Healthy Mind

Julián Melgosa

HealthyMind Understanding, Preventing and Coping with Depression

General Plan of the Work

Foreword . . . . . . . . . . . . 9

1

What Is Depression? ................... 10 Definition ....................................................................................... 12 Myths about Depression ................................................................ 16 Why Does Depression Happen? .................................................... 20 The Impact of Depression .............................................................. 25

2

How to Recognize Depression? .....................................28 What Depression Looks Like ..............................................................................................................................30 Types of Depression ............................................................................................................................................35 Risk Factors ..........................................................................................................................................................38 Protective Factors ................................................................................................................................................42

3

Depression in Childhood and Adolescence ...............46 Depression in the Preschool ...............................................................................................................................48 Depression in the School ....................................................................................................................................51 Depression in Adolescents ..................................................................................................................................54

4

Depression and Its Environment ....................................62 Depression and Relationships .............................................................................................................................64 Depression and the Environment.......................................................................................................................66 Depression and Other Diseases...........................................................................................................................71 The Best Lifestyle ................................................................................................................................................77

5

Depression in Women ................................................... 82 The Female Condition...................................................................................................................................84 The Biological Factors ...................................................................................................................................89 The Impact of the Environment ................................................................................................................... 93 Coping with Depression in Women ............................................................................................................. 97

6

6

Depression in Old Age .................................................. 104 Depressive Symptoms in the Elderly ................................................................................................................106 Ailments Related to Depression ........................................................................................................................109 Preventive and Palliative Measures .................................................................................................................. 113 Situations That Cause Depression .................................................................................................................... 118 How to Regain Hope in Old Age .......................................................................................................................121

7

Depression and Suicide.............................................. 126 The Problem of Suicide .................................................................................................................................... 128 Suicide Risks ..................................................................................................................................................... 132 Signs of Suicide ................................................................................................................................................. 136 Suicide in Adolescence ..................................................................................................................................... 138 Measures to Be Taken ........................................................................................................................................142

8

Psychological Treatment of Depression ................. 146 Cognitive-Behavioral Therapy..........................................................................................................................148 Interpersonal Therapy.......................................................................................................................................155 Other Interventions ..........................................................................................................................................159

9

Self-Help Methods ......................................................... 166 Self-Esteem.........................................................................................................................................................168 The Control of Thought ...................................................................................................................................173 Activity Plans.....................................................................................................................................................179 Problem-Solving ................................................................................................................................................183 Setting Objectives .............................................................................................................................................185 Social Support....................................................................................................................................................188

10

The Spiritual Factor and Depression ..................... 192 Prayer ............................................................................................................................................................194 The Reading of Sacred Texts ........................................................................................................................197 Forgiveness................................................................................................................................................... 200 Belonging to a Religious Group .................................................................................................................. 204 Expressing Gratitude ................................................................................................................................... 207 Serving Others ..............................................................................................................................................210

7

1 What Is Depression?

er to 22-year-old twins, was Laur yn, a marr ied woman and moth apparent cause, although no was e diag nosed with depression. Ther have fueled the problem. d coul ren child her of ng the imminent leavi treatment. Her methodiher of ess Most remarkable was the effectiven and psychology made icine med in e denc cal personalit y and her confi kly.

Laur yn leave the pit of depression quic ........ 1 of?deep21sadness a feelin ressgIon r ep ............ suffe to n Is D bega t she : Ha clear W ............ .. .1 The diagnosis was .. .. .. .. .. .... .... ...... taste for food and for the relation............ ............ ar y that remained constant; she lost the ............ m ............ .... .. .. .. .. .. .. m .. .. .. ys .. .. .. u alwa .. .. .. .... ...... ......

She wanted to be isolated— S ............ ............ ............ ships with her family and friends. ............ ......... ............ ............ ht and begaDnefito weig lost ............

She ............ nition.. ............ ne. .. .. ortu .. n .. misf .. her .. io of .. .. s king .. ss .. sm thin ni re .... .... ha p crying and .. .. ec e .. ..

M l D .. .. ca .. t .. ly gi u .. slept pooryths abo urolo ....

She en?

