Tuesday, 4 August 2015

More Research

Issue:
One of the most common symptoms of depression is lack of motivation, the inability to simply do anything. Not doing anything has a variety of negative impacts to an individual (low self-esteem, less active, limited contact, stress builds up) which in turn makes the depression worse.

“The journey of 1000 miles starts with a single step”

It’s not that we don’t want to feel better, we just lack the physical motivation to move and the emotional motivation to care if we move.

Your mood is closely linked to your thoughts and ideas, and all the stuff that’s happened to you and around you. On top of that, your body has chemicals in it that control your mood. Sometimes these chemicals get out of balance. As well as causing low mood, this imbalance can also be triggered by your own negative thinking. They both make things worse, which is why depression is said to ‘feed on itself’



71% of depressed people get side-tracked easily by obstacles to their
goals (vs. 57% for non-depressed people).


65% of depressed people have difficulty getting themselves going when they know
they have a lot of tasks to take care of (vs. 53% for non-depressed people).


60% of depressed people admit that they've put off completing their personal goals
several times (vs. 40% for non-depressed people).


48% of depressed people admit that fear often holds them back from accomplishing
their goals (vs. 28% for non-depressed people).













Background:
Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.
Depression can be long-lasting or recurrent, substantially impairing an individual’s ability to function at work or school or cope with daily life. At its most severe, depression can lead to suicide. When mild, people can be treated without medicines but when depression is moderate or severe they may need medication and professional talking treatments.
Key facts
Depression is a common mental disorder. Globally, more than 350 million people of all ages suffer from depression.
Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease.
More women are affected by depression than men.
Although there are known, effective treatments for depression, fewer than half of those affected in the world (in some countries, fewer than 10%) receive such treatments.

The burden of depression and other mental health conditions is on the rise globally.
Unipolar depression: in its typical depressive episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.
Depression results from a complex interaction of social, psychological and biological factors. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

In the same survey, the most common social networks people belong to were: people from work or school (47%), online networks such as social media, gaming and forums (46%), and sports clubs or hobby/interest groups (27%).
Around 40% of people took notice often (score of 8 or more); more people aged 60 years and older took notice often, as did more Māori and Pacific people compared with other ethnic groups. There was little difference with income. People’s wellbeing increased as they took notice more, with people who did so “always” having an average wellbeing score of 48.1, compared with 28.0 for people who “never” took notice. 3
One in six people sometime in their life, and one in seven young people, have a problem with depression.
Audience:
One in seven young New Zealanders experience a major depressive disorder before the age of 24.
One in six people sometime in their life, and one in seven young people, have a problem with depression.
How common is depression? It’s very common. One in six New Zealanders will experience a major depressive disorder at some time in their life. It’s more common among females (one in five females, compared to one in eight males).



In the 2012/13 New Zealand Health Survey, one in six New Zealand adults (16%, or an estimated 582,000 adults) had been diagnosed with a common mental disorder at some time in their lives (including depression, bipolar disorder and/or anxiety disorder).

Mental disorders, as a group, are the third-leading cause of health loss for New Zealanders (11.1% of all health loss), behind only cancers (17.5%).

14.3% of New Zealand adults (more than half a million people) had been diagnosed with depression at some time in their lives.

Women were around 1.6 times more likely to have been diagnosed with a common mental disorder (20%) than men (13%), and rates were higher in all age groups. The highest rates for women were from 35 – 44 years of age (23.8%) and for men were from 45 – 55 years of age (15.5%).

Six percent of New Zealand adults, or more than 200,000 adults, experienced psychological distress in the last four weeks. (People experiencing psychological distress are highly likely to have an anxiety or depressive disorder.)










Audience need:

To be able to perform/achieve the motivation to complete simple tasks
20% of people want more contact with friends and family who do not live with them.
In the 2010 Quality of Life Survey of residents from eight New Zealand cities, just over half (54%) said that family was one of the three main components that contributed to their quality of life.

o   Sense of reward
o   Goal
o   Sense of self worth
o   Routine
o   Quality support
o   Cause/reason/commitment
o   Passion
o   Inspiration
o   Structure
o   Responsibility
o   Break the self-feeding cycle



















Client/stakeholder:

Health NZ
Health department of the NZ Gov, help population & provide a service

TheLowdown.com
Website/company aimed specifically at depression in younger New Zealanders

Depression.org
Website/company aimed specifically at depression in midlife-old New Zealanders

Families
Care about family members/close relatives

Universities/higher education
Provide a service for the age group that attends

Small communities
Community centres, workplace friends/colleges, sports teams, clubs/groups




















Client/stakeholder motivation:
































Barriers:
Barriers to effective care include a lack of resources, lack of trained health care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. Even in some high-income countries, people who are depressed are not always correctly diagnosed, and others who do not have the disorder are occasionally misdiagnosed and prescribed antidepressants.



