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What is Depression?

Depression is a mood disorder that can emerge following a serious injury.

 

Experiences of severe loss or prolonged suffering associated with injury are factors that can contribute to the emergence of depressive symptoms. There are different types of depressive disorders. Major Depressive Disorder is the type of depression most likely to be experienced following a serious injury. It is estimated that approximately 2 in 10 individuals who have been in a serious motor vehicle crash develop Major Depressive Disorder.

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The Diagnosis of Major Depressive Disorder

A diagnosis of Major Depressive Disorder is typically made on the basis of a clinical interview conducted by a trained health or mental health professional.

During the clinical interview, the health or mental health professional will enquire about the types of symptoms the individual might be experiencing, how these symptoms might be impacting on the individual’s life, and how long the symptoms have been present. Feelings of depression are common, and most periods of depressed mood that a person might experience would be considered a normal part of dealing with the stresses of everyday life. However, if symptoms of depression persist for more than 2 weeks, it is recommended that the individual contact a doctor or mental health professional.

The Symptoms of Major Depressive Disorder

Depressed Mood and Loss of Interest

The dominant symptoms of Major Depressive Disorder are depressed mood and loss of interest in activities that were once experienced as enjoyable. A person with Major Depressive Disorder might feel low or sad, or might be experiencing more frequent episodes of tearfulness. Major Depressive Disorder also makes it more difficult for the person to feel interested, or motivated to engage in important activities of day-to-day life. Since changes in mood occur over a period of days or weeks, there are times when family members or friends might notice that someone is depressed even before the depressed person realises that he or she might be depressed.

Changes in Sleep and Appetite

Changes in sleep and appetite occur when someone is experiencing symptoms of depression. The nature of these changes will vary from one person to the next. Some depressed individuals might have difficulty falling asleep or staying asleep, others might be sleeping excessively, still others might find that they are awake at night and sleepy in the daytime. Similarly, some individuals with depression might lose their appetite while others might have a tendency towards over-eating.

Changes in Energy

Depression seems to have a ‘slowing’ effect on the mind and the body. Individuals who are depressed might find themselves moving slower, feeling more fatigued, and might have more difficulty ‘getting started’. Others might experience the opposite where they feel more restless or agitated. Restlessness or agitation might also take the form of expressions of frustration or irritation.

Negative Attitudes Towards the Self, Others and the Future

Individuals with Major Depressive Disorder will often be very critical toward themselves. They might use a self-deprecating language in describing themselves and will be quick to highlight their own faults and deficiencies. This negativity of perception often extends to others and the future. The depressed person appears to have difficulty appreciating the positive aspects of his or her life.

Thoughts of Death

The depressed individual might experience more frequent thoughts of death. These thoughts might be about people that have died in the past, or they might be thoughts about the depressed person’s own death. When depression is severe and prolonged, thoughts of death might take the form of suicidal thinking. When suicidal thinking entails actual plans to end one’s life, the risk of suicide is increased.

If you, or someone you know is experiencing these thoughts, seek advice urgently by seeing a doctor or mental health professional, or call a helpline for advice.

Duration of Symptoms

For some individuals, the symptoms of depression may appear shortly following the time of their injury.  For others, depressive symptoms may appear only weeks or months after the injury. It is difficult to predict how long the symptoms of depression will persist. Some individuals might recover within a few months of the onset of depression. For others, the symptoms of depression might persist for a longer period of time. Individuals who have previously experienced mental health problems appear to be more likely to develop chronic symptoms of depression.

Disability associated with Depression

When severe, the symptoms of depression can interfere with an individual’s ability to engage in many activities of daily living. In some cases, depression can contribute to work disability. Prolonged work absence can complicate the recovery process as a result of stresses brought about by loss of independence and the loss of financial security.

Other problems associated with Depression

There are a number of additional health or mental health problems that can co-occur with Major Depressive Disorder. Individuals who have been diagnosed with Major Depressive Disorder often report experiencing symptoms of pain. Pain symptoms might be experienced in parts of the body that were injured, or they might be unrelated to bodily injury. Individuals who have been diagnosed with Depression often report symptoms of anxiety as well. They might also experience problems with alcohol or drug abuse. The presence of these additional problems can slow the pace of recovery of Major Depressive Disorder.

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The Treatment of Major Depressive Disorder

Several psychological and pharmacological interventions have been used to treat the symptoms of depression.

