Twenty-three year old Janice was having a hard time getting out of bed everyday. She would often lie in her darkened room long past noon, disregarding the chores, her own grooming, and she rarely spent anytime with her five year old son Rory. Rory’s care was put almost entirely into the hands of Janice’s mother, Dorothea, who had taken both of them in after Janice’s husband had left them. Janice, when she was out of the confines of her room, was constantly snapping at her mother and son, and her lack of appetite had caused the already petite girl to lose fifteen pounds in under a month.
Dorothea became increasingly concerned with her daughter’s restlessness and apathy, as well as some of the other problems with self-esteem and inability to concentrate. She sought out help at her church, and the pastor told Dorothea that he’d be sending a social worker to her home to interview Janice. It took no more than a few moments of talking with Janice, that the social worker could see definite symptoms of depression. She referred Janice to a psychologist who confirmed the assumption with a diagnosis of Single Episode Depression.
The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), characterizes depression as a mood disorder, and defines it as: “A. Five (or more) of the following symptoms which have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure. (1) Depressed mood most of the day, nearly every, as indicated by either subjective report (e. g. , feels sad or empty) or observation made by others (e. g. , appears tearful). In children or adolescents, can be irritable mood.
(2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others). (3) Significant weight loss when not dieting or weight gain (e. g. , a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (4) Insomnia or hypersomnia nearly every day. (5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
(6) Fatigue or loss of energy nearly every day. (7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self reproach or guilt about being sick). (8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). (9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e. g. , a drug of abuse, a medication), or a general medical condition. E. The symptoms are not better accounted for by bereavement after the loss of a loved on, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. ”
This illness involves the body, mood and thoughts, and it can affect everything about a person. It is not the same as just a passing feeling of “blues,” or a sign of personal weakness. People with a depressive illness cannot merely “pull themselves together,” and have everything the way it was. The disorder can last for weeks, months, or even years, and treatment can help, but is not guaranteed to prevent a future episode. In any given one-year period, up to 10 percent of the population (about 19 million American adults) is affected by this disorder, but only around 10 percent of documented cases receive clinical treatment.
Despite the few that seek treatment, most can be helped due to productive research on medications and psychosocial therapies that can aid with the healing from this disorder. Some types of depression run in families, a theory that suggests that a biological vulnerability can be inherited. But, not everybody with the genetic makeup that causes this vulnerability for depression will have the illness. Apparently, additional factors, possible stresses at home, work or school are involved in its onset. Inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.
People who have low self esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether or not this represents a psychological predisposition or an early form of the illness is not clear. In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as a stroke, heart attack, cancer and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period.
Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Dr. Ellen Leibenluft, director of affective disorders in the National Institute of Mental Health’s Pediatrics and Developmental Neuropsychiatry has been conducting research on the effects of depression and the gender difference.
She reported that men and women report similarities in the degree of impairment, length of episodes, chronicity of the illness, time to first recurrence, but women are much more likely to report seven or eight symptoms of depression, more than men. Pure depression – a case with no other psychological illnesses – is more common in women, or if it is a secondary disorder, it is generally accompanied by an anxiety disorder. Men, however, generally are diagnosed with depression in conjunction with substance abuse or conduct disorder.
Substance abuse is not absent from women, nonetheless, they are more apt to develop a substance abuse disorder following the depression. The substance of choice is generally alcohol, and, like many other cases, it is used as an escape from their current environment. Women and men of all socio-economic statuses are subject to a mood disorder, but it seems much more common in those who are at or under the poverty level. Lisa Renzi, a graduate student of psychology at the University of Georgia, has been working with families who are on welfare for several months.
Her initial research is being conducted on physical abuse, both focused on women and children, but she finds a common link between many of these families. “I’d estimate that close to 40 percent of the mothers or children in the families I work with have some level of depression” (interview). She reports that many of the mothers are also alcoholics, using the drug as a means to forget about their unfortunate situation. Renzi recently expressed concern for one of the women, a twenty-five year old mother of four, who often shows little emotion during their sessions, and believes that there maybe intentions of harming herself or her children.
Many of these families are already working with social workers, and after Renzi has concluded her study, she will be able to contribute the research in hopes of finding better solutions for treatment. One of the most severe consequences of depression is the need or desire to end one’s life. Dr. William McDonald of Emory University studied the statistical evidence of suicide attempts in depressed individuals. “If you look at a population of people who are untreated and have severe, major depression, 15 percent of people will eventually go on to kill themselves” (Gupta & McDonald, CNN).
He and his colleague, Dr. Sanjay Gupta, were firm believers that if someone thinks that they could have depression, there is a high probability that they do. And instead of ignoring the problem, they should seek medical care before they find themselves seeking ways to end their suffering. Fortunately, for those who are suffering from this disorder, treatment is vastly effective. Antidepressants fall under three main categories: selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs).
SSRIs affect neurotransmitters in the brain such as dopamine and norepinephrine, and they generally have fewer side effects than tricyclics. MAOIs, while effective, can be fatal when mixed with foods that contain high levels of tyramine, such as many cheeses, wines and pickles . Psychotherapy, another form of treatment, often involves patients talking though their episodes in hopes of resolving their problems. Interpersonal therapists focus on the patient’s disturbed personal relationships that both cause and exacerbate the depression.
Cognitive-behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression. Psychodynamic therapies focus on resolving the patient’s internal conflicts. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication along with, or preceding psychotherapy for the best outcome. Depression can affect anyone at anytime during their lives. It is not a weakness or failure.
The disorder can be treated if the person who is suffering is able to recognize that they are in need of help. It effects more than just the person diagnosed, though. As the symptoms rise to the surface, someone who is irritable can cause a rift between family members, inactivity will promote a feeling on being unwanted, and feelings of worthlessness may lead to suicide, which hits everyone hard. It is extremely important for social workers to identify depression in their clients if they are to truly get back on their feet and become part of society again.
Bibliography : Works Consulted Barker, Krista L. (Speaker). (February 2002). Mental Health. Athens, GA: SOWK 2154. Depression. (2001). Mental Health Sanctuary. Available: http://www. mhsactuary. com/depression/depression1. htm Gupta, Sanjay and William McDonald (Transcript). Conquering Depression Today (March 8, 2002). Atlanta, GA: CNN. Leibenluft, Ellen. (2001). Depression Can Differ in Men and Women. National Institute of Mental Health. Renzi, Lisa. Personal Interview. April 14, 2002.