"Teachers: Nikki neuron reminds you to check the standards tables in the front of the toolkit to see which ones apply for this lesson and your subject area."
■ Identify symptoms of depression and its prevalence.
■ Analyze the defining nature of depression.
■ Describe the major types of depression.
■ Identify risk factors and course of depression.
■ Relate the co-morbidity of depression to other illnesses.
■ Evaluate the social and economic costs of depression.
■ Understand depression in the context of culture.
Suggestions for Presentation of Material
■ Write on the board: the words “sad,” “blue,” and “hopeless.” Talk about normal feelings. Invite the students to discuss whether they think these feelings are different than what is called “depression.” Discuss the importance of these symptoms. Then write on the board the other symptoms of depression to show what clinical depression looks like.
■ Write on the board: “19 million” (number of depressed persons in adult U.S. population); “148 billion” (cost in dollars in the United States in 1990 for all types of mental illness); “63 billion” (cost in dollars in the United States for lost productivity due to mental illness of all types); “1 in 8” (estimated number of adolescents who may be depressed). Ask students what they think the numbers refer to. To convey the significance of the figures, give figures for the gross national product and sectors of the economy and federal budget, such as education, defense and the environment. Invite the students to discuss the impact of these figures on society. Write their answers on the board.
■ Discuss the importance of getting help, for economic as well as social and psychological reasons. Describe scenarios that engage students: why a parent might be depressed and the effect on other family members; why a child or teenager might be depressed and the effect on the kid’s quality of life (friendship, school, fun), etc. Discuss conditions in a community that might make some people especially vulnerable to depression (such as poverty, violence, high number of single-parent families, lack of social support).
Key Points of Discussion
Depression vs. normal low moods: Depression is more than a passing mood but is a very treatable medical illness. If left untreated, symptoms can last for weeks, months, or years and can reoccur.
Symptoms of Depression
■ A depressed mood: pervasive feelings of sadness and/or emptiness (in children and adolescents, can be irritability or frustration) or
■ Loss of interest or pleasure in activities, and at least four additional symptoms of the following:
■ Significant changes in appetite; weight gain or loss
■ Insomnia or excessive sleeping
■ Chronic and high levels of irritability or agitation or
■ The opposite: persistently slow moving or sluggish
■ Loss of energy, persistent lethargy or fatigue
■ Excessive or inappropriate feelings of guilt or worthlessness
■ Inability to concentrate or indecisiveness
■ Recurring thoughts of death or suicide
Types of Depression
■ Major depressive disorder: A more severe form of depression that tends to reoccur over the course of the person’s life.
■ Dysthymia: A condition that is milder than major depressive disorder, but chronic. Many people with dysthymia experience a major depressive episode at some time in their lives.
■ Bipolar disorder: A type of serious mental illness, once called manic-depression, in which an individual alternates between periods of extreme depression and periods of mania. Manic episodes are characterized by highly energetic, driven behavior and thinking, during which an individual may have racing thoughts, unrealistically positive or grandiose expectations, inflated views of one’s abilities, little need for sleep, a tendency to talk about a number of rapidly changing subjects, a propensity for getting heavily involved in a number of projects without finishing them, and excessive involvement in pleasurable or high-risk activities to the extent that they may risk experiencing negative consequences. Mania can become severe enough that psychosis (failure to differentiate reality from unreality) develops.
■ Substance-induced mood disorder: A type of depression attributed to exposure to an environmental toxin, medication or illicit drug.
■ Mood disorder due to a medical condition: A type
of depression that is induced by any of a spectrum of medical problems such as Parkinson’s disease, stroke, endocrine dysfunction (particularly of the thyroid gland), AIDS, and some cancers.
■ Other types of depression:
Postpartum depression – occurs in women following childbirth, possibly because of hormonal changes during pregnancy and after childbirth. Symptoms are similar to major depression and may include feelings of worthlessness or guilt especially related to failure as a mother, as well as excessive anxiety about the child’s health, and fear of being alone with or harming the baby or oneself.
Seasonal affective disorder (SAD) – results from reduced sunlight during the fall and winter. Increased environmental lighting of specific types may be an effective treatment.
Prevalence: Who Gets Depressed?
■ People of all ages, races, ethnic groups and social classes can become depressed. In any given one-year period, 9.5% of the population, or about 18.8 million American adults, suffer from a depressive illness.
■ Although depression can strike at any age, its onset is typically between the ages of 24 and 44.
■ The rate of teenage depression is on the rise, and with that, teenage suicide is on the increase.
■ Depression is even seen in younger children, although the symptoms are not always as easy to recognize at these young ages.
■ Major depressive disorder affects 5% to 12% of men and 10% to 25% of women at some point in their lifetime. We don’t know why more women than men are diagnosed with depression, but the disparity could be caused by differences in learned gender roles. Males are socialized to be self sufficient and emotionally “tough,” so they are less likely to admit to or seek help for depression, seeing depression as a sign of weakness or low masculinity. The higher prevalence of depression among females may be due in part to hormonal fluctuations associated with childbirth, the menstrual cycle and menopause.
Course of Depression:
Onset to Outcome
■ Symptoms usually evolve gradually, often taking weeks to months for a major depressive episode to develop. With treatment, the length of the episode may be greatly reduced.
■ It is estimated that approximately 50% of those who have had a single depressive episode will have another episode at some point in their lives. With each untreated episode, the risk for future episodes increases.
Suicide and Depression
■ A very common symptom of depression is preoccupation with death or suicide.
■ For ages 15-25 years, suicide is the third leading cause of death.
■ When dealing with someone who is depressed, it is important to carefully assess for suicidal ideas, plans and intent, and to provide treatment and support to minimize the risk of this most devastating outcome of the disease of depression.
■ Any talk of suicide, even that which seems joking, should be taken seriously.
Risk Factors for Depression
■ Being older
■ Having symptoms of anxiety
■ Involvement with substance abuse
■ Exposure to stressful life events: eg., marital conflict, early childhood physical or sexual abuse, poor relations with peers, learning disability
■ Major life changes, particularly the death of a spouse or loved one
■ Negative change in health status
■ Chronic pain
■ Family or personal history of depression
■ Social isolation
■ A pessimistic outlook on life and perception of self and others
Cognitive and Other Factors
Associated with Depression
■ Chronic low self-esteem
■ Distorted perception of others’ views
■ Distorted sense of life experience
■ Inability to acknowledge personal accomplishment
■ Negative idea of self
■ Pessimistic outlook
■ Quick and exaggerated temper
Depression and Co-Morbidity
■ Co-morbidity means having more than one illness at the same time.
■ Depression commonly co-occurs with medical illnesses but often goes unrecognized.
■ Depression often co-exists with other mental illnesses: substance abuse, anxiety disorders and eating disorders are commonly accompanied by depression.
The Social and Economic Costs
■ Depression is among the most common of chronic health problems. It is associated with higher societal costs than many other chronic diseases.
■ Persons with depression spend more days in bed than those with other chronic illnesses.
■ In 1990, mental disorders of all types cost the nation an estimated $148 billion.
■ Treatment brings some degree of relief in more than 80% of cases, enabling most people with depression to return to satisfying, productive lives.