Ne d slowly. es whenrable us,mise r. Th moved and talke ............ . She (magn Happ earcheill M the reslook and ............ epressio imaging techniqu WHat Is D yond the control of o neuro gh rou ............ ed by twlf Th D o es D .. fer at n suf y . epr th tired on h y io ssi ow tantl ss pre W cons kn re d herse ), we and founw we compare the de of Dep ch is t in onance imag ing c mu res Re a tic ho p so . ne ow in larly lv kn regu ed Im t took olv no g Doubts e she inv can that h are sant we t T epres rs, tha antid the as an her bro are tw in ord presc how ribed Her ses an cesdoct there are four brain collabo- My W pment pro holo ses: every week and fully psyc due to genetic develo e rienc ed siv cesgist ife Has D expe uniqu e pro andd an visite She ces depres tan ms cu cir epression l depreshow ing know gist, holo psyc much to persona The erapy. al Shor tly af hoth on psyc oti the em with of rated ter cen ter the bi h. a eac is of and la ve ces da beha to en yg how eri rt ren h of our se e am exp • Th husband and child ree month yn´s sed Laur for ms cond s, advi work d the alarm when thsoon vanced sion re ad of mo pared to sen ry pre ltsls.wereeven today, s and she still suffers child, my wife was diag mo resu me The ed.

With the advent y help na ybod sis, sig ever aly so s, ing an it s conseq c nosed with ptom en I eti sym eat do her gen thr to r s not know react ula ive lec rce uences. Fo mo pe n as depression h rso yo after suc pe ths u w ch the mon give me? hat to do r me, this of resear is was completely back to normal four . It e. Thyn , what to precisLaur the cogre and has been s mo uce ing rod le int om visib sa bec tex y very shoc cor are or Learn ever l nta how to ac fro ito the findings orb n e k tio yt Th va hing you • g t. What re ser kin ob ma ect n dir isio n. ca bega dec t the co men n. ors in derstand fav mmenda First, you the treat depr t method consists m ive component and and

ust be wel nit th ession and rm. you l informed ever ything in participants wi do not blam h the amygdala ala . In order related to of genetic mater ial e her. You as to what to do wit to help yo it. This will ish differences at a abl an o w est ur wife, yo als d ill to x n ev al rte sio en so co help you un res tal discover th separation on um efr pr l without dep l ica era log derstand lat at ideas are no uro rso ne your own do e the ca Th le, n • all the sym mp ht an exa lig d rm feelings an the talk to peop al in a spou in t bu g pt kin molecular level. For d ma 2 at the Un ithoughts ion se whose le who are cis de in m lps tea Yo of he his pa d educated guilt, frust . ur rtner has de an on the subj d facing the fut ure ta role in the course of pression. study of E. K. Green an t fied en nti gm ide , jud ec m) Re ial t. gdo ad ever ythi ke the diseas of soc ited Kin e is crucia with a positive turn due to versity of Cardiff (Un l. As a clos nts with late cortex deals your influ • Participa e membe ence. Her similar in participa The anter ior cingu te in medica • d an r of ms e ble ar an allele that was th is e pro Th e some exam l treatmen er. family, th ticipating and having e diseas t. Monitor ples of supp o with bipolar disord detecting errors, an the medic the admin or tive beha depression and als le ation alw istration of make her viors: otional responses. y distinct in peop all em ays availa g gic tin dr olo sy ula ug rph m reg mo pt s, s ble. Keep oms worse reminding allele wa risk was changed un in mind th them of th for severa e. The increase in at not taki l days. So til the right e in g in an intemetimes, ng the pi without the diseas combinatio age her to rying this chanisms operatin me car ll one day ce h ple suc rt peo n th ai se be n is Wi tho drugs do found. Do h patient. in wit e 15% at cop d to e ate no abl im no is est t work an • Suppor t let her ge person d mus t psyc t discoura grated manner, the ged by th ether they areseofveral pe hotherapy. Couples an type of allele. is, but enc etics d family th alities that come—wh ople and gen ntu at eve th the ny my de t ato not just th erapy is be no an the trea ose who su coming in In short, we can nce. But when the tment. W estation creasingly ffer from hen you ca little or great releva nk ight in the manif depressio moc common, nnot go w of the brain contai the psycho as are n. Attend se involv have a cer tain we as the d ith of ere on he sid therapeutic cti r, work with con sessions w fun be or t e no om ps can bec it yc t can treatment hen it is pa t hologist so her on the jec sub the or, t of depression, bu bu err tha rt he or she or task s assig t quite th im ect cla def e can we som sh e, ca e ne for ou n make ch opposite. d to her. D ere sion. ld consider If things do anges. If, on a determinant. Th changing e end up with depres Ta d eas an dis d me the de hel to no sp rw ty ps ite ever ythi ove t work, ta ychotherap lkin a propensi g ab - out what mu lk to th ng, treatm ists. But do genetics transmits one feels tors. ors arise due to com ents do no not conclu she is will may be th t work, yo de that ps ending on other fac Frequently, such err icaling, listen to he log erapeutic uro yc ne ho that can var y dep the th en erapy does r with th way, the sy . O ften, yo bet we not work ur wife will nication problems allele at CACNA1C system mptoms will get be e utmost attention an not want bipolar disorder risk Take care d with as tter. ces of the nervous to talk, bu 2 Green, E. K.et al. “The rrent major depression and of of yourse much em t when areas and other pla of recu 6-1022 (2010). also confers risk ar Psychiatry, 15: 101 schizophrenia”, Molecul

