3. Introduction
Depression is a mood disorder
characterized by persistently low mood
and a feeling of sadness and loss of
interest. It is a persistent problem, not a
passing one, lasting on average 6 to 8
months
3
4. DEPRESSION AS A MOOD STATE
•As a reference to mood, depression
identifies a universal human experience.
Adjectives from a standard measure of
mood (The
Multiple Affect Adjective Checklist; Zuckerman
& Lubin, 1965) point to subjective feelings
associated with a depressed mood: sad,
unhappy, blue, low, discouraged, bored,
hopeless, dejected, and lonely.
4
5. cont.
As described by the DSM 5(pg55), the
common feature of depressive
disorders is the presence of sad,
empty or irritable mood ,accompanied
by somatic and cognitive changes that
significantly affect the individual’s
capacity to function
5
6. def
Depression can be defined as a mental
state characterized by feelings of
sadness, despair, unhappiness,
worthlessness, and hopelessness.
6
7. Cont.
According to the Centers for Disease
Control and Prevention (CDC),7.6
percent of people over the age of 12
have depression in any 2-week period
7
8. According to theWorld Health
Organization (WHO), depression
is the most common illness
worldwide and the leading cause
of disability.They estimate that
350 million people are affected by
depression, globally.
8
10. •one fifth of the adult population will
have significant
depressive symptoms, and that most
of this depression goes untreated
(Weissman & Meyers, 1981).
10
11. •Depression seems to be more
common among women than men.
•Symptoms include lack of joy and
reduced interest in things that used
to bring a person happiness.
11
12. •Life events, such as bereavement,
produce mood changes that can
usually be distinguished from the
features of depression.
•The causes of depression are not
fully understood but are likely to
be a complex combination of
genetic, biological,
environmental, and psychosocial
factors.
12
13. When a person's depression becomes
such that the individual cannot
function or is a danger to society, that
depression has moved out of the
normal range.The individual must
have professional help.
13
15. Life events:These include
bereavement, divorce, work
issues, relationships with friends
and family, financial problems,
medical concerns, or acute
stress.
15
16. Personality: Those with less
successful coping strategies, or
previous life trauma are more
susceptible.
16
21. Chronic pain syndromes:These
and other chronic conditions, such as
diabetes, chronic obstructive
pulmonary disease, and
cardiovascular disease and
fibromyalgia (which amplifies painful
sensations by affecting the way your
brain processes pain signals ) make
depression more likely. 21
23. Exogenous Depression
is often referred to as situational
depression because it comes from
something outside the person.
Possible causes include the loss of a loved
one (death or departure of a parent or
child); loss of self-esteem due to
business failure, rejection, or divorce; or
inability to express or admit anger
toward others ("holding it in").
23
24. Endogenous Depression
Just comes out of the blue and is not
caused by any situation or event.
•It may be caused by a chemical
imbalance in the brain.
•Much research in this area indicates
that this type of depression may be due
to some mental illness or even a dietary
deficiency. 24
25. Endogenous Depression, the type that
comes out of the blue, is more severe
than Exogenous depression.
25
28. bipolar depression
(previously called manic
depression).
is characterized by both
manic and depressive
episodes separated by
periods of normal mood
28
29. Postpartum depression
Women often experience "baby blues"
with a newborn, but postpartum
depression- also known as postnatal
depression – is more severe
29
30. seasonal affective
disorder (SAD)
this condition is related to the
reduced daylight of winter - the
depression occurs during this
season but lifts for the rest of the
year and in response to light
therapy.
30
32. •Trouble with concentration and
memory.
•Feelings of guilt about
inconsequential events.
•Insomnia or excessive sleepiness.
•Feelings of hopelessness and
worthlessness.
•Withdrawal from activities and
interests. 32
33. •Decreased interactions with family
and friends.
•Decreased work productivity.
•Decreased relationship with
coworkers.
•Changes in bowel habits.
•Weight loss or gain.
•Decreased libido (sexual drive).
•Slowed speech and/or motor activity.
33
34. Endogenous Depression
Cluster Symptoms
A typical symptom cluster for endogenous
depression includes:
• Retardation of thought and motion
(thinks in "slow motion").
• Substantial weight loss due to very poor
appetite.
• Feeling that depression "crept upon him"
34
35. Endogenous Depression Cluster
Symptoms(contd)
• Feeling that depression "crept upon
him" and "came out of the blue."
• Wakes very early in the morning and
can't get back to sleep.
• Feels worse in the morning and
improves as the day goes on.
• Does not react to the environment. 35
36. Endogenous Depression Cluster
Symptoms(contd)
•Wakes very early in the morning and
can't get back to sleep.
• Feels worse in the morning and
improves as the day goes on.
• Does not react to the environment.
36
37. Exogenous Depression
Cluster Symptoms
A typical symptom cluster for
exogenous depression includes:
• Precipitating event.
•Trouble getting to sleep at night.
• Feeling fine in the morning and
getting worse as the day goes on.
