Psychological

and Physiological

Trauma Research

Seize Your Journeys

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Traumatic stress is found in many competent, healthy, strong, good people.  No one can completely protect themselves from traumatic experiences.  Many people have long-lasting problems following exposure to trauma.  Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy.  What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences.  Having symptoms after a traumatic event is NOT a sign of personal weakness.  Given exposure to a trauma that is bad enough, probably all people would develop PTSD.

By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment.

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Depression and African Americans

“Depression doesn’t life at the end of the day or disappear when others try to cheer us up.  When feelings of helplessness and depression worsen and grow into a full-blown clinical depression, it is truly an illness, not a character flaw or an insignificant bout with the flues.”  --Meri Nana-Ama Danquah, Willow Weep for Me

Clinical depression is more than life’s “ups” and downs”

“Life is full of joy and pain, happiness and sorrow.  It is normal to feel sad when a loved one dies, or when you are sick, going through a divorce, or having financial problems.

But for some people the sadness does not go away, or keeps coming back.  If you “blues” last more than a few weeks or cause you to struggle with daily life, you may be suffering from clinical depression.

You cannot “snap out of” clinical depression, nor can you will it or wish it away.  Clinical depression is not a personal weakness, gracelessness or faithlessness—it is a common, yet serious, medical illness.

Clinical depression is a “whole-body” illness.  It affects your mood, thoughts, body and behavior.  Depression changes the way you eat and sleep, the way you feel about yourself and the way you think about things.  Without treatment, symptoms can last for weeks, months or years.  Appropriate treatment, however, can help most people who have clinical depression.”

“We have all, to some degree, experienced…when nothing is going our way, when even the most trivial events can trigger tears, when all we want to do is crawl into  a hole and ask ‘Why me?’  For most people, these are isolated occurrences.  When the day ends, so too does the sadness.”  --Willow Weep for Me

Clinical depression can affect anyone, at any time of life

Young or old, man or woman, regardless of race, creed or income—anyone can experience clinical depression.  Clinical depression does not discriminate.  Every year more than 17 million Americans suffer from some type of depressive illness.  This includes major, or clinical, depression; bipolar disorder (often called manic-depressive illness); and dysthimia, a milder, longer-lasting form of depression. 

Although depression is common, it can be a very serious illness.  In fact, depression robs people of the enjoyment found in daily life and can even lead to suicide.

One of the most common myths about depression is that it is “normal” for certain people to feel depressed—older people, young adults, new mothers, menopausal women, or those with a chronic illness.

The truth is that depression is not, and should not be accepted as, a normal part of life any African American regardless of age or life situation.”

“Emotional hardship is supposed to be built into that structure of our lives.  It went along with the territory of being black and female…It seemed that suffering, for a black women, was part of the package.  Or so I thought.”  --Willow Weep for Me

Myths about clinical depression can cause unnecessary pain

“The myths and stigma that surround depression create needless pain and confusion, and can keep those with depression from getting proper treatment.  An important part of overcoming depression is recognizing the myths and understanding the facts.  The following statements reflect some common misbeliefs about African Americans and depression:

‘What do you have to be depressed about?  If our people could make it through slavery, we can make it through anything.”

‘When a black woman suffers from a mental disorder, the overwhelming opinion is that she is weak.  And weakness in black women is intolerable.’

‘Black women are supposed to be strong—caretakers, nurturers, healers of other people.”

‘You should take your troubles to Jesus, not some stranger/psychiatrist.’ “ --Willow Weep for Me

“Stereotypes and clichés about mental illness are as pervasive as those about race.”  --Willow Weep for Me

No one is immune to the potentially debilitating symptoms of depression.  The truth is that getting help, a critical step in conquering depression, can be a sign of strength.  People with depression cannot just ‘pull themselves together’ and get better.  Spiritual support can be an important part of healing, but for those with clinical depression, the care of a qualified mental health professional is essential.  As with many illnesses, if treatment is needed, the earlier it begins, the more effective it can be.”

Clinical depression can be successfully treated

“The good news is that, like other illnesses such as heart disease or diabetes, clinical depression is both diagnosable and treatable with the help of a health care professional.  In fact, over 80 percent of people with depression can be treated successfully with medication, psychotherapy or a combination of both.  With treatment, generally on an outpatient basis, most people improve and return to daily activities, usually in a matter of weeks.

