DISABILITY

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DISABILITY DEPRESSIONHow to recognize the
problem and get the help you want.

• Pamela J. Szeeley, MD, MSc
• Cooper University Hospital
• UMDNJ/Robert Wood Johnson
• Medical School at Camden

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• Depression is an illness that affects more than
  17 million Americans each year, many of whom are
  individuals with disabilities.
• 20 of all women are expected to be significantly
  depressed at some time in their life.
• Symptoms of depression are 2 to 10 times more
  common in individuals with disabilities or
  chronic illnesses.

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What is depression?

• Not just feeling sad, blue or discouraged
• Much more than just the normal ups and downs of
  life
• A pervasive illness that changes how a person
  experiences life, and can affect emotions,
  thinking, sleeping, physical well-being, and
  interpersonal relations.

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Symptoms of depression

• Sadness, hopelessness, or emptiness
• Decreased interest in usual activities
• Sleep problems, sleeping too much or too little,
  difficulty falling or staying asleep, waking too
  early in the morning
• Changes in appetite with weight loss or gain
• Increased irritability restlessness, or
  frustration
• Decreased energy or becoming tired more easily
  than usual
• Difficulties with concentration, memory, decision
  making
• Excessive guilt, worthlessness, or helplessness
• Decreased interest in being with other people
• Crying more than usual
• Recurrent thoughts of death or dying
• Thoughts of suicide or suicide attempts

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• When someone is depressed, they have symptoms
  nearly all day, everyday, that last at least two
  weeks.
• Occasional changes in sleep or appetite, or
  feelings of sadness, guilt, irritability or
  fatigue are part of the normal human experience.

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Depression is treatable

• MAJOR DEPRESSION people often feel overwhelmed
  or have trouble getting out of bed or taking care
  of themselves.
• With some kinds of disabilities, neglecting even
  routine aspects of self-care can lead to
  potentially life-threatening medical conditions
  and so depression can contribute to preventable
  death. Suicide rates are also higher among some
  groups of people with disabilities.

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• DYSTHYMIA
• and ADJUSTMENT DISORDER
• less severe conditions that can lead to
  persistent dissatisfaction, discouragement and a
  poor quality of life.

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• Depression isnt
• all in your head
• It is not a sign of weakness, laziness or lack of
  willpower.
• Causes include
• Biology
• Heredity
• Personality
• Life experiences

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• Depressive disorders involve chemical changes in
  the brain too much or too little of brain
  chemicals called neurotransmitters
• Depression can be caused by chronic medical
  conditions or the medicines used to treat them,
  or by alcohol or drug abuse
• Depression tends to run in families and women are
  twice as likely as men to experience depression
• Certain personality characteristics, coping
  styles, low self-esteem, lack of control over
  events are associated with depression it is
  often not clear what is cause and what is effect.
• The suffering and hopelessness associated with
  clinical depression are more intense, last
  longer, and have a greater impact on day-to-day
  functioning than the feelings associated with any
  particular loss or life crisis.

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Why are people with disabilities at risk for
depression?

• Not all people with disabilities suffer from
  depression, and for those who do, their
  depression may have little to do with their
  disability. However, depression is associated
  with certain life experiences that are more
  common among individuals with disabilities. In
  addition, people with disabilities face many
  unique problems and challenges which may place
  them at increased risk for depression.

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Challenges that can contribute to risk of
depression

• MOBILITY for some, decreased mobility affects
  everyday activities, like dressing or bathing, as
  well as ability to leave the house. It can mean
  needing help from others, which can be
  frustrating or embarrassing. Being unable to
  drive may limit ability to work, socialize or
  take care of everyday activities. Not having the
  strength, endurance, or other abilities to do
  what you want to do, when and how you want to do
  it, may cause you to feel frustrated, angry or
  helpless.