lf. Living w pathy as po Find someo ith someo ssible. In th ne to talk ne with de is to about yo evil of code pression pu ur emotio pendence ts us ns to maint at risk of st and maint in social ne ai ress and de n your men ain your ow tworks. Yo pr ta l health. Be ession. n emotiona u can be pa ware of fa Be patient l independ rt of a rest lling into th . Because, ence at al ricted grou e l times. Th although p of peop it can be on th er e e le who are treatment is suppor t e or two ye works, it w in your sa ars. Do no frustration. me situatio ill take mon t expect to n. ths and, if o much ch there are ange in lit Faith can difficulties tle time be be a blessi , cause it w ng. If you religion ca ill increase are people n cause th your of faith, pr ese proble guilt beca ay with he ms by the use it is fu r and trust presence ll of forgiv in God. So of guilt, bu eness and me believe t well-und hope. that erstood re ligion frees us from

Why Does Depression Happen? already A month after Robert lost his job, he major with iated had enough symptoms assoc was uel Sam , time e sam the depression. At ugh he altho and ry, facto same the from fired ement, experienced uncertainty and discourag them of Both n. essio depr d lope he never deve the same were married, had two kids and were The anage, so where do the differences lie? ing the know of ulty diffic the sents swer repre etiology of depression. with Robert and Samuel could be endowed and e pron one e different genetics that mad had both that ible poss also is It the other not. ected one prot that es renc diffe ical olog neur of them more than the other. Perhaps one other the and rsity adve e com over learned to es rienc expe never managed to do so. The life arprep rent, diffe very of both may have been moments ing one (and not the other) for those the supin s rence of stress. They may have diffe friends, , (wife ork netw l socia port from their attit ude, onal pers the lly, Fina .). ren.. child to take indiv idual choice and determination e the mak to help d coul her anot one path or difference between both results.

are In addition, there are other factors that t: fican signi are that ple exam not given in this Resea l rch Box or socia re cultu age, er, gend in es renc diffe t mos the ine outl Depression and class. In this unit we will Family at least relevant elements that try to explain, in part, the origin of depression. The study carried out by João Guassi Mo

WHat Is

Cohesion

reira and Eva Telzer1 especially of parent shows the influence s, on the manifesta of tion of depression in their adolescent 338 stu dents at the start Genetics children. T of their first year of col lege, a transition ore sympto ms. the period that can le The average age of The trad itional met hod to expl the par ticipants wa s 18.4 years: one thir been has n essio The depr in res tics d were men and ear gene of chers gathered info influence rmation on the lev essive el of family cohesio of depr , at the n throughout the same time, monit done by observing the similarity and t ored the level of dep ozy(mon gsnth ression among you s. The result s showe ng people duri symptoms in pairs of twin siblinmo d tha t the stu den ts with the lowest in unand fro)m levels of depressio cohesive families, gotic), in twin brothers (dizygotic n were especially the girls from these familie the more s.

Result s like these related people. The results show that rem ind us that the social mon, the context plays an imp depression and tha genetic resources there are in com ortant role in the d i- t, unlike the genetic load, there are man e essiv depr in s exist y larit things that can be greater simi 1 Guassi Moreira, done to cha J. t & Telz men er, agree E. of H. « Cha degree Adolescence, 43: 72-8 festations. However, the 0 (2015). according is far from the totality and varies, 1 How. to the studies, between 31% and 42% reliable ever, the methodology is not entirely in the ent ronm envi because the role of the is bese disea the of tion ifesta man process of

nges in family cohesio

n and links to depress

ion during college

transitio

of major depression: 1 Sullivan, P. F. et al., “Genetic epidemiology l of Psychiatry, Review and meta-analysis” in American Journa 157(10), 1552-1562 (2000).

the worst of the extremes: “If we go on vacation to a for eign country, ou r money and passports wi ll be stolen for sur e”; “Torrentia l rains are coming, so mayb e ou r house will be tot ally destroyed”; “I have chest pain and th at means I have cancer and I will die soo n.”

