Bargmann 1

Erica S. Bargmann
12 May 2009
Mr. Schlueter
Research Paper

Depression Outline
Intro-
• Attention Getter:
 Most people have felt sad or depressed at times. Feeling depressed can be a
normal reaction to loss, life's struggles, or an injured self-esteem. But when
feelings of intense sadness -- including feeling helpless, hopeless, and
worthless -- last for days to weeks and keep you from functioning normally,
your depression may be something more than sadness. It may very well be
clinical depression -- a treatable medical condition.

 According to the website of the National Institute of Mental Health,

depression is the leading cause of disability among Americans between the
ages of 15 and 44. Further statistics show that 6.7 % of the U.S. populations
(14.8 million adults) are affected by Major Depression in any particular
calendar year. And at least in the U.S., more women are diagnosed with
depression than men, with the median age of onset being 32 for both genders.

• Thesis:
1. Most people when asked what depression is think that it’s when someone is so sad
that they feel worthless and constantly think about taking their own lives. What
they don’t know is that it’s much more than that. The definition of depression is a
mental state characterized by a pessimistic sense of inadequacy and a despondent
lack of activity (http://wordnet.princeton.edu) which reflects a sad and/or irritable
mood exceeding normal sadness or grief. The signs and symptoms are not only
characterized by negative thoughts, moods, and behaviors but also specific
changes in bodily functions (for example: crying spells, body aches and pains,
low energy, as well as problems with eating, weight, and sleeping.) In spite of
clear research evidence and clinical guidelines regarding therapy, depression is
often undertreated and misunderstood. Hopefully, this situation can change for the
better. If this illness is not treated correctly, it can cause severe damage towards a
person and their families and friends. This research paper will go in depth on the
things that cause depression, the effects it has on patients, their families, and
friends, as well as the solution to treating this illness.

First Body Paragraph- Causes

• Family History and Physical Conditions
1. Depression runs in families for generations but researchers have not yet located a
single, defective gene responsible for the condition. When a family member has
depression, spouses, siblings, or children are inevitably affected emotionally by
 Bargmann 2

the illness and while depressed parents don’t pass on depression per se to
children, the way they pass on hair or eye color, they can pass on a vulnerability
to depression. Whether inherited or not, depression is often associated with
changes in brain structure or brain function.

2. Serious medical conditions like heart disease, cancer, and HIV/AIDS can
contribute to depression, partly because of the physical weakness and stress they
bring on. Depression can make medical conditions worse, since it weakens the
immune system and can make pain harder to bear. In some cases, depression can
be caused by medication used to treat medical conditions. Depression also can
increase the risk for subsequent physical illness, disability, and premature death.
The symptoms of depression can also be caused by undiagnosed medical
conditions, including epilepsy, multiple sclerosis, Huntington’s disease,
Parkinson’s disease, hyperthyroidism, Lyme disease, and pancreatic cancer.

 Heart Disease- For people with heart disease, depression increases the risk for
an adverse cardiac event such as a heart attack or blood clots. For people who
do not have heart disease, depression increases the risk of heart attack and
coronary disease. During recovery from cardiac surgery, depression can
intensify pain, cause worsened fatigue and sluggishness, or cause a person to
withdraw into social isolation. Patients who have had coronary artery bypass
graft (CABG) surgery and have untreated depression after surgery also have
an increased morbidity and mortality rate.

 Cancer- People diagnosed with cancer may face an increased risk of

depression that persists for years, according to research published online Feb.
17 in the Journal of Clinical Oncology and up to 1 in 4 people with cancer
have clinical depression which causes great distress, impaired functioning,
and may even make the person with cancer less able to follow their cancer
treatment plan. When someone is diagnosed with cancer, their “normal
reaction” is depression, which means that it doesn’t require any special
treatment-the prevalence of depression among cancer patients ranges from 23
percent to 60 percent. While doctors today are better than ever at fighting the
disease, a new study by the Institute of Medicine in Washington, D.C., finds
that the anxiety, fear and depression associated with cancer often go untreated.
Of the country’s top 20 cancer care centers, eight reported screening for
emotional stress in only some of their patients. "It's becoming a chronic
illness, so now we have to take a wider view and treat the whole patient and
take care of all their needs, including their cancer," said Dr. Lee Schwartzberg,
co-author of the study and the medical director of the West Clinic in
Memphis, Tenn.