29% of depressed people get discouraged when faced with a difficult challenge (vs. 22% for non-depressed people).

The top reasons for not feeling a sense of community were: a busy life (42%), people in the neighbourhood not talking with each other (41%) and a preference for socialising with family and friends (37%).


o   Unsure how
o   Afraid
o   Anxiety
o   Self-conscious
o   Limited access to resources
o   Limited support




  in its typical depressive episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.
Depression results from a complex interaction of social, psychological and biological factors. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

·        feeling tired all the time
·        getting too much sleep or not enough
·        feeling worthless and helpless
·        thinking about death a lot
·        having no energy and feelings of low self-esteem
·        loss of appetite or overeating
·        sadness or emotional ‘numbness’
·        loss of pleasure in everyday activities
·        irritability or anxiety
·        poor concentration
·        feeling guilty, or crying for no apparent reason.
possible signs
·        irritability or restlessness feeling tired all the time, or general loss of energy
·        feelings of emptiness or loneliness
·        no longer interested in favourite activities
·        sleep problems – too much, or too little
·        weight loss or gain
·        low self-esteem
·        problems with concentration
·        reduced sex drive
·        thinking about death a lot

anxiety

Often people with depression also find they worry about things more than usual. This is known as anxiety.

Signs to look for (symptoms)

Symptoms of depression usually develop over days or weeks, though you may have a period of anxiety or mild depression which lasts for weeks or months beforehand. Not everyone with depression will complain of sadness or a persistent low mood. They may have other signs of depression such as sleep problems. Others will complain of vague physical symptoms.
Signs to look for in yourself or a loved one include:
  • Persistent low, sad or depressed mood – this is described in varying ways by people, especially if they are from non-European cultures. The person may describe feeling empty, having no feelings, or may complain of pain.
  • Loss of interest and pleasure in usual activities. This is a reduced ability for enjoyment. It includes loss of interest in sex.
  • Irritable mood. This may be the main mood change, especially in younger people, and in men (especially from Maori and Pacific ethnic groups).
  • Change in sleeping patterns. Most commonly reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to go back to sleep. Some people sleep too much. Most people with depression wake feeling unrefreshed by their sleep.
  • Change in appetite. Most often people do not feel like eating and as a result will have lost weight. Some people have increased appetite, often without pleasure in eating. This is often seen in those who also sleep more.
  • Decreased energy, tiredness and fatigue. These feelings may be so severe that even the smallest task seems too difficult to finish.
  • Physical slowing or agitation often comes with severe depression. The person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, but pace and wring their hands. The same person may experience alternating slowing and agitation.
  • Thoughts of worthlessness or guilt. As a result of feeling bad about themselves, people may withdraw from doing things and from contact with others.
  • Thoughts of hopelessness and death. The person may feel there is no hope in life, wish they were dead or have thoughts of suicide.
  • Difficulty thinking clearly. People may have difficulty in concentrating. They may not be able to read the paper or watch television. They may also have great difficulty making even simple everyday decisions.

Anxiety symptoms

These are very common as part of depression, but as the depression is treated these symptoms usually stop. Anxiety symptoms include:
  • Excessive worry or fear, with associated physical symptoms such as muscle tension, pounding heart, dry mouth.
  • Panic attacks. Sudden episodes of extreme anxiety and panic with physical symptoms of fear.
  • Phobias. Specific fears regarding situations, objects or creatures.
  • Excessive concern about physical health.

