Division of Occupational Therapy - OT Connect
Depression
Fact Sheets
Major Depressive Disorder is a serious medical illness affecting 9.9 million American adults, or approximately 5 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the U.S. and many other developed countries (http://www.nami.org/).
Common Symptoms/Course of disease
The onset of the first episode of major depression may not be obvious if it is gradual or mild. The symptoms of major depression characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression include:
- persistently sad or irritable mood
- pronounced changes in sleep, appetite, and energy
- difficulty thinking, concentrating, and remembering
- physical slowing or agitation
- lack of interest in or pleasure from activities that were once enjoyed
- feelings of guilt, worthlessness, hopelessness, and emptiness
- recurrent thoughts of death or suicide
- persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
When several of these symptoms of depressive disorder occur at the same time, last longer than two weeks, and interfere with ordinary functioning, professional treatment is needed.
Major depression can occur at any age including childhood, the teenage years and adulthood. About three - fourths of those who experience a first episode of depression will have at least one other episode in their lives. Some individuals may have several episodes in the course of a year. If untreated, episodes commonly last anywhere from six months to a year. Left untreated, depression can lead to suicide.
Age of Onset or Usual Age of Presentation: Symptoms can begin at any age however, the average onset of symptoms is during the middle 20s (DSM-IV-TR, 2000).
Sexual Biases: Women are at a significantly greater risk in developing symptoms than men. Ratios include 5% to 9% for women and 2% to 3% for men (DSM-IV-TR, 2000).
Cultural Biases: Symptoms often present differently in various cultures guided by cultural standards. Prevalence rates for Major Depressive Disorder appear unrelated to ethnicity (DSM-IV-TR, 2000)
Types of the Disorder:
- Full criteria of episode are currently met for Major Depressive Episode: Mild, Moderate, Severe Without Psychotic Features/Severe With Psychotic Features, Chronic, With Catatonic Features, With Melancholic Features, With Atypical Features, With Postpartum Onset
- Full criteria are not currently met for Major Depressive Episode with most recent episode described: In Partial Remission, In Full Remission, Chronic, With Catatonic Features, With Melancholic Features, With Atypical Features, With Postpartum Onset
- Specifiers to describe recurrent episodes include: Longitudinal Course Specifiers (With an Without Full Inter-episode Recovery), Seasonal Pattern, and Rapid Cycling
- Seasonal Pattern-essential feature is onset and remission of Major Depressive Episodes at characteristic times of the year. Most cases present with episodes that begin in fall or winter and remit in spring. This pattern of onset and remission must have occurred during the last two years, with no non-seasonal episodes occurring during this time period. Psychosocial stressors must not coincide with episodes. Characteristics of Seasonal Pattern include loss of energy, hypersomnia, overeating, weight gain, and craving for carbohydrates. Prevalence increases with higher latitudes and young age with 60% to 90% of individuals being women (DSM-IV--TR, 2000)
Examples of Celebrities Who Have Experienced Depression:
Current Medical Treatment:
- Medications include tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, lithium, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs).
- Electroconvulsive Therapy (ECT) which involves electrically inducing a seizure that causes physiological and biomechanical changes in the brain. This treatment may be utilized when no other treatment has proven effective (Cara, 1998).
- Testing Utilized: Hamilton Rating Scale for Depression: an interview utilized to rate the severity of symptoms in individuals diagnosed with the disorder.
- Beck Depression Inventory: a self-report method that assesses the severity of the disorder.
- Zung Self-Rating Depression Scale: assesses items such as mood, psychological factors, and psychomotor factors.
- Depression Adjective Checklists: checklist format assessment that measures symptoms of depression (Katz, et al., 1995).
Occupational Therapy Involvement
Occupational Therapy often becomes involved with the depressed client in an attempt to assist in the remediation and treatment of symptoms listed above:
- Assistance in the pursuit of leisure and vocational interests that may be lacking due to decreased involvement in activity
- Provide the opportunity for and encourage social interaction through group therapy activities
- Work to increase self-esteem with attainable goals
- Instructing the individual on setting realistic goal
- Re-establishing normal routines
- Activities of Daily Living
- Psychoeducation concerning symptoms and pre-cursors to symptom exacerbation
- Management of medication routines
- Encourage self-exploration and self-expression through various activities
- Provide structure
- Time management skills (Cara, 1998)
- Stress management tasks (relaxation training, attention to stressors, biofeedback) Cognitive-behavioral therapy
- Clients may also be referred to work programs that may involve stress and time management skills, social skills, and vocational pursuits due to the fact that many of these aspects that are lacking can greatly affect the client’s success in gaining and holding employment
- Most importantly, the occupational therapist will strive to gain and maintain a high level of trust with the client
- Evaluations used: Canadian Occupational Performance Measure (MacRae, 1998), Kohlman Evaluation of Living Skills, and the Scorable Self-Care Evaluation (Cooper, 1998) can all be utilized to assess an individual's functional abilities
Reference
- American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: Text Revised (4th ed.). Washington, DC: Author.