 Huntington’s Disease- a disorder passed down through families in which

nerve cells in the brain waste away, or degenerate. American doctor George
Huntington, who traveled over the bleak countryside five miles to the larger
town of Middleport, Ohio, first described the disorder in 1872 to the local
 Bargmann 3

medical society, composed of physicians of sparsely populated Meigs and

Mason Counties. His brief, uniformly anecdotal and entirely unreferrenced
address, not suffering publication delay, was put eight weeks later in the
Medical and Surgical Reporter of Philadelphia (v 26, no. 15, April 13, 1872).
This has become one of the classical descriptions of neurological disease.
People with Huntington’s disease have progressive motor problems, cognitive
deficits (dementia) and psychiatric symptoms (the most common is
depression) that usually start to appear in mid-life. There is no cure and death
usually results within 10 to 20 years of symptom onset, or faster in the
childhood-onset form of the disease. The disease is caused by a mutation in a
single gene and when this defective gene is passed from parent to child, 50
percent of the offspring inherit the disorder, which can be detected by genetic
testing.

• Trauma and Stress

1. When dealing with trauma, most people who become depressed can recall a
single traumatic event that happened just prior to their becoming depressed.
Painful experiences such as the death of a loved one, divorce, a medical
illness, or losing everything in a natural disaster may be so impactful as to
trigger depression. Events like these take away a sense of control and cause
great emotional upheaval. A person’s recovery from depression may also be
affected by traumatic events. The more trauma and difficulty a person
experiences, the longer a recovery from depression may take. If a person is
run down psychologically, suffers from anxiety or depression or has endured
previous traumatic experiences; it’s more difficult to handle another setback.
As a result, additional grief symptoms can be unbearable. In order to cope, the
traumatized individual may attempt to avoid grieving altogether.

2. It is clear that some people develop depression after a stressful event in their
lives such as the death of a loved one, the loss of a job, or the end of a
relationship are often negative and traumatic and cause great stress for many
people. It is not certain why stress may lead to depression in this way.
However, researchers have theorized an explanation called the "kindling
effect," or "kindling-sensitization hypothesis." This theory surmises that initial
depressive episodes spark changes in the brain's chemistry and limbic system
that make it more prone to developing future episodes of depression. This may
be compared to the use of kindling wood to spark the flames of a campfire.
Since early episodes of depression make a person more sensitive to
developing depression, even small stressors can lead to later depressive
episodes. It is not certain why stress may lead to depression in this way.
However, researchers have theorized an explanation called the "kindling
effect," or "kindling-sensitization hypothesis." This theory surmises that initial
depressive episodes spark changes in the brain's chemistry and limbic system
that make it more prone to developing future episodes of depression. This may
be compared to the use of kindling wood to spark the flames of a campfire.
Since early episodes of depression make a person more sensitive to
 Bargmann 4

developing depression, even small stressors can lead to later depressive

episodes.

• Pessimistic Personality
1. Someone with a pessimistic personality is often not as easy going or fun to be
around. They have a negative view of the current world around them and the
future does not look a lot better. Things can never go right, other people are
only nice because they want something from them and there is no point in
having dreams or goals because they will never happen or be achieved.
Pessimistic people tend to feel that they have no real purpose in life and that
there really doesn't seem to be any reason for them to try or even be around.
There are people who are only a little pessimistic at times, but there are also
people out there who are more consistently pessimistic about themselves, their
life and the world around them. It is these people who are more prone to fall
into serious depression, though it can sometimes be depression that can cause
a person to develop a more pessimistic outlook. Oftentimes, depression and
emotional health are further exacerbated by how others react to negativity.
Negative people are frequently perceived as "wet blankets" and may be
avoided. For some people a pessimistic attitude serves as a source of sardonic
humor and might even be a coping mechanism. People that fall into this
category might feel they are actually warding off negativity by being prepared
for the worst. "If you continually expect the worse, you are apt to be
pleasantly surprised a lot. If you always expect the best, you may be
disappointed frequently." This can be a reasonable rationale for a pessimist.