Only a qualified healthcare professional can diagnose depression.  As with other illnesses, the earlier treatment begins, the more effective it can be.”

Treating clinical depression requires the help of others

“Depression saps energy, making a person feel tired, worthless and hopeless.  The nature of clinical depression often makes it difficult for the depressed person to find the strength, motivation or energy to seek treatment on their own.

Friends and family can help the depressed person get treatment.  People with depression need encouragement to get an accurate diagnosis and to seek the treatment that can ease their pain.  It may be helpful for family, a friend or minister to accompany the depressed person to the initial physician’s evaluation for support of to ask questions an note instructions.

Some people think that it they just ‘tough it out’ the depression will go away on it own, or that the support of their religious community alone will cure their depression.  The fact is, like other medical illnesses, clinical depression needs to e diagnosed and treated by a doctor or other mental health professional.”

Learning to recognize clinical depression

“Does this sound like your, or a friend or family member?

‘I felt like I was fading away, being erased.  I just wanted to sleep and disappear.  Living felt like a waste of time and effort.’

‘It’s been more than a year since her husband died and she still can’t seem to get back on her feet.’

“Daily tasks—bathing, ironing clothes, dressing, braiding hair, making breakfast, preparing lunch, school drop-offs and pick-ups—require every bit of get-up-and-go I have.’

‘She’s always liked good food, but now she eat alls the time.’

‘I’m so tired of everything.  I feel like I just want the world to sop spinning for a while so I can take a break.’

‘My mother shouldered so many heavier burdens and her I am thinking my life is too much to bear.  I feel so guilty, and weak—unworthy of my heritage’

I don’t know what’s wrong with me.  I seem to be crying over the dumbest things lately.’”

Clinical depression is a treatable medical illness and getting treatment can save lives

“The most common ways to treat clinical depression are with antidepressant medication, psychotherapy, or a combination of the two.  The choice of treatment depends on how severe the depressive symptoms are and the history of the illness.

When you talk to your doctor or mental health professional, make sure they tell you about all of these treatment options.

Medication

Recent research strongly supports the use of medication for the more severe episodes of clinical depression.  Antidepressant medication acts on the chemical pathways of the brain related to moods.  There are a number of very effective antidepressants.  The two most common types are selective serotonin reuptake inhibitors (SSRSs) and tricyclic antidepressants (TCAs).  Monamine oxidase inhibitors (MOAIs) are also prescribed by some doctors.

Antidepressant medications are not habit-forming.  It may take as many as eight weeks before you notice an improvement.  It is usually recommended that medications be continued for at least four to nine months after the depressive symptoms have improved.  Those with chronic or recurrent depression may need to stay on medication to prevent or lessen further episodes.

People taking antidepressants should be monitored by a doctor who knows about treating clinical depression to ensure the best treatment with the fewest side effects.

Do not stop taking your medication without first talking with your doctor, since some medications cause problems if stopped abruptly.

Psychotherapy can help teach better ways of handling problems by talking with a trained mental health professional.  Therapy can be effective in treating clinical depression, especially depression that is less severe.  Scientific studies have shown that short term (10-20 weeks) courses of therapy are often helpful in treating depression.

Cognitive/behavioral therapy helps change negative styles of thinking and behaving that may contribute to clinical depression.

Interpersonal therapy focuses on dealing more effectively with other people, and working to change relationships that can cause or worsen clinical depression.

Other treatments

Electroconvulsive therapy (ECT) may be recommended in the following cases:

When people cannot take or do not improve with medication;

When the risk of suicide is high, or

If someone is debilitated due to another physical illness.

Today, ECT is a safe and effective treatment that can save lives.

Some people may experience side effects such as memory loss.  A thorough discussion between patient and doctor needs to take place when ECT is being considered.”

Check List

“Different people have different symptoms.  Not everyone experiences clinical depression in the same way.  To help decide if you—or someone you care about –need an evaluation for clinical depression, review the following check list of symptoms and mark the descriptions that best apply.  If you experience five or more of thee symptoms for longer than two weeks, if you feel suicidal, of if the symptoms are severe enough to interfere with your daily routine, see your doctor, and bring this sheet with you.  As a first step, your doctor ore another health professional may recommend a thorough examination to rule out other illnesses.