4. To make matte rs worse, this typ e of thinking is ver y compre hensive and its ne gativity extends to the person himself (“I am a disaster, everythin g goes wrong”), to the world (“a ll men are sel fish”) and to the

2 How to Recognize Depression?

a eer and moved to her university car ed ish . fin job w ret ne rga r he Ma At 23, d siblings to start m her parents an n caused tio ua sit w ne r location away fro he to g and the adaptation areas of her life.

The stress of movin d to take root in all me see t tha ss ne anything and do to e her a deep sad sir de or o energy

future (“This eco nomic crisis w fixed”). In fact, pe ople who ten this way suffer mo re easily from than those who assume more attitudes.

Environment an d

Experien

Part of depression is explained by If a child is raised in a peaceful a family environme nt, where he is enjoy the simple things in life an d fic ulties and pain with resilience, t

32

HealtHyM

ind

al of nocturn ng episodes rLo u d ia s n es m in ssive sleep • Hyperso ed by exce at used h ow w ll in fo st p slee disintere ies . ion, will or ed in hobb ing the day of motivat sily observ tigue ea faind is g n It . gi re an ealtHy Hie nced asM su h r ea o pl l al ve is36exper tb o to gi gy fo er g n en p yi g of te in hysirds, pla The lack y exhaust nce favori (playing ca g done an ich were o h in can be a w av er , m h h s) to t d p ot u n m ie witho hateful. An ty. This sy vi out with fr en ti ev ac possible l or ta t im differen cause it is cal or men at vanishes and now in l. problems be st in sex th k ve re le or te w m es in u of e, e e im th caus ng impuls at the min ro st example is sk a ta y a sl t and u rm to perfo as previo also frequen when it w petite are They ap . h in lt s . ea ge h men Chan e they affect pecially in us eat ca be to us re ro ck of desi very dange tions tite rections: la a di pe st e ap th if e bo n iv a ss in ce m can go t loss or ex somatic co Somatic M gh e ei th w s. e n d ar io te e complicat tified and fatigu with unwan ng health often iden Insomnia pression is correspondi at de h th it h g w ic h in w er ov sc plaints by ctor and di re. Both g to the do estations ics ssive pictu when goin re ep d ther Manif te characterist ent le O u p eq m fr co t a os number of m a e e mth ar co there is ly e er ab , have been Besides, th ons are prob ing criteria p as el be manifestati h t d u o an h it n that, w depressio these r of the list. ciated with t in one of agnosis. Fo monly asso ces manifes n of the di io an at rb tu rm is fi d y, phocon et d xi Sleep an an t , n or supp minatio mptoms, ritability, ru three ways: t physical sy example, ir asleep at ou g ab in ry ll fa or y w aches, ive ifficult ints: head bias, excess somnia. D ic compla , are at t. m th h u so • Early in o ig n er m e and oth ing of th ion or dry in p at u ip ion. es st ss n ak re the beginn w co n ts with dep myalgias, . The perso d in patien ifficulty n insomnia d u le fo as d y h tl id d M en • ht an frequ of the nig the middle . p ee sl resuming

Bipolar Disorder

Although this disease is not currently classified as a depressive disorder (as it has its own bipolar section), it is indeed a depressive problem, since bipolar disorder almost always includes major depression in its symptoms (see the Information Table).

Other Forms of Depression

• Severe. High number of symptoms w unmanageable discomfort and drastic terioration of normal life.

Finally, there is depression with seaso pattern (formerly called seasonal affec disorder) with symptoms similar to m depression. It has the peculiarity of ari with the absence of light, that is, in the wi months and in areas of the world far from equator. Phytotherapeutic treatment is usu sufficient: the patient is exposed to a l box that emits 2500-10000 lux rays (nor electric light emits 300-500 lux), thus re ing symptoms.

In addition to the types mentioned, labels are usually used that do not classify the disease but describe levels of severity or ways of manifesting. For example, we talk about psychotic depression when the affected person experiences psychotic symptoms: delusions or 37 hallucinations. We refer to recurrent depres?