37
38. Exogenous Depression Cluster
Symptoms(contd)
• Weight loss of less than 10
pounds.
• Reaction to the environment--if
the person is with an "up"
crowd, he will seem to come out
of his depression for a while.
38
40. 1. medication
Types of medications used
with severely disturbed
depressive patients
include Antidepressant,Tran
quilizing, and Anti-anxiety
drugs. 40
41. N/B: drug treatment is combined with
other forms of therapy such as individual
or group psychotherapy. Medications
given to treat depression are classified in
three groups:
•Anti-anxiety Agents
•Antidepressant Agents
•Anti-psychotic Agents
41
43. Anti-Anxiety Medication includes the
following Agents:
•Hydroxyzine (Atarax®,Vistaril®).
•Meprobamate (Equanil®, Miltown®).
•Chlordiazepoxide (Librium®).
•Diazepam (Valium®).
•Central nervous system (Central
Nervous System) depressants
producing mild sedation are included in
anti-anxiety medication. 43
45. •Antidepressant Agents commonly used
include the following:
• Imipramine (Tofranil®).
•Amitriptyline (Elavil®).
•Amitriptyline and Perphenazine (Triavil®).
•Doxepin (Adapin®, Sinequan®). Central
Nervous System depressants producing mild
sedation are also included as
antidepressants.
• Improvement of depression may take one to
four weeks. 45
47. 47
Anti-Psychotic Agents that are
commonly used are as follows:
Thioridazine (Mellaril®).
Haloperidol (Haldol®).
Lithium (Lithane®, Lithonate®).
Central Nervous System depressants
used as antipsychotic agents
are sedative or hypnotic and do not
depress the vital centers.
Generally, Central Nervous System
depressants are NOT used to treat
depression.
48. Myths on depression
• Myth #1: Depression doesn’t affect me.
• Fact: According to a 2004 survey by the American College
Health Association, nearly half of all college students report
feeling so depressed at some point in time that they have
trouble functioning, and 15 percent meet the criteria for
clinical depression.This means that someone in your life
that you care about or maybe yourself could face
depression at some point in college or in adulthood.
49. • Myth #2: Depression is not a real medical problem.
• Fact: Depression is a real and serious condition. It is no
different than diabetes or heart disease in its ability to
impact someone’s life. It can have both emotional and
physical symptoms and make life very difficult for those who
have it.The medical community has acknowledged the
seriousness of depression and recognizes it as a disease.
While no one is completely certain what causes depression,
we know that genetic and biological factors play a significant
role in development of this disease.
50. • Myth #6: Antidepressants will change your personality.
• Fact:The thought of taking medicine that changes your brain
chemistry can be scary. However, antidepressants are
designed to change only certain chemicals that underlie the
symptoms of depression, not to change your personality.
Most people who take antidepressants are actually happy to
feel like themselves again, rather than feeling like a different
person. It is best to speak with your doctor about the effects
that antidepressants can have.
51. Myths of suicide
•Myth #1: People who talk about suicide do not
mean to do it.
•Fact: People who talk about suicide may be
reaching out for help or support. A significant
number of people contemplating suicide are
experiencing anxiety, depression and
hopelessness and may feel that there is no other
option.
53. Theoretical approaches
to depression
Today we will focus on :
a)Behavioral thories
b)Interpersonal theories
c)Cognitive theories
d)Socialcognitive theories
e)Psychoanalytic approach 53
54. Depression is the number one
reason people seek mental
health services to enhance
speed recovery, yet most people
suffering from major depression
return to normal without
professional help (Meyer, 2001). 54
55. Behavioral approaches
Behavioral therapists describe
depression as unhealthy reaction to
stress, and the greater the stress the
more severe the unhealthy response
(Coleman, 1964).
Depression often arises as a reaction to
stressful events, such as breakup of a
relationship, the death of a loved one, a
job loss, or a serious medical illness. 55
56. Behavioral approaches(contnd)
Depressed people are more likely
than no depressive people to have
chronic life stressors, such as
financial strain or bad marriage.
People who suffer depression also
tend to have a history of traumatic
life events, particularly events
involving loss (Kessler, Davis,
&Kendler, (1997).
56
58. Behavioral approaches(contnd)
people with poor social skills, are more
likely to experience rejection by others
and to withdraw in response to this
rejection, rather than find ways to
overcome the rejection (Lewisohn,
1974). In addition, once a person begins
engaging in depressive behaviors, these
behaviors are reinforced by the
sympathy and attention they engender
in others.