2. However, some researchers believe that a pessimistic attitude might

negatively affect health. Studies conducted in the Netherlands between 1995
and 2001 suggest a possible link between pessimism and heart disease. The
studies, published in The Archives of General Psychiatry, followed over 900
Dutch citizens from ages 65 to 85 over the six-year period. Each participant
was ranked on a scale of optimism and pessimism. The study found that
30.4% of the optimistic participants died during the study period, compared to
56.5% of the pessimistic participants. While factors like diet and smoking
were accounted for, it should be noted that participants were not screened for
depression. Whether or not a link does exist between pessimism and heart
disease, it has become widely accepted that a positive attitude is certainly
helpful in life. If being a pessimist doesn't shorten life, being an optimist will
make it more enjoyable. Virtually anyone who nurtures a habitually negative
temperament can transform from a pessimist to a more positive person with
time and effort. Psychotherapy and cognitive behavior therapy can help a
person to change his or her thinking habits. If the cost of therapy is
prohibitive, a more affordable method might be to seek out self-help books
that teach how to recognize negative thinking patterns and replace them with
positive habits of thinking. Local classes and seminars might also be of
assistance. With practice and diligence, positive thinking can become a habit
as easily as pessimism does.
 Bargmann 5

Second Body Paragraph-Effects

• Families and Friends
1. Depression can be especially cruel in that it doesn't affect just the depressed
person, but everyone around them, too. Someone who is depressed can be
very difficult and draining to deal with. What makes this so cruel is, that as a
depressed person's relationships become strained--to the point where others
actively avoid having anything to do with them. This further contributes to a
worsening self-image and makes the person feel even more isolated,
intensifying the depression. Depressed patients must learn to understand how
their illness affects other people, and expect that their relationships will not be
what they were, for some time. By the same token, those around them must
understand that it is not the person, but the illness, which is an inconvenience.
The best way for them to be relieved of the stress, is to help the patient toward
recovery. Friends and family must remember that the depression patient did
not ask for this illness, it is not a character flaw, and the patient often doesn't
have much control over what he or she does. They cannot afford to take the
symptoms of depression in someone else, personally. Most primary
relationships, however strong, go through trying times during the course of
normal life even when everyone is in the best possible state of mind.
Therefore, one can only imagine the difficulties and setbacks experienced by
people suffering from depression. It is also equally challenging and difficult
for the other person or people in such relationships, because, as part of the
negative effects of depression, depressed people often fail to see reason, do
not want to believe there is hope, and ultimately give up any and all effort
towards making relationships work.

• Individuals
2. Depressed individuals will tend to avoid friends and social gatherings, and be
unable to derive satisfaction from hobbies and leisure interests. It impairs their
ability to sleep, eat, work, and get along with others. It damages their self-
esteem, self-confidence, and the ability to accomplish everyday tasks. People
who are depressed find daily tasks to be a significant struggle. They tire easily,
yet cannot get a good night's sleep. They have no motivation and lose interest
in activities that were once enjoyable. Depression puts a dark, gloomy cloud
over how they see themselves, the world, and their future. This cloud cannot
be willed away, nor can we ignore it and have it magically disappear.

• Work and School

3. Ongoing stress and pressure can cause work depression. It is a reality of the
fast paced work environment of today. More than $43 billion are lost each
year as a result of so-called work depression. It is a rather common illness
affecting 1 out of every 20 adults at any given time. Work depression affects
three out of every ten workers at least once a year. Most people see the
workplace as a secure environment where they obtain some form of stability
and structure. When a person struggles with symptoms of work depression,
 Bargmann 6

the very same place of structure can become a cage where he/she feels trapped
without a means to get out. Depressive can affect an employee's productivity,
judgment, ability to work with others, and overall job performance. The
inability to concentrate fully or make decisions may lead to costly mistakes or
accidents. Changes in performance and on-the-job behaviors that may suggest
an employee is suffering from a depressive illness include:
i. Decreased or inconsistent productivity
ii. Absenteeism, tardiness, frequent absence from work station
iii. Increased errors, diminished work quality
iv. Procrastination, missed deadlines
v. Withdrawal from co-workers
vi. Overly sensitive and/or emotional reactions
vii. Decreased interest in work
viii. Slowed thoughts
ix. Difficulty learning and remembering
x. Slow movement and actions
xi. Frequent comments about being tired all the time

4. School depression is the type of depression that occurs in school going

children and research shows this is a more common illness than was
previously thought. Numbers of students are affected by depression every year
and due to the age group that can be affected by depression it is important at
the first signs to have the child diagnosed. School depression is not a strange
kind of depression; it is just the same as some of the other types of depression.
Following are the symptoms of school depression:
i. The first and the foremost symptom of depression in school going
children is the inability to concentrate while studying.
ii. Irritation at school without a proper reason.
iii. Poor appetite.
iv. School going children may exhibit sleeping problems; these consist
of too little sleep or too much sleep.
v. Little interest in extra curricular activities.
vi. Nervousness or hesitation without any reason.
vii. Fatigue.
viii. Negative thoughts and poor self-confidence also are the symptoms
of depression in school going children.