Ion Depres press sIon a sion when symptoms return after they have Ize De n g o nD Its ec r o env t more been overcome. The risk increases the HoW there is recurrence: 60% of people who have suffered a period of depression suffer another; once they have suffered from it three times, ? the risk rises to 90%. r e d Ii Disor r a l o Also, depression is classified as mild, moderp i B Table r I and the severity: There a depending e rmation d between ate, or severe, r e o m re disea on s i sa e th ses that with de olar D p rnate in i e lt tend to B a p t s re a I ssion.number th occur alo • Mild.

Generallof symptoms, lives Minimum What mptoms ng with an y, the harm te the sy a abuse. It h n it g si w y patienin e t and little o d discomfort n . manageable f e e) to ti th ha a d sa d t who p o e d se is se e ness an p u h e T d is is ic s. n e r” si a a e of the su s also been foun o se h rd d c s r (m h sy iso e e n p o d x life. daily th a p r p e o e e d la iv d bjects w e le ri n o can lea ss a e ss th re n d d n p c “bip o n e e e o a ss s -d m . ith depre that a e) ic d to de c d relative Such a n euphori pressthat si ive episo alled ma ss w into fit not n does c tu ss a it Depression ion ha s p Moderate.

• s h re a a ro ). a p io ti w a ia h e c o t d n n ess is th e n a diction . Other tha me (d which h e opposi s hypom problem picture times, The join or severe. mild pressio me case more) in s. e classic te r th so o th : e in k t th c is e r n ri p I e e (o o r resenta causes a h presenc e ew substan disorde the eup tion of state of e of dee episod riod (on weaken ces is p ion, but epressiv decayed d long pe d ss s ep a a th re rt te s p ly le e e p ce p d o e n due to th rson affe r rganism mood th com ing the experie has majo cted by and its d e fact e d by a at way to th . It also depressio or othe rt e y, follow a fe rg p n e se . ic n e s e n ic s, r substa ailment. lk n turns an open ma al rise in erson ta notable disease nces to to Here are an the m er in the Howeve se, the p s that li relieve ttle soft r less) th the most r, altho anic pha kely app psych wsdepression: er is a li r days o m u ro e rd u o g o g (f th h is m r h g e e d id e n alcohol ear alon rt II ri st e o u -e d d sh lf , is , se is c se o t g with and oth au mfort, in His tha rver bec e physica nstantly. manic,” the lon the obse l, menta active co is “hypo Substan g run th remains ceable to l ti d a ey o ti n n c n a d o e y n ry re A s, apart e rg v la e b n ti re u e a o s le n s e sh ib from th ip com mptom Alcohol, exhaust e risk of y. drugs, o The pre has an in addictio ctive wa r the abu ications ps little, sence o an overa n. in g top, slee a si se f in re o substan of certain n can a among every th ces and lso incre or main the subst medipates in tain dep a de a a n se n x c ie th e he partic ty s e that attra . ression. risk of su begin fo A third ct icid rmal tre o f p W e o h a tm p a t to do w a recent le who ent for history hen facin depress being co or are in ion hav g this pro nfirmed e volved blem? that, te ndency in subst to depre in people with a ance trigger c ssion, c gen ertain su hemica l brain bstan changes that pre c

Depressi on and O

ther Dise a

the sa in adults as in childr en , bu t they could manifest diffe re nt ly. Th e schild with depre ry sad sion appears ve typical childin contrast to the cries a lot, h s vio tic hood beha r. He Characteris orite gam fav ol in e prescho no interests Depression in th s very litt ow sh , on ys rly to d “ea an stage is also called ls guil joviality and fee because it set depression” aggr en ev d irritable an in later tends to resurface s lack ow sh He e. ld ou siv sh stages. This fact ress disenergy, has inexp not be considered d possible an es r ey he rat t bu couraging, su matic symptoms an co ns id er ed as ma sto e, ach ad as he ce opportunity, sin l ache, or weight atany quality tre ms h pto sym ese Th ch ment will be mu s at no apparent cau more effective ited to lim e en ar wh ge th is sta re or two days bu the child has mo es persistent day tur uc str le ab lle ma s on day for at leas cti 58 fun HealtHyMin and brain d weeks at a es. than at later ag

linked to depression The diagnosis of would disappear. ver, today we Ho s. ult ad ed for was, then, reserv nized in og rec on al depressi not only is clinic also applies to it t bu , nts sce ole children and ad tly, proven years). Only recen preschoolers (3-5 and much e erg em begun to treatments have area of childthe in red ve co remains to be dis . hood depression

3

Depress ion in Childhoo d and Adolesce nce

Shortly afte r beginnin diagnosed g the first with child year of sch hood depr ooling, Aus tion period ession at 6 tin was passed, bu years of ag t parents an discourage e. The adap d teacher ob ment and ea tase sy rv crying did ed that sadn the activiti not disapp es that exci ess, ear even w te all child hen he did ren.