It is estimated that 30% of young people and 50% of adults who experience an episode of depression subsequently relapse (regardless of treatment) (therefore self help is the best method)
Standard Treatments Inadequate

How common is depression and anxiety? While the precise rates of depression and anxiety in older people are not yet known, it is thought that between 10 per cent and 15 per cent of older people experience depression and approximately 10 per cent experience anxiety. Rates of depression among people living in residential aged-care facilities are believed to be much higher than the general population – around 35 per cent.2

·        Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment. (DBSA, 1996)
·        An estimated 50% of unsuccessful treatment for depression is due to medical non-compliance. Patients stop taking their medication too soon due to unacceptable side effects, financial factors, fears of addiction and/or short-term improvement of symptoms, leading them to believe that continuing treatment is unnecessary. (DBSA, 1999)
·        Participation in a DBSA patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. Support group participants are 86% more willing to take medication and cope with side effects. (DBSA, 1999) 



  • 80% of people who experience depression do not receive any sort of treatment.

adults aged 45-64 are more likely than any other age group to have a diagnosis of depression. A peak of 4.6% for adults 45-64 years.

Expression was associated with functional impairment in many areas of life

Overall, approximately 80% of persons with depression reported some level of difficulty in functioning because of their depressive symptoms.
In addition, 35% of males and 22% of females with depression reported that their depressive symptoms made it very or extremely difficult for them to work, get things done at home, or get along with other people.
More than one-half of all persons with mild depressive symptoms also reported some difficulty in daily functioning attributable to their symptoms.

There was a significant overall increase in the proportion of Americans receiving outpatient depression treatment, from 2.37 per 100 persons in 1998 to 2.88 per 100 persons in 2007 (Table 1). This corresponds to approximately 6.48 million (1998) and 8.69 million (2007) persons, respectively (data not shown).
The overall prevalence of antidepressant use increased from 6.5% in 1999-2000 to 10.4% in 2009-2010
From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400% (1).
 The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. 

Standard Treatments Inadequate
  • Antidepressants work for 35 to 45% of the depressed population, while more recent figures suggest as low as 30%. [14]
  • Standard antipressants, SSRIs such as Prozac, Paxil (Aropax) and Zoloft, have recently been revealed to have serious risks, and are linked to suicide, violence, psychosis, abnormal bleeding and brain tumors. [15]
Antidepressants (particularly SSRIs) work only as well (or less) than placebos. [17]

What is causing the rapid rise in mental illness around the world?


One again, mental health “experts” disagree wildly on the causes of the rapid rise of mental illness, with some blaming modern culture and society, others blaming modern food, some drugs such as marijuana and alcohol and others still blaming an as yet undiagnosed virus.


In terms of drug abuse, there is no question that excessive use of opiates and/or sedatives can lead to severe mental illness. Contrary to marijuana being a major cause of mental illness as promoted by some politicians and media, alcohol abuse is twenty times more prevalent a cause for mental illness than “smoking pot”.


In terms of food additives and diet, there is some evidence to suggest that high sugar and salt diets can affect the brain over long periods of time causing some people to be more prone to mental illness such as depression. However, the number of people and the consistency of data cannot mean this is the sole reason, or even a significant factor alone.


In terms of modern society, there is a wide number of possible candidate contributing factors to mental illness, from the rise in isolated behaviour, the rise of personal and home pressures and the general processing stresses placed on the modern human brain. Excluding extreme substance abuse, the effects of modern society seem to be a major contributing factor in the rise of mental illness.




The found that patients with major depressive disorder who did not take medication for it had a 25% risk of relapse, while patients who took antidepressants and eventually stopped taking them had a 42% risk of relapse.

Genes—people with a family history of depression may be more likely to develop it than those whose families do not have the illness. Older adults who had depression when they were younger are more at risk for developing depression in late life than those who did not have the illness earlier in life.
Brain chemistry—people with depression may have different brain chemistry than those without the illness.
Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression.
For older adults who experience depression for the first time later in life, the depression may be related to changes that occur in the brain and body as a person ages. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels may stiffen and prevent blood from flowing normally to the body’s organs, including the brain.
If this happens, an older adult with no family history of depression may develop what is sometimes called “vascular depression.” Those with vascular depression also may be at risk for heart disease, stroke, or other vascular illness.
Depression can also co-occur with other serious medical illnesses such as diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse, and vice versa. Sometimes, medications taken for these illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

. Depression affects the entire family.
“People tend to think of depression as an individual condition,” said Kolakowski, also author of the book When Depression Hurts Your Relationship.However, it’s a systemic condition that affects couples and families, she explained.
For instance, depression can affect everything from a couple’s communication and connection to their sex life to how they handle conflict to their ability to empathize with each other and enjoy time together, she said.
When someone is struggling with depression, it’s hard to foster warm, supportive relationships, Hammen said. This isn’t “because one is a ‘bad’ parent or spouse, but because they cannot will away the irritability, withdrawal, oversensitivity, lack of interest [and] low energy that are needed to sustain healthy relationships.”
Consequently, when someone has recurrent or chronic depression, their partner and kids may need treatment, as well, she said. (Learn more about how depression damages relationships and tips for rebuilding your bond here.)
THE STIGMA OF DEPRESSION 