Symptoms of clinical depression

A persistent sad, anxious or ‘empty’ mood, or excessive crying.

Reduced appetite and weight loss or increased appetite and weight gain.

Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain

Irritability, restlessness

Decreased energy, fatigue, feeling ‘slowed down’

Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism

Sleeping too much or too little, early-morning waking

 Loss if interest or pleasure in activities, including sex

Difficulty concentrating, remembering, or making decisions

Thoughts of death or suicide, or suicide attempts”

Commonly asked questions about clinical depression

“How do I get help for clinical depression?

The first step is to talk to your doctor.  Bring in your checklist and explain the symptoms you hae been experiencing.  He or she may recommend a physical cause for the depressive symptoms.  If clinical depression is diagnosed, then your physician, health maintenance organization or a local mental health association may make referrals to a mental health specialist.

Mental health professionals include psychiatrists, psychologists, pastoral counselors and social workers.  Psychiatrists can prescribe antidepressant drugs because they are physicians.

Mental health professionals who are not physicians cannot prescribe medication, but can provide psychotherapy and often work with psychiatrists and other doctors to ensure that heir patients receive the medications they may need.

What if I don’t feel comfortable talking to my doctor?  Is there anyone else who can help me?

Many people find strength and support through their religious and spiritual communities.  While counseling and support are considered an important part of any ministry, only a physician or mental health professional is able to diagnose clinical depression.  Pastoral counselors with degrees in psychology and theology, offer an integrated religious and spiritual approach to treatment.

How do I pay for treatment?

There are many different options to help you pay for treatment of clinical depression.  If you participate in a private insurance or a health maintenance organization (HMO) plan, your costs for treatment may e covered.  A mental health benefit may be included in your overall health benefit, but pay close attention to the restrictions.  Unfortunately, many plans do not provide equal coverage for physical and mental illnesses.  Contact your health insurance provider for details on your coverage for treatment of clinical depression.

If you are over 65 years old, Medicare now pays for 50 percent of the costs of treatment, and Medigap insurance will typically reimburse the remainder if you have this type of coverage.  Counseling by a certified pastoral counselor is generally covered by health care plans if the pastoral counselor is licensed by the state.  Your workplace may also have an employee assistance professional available to provide counseling or to help you find appropriate care.

If you do not have insurance or are unable to afford treatment, your community may have publicly-funded mental health centers and other mental health programs that charge you for services according to what you can afford to pay.  This is called sliding-scale or sliding-fee basis of payment.  So, even if you have little or no money, services may still be available.  Some mental health professionals in private practice may also accept patients on a sliding-fee basis.  University or teaching medical centers can also be a source of low-cost or free treatment services.

If is important to note that many publicly-funded entities have limited waiting lists or other barriers to treatment.  If you have trouble accessing treatment contact your local mental health association for further assistance.

The National mental health Association sponsors a state health care  reform training program to advocate for improved coverage for mental illnesses.  Contact your local mental health association for further information.

What contributes to clinical depression?

Many things can contribute to clinical depression.  For some, a number of factors seem to be involved, while for others a single factor can cause the illness.  Often time, people become depressed for no apparent reason.  Regardless of the factors involved, clinical depression needs to be diagnosed and treated.

Biological—People with depression typically have too little or too many of certain brain chemicals, called ‘neurotransmitters.’  Changes in these brain chemicals may cause, or contribute to, clinical depression.

Cognitive—People with negative thinking patterns—people who are pessimistic, have low self-esteem, worry too much or feel they have little control over life events-may be more likely to develop clinical depression.

Gender—Women are twice as likely as men to experience clinical depression.  While the reasons for this are still unclear, they may include the hormonal changes women go through during menstruation, pregnancy, childbirth and menopause.  The stress of the many roles and responsibilities women have, including homemaker, mother, employee and spouse may also be a reason.  In some cases, being a victim of abuse, of poverty or of low self-esteem may contribute to an increased risk of clinical depression.

Medications—Some medications can prompt clinical depression.  That’s why it is important to tell your doctor abut all the medications you are taking, even over-the-counter medications.

