Depression is a debilitating mental disorder affecting a great number of individuals. This presentation covers most common causes of depression, its symptoms and most effective treatments. Alcohol, drugs, and risk of suicide are also addressed. Presentation created by Lucia Merino, LCSW for Women in Transition,a weekly support group offered at Kaiser Permanente Adult Psychiatry -Cupertino, CA. 2014

1. DEPRESSION
Presentation Created by Lucia Merino, LCSW
September 2014

2. WHAT IS DEPRESSION?
Clinical depression goes by many names --
depression, "the blues," biological depression,
major depression. But it all refers to the same
thing: feeling sad and depressed for weeks
or months on end (not just a passing blue
mood). This feeling is most often
accompanied by feelings of hopelessness, a
lack of energy (or feeling "weighed down"),
and taking little or no pleasure in things that
gave you joy in the past. A person who's
depressed just "can't get moving" and feels
completely unmotivated to do just about
anything. Even simple things -- like getting
dressed in the morning or eating -- become
large obstacles in daily life.

3. WHAT CAUSES DEPRESSION?
The cause of depression is not fully
known. A number of factors may be
involved, such as chemical imbalances in
the brain or family history. Sometimes
depression can be linked to stressful
events, such as the death of a loved one,
a divorce or job loss. Certain medicines,
overuse of drugs and alcohol, and
chronic diseases can also lead to
depression. Depression isn’t caused by
personal weakness, lack of willpower, or
a ‘bad attitude’.

4. WHAT CAUSES DEPRESSION (2)
Sorry, there is no easy answer to what causes
depression.
The answer to what causes depression, in most
cases, involves a combination of factors that are
biological, genetic, psychological and
environmental in nature.
An affected individual cannot regulate
depression without deliberately altering the
intensity of one of those four factors, often by
counseling and medication in conjunction with
lifestyle changes.

5. A COMBINATION OF FACTORS
Biological Factors Genetic Factors

6. A COMBINATION OF FACTORS
Psychological Factors Environmental Factors

7. UNDERNEATH THE SURFACE OF A
DEPRESSION, ANGER MAY BE HIDING
• Although someone suffering from depression appears sad and withdrawn,
that person is actually dealing with deep-seated anger in an unhealthy way.
Depressed people are frequently frustrated, irritable and snappish, but do
not realize why they are reacting this way simply because they do not or
cannot acknowledge the anger they feel.
• As adults, we repress negative emotions for fear of embarrassment or
reprisal, and may tend to show only positive emotions to gain acceptance
by others. What may cause depression is the result of anger continually
building and not being released either verbally or by taking action. As a
result, depression overwhelms the bewildered individual as a form of coping
mechanism. Indirect causes of depression that produce a chronic feeling of
hostility in an individual may also compel that person to seek unhealthy
release methods, such as drug, alcohol or sexual addiction.
• http://www.what-is-depression.org/what-causes-depression/#
sthash.LL8s0YeF.dpuf

8. DEPRESSION SYMPTOMS

9. DEPRESSION SYMPTOMS (2)

10. DEPRESSION SYMTOMS (3)

11. DEPRESSION (4)

12. DEPRESSION OR PERIMENOPAUSE?

13. DEPRESSION IN MEN AND WOMEN

14. LET’S STOP TO DISCUSS SUICIDE AND
DEPRESSION

15. LET’S DON’T FORGET
DEPRESSION KILLS

16. HOW IS DEPRESSION TREATED?

17. DIFFERENT WAYS TO TREAT DEPRESSION
Psychotropic Medication: Antidepressants
Psychotherapies: psychoeducation, family systems, CBT,
interpersonal, psychodynamic, solution-focused, analysis
transactional, art therapy, self-help, support groups, etc.
Complementary and Alternative Medicine: Omega-3 Fish
Oil, Vitamins, etc.
Holistic Approaches: Acupuncture, Exercise, Journaling,
Artistic Expression ,Meditation, Reiki, etc.
ECT: Electro Convulsive Therapy
rTMS: Transcranial Magnetic Stimulation

18. PHARMACOLOGICAL TREATMENT:
ANTIDEPRESSANT MEDICATION

19. HOW DO ANTIDEPRESSANTS WORK?
• It often takes two to four weeks for antidepressants to start
having an effect, and six to 12 weeks for antidepressants to
have their full effect. In some cases, people may have to try
various doses and different antidepressants before finding the
one or the combination that is most effective. Friends and
relatives will sometimes notice an improvement on
medication before the depressed person will notice any
changes. Antidepressants are not habit forming; however
they should not be stopped abruptly as withdrawal symptoms
(muscle aches, stomach upset, headaches) may occur.

20. MEDICATIONS OFTEN USED TO TREAT DEPRESSION
• Selective serotonin reuptake inhibitors (SSRIs) act
specifically on the neurotransmitter serotonin. They are the
most common agents prescribed for depression worldwide.
These agents block the reuptake of serotonin from the
synapse to the nerve, which increases the level of serotonin.
SSRIs include fluoxetine (Prozac), sertraline (Zoloft),
paroxetine (Paxil), citalopram (Celexa) and escitalopram
(Lexapro). Common side effects include sexual dysfunction
and gastrointestinal problems.

21. SELECTIVE SEROTONIN REUPTAKE INHIBITORS

22. SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are
the second most popular antidepressants worldwide. These
agents block the reuptake of both serotonin and
norepinephrine from the synapse into the nerve, which
increases the amounts of these chemicals. SNRIs include
venlafazine (Effexor), desvenlafazine (Pristiq) and duloxetine
(Cymbalta).