School depression or depression in school age children exhibit the above listed
symptoms commonly, but these symptoms might vary child to child. The
prevalence of depression in school going children is 3 to 4 out of 100 children.
School depression occurs equally in boy and girls. The relationship of students
amongst their friends and teachers play a big role in school depression. Some of
the causes that may lead to depression in school age children are:
ix. Extra pressure of parents or schoolteachers on students to perform
well in examinations.
x. Too many expectations from parents.
 Bargmann 7

xi. Students that do not join activities may also develop depression.
xii. Bookworms may also develop depression.
xiii. Low self-confidence can also develop depression in school age
children.
xiv. The fear of bad performance in activities such as sports or bad
performance in studies could also be the reason of depression in
school age children.
xv. Students that have no friends are often found stressed, the stress
may also lead to depression.
xvi. Inferiority complex in students is also a reason that they may
develop depression.

School depression is a treatable illness and can be treated if the proper treatment
technique is followed. Parents need to identify the symptoms in their school age
children, as most of the children do not even know that they are suffering from
depression. Parents need to take their child to a specialist and look for proper
treatment plan. Talk therapy, Cognitive behavioral therapy, family therapy or
interpersonal therapies are good method in these cases. The parents can also help
the child getting over school depression.

Third Body Paragraph-Solution

• Antidepressants
5. Antidepressants are medication used for people who have depression. Most
antidepressants are believed to work by slowing down the removal of certain
chemicals from the brain. According to the chemical imbalance theory, low
levels of the brain chemical serotonin lead to depression and depression
medication works by bringing serotonin levels back to normal. Researchers
agree that when depression is severe, medication can be helpful – even life
saving. The most widely prescribed antidepressants come from a class of
medications known as selective serotonin reuptake inhibitors (SSRIs).
Selective serotonin reuptake inhibitors are available only with a doctor's
prescription and are sold in tablet, capsule, and liquid forms. Commonly used
selective serotonin reuptake inhibitors are fluoxetine (Prozac), paroxetine
(Paxil), sertraline (Zoloft), and fluvoxamine (Luvox).

xii. Prozac is the registered trademarked name for fluoxetine

hydrochloride and the world's most widely prescribed
antidepressant to-date, the first product in a major new class of
drugs for depression12 called selective serotonin re-uptake
inhibitors. Prozac was first introduced to the US market in January
1988. It took two years for Prozac to gain its 'most prescribed'
status and had become the world’s most widely prescribed
antidepressant. The team of inventors behind Prozac was lead by
Ray Fuller. Fuller was posthumously awarded the Pharmaceutical
Discoverer's Award from NARSAD for discovering fluoxetine or
 Bargmann 8

Prozac. Also awarded were Bryan Molloy and David Wong, both
members of the Eli Lilly Company research team.

• Psychotherapy
6. The most common treatment for depression includes the combination of
antidepressant medicine and psychotherapy (called "therapy" for short, or
"counseling"). Psychotherapy is a general term for a process of treating mental
and emotional disorders by talking about your condition and related issues
with a mental health provider. During psychotherapy, you learn about your
condition and your mood, feelings, thoughts and behavior. A licensed mental
health professional helps people with depression focus on behaviors,
emotions, and ideas that contribute to depression, and understand and identify
life problems that are contributing to their illness to enable them to regain a
sense of control. Psychotherapy can be done on an individual or group basis
and can include family members and spouses.Using the insights and
knowledge you gain in psychotherapy, you pick up healthy coping skills and
stress management. Psychotherapy often can be successfully completed in just
a few months, but in the case of a severe mental illness, long-term treatment
may be helpful. There are many specific types of psychotherapy, each with its
own approach to improving your mental well-being. The type of
psychotherapy that's right for you depends on your individual situation.
Psychotherapy is also known as talk therapy, counseling, psychosocial therapy
or, simply, therapy.

• Alternative Methods of Treatment