They took him to the psychologi typical case 51 st , d it was D aDolescence of depressi on. AustincHIlan clear that it challenge to DHooD an In ’s pare w Ion as heD ss n a lpep re ts th to e child get ok the diag life, like m out of that nosis as a ost childre situation an n do. So th son on a re d live a happ ey attended gular basis. y fa m ily So th m older than erapy with etimes, Aus him, attend their tin’s sister, who was th ed too. All sion includ of ree years them learne ing its caus d a lot abou es and cons ways to orga t depresequences. nize their liv Above all, es, perform games and they learne tasks, plan teach Austi d activities an n ways in pr thoughts. d family ocessing ne After four ga or tive and de five weeks, Since then pressing they began , they have to see impr done interm lives a norm ovement. ittent family al life witho therapy an ut the need d Aputibe for medicat n rty and rebegin until us noiot n.

chool S e th in n io s s re p e D

preof depression in e number of cases ch rea we ases when ol age (1%) incre olesad in ck ba ws gro ol age (2-3%). It show dition, statistics e and youth. In ad r than in ate gre is e nc ide the current inc It is, ious generations. wo or three prev ose risk inwh lem ob pr ing efore, a press ses with age.

teristics

women does . t of a person’s life mains for the res

arac l sympssion carries severa Childhood depre Inforxt ne e th in lete list ms (see the comp not tranare s nt me ail ese tion Table). Th st, two) for weeks (at lea nt, but they last iously ser ey addition, th even months. In rmance rfo pe l oo sch d an ect the social life children. er dif, there are no gend During this stage experience y ma ys bo d an ences; both girls nce for The double incide pression equally.

s Advice for Parent

in famdepression occurs The lowest risk of ct for pe res is ere th s where ily environment style n ria ita or ere the auth children and wh ection and aff of re he osp atm is avoided. The ue, where ere there is dialog good humor wh er, includoth h eac to lly efu everyone listens car against nt me on vir en e best ing children, is th ild can ch e th ch a context, depression. In su otions. em d an gs lin fee their vent and express parents communication, Apart from good (walks, ity tiv ac l te physica should incorpora clear that me co be s ha it as bike ride, etc.), ats depresprevents and comb physical exercise friends, th wi ial relationship sion. Quality soc protecat gre a o als is s lleague neighbors and co tor of the problem.

How to treat depression su ccessfully? A study of grea t importance raised to 65% entitled The tre -85% ment for adoles atcents with depr re ached the leve ession was carr l out by a team ied funded by the The most effe American Nat al Institute of c ionMental Health1 the combine with seventee million dolla d on n rs. The resear (c ognitive-beha chers studied efficacy of va vio the rious modes of fluoxetine (Pro intervention 36 weeks with zac) fo r the participat behavior appe ion of adolesce (12-17 years) ared nts with severe or treated only w moderate maj depressive diso ith d or rder. in only 8.4% of thos The participan treatment. ts (45% boys and 55% girls came from th ) irteen differe This and othe nt communiti After a rigorou rs es. s selection pr highest effic oc ess, the 327 finalists were ra acy is ndomly assigne psychotherap d to one of th treatment gr y. Wh ree oups: a) cogn chotherapy in itive-behavi therapy, b) flu adoles oral oxetine, and some exampl c) combinati therapy. es of str on The results sh owed that an y treatment method used increased its ef fectiveness w it was applied hen for a long tim e. For exampl twelve weeks e, at the effectiven ess was betw 48% and 73 een %, dependin g on the treatment. At eighteen weeks the effectiven ess was 1. TADS Team.

The treatment for adolescents wi th depression stu dy Long-term effec (TADS): tiv and safety outco eness mes.

Archives of Gene ral Psychiatry, 64: 11 32-1144 (2007).

Depression in Adolesce nts

Research Box

olescent ression in the Ad Family and Dep

out an

ried Depression collaborators, car , together with his in the adol y were y of Pennsylvania escent stag a new jum s par ticipated. The ilie 1 of the State Universit fam tive e supposes pec p in its inci co their res Gregory Fos dence: it in adolescents with puberty (1 Be 593 up. si ich gro de wh l in cr tro s, dy ea con during thes 2-14 years) ses in the to the experimental stu ation e ages, the and return rvention group or between ge in the mid s received inform either to the inte differen s to ascen nders is ev dle of the regimen. Familie ceed s randomly, assign d ident: two y were a family support adolescen the with depres to The estimat ich ted wh jec in sub ws s cases of gi rvie ce (14-16 sion for ea ion of case rls intervention group wa pated in three inte ).