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• ACCESSIBILITY Many buildings still do not meet
  the Americans with Disabilities Act guidelines
  and people who move slowly or use wheelchairs,
  scooters, walkers, or canes may find it difficult
  to shop, dine, work, or access health care and
  other professional services.
• SOCIAL BARRIERS ISOLATION Many people without
  disabilities dont understand what its like or
  dont know how to act around someone with a
  disability. Also, some people feel uncomfortable
  or have negative attitudes toward people with
  disabilities. This can make personal
  relationships with others more difficult. Not
  having good social support increases your risk of
  depression.

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• EMPLOYMENT People with disabilities may have
  more difficulty finding and keeping jobs, either
  because of physical or other limitations, or
  social prejudices and misconceptions. This can
  lead to financial problems, and decreased self
  esteem. Not being able to work when you want to
  may lead to feelings of worthlessness or guilt.
• HEALTH If your disability affects your health
  this may affect your mood. Also, access to
  healthcare and paying for it may be more of a
  problem for people with disabilities.

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Not all disabilities are obvious

• Some disabilities are less obvious to the general
  public than others but can still make it
  difficult to go to work, or school, take care of
  yourself or communicate with others. This may be
  especially hard to deal with because people may
  not understand or try to help.

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• Any of these challenges are difficult to deal
  with. If you have to deal with several at the
  same time, your risk of developing depression
  increases.
• However, regardless of the cause or contributing
  factors, depression can be treated.

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How is depression treated?

• COUNSELING or PSYCHOTHERAPY helps people learn to
  cope with depression and deal with family,
  developmental, interpersonal or external factors
  that my be contributing.
• ANTIDEPRESSANT MEDICATIONS help restore the
  chemical balance in the brain that is altered
  when someone becomes depressed. Although the
  combination of talk therapy and antidepressant
  medication is effective for most depression,
  sometimes more aggressive treatments are required.

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What should you do if you think you are depressed?

• Depression is very treatable, but often, people
  dont get help.
• They may not recognize their depression, blame
  themselves or be too embarrassed to ask. They
  may think it will go away on its own or they
  dont know how to find help.
• You can contact your family doctor, local
  hospital, public health clinic or mental health
  center.
• IF YOUR DEPRESSION IS SO SEVERE THAT YOU ARE
  THINKING ABOUT SUICIDE, DONT WAIT. GO TO YOUR
  LOCAL EMERGENCY ROOM.

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Choosing a provider

• PSYCHIATRIST
• A medical doctor with four additional years of
  training (residency) in mental health. Only a
  medical doctor or specially trained nurse can
  prescribe medication but may also do some
  therapy, depending on his/her training,
  personality and type of practice.

• PSYCHOLOGIST
• A Ph.D (or Psy.D) has doctoral degree in
  psychology, which includes training in providing
  different types of therapy and (maybe)
  psychological testing.

• MASTERS EDUCATION (COUNSELING)
• And other Masters or doctoral level programs
  which train people to do counseling. Often these
  practitioners are associated with an organization
  that provides multiple programs
• PSYCHIATRIC NURSE PRACTITIONER
• Advanced practice nurse with clinical specialty
  in psychiatry can also provide medication and
  therapy, usually not in private practice.

• SOCIAL WORKER MSW, LCSW
• Has a degree in social work and training in
  helping people through various circumstances.
  Some social workers are also trained therapists
  and can bill insurance individually.

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What to expect when you see a mental health care
provider

• The first hour is usually a one hour complete
  psychiatric interview including
• Why youre there now
• What problems youve had in the past
• Current medications psychiatric and medical
• Psychiatric medications in the past
• Specific symptoms and how long youve had them
• Medical history
• Substance abuse history
• Social history including whether or not youve
  been abused or mistreated (physically, sexually,
  mentally)
• Family history

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• Usually a psychiatrist will not do a physical but
  will rely on your primary doctor. If there is
  concern regarding your physical condition, he
  will either contact your doctor or refer you back
  to him.
• The goal of the first visit is to obtain an
  understanding of the mental problems youre
  having, how this is (or is not) a change for you
  and what, if anything, can be done to help you.