23. NOREPINEPHRINE-DOPAMINE REUPTAKE INHIBITOR
• Bupropion (Wellbutrin) is a popular antidepressant
medication classified as a norepinephrine-dopamine
reuptake inhibitor (NDRI). It acts by blocking the reuptake of
dopamine and norepinephrine and increases these
neurotransmitters in the brain. It also helps with smoking
cessation strategies. Buproprion generally causes fewer side
effects than most other antidepressants (particularly
nausea, sexual side effects, weight gain, and fatigue or
sleepiness).

24. OTHER ANTIDEPRESSANTS
• Mirtazapine (Remeron) works differently from the compounds
discussed above. Mirtazapine targets specific serotonin and
norepinephrine receptors in the brain, thus indirectly increasing the
activity or several brain circuits. Mirtazapine is used less often than
other, newer antidepressants (SSRIs, SNRIs, buroprion) because it is
associated with more weight gain, sedation and sleepiness. However,
it appears to be less likely to result in insomnia, sexual side effects and
nausea than the SSRIs and SNRIs. Other side effects include
headaches, dry mouth and constipation. Remeron is not
recommended for those with hepatic or renal dysfunction, a history of
mania or seizure disorder.

25. OLDER ANTIDEPRESSANTS
• Tricyclic antidepressants (TCAs) are older agents seldom used today as first-line
treatment. They work similarly to the SNRIs, but have other properties that
often result in higher rates of side effects, as compared to almost all other
antidepressants. They are sometimes used in cases where other
antidepressants have not worked. TCAs include amitriptyline (Elavil),
desipramine (Norpramin), doxepin (sinequan), imipramine (Tofranil),
nortriptyline (Pamelor, Aventyl) and protriptyline (Vivactil). TCAs (and
duloxetine) may be helpful with chronic pain as well. TCAs generally have
more side effects than all other antidepressants, including headaches,
sleepiness and drowsiness, significant weight gain, nervousness, dry mouth,
constipation, bladder problems, sexual problems, blurred vision, dizziness and
skin rash.

26. MORE AND MORE ANTIDEPRESSANTS…
• Monoamine oxidase inhibitors (MAOIs) are less commonly used today. MAOIs work
by inactivating enzymes in the brain, which catabolize (breakdown) serotonin,
norephinephrine and dopamine from the synapse, thus increasing the levels of these
chemicals in the brain. They can never be used in combination with SSRI
antidepressants. MAOIs can sometimes be effective for people who do not respond
to other medications or have atypical (abnormal) depression with marked anxiety,
excessive sleeping, irritability, hypochondria or phobic characteristics. They have
important food and medication interactions, which requires strict adherence to a
particular diet. MAOIs include phenelzine (Nardil), isocarboxazid (Marplan),
tranylcypromine sulfate (Parnate) and selegiline patch (Emsam). Selegiline (Emsam)
is a patch approved by the FDA in 2006. This delivery system reduces the risk of the
dietary concerns noted above.
• The FDA periodically approves medication. For a current list, visit www.fda.gov

27. SUMMARY OF THE MAJOR ANTIDEPRESSANTS
BEING PRESCRIBED
• Selective serotonin reuptake inhibitors (SSRIs) –Prozac, Zoloft, Celexa, Lexapro.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) –Effexor, Pristq, Cymbalta
• Norepinephrine-dopamine reuptake inhibitor (NDRI) –Bupropion
• Miratzapine –Remeron
• Tricyclic antidepressants (TCAs) -Elavil, Norpramin, sinequan, Tofranil, Pamelor,
Aventyl, Vivactil.
• Monoamine oxidase inhibitors (MAOIs) -Nardil, Marplan, Parnate, Emsam.
The FDA periodically approves medication. For a current list, visit www.fda.gov

28. A LITTLE BIT OF HUMOR…

29. PSYCHOTHERAPY APPROACHES
Psychoeducation Talk Therapy

30. PSYCHOTHERAPY APPROACHES (2)
Cognitive Behavioral (CBT) Interpersonal Psychotherapy

31. PSYCHOTHERAPY APPROACHES (3)
Psychodynamic Therapy Group Therapy

32. PSYCHOTHERAPY APPROACHES (4)
Family Oriented Self-help

33. SUMMARY OF MOST USED
PSYHOTHERAPY APPROACHES
Psychoeducation
Psychotherapy
Talk Therapy
Psychodynamic
CBT
Interpersonal
Self-Help
Group Support
Family Oriented

34. HUMOR IS ALSO THERAPEUTIC
Brings endorphins up High level coping mechanism

35. OTHER TREATMENTS FOR DEPRESSION

36. TREATING DEPRESSION
Alternative Medicine Holistic Approaches

37. SOME STATISTICS

38. WHEN ALL ELSE FAILS…
Electro Convulsive Therapy Transcranial Magnetic Stimulation

39. WARNING ON ALCOHOL AND DRUGS

40. THE GOAL IS TO HAVE A LIFE…

41. AND THE TRUTH IS THAT …

42. THANKS TO THE FOLLOWING WEBSITES
https://healthy.kaiserpermanente.org
http://www.mayoclinic.org
http://www.managingdepression.us
http://www.dsm5.org
http://psychcentral.com
http://www.what-is-depression.org
http://www.nami.org
http://www.allaboutdepression.com
http://www.acuquest.com
http://cure-depression.com

43. HAD FUN CREATING THIS
PRESENTATION –FUNNY MOMENTS

44. HAHAHAHAHAHAHAHA!

45. THANK YOU FOR YOUR PARTICIPATION IN THIS
GROUP –YOU MAKE ALL THE DIFFERENCE!

46. SUPPORT GROUP

47. SEE YOU NEXT WEEK!