- Cara, E. (1998). Mood disorders. In Cara, E. & MacRae, A. (Eds.) Psychosocial Occupational Therapy: A Clinical Practice, pp. 285-311. Albany, NY: Delmar Publishers.
- Cooper, N. (1998). Case management. In Cara, E. & MacRae, A. (Eds.) Psychosocial Occupational Therapy: A Clinical Practice, pp. 577-606. Albany, NY: Delmar Publishers.
- Katz, R., Shaw, B. F., Vallis, T. M., & Kaiser, A. S. (1995). The assessment of severity and symptom patterns in depression. In Beckham, E. E. & Leber, W. R. (Eds.) Handbook of Depression (2nd ed.), pp. 61-85. New York: The Guilford Press.
- MacRae, A. (1998). Occupational therapy models. In Cara, E. & MacRae, A. (Eds.)
- Psychosocial Occupational Therapy: A Clinical Practice, pp. 97-136. Albany, NY: Delmar Publishers.
- People.com. (2002). Retrieved January 14, 2003, from:
http://people.aol.com/people/index.html
How OT Makes a Difference: Evidence-Based Practice
Devereaux, E. & Carlson, M. (1992). The role of occupational therapy in the management of depression. The American Journal of Occupational Therapy, 46 (2), 175-180.
A study conducted concerning psychiatric day treatment for clients with depression explored the effectiveness in engaging individuals in meaningful activities to that particular individual. Overall, this type of treatment significantly increased the clients’ engagement in activities, which often is lacking in individuals diagnosed with depression.
An additional study examines the effect that occupational therapy had on a group of depressed adolescents. The treatment involved working on general, interpersonal, and work behaviors, all of which increased by the conclusion of treatment.
A final study states that occupational therapy assisted clients in becoming less anxious by the end of a program involving group discussion, biofeedback, relaxation training, behavioral reversal, and focusing attention to everyday stressors and how to control the stressors. This particular group was acutely depressed psychiatric inpatient.
Anecdotal Reports
This interview was conducted by securing information from an individual whom will be called “J” who is currently in an inpatient psychiatric facility. Occupational therapy services were available to “J” within the facility for depressive symptoms. “J” reported receiving occupational therapy services “a couple of days a week”. “J” also reported that therapy would last approximately 45 minutes from when the session began.
"J" explains that both the certified occupational therapy assistant and the occupational therapist provided his services. Activities involved in therapy included cooking groups, movement groups including exercising with Thera-band, craftwork, and artwork, such as painting. “J” feels that his needs were met during occupational therapy. For example, “J” remembered one time in particular that he was able to make the dessert that he wished as an activity.
“J” states that the reasoning behind particular interventions was not fully explained to him, however he understood why he was completing the various activities. He says he just “went with the flow”. “J” also does not feel that therapy proved more challenging as he progressed.
Overall, “J” feels that occupational therapy was very beneficial to him in that during therapy sessions, he was able to “forget about his problems”, stay focused on task, and was kept busy. Improvements that he feels he made are teamwork skills and the increasing ability to focus on tasks. He feels that the best skill he learned was teamwork skills. “J” felt that occupational therapy was ultimately a very positive experience. He stated that “the groups have been great” and the therapists were not always focused on his diagnosis. They gave him the opportunity to talk about “everyday things”.
Client Handout
Web Links
- http://www.nimh.nih.gov/publicat/depressionmenu.cfm
This particular site allows the reader to browse links that explain depression, its symptoms, and how the reader can receive a full brochure from the National Institute of Mental Health on the topic. The reader is also able to print the brochure from the site and is provided with a way to contact this prestigious organization if a problem is suspected.
- http://www.nmha.org/ccd/index.cfm
This site provides a description of depression by stating symptoms and many facts that pertain to the topic. Free brochures are also available through this site by dialing an 800 number. This site is posted by the National Mental Health Association also a prestigious organization.
- http://www.psychologyinfo.com/depression/medication.htm
This site provides a vast array of information of depression including symptoms, available treatment, types, among much more. The site is easily read and navigated. The site credits the National Institute of Mental Health for the information posted.
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