Evidence supported treatments include:

  • Psychological Interventions
    • Cognitive-Behaviour Therapy
    • Interpersonal Psychotherapy for Depression
    • Behaviour Therapy/Behavioural Activation
    • Mindfulness based cognitive behaviour therapy
  • Pharmacological Interventions
  • Rehabilitation

Psychological Interventions

There are many different forms of psychological interventions used to treat depression. These differ in terms of the focus of treatment, the duration of treatment, and the intended outcomes of treatment. Some treatments might be tailored to a particular client’s needs, others might be provided in group format, and many are also available online as e-therapies.

Cognitive-Behaviour Therapy

The most commonly used psychological approach to the treatment of depression is called Cognitive-Behaviour Therapy, or CBT. This type of treatment proceeds from the view that the symptoms of depression often persist as a result of the way in which the person ‘thinks’ or ‘acts’ in relation to stressful events in his or her life. By guiding the client to think or act differently in relation to life stresses, the goal of treatment is to reduce the severity of symptoms of depression and assist the client in resuming involvement in important activities of his or her life.

CBT does not refer to a specific treatment technique, but rather, refers to a collection of techniques that might be used to help a client change how he or she thinks or behaves. Some of these techniques might include education, thought monitoring, problem-solving, or relaxation. A client referred for CBT might receive a particular combination of techniques that might differ from that received by another person with the same problem. A depressed client who is receiving CBT might meet with his or her psychotherapist once per week for approximately 8 to 12 weeks.

Interpersonal Psychotherapy for Depression

Interpersonal Psychotherapy or IPT is concerned with the relationship’ factors that predispose, precipitate and perpetuate an individual’s depressive symptoms. Within this approach to psychotherapy, interpersonal relationships are the focus of attention. The therapist proceeds from the view that life stresses might have impacted negatively on important relationships in the person’s life; depressive symptoms are seen as being caused by disruptions in the structure or quality of important relationships. By helping depressed people improve their interpersonal relationships or change their expectations about them, the goal is to reduce the severity of depressive symptoms and assist the individual in resuming important activities of daily living. A depressed client who is receiving IPT might meet with his or her psychotherapist once per week for approximately 8 to 12 weeks.

Behaviour Therapy/Behavioural Activation

Behaviour therapy is part of cognitive behaviour therapy but when it is the primary intervention it does not include changes to thinking and beliefs. Rather the focus is on changing the range and quality of activities that the depressed person is engaging and by reducing avoidance, social and personal withdrawal and inactivity which maintains depression.

Mindfulness-based Cognitive Therapy

MBCT is a form of cognitive behaviour therapy that includes the use of mindful meditation as a means of reducing the depressing thinking processes and promoting a less depression focused experience.

Pharmacological Interventions

There are several classes of medication that have been specifically designed to treat the symptoms of depression. Most antidepressants appear to be similar in terms of how effective they are. Most antidepressants are prescribed by primary care physicians. A referral to a psychiatrist is typically only considered if a depressed person does not respond well to an anti-depressant that was prescribed by a primary care physician. Some depressed individuals will respond well to the first anti-depressant that is prescribed; for others, it might be necessary to try different medications until the right one is found.

The beneficial effects of antidepressants are not immediate; improvement might not be seen for one to two weeks after starting to take the medication. Some antidepressants will cause some unpleasant side effects such as dry mouth, nausea or drowsiness. The side effects usually begin to subside within a week to 10 days of starting the medication. One thing all anti-depressants have in common is that they work best if taken the way they have been prescribed.

There are a number of anti-depressants that have been developed to treat the symptoms of depression. One class of anti-depressants known as ‘serotonin specific reuptake inhibitors’ or SSRIs, are the most frequently prescribed anti-depressants for symptoms of depression. Medications such as Zoloft, Lexapro, Paxil and Prozac are SSRIs that are often prescribed for individuals with depression.

Rehabilitation

The treatment of depression is not just about reducing the severity of symptoms. Full participation in important life activities is as important as reducing the severity of symptoms.  Some symptoms of depression might persist for a long period time. New research findings indicate that depressed individuals can resume important family, social and even occupational activities in spite of fact that symptoms of depression persist. Rehabilitation interventions can be useful to help individuals resume important activities of their lives even though they continue to experience symptoms of depression.

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