The ch male w s range from syndrome. percent. O teen. They par tici tionships and to ith the• sam This differ 10 and 14 n the othe to support their timize family rela en ily situations, op onethe best ways r hand, th fam ce e in adolescent is nag g ma th m aintained e rest of th ldren, ere are man chi ir the s who esca te tiva du e life cycle r-ght to mo y tau pe from th il in part, by suffering so and is expl ds. e statistics t without the fam the female me depres aineapp m the school bu d, ly communication metho by hormonal sive sympt part, by th reaching th usual support fro the e eiv sh rec oc om to e k sp ued e clinical pi and, in without ecial deman up contin cture. and cultur d that each • The control gro years old The magn e imposes society rs (from 12 to 16 on women itude of th emphasis. h grade school yea . that the W e problem g the 6th to 10t rin du rs, yea orld Healt five is of such Character h Organiz After a follow-up considers de istics of depression ation (WH pression as ed that: ed ver y low levels O) the first ca the result s reveal ability in D treatment exhibit ep the re ed eiv ss rec io us n is more adolescen s had e of dislikely to ap ts, apart fr nts whose familie lescents w depression al treatment. om suicide pear in ad• Adolesce hen parent as the thir depression. o followed the usu oby s suffer or d most freq imal incidence of from the di pared to those wh of death in com ha children with a min s suffered uent caus se had as ts this age. e, flic es con t parent s have ab of tha pe e cially the m low level adolescen knowledge • Families with other. Also, ts who had environment, the any ot rn that the family ily conflicts and lea traumatic fam we id experience , avo nce to erie lity ir abi childhood s such as ab From this exp te adolescent s, the ting and overcom tiva ven mo pre andonmen to in e lity isiv abi are dec t, rejectionthe disease, their ce in the family, harmony and pea aining method of maint en. ir teenage childr the in n sio res dep

DepressIon

ing family conflict ily check-up: Examin5). ression with the fam (201 ng adolescent dep online publication: September 28 enti Prev al. et M. Advance 1. Fosco, G. Family Psychology, change. Journal of

In

c

as a mechanism

Self- Help Box

Quality of Sle ep and Depre ssion

The quality of

56

HealtHyMind on. At the prone to depressi or abuse are more in adoon ssi pre sence of de same time, the pre substance ult ad of k ris e th lescence increases er mental depression and oth abuse, recurrent . od ho ult ad in health problems particular ssion arise with a pre de es do hy W reditary he e th Apart from force at this age? of factors s up gro ree th are mechanisms, there vent: that explain its ad ge mental tors. With the hu • Cognitive fac ring adodu ce pla takes development that thinking in a risk of errors lescence, there is nt and me on vir en e out th about oneself, ab in the at th is well known the future; and it ately im int ors err ese s, th way of seeing thing on. linked to depressi onships is The world of relati • Social factors. nts. Famsce ole ad ntal in basic and fundame e adolescent th as ge an ch ily relationships risk of with the natural enters adulthood hand, er icts. On the oth parental-filial confl

sleep is an indi cator of menta l health in gene in particular. Th ral an e teenager with lack of sleep is driver. Other ris exposed to car ks are the low acc school perform contribute to m ance and lack of con oodiness and a depressed m substances such ood. It has als o been as caffeine, nico tine, or alcohol The most com is linked to po or mon problem in cases of adol sleep. A report escent depres sion is from sleepfoun dation.org stat day. However, es that teenag the data show ers nee that most adol escents sleep co Advice for the ns iderab adolescent rega rding sleep qu ality: • Regularit y.

Take your sleep seriously and go to bed and ge • Transition t up from wakeful ness to sleep.

Before sleepin intense menta g, get rid l activity little by little and tu rn of f ever ythi • To -do list fo ng tha r tomorrow. If you are over w he list. This practic lmed by the ac e trans fers wor tiviti come ry to paper an een equals also be unfinished prob d prevents your relationships betw le gs min m lin s. fee th me loaded wi complex and co se • Nap. Napping ca en int se cau s me n make you feel someti better and you and emotions that anges should be sh should use it w or t and early so pain. All these ch h pleasure and deep as . no ms t to interfere w pto sym ve ssi • pre de En d ith an vi the day-night ro ess nm str ent. The place can cause of nocturnal sle adolescent, do ac ep must be co rk factors. The tive projects ou ol, silent an • School or wo ead ts ac id h e the bedroom an hig et me s to ha , res ltu d retire to sleep cu • st Su bs in mo ta to nc gin es when t be .