Co-occurrence—Clinical depression is more likely to occur along with certain illnesses, such as stroke, heart disease, diabetes, cancer, Parkinson’s disease, Alzheimer’s disease, diabetes and hormonal disorders.  This is called ‘co-occurring depression.’  Any depressive symptoms with other illnesses should be reported to your doctor.  It is important that co-occurring depression be treated in additional to the physical illness.

·         Depression can ‘co-occur’ in people who suffer from other mental illnesses such as eating disorders or anxiety disorders including panic disorder, obsessive-compulsive disorder and post-traumatic stress disorder.

·         In an effort to cope with the emotional pain caused by depression, some people try to ‘self-medicate’ through the abuse of alcohol or illegal drugs.  Therefore, depression can also ‘co-occur’ with alcohol and/or substance abuse. Recent studies show that one out of three people with depression also suffer from some form of substance abuse or dependence.

Genetic—A family history of clinical depression increases the risk for developing the illness.  However, clinical depression can also occur in people who have had no family history of clinical depression.

Situational—Difficult life events, including the death of a loved one, divorce, financial problems, moving to a new place or significant loss can contribute to clinical depression.

Making the most of your treatment

“Make treatment a partnership

Treatment is a partnership between the person with clinical depression and their health care provider.  Be sure to discuss treatment options and voice concerns with your doctor or therapist.  Become informed—ask questions and make sure you get answers.

Continue your treatment

It can often take time to find the right treatment for each individual.  Be patient and do not stop taking your antidepressant medication too soon or without your doctor’s knowledge.  Inform your doctor about any side-effects.  Remember, it may take up to eight weeks before you start feeling better.  It is usually recommended that you continue to take your medication for four to nine months after you feel better in order to prevent a recurrence of clinical depression.  Carefully follow your doctor’s instruction to because you take the proper dose.

Change your treatment or get a second opinion

Treatment changes may be necessary if there is no improvement after six to eight weeks of treatment, or if symptoms worsen.  Trying another treatment approach, another medication or getting a second opinion from another health care professional may e appropriate.

Join a patient support group

In addition to treatment, participation in a patient support group can also be very helpful during the recovery process.  Support group members share their experiences with the illness, learn coping skills and exchange information on community providers.

Take care of yourself

Take good care of yourself during treatment for clinical depression.  Be sue to get plenty of rest, exercise in moderation and eat, regular, well-balanced meals.  Many people also find strength and support through religious and spiritual affiliations.

Share this information with your family and friends and ask for extra support and understanding.

You can enjoy your life again!  With proper diagnosis and treatment, clinical depression can be overcome.”

From: National Mental Health Association

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What is Depression?

“Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act.

Depression has a variety of symptoms, but the most common are a deep feeling of sadness or a marked lose of interest or pleasure in activities.  Other symptoms include:

Changes in appetite that result in weight losses or gains unrelated to dieting.

Insomnia ore oversleeping

Loss of energy or increased fatigue

Restlessness or irritability

Feelings of worthlessness or inappropriate guilt

Difficulty thinking, concentrating, or making decisions

Thoughts of death or suicide or attempts at suicide

Depression is common.  It affects nearly one in 10 adults each year—nearly twice as many women as men.  It’s also important to note that depression can strike at any time, but on average, first appears during the late teens to mid-20s.Depression is also common in older adults.

Fortunately, depression is very treatable.

How Depression and Sadness are Different

The death of a loved one, loss of a job, or the ending of a relationship are difficult experiences for a person to endure.  It is normal for feelings of sadness or grief to develop in response to such stressful situations.  Those experiencing trying times often might describe themselves as being “depressed.”

But sadness and depression are not the same.  While feelings of sadness will lessen with time, the disorder of depression can continue for months, even years.  Patients who have experienced depression note marked differences between normal sadness and the disabling weight of clinical depression.

Postpartum  Depression

Postpartum depression—an illness associated with the delivery of a child—is caused by changes in hormones and can run in families.  It is distinguished from “baby blues”—an extremely common reaction following delivery—both by its duration and the debilitating effects of indifference the mother has about herself and her children.  About one in 10 new mothers experience some degree of postpartum depression; women with severe premenstrual syndrome are more likely to suffer from it.

Women with postpartum depression love their children but may be convinced that they are not able to be good mothers.

What Causes Depression?

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.