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• Sometimes small medication changes can be made
  initially to grant you some immediate relief.
• Usually you can expect to see the psychiatrist on
  a regular basis (from once a week to every few
  months) depending on your situation.
• IT IS OFTEN NOT EASY FOR ANYONE TO FIND THE
  APPROPRIATE MENTAL HEALTH PROVIDER as there is
  variation in training and style of even
  practitioners who are similarly trained.

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• Before making an appointment, be sure to
  determine
• Type of practitioner
• Type of practice
• Payment policy
• If possible, experience with your type of
  disability or with providing the type of help you
  think you need (usually, the office staff can
  answer these questions)
• Accessibility
• Bring a list of medications (and doses) and
  medical problems with you
• Mention any special needs before hand to make
  sure they are prepared
• If possible, bring any relevant medical records
  with you or have them sent before hand
• If accompanied by a caregiver, do not assume the
  caregiver will accompany you into the doctors
  office
• The first meeting is often difficult, because
  there is a lot of information to be obtained. Try
  not to feel frustrated if immediate relief is not
  possible.
• At times, a mental health practitioner will feel
  you would be better served by another type of
  practitioner and refer you there in addition
  (e.g. If you need meds or intensive therapy)
• If a practitioner is not satisfactory after
  several visits, do not be afraid to change,
  recognizing that no one is perfect but sometimes
  a better fit is possible.

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What else can you do to feel better?

• If you have a serious depression you should seek
  help from a competent mental health professional.
• If you have occasional down or anxious periods
  you can talk to friends or family about what you
  are feeling, if necessary by phone or letter.
• Get in touch with other people with disabilities.
  If you are feeling alone or misunderstood,
  talking with someone who has a similar disability
  can make a big difference.
• Support groups for individuals with specific
  disabilities can also be an important source of
  information on how to cope with disabling
  conditions.
• Your public library may supply computer access to
  find or contact groups and agencies that provide
  education and support.

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• Become an Advocate
• If you think that environmental and social
  barriers are causing you to feel discouraged,
  down, angry, or bad about yourself, do something
  to make a difference.
• Talk to your doctor, local hospital, store
  managers about how they could correct problematic
  situations.
• Write your congressman about the problems with
  health care and health insurance.
• Respond directly, but with dignity, when people
  who dont know better behave poorly or use
  language that offends you when talking with you
  about your disability.

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• Exercise
• Even if you have significant physical
  limitations, increasing your level of physical
  activity even just a little bit will help improve
  your mood.

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• Volunteer
• It can get you out of the house and interacting
  with others, or you can make telephone calls,
  write letters, or do other activities from your
  home. Spending time and energy helping others
  can help you as well as them.
• Stress Management
• Stress tends to make depression worse. Relaxing,
  meditation, praying, watching movies, doing
  crafts, keeping a journal, or other activities
  can make you feel less stressed, and less
  vulnerable to depression.

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Talking with your doctor

• Make a list of concerns and questions.
• Describe symptoms clearly and briefly.
• Be honest about your history, including alcohol
  or drug use and sexual history.
• Dont be afraid to ask questions and dont feel
  embarrassed about
• discussing sensitive topics.

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• By the end of the first visit you should know
• How the mental health professional understands
  your problems
• Suggestions for treatment
• Suppose you dont like that idea? Other possible
  equally reasonable treatments should be discussed
  with you.

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To aid in communication

• Consider bringing a friend or family member with
  you
• Ask your personal doctor or nurse
• Ask your pharmacist any remaining questions about
  medicines or just to double check
• If you still do not understand, let your doctor
  know..

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Possible questions to ask

• Will changing my lifestyle (diet, exercise,
  smoking, drinking) help me?
• Is there any reading material or videotapes?
• Are there support groups or community services?
• Are there any tests that I need to undergo? And
  what is involved?
• Is there any other possible cause for my
  symptoms?
• What may have caused this condition?
• What are possible side effects of this
  medication?
• Are there certain foods, drugs, I should avoid?
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