFT, hypnosis, EFT, CBT &tcCBT &tc

GROUP THERAPYGROUP THERAPY

Belong to a group Belong to a group with similar with similar problems – receive problems – receive social supportsocial support

Gain insight into Gain insight into your own problemsyour own problems

Group facilitator – Group facilitator – a mental health a mental health professionalprofessional

THERAPEUTICAL GOALSTHERAPEUTICAL GOALS

The goal of any therapy is to The goal of any therapy is to remove all remove all

the symptoms regarding –the symptoms regarding – Unhelpful behavioursUnhelpful behaviours Negative thoughtsNegative thoughts Bad feelingsBad feelings Unpleasant physical Unpleasant physical

symptomssymptoms

HOW TO HELP HOW TO HELP YOURSELFYOURSELF

There is much you can do There is much you can do to help yourself get rid of to help yourself get rid of many of the symptoms of many of the symptoms of

depressiondepression

SPIRITUAL LIFESPIRITUAL LIFE

Strengthen your relationship Strengthen your relationship with Godwith God

NUTRITIONNUTRITION

Eat enough FRESH veggies & Eat enough FRESH veggies & fruitfruit

Eat enough fibre & low GI foodsEat enough fibre & low GI foods Use supplements: Omega-3 Use supplements: Omega-3

fatty acids, Vit B comp., Vit C, fatty acids, Vit B comp., Vit C, zinc, calcium & zinc, calcium & magnesium magnesium

NUTRITIONNUTRITION Supplement with Supplement with

L-Tryptophan or L-Tryptophan or 5-HTP to 5-HTP to increase increase Serotonin levels Serotonin levels (not together with (not together with antidepressants)antidepressants)

Use Melatonin or Use Melatonin or GABA as a GABA as a sleeping aidsleeping aid

NUTRITIONNUTRITION

AVOID:AVOID: Food fried in oilFood fried in oil Fatty foodFatty food Processed foodProcessed food SugarSugar CaffeineCaffeine Alcohol & drugsAlcohol & drugsThese things mess with your brain These things mess with your brain

chemistrychemistry

EXERCISEEXERCISE Your body is designed for Your body is designed for

movementmovement Exercise produces Exercise produces

endorphins – potent pain endorphins – potent pain killers and killers and enhancers of moodenhancers of mood

Helps with Helps with relaxation & sleeprelaxation & sleep

Good for your Good for your overall health overall health

DO SOMETHING DO SOMETHING PLEASANTPLEASANT

Go for a walk with your dogGo for a walk with your dog Take a bubble bathTake a bubble bath Work in the gardenWork in the garden Practice a hobbyPractice a hobby Read a bookRead a book Listen to musicListen to music Go to the cinemaGo to the cinema Spoil yourself!Spoil yourself!

GET SOCIAL SUPPORTGET SOCIAL SUPPORT

Nurture your Nurture your relationshipsrelationships

Visit friends Visit friends and relativesand relatives

Avoid Avoid isolation – this isolation – this will only make will only make you feel worseyou feel worse

RELAXATION RELAXATION EXERCISESEXERCISES

Get your Get your partner to partner to massage your massage your back and legsback and legs

Practice Practice relaxation and relaxation and self-hypnosisself-hypnosis

JOIN A SUPPORT GROUPJOIN A SUPPORT GROUP Receive Receive

informationinformation Meet new Meet new

friendsfriends Become part Become part

of a network of a network where you where you can help can help othersothers