Buts several factors can play a role in the onset of depression:

Biochemistry.   Abnormalities in two chemicals in the brain, serotonine and norepinephrine, might contribute to symptoms including anxiety, irritability and fatigue.  Other brain networks undoubtedly are involved as well; scientists are actively seeking new knowledge in this area

Genetics.  Depression can run in families.  For example, if one identical twin has depression, the other has a 70% chance of having the illness sometime in life.

Personality. People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be vulnerable to depression.

Environmental factors.  Continuous exposure to violence, neglect, abuse or poverty may make people who are already susceptible to depression all the more vulnerable to the illness.

Also a medical condition (e.g., a brain tumor or vitamin deficiency) can cause depression, so it is important to be evaluated by a psychiatrist or other physician to rule out general medical causes.

How is Depression Treated?

For many people, depression cannot always be controlled for any length of time simply by exercise, changing diet, or taking a vacation.  It is, however, among the most treatable of mental disorders; between 80% and 90% of people with depression respond well to treatment, and almost all patients gain some relief from their symptoms.

Before a specific treatment is recommended, a psychiatrist should conduct a thorough diagnostic  evaluation, consisting of an interview and possibly a physical examination.  The purpose of the evaluation is to reveal specific symptoms, medical and family history, cultural settings and environmental factors to arrive at a proper diagnosis and to determine the best treatment.

Medication.  Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.  These medications are not sedatives, “uppers” or tranquilizers.  Neither are they habit-forming.  Generally antidepressant medications have no stimulating effect on those not  experiencing depression.

Antidepressants may produce some improvement within the first week or two of treatment.  Full benefits may not be realized for two to three months.  If a patient feels little or no improvement after several weeks, his or her psychiatrist will alter the dose of the medication or will add or substitute another antidepressant.

Psychiatrists  usually recommend that patients continue to take medication for six or more months after the symptoms have improved.  After two or three episodes of major depression, long-term maintenance treatment may be suggested to decrease the risk of future episodes.

Psychotherapy.  Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, it is often used in combination with antidepressant medications.

Psychotherapy may involve only the individual patient, but it can include others.  For example, family or couples therapy can help address specific issues arising within these close relationships.  Group therapy involves people with similar illnesses.

Depending on the severity of the depression, treatment can take a few weeks or substantially longer.  However, in many cases, significant improvement can be made in 10 to 15 sessions.

Conclusion

Depression is never normal and always produces needless suffering.  With proper diagnosis and treatment, the vast majority of people with depression will overcome it.”

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Depression and Chronic Conditions

Depression is more than just feeling “blue” or “down in the dumps.”  Clinical depression is a medical condition just like diabetes or high blood pressure.  Up to a third of people who are coping with a chronic medical condition show symptoms of depression.  And the more severe the medical condition(s), the more likely the person is to be clinically depressed.

Illness  upon illness…

While it hardly seems fair that someone already struggling with heart disease or the effects of a stroke also has to be concerned about depression, it’s the truth.  Experts believe that some medical conditions may contribute biologically to depression, and that depression may be an emotional reaction to being ill.

A medical illness that results in disabilities and losses can affect the role a person plays as a provider and/or parent and can cause the person to feel inadequate or damaged.  Other factors that may contribute to depression include chronic pain, dietary restrictions, and medical regimens.  Alcohol is also a well-known contributing actor to depression.

To treat or not to treat

There is growing evidence that treating depression in patients with chronic physical conditions may improve their health, reduce their pain, increase activity levels, help them in following their treatment plans, and, in general, enhance their quality of life.

Clinical depression is a highly treatable illness.  In fact, 80 percent of those with depression can be helped by behavioral change, therapy, antidepressants or some combination of these approaches.  Symptoms can often be relieved in a matter of weeks.

If you think you may have symptoms of depression along with your medical condition, the first step is to see your doctor.

Your doctor must first find out whether you have one diagnoses or two.  This requires careful evaluation.

Your medical illness may have symptoms similar to depression.  Weight loss, trouble sleeping and low energy, for example, occur in diabetes, cardiovascular disease, vitamin or mineral imbalances and endocrine disorders.

If the symptoms are part of the medical illness or side effects of medications, the doctor may need to change your medications or treatments to help you feel better.

If depression is an additional problem, the doctor may treat you or refer you to a specialist.

National Institute of Mental Health, InteliHealth/National Mental Health Association, 2002.i-health