58
59. InterpersonalTheories
Klerman et al. (1984) suggests that
Disturbances in the roles that people
create create in close relationships are
thought to be the main source of
depression.These disturbances may be
recent, as when a woman who believes
that her marriage has been successful
for years suddenly finds that her
husband is having an affair
59
60. InterpersonalTheories(continued)
Jack (1991) argues that women
are socialized to base most of
their self-concept and self-worth
on their relationships with
others and this is what makes
them more prone than men to
depression 60
61. InterpersonalTheories(continued)
Females are more likely to silence their
own needs and wants in a
relationship in favor of maintaining a
positive emotional tone in the
relationship and to feel too
responsible for the quality of the
relationship.This leads females to
have less power and to obtain less
benefit from relationships (Helgeson,
1994)
61
62. CognitiveTheories
The cognitive theories of depression
argue that the ways people interpret
the events in their lives determine
whether they become depressed.
According to Beck (1967) depressed
people look at the world through a
negative cognitive triad:
They have negative views of themselves,
of the world, and the future, which is
maintained by, distorted thinking.
62
63. CognitiveTheories(contd)
Burns (1980) illustrates examples
of cognitive distortion such as
first, overgeneralization
whereby depressed people see a
single negative event as a never
ending pattern of defeat,
second, mental filter 63
64. Social-cognitive perspective
The social-cognitive perspective
speculates that negative moods feed
negative thoughts.
Self-defeating beliefs, self-blame and
negative attributions do support
depression.
Barnett and Gotlib (1988) note that such
cognitions are indicators of depression.
64
65. Social-cognitive perspective
Depression thoughts coincide with a
depressed mood. But, before or after
being depressed, people’s thoughts
are less negative. Perhaps this is
because, a depressed mood triggers
negative thoughts
65
66. PsychodynamicTheories
Freud (1926) believed overt
symptoms were an expression of
underlying psychological
disturbance. As symptoms are a
substitute for repressed conflicts
the perceptual of the symptom
enables us to avoid facing
devastating personal truths
66
67. PsychodynamicTheories(contnd)
Freud 1917 and Abraham 1924
demonstrated that the illness was
related to loss whereby the lost object
is internalized, but as a consequence of
ambivalent attitude to the lost object
there occurs within the patient a
conflict of feelings between love and
hate.The hate may be directed against
the object because of abandonment.
This results in self-hatred leading to
self-criticisms.
67
69. Free association
This is a psychoanalytic technique
which allows the client to freely
express themselves as you
analyze the psychological
disturbance presented
69
70. Dream analysis
Dreams have two levels of content:
• Latent content that consists of hidden,
symbolic and unconscious motives, wishes
and fears. Because they are painful and
threatening, the unconscious sexual and
aggressive impulses are transformed into the
more acceptable.This process is known as
dream work
• Manifest content which is the dream as it
appears to the dreamer.The therapist task is
to uncover disguised meaning by studying
the symbols that manifest in the content of
the dream.
70
71. Systematic desensitization
Systematic desensitization is a
behavioral therapy technique where by
a person overcomes the maladaptive
anxiety elicited by a situation or an
object by approaching the feared
situation gradually, in a psycho
physiological state that inhibits the
anxiety. 71
72. Relaxation training
The signs of relaxation are
a. Physiological signs: slow heart rate, increased
peripheral blood flow and neuromuscular stability,
pupil constriction, increased peripheral
temperature, decreased oxygen consumption
b. Cognitive signs: altered state of consciousness,
heightened concentration on single mental image
c. Behavior changes: lack of attention and concern
for the environmental stimuli, no verbal
interaction, no voluntary change in the position .
72
73. Carl Rodgers’ Core conditions
Congruence - the willingness to
transparently relate to clients without
hiding behind a professional or personal
facade.
Unconditional positive regard - the
therapist offers an acceptance and
prizing for their client for who he or she
is without conveying disapproving
feelings, actions or characteristics and
demonstrating a willingness to
attentively listen without interruption,
judgment or giving advice. 73
74. Unconditional positive regard - the
therapist offers an acceptance and
prizing for their client for who he or she
is without conveying disapproving
feelings, actions or characteristics and
demonstrating a willingness to
attentively listen without interruption,
judgment or giving advice.
Empathy - the therapist communicates
their desire to understand and
appreciate their client’s perspective.
74
76. Reversal exercise
Certain symptoms and behaviors
often represent reversals of
underlying latent impulses.Thus, a
therapist could ask a person who
claims to suffer from severe
inhibitions and excessive timidity to
play the role of exhibitionist 76
77. The Rehearsal Exercise
Internal rehearsal consumes much
energy and frequently inhibits our
spontaneity and willingness to
experiment with new behavior. When
clients share their rehearsal out loud
with a therapist, they become more
aware of the many preparatory means
they use in bolstering their social roles 77
78. A-B-CTheory of Personality
The A-B-C theory of personality is central to (REBT) theory and
practice
A (activating event) B (belief) C (emotional and
behavioral consequence)
D (disputing intervention) E (effect) F (new feeling)
78
79. Changing one’s Language
REBT contends that imprecise language
is one of the causes of distorted
thinking process. Clients learn that
“musts,” “shoulds,” and “oughts” can
be replaced by preferences e.g. instead
of saying “It must be absolutely awful
if….”They learn to say “it would be
inconvenient if…” 79