Avoid the use sides, they must of products th mis standards. Be at on th alt ati ey uc er ed in th r te e he rfe qu re with the na ality of slee ities for hig tural cycles of examine possibil t supday and night ese changes are no Th an ty. d ruin qua ivi act rk wo or st of these oblems in mo posed to bring pr nt in ey do make a de th t bu s, ter gs youn . ne to depression those who are pro

Treatment

follow nts with depression Very few adolesce with es tri un co ent. Even in professional treatm of the lf ha an th re mo tems, integral health sys er parts of d and in many oth cases go untreate only 10% to en giv atment is the world the tre or less of the cases.

Depression and Relationsh ips Depression has a direct link to relationships.

A sick relationship can be a precipitating cause of depression, while hea lthy treatment and coexistence protect from depression and relieve symptoms when presen t. An epidemiological study conducted at the University of Warwick1 (United Kingdom) sho wed that, when young participants had a strong circle of friends, the probability of depression was reduced by half and the probability of reco vering from depression was doubled.

4

Depression and Its Environment

Obstacles and Opportu

nities

Helping a friend or fam ily member with depression can be difficul t for several reasons.

The stigmatization is one of them: many consider depression and oth er mental illnesses as something shameful and blame the sick person (“he has gon e crazy”,

68

her parents and her older sister Natalie, a medical student, lived with —a classic example of illness ssion and was diagnosed with major depre es since she had no family history stanc circum ntal onme envir by d cause e. She then went to a psychology and had never had the disease befor months. The symptoms did not four for ent clinic and received treatm to subside. Her sister played began disappear immediately but persistently and gave her a lot of encourclose d staye she se becau role rtant an impo of the treatment. agement to follow all the guidelines about? Her best friend had an accome ssion depre ie’s Natal did How tating. She had the following devas was ience exper The cident and died. of energy, irritability, restlesslack ss, sadne of symptoms: strong feelings did not sleep and eat well.

She e. ness and a very bleak vision of the futur rtant exams and had to leave impo two from nded suspe was she This way, not understand the situation and her major temporarily. Her parents did own marital conflicts, they did their with es, were unable to help. Besid accumulation of circumstances This transmit stability to the family.

Heanot . In spite of everything, with a lot toms symp ssive l depre t the H itated precipyMin d her sister and a psychologist, Natalie of personal effort and the support of was able to overcome this.

What S hould B e Done and Re to Prev lieve D ent e p ressive in the W Sympto orkplac ms e • Lear ? n

to r 3-5 seco elax. Breathe deeply, nds and inhale exhale • Liste fo for 8-9 n to m seconds. r usic if y • Keep our job a mem allows it ory th . such as a picture at makes you feel goo of a fav vacatio d orite ch n spot. ild, pet, • Clos or e your eyes an ments d think of som for a fe ething you sm w m ofunny ile. that m • If yo akes u are a believe text an r, m emoriz d repea e a bib t it seve are ten lical ral time se (for s when e xample nothing you : “Be a ” [Philip nxious pians 4 for :6]).

DepressIon

“that happens to him because h much”, “he is going to complicat ily so much!”). There is also a lot and, even with good inte ntions, m know what to do when they meet Another barrier is the weariness those who are close to the affecte cause it is very exhausting to care or friend who is sufferin g from de However, there are mu ltiple op If you want to help som eone with look for abundant informa tion bec standing the disease can be key wh to providing support.

Here there of data that you should know:

• Depression can tou ch anyone of age, gender, race, cul ture, or status.

• The affected are not guilty of ation, although their attitud social support they rec eive can c positively to the evoluti on of the • Depression reaches physical, m emotional areas, in add ition to the quality of relationshi ps.

• The patient does not usually see himself; and even less if his age is 18 to 25 years.

• The patient can be cured in seve psychotherapy, medicatio n, group self-help, healthy social environme tuality, etc., and the pro bability of is high.

71 Ironment anD Its env 1. Hill, E. M. et al. Spreadin g of healthy mood i adolescent social networks.

Proc Society B, 282: 20151180 (201 eedings of t 5).

iseases D r e th O d