A problem that touches on nearly every aspect of the recognition, diagnosis, and treatment of depression is the continued stigma attached to disorders perceived as “mental” rather than “physical” in origin.[1]
This dichotomy and the ideas it engendered led to the separation of “mental” health treatment from the treatment of physical health, and the sequestering of those suffering from severe emotional or behavioral disorders in asylums, especially during the 19th century.[1]
Public attitudes toward behavioral health continued to be influenced by this early separation of “mental” and “physical” health. Even at the midpoint of the 20th century, most people only identified patients with the most severe forms of behavioral disorders (such as psychoses) as “mentally ill.” Depression and anxiety were not recognized by most people as clinical states and were commonly confused with ordinary unhappiness or worry.[1]
By the 1990s, public awareness and the knowledge about behavioral disorders, and their basis in both biologic and environmental factors, had improved substantially. However, for many this knowledge does not eliminate the stigma attached to these disorders. The willingness of individuals affected with depression to discuss their illness with physicians and other health care providers is directly influenced by lingering concerns about being ostracized or discriminated against if diagnosed with a “mental illness.”[1]
The 1999 Surgeon General’s report on mental health states that public awareness and advocacy programs, in addition to better treatments for behavioral disorders, should help reduce the stigma and fear associated with depression and other behavioral disorders. A recent study of the effectiveness of various methods for reducing fears about mental illness among college students suggested that education through replacement of myths with facts about depression is useful. This approach can be implemented at the level of either the practice site or the health plan.

PUBLIC SUPPORT FOR MENTAL HEALTH CARE FUNDING IS "SOFT" 

One of the carryovers from the historic segregation of behavioral from physical health care is that public willingness to fund treatment of behavioral disorders is not as strong as the willingness to support funding of treatment for physical disorders. Public opinion polls have suggested that willingness to pay for mental health services diminishes when costs are factored in, although there is greater support for care of more serious disorders, such as schizophrenia or major depression.[1]
For most purely physical disorders, treatment costs are usually borne by insurance coverage, even when such treatments precede the development of the disorder itself. For example, reimbursement is routinely provided for cholesterol-lowering statin medications in treating patients with high levels of low-density lipoprotein (LDL) cholesterol, whether or not these patients have symptomatic cardiovascular disease. The relationship between high LDL-cholesterol and cardiovascular diseases is well established, and the toll of these disorders in terms of direct costs and lost productivity has been amply documented.
The economic impact of depression and other behavioral disorders is far more clearly appreciated now than in the past. The high level of effectiveness of certain risk-factor reduction, screening, or treatment modalities has been demonstrated. However, partly because of continued stigma and misunderstanding, it has been difficult to link payment with the provision of effective care and the willingness to fund it.[1]

GAPS IN RECOGNITION 

Successful treatment of depression relies first upon accurate diagnosis. The high prevalence of depression and related disorders, failure of patients to recognize the signs and symptoms of the disease, and the frequent presentation of depression with nonspecific physical symptoms suggest that the primary care setting is highly important as a focus for initial diagnosis. However, a number of studies have suggested that only about half of patients with depression are accurately diagnosed at the primary care level; and of those recognized, fewer than 10% will be effectively treated.[2] Diagnosis by primary care physicians (PCPs) may be hampered by a variety of factors:
  • Limited awareness regarding the high prevalence of depression and its frequent manifestation through nonspecific physical symptoms. A blood pressure check is a routine part of a visit, yet depression is more prevalent than hypertension. 

  • Variable training especially in the use of screening tools and algorithms, treatment options, and clinical practice and referral guidelines. 

  • Perceived lack of time and/or resources for adequate workup This in part stems from the varying awareness of rapid screening tools to detect depression, coupled with actual or perceived limitations in the adequacy of reimbursement for the time required. Time constraints may also affect coordination of care with mental health professionals. 

  • Underappreciated ability to provide effective treatment, especially during maintenance therapy or for patients with early mild depression or risk factors. Brief counseling and pharmacologic therapy with ongoing brief counseling have been shown to be effective in many instances.[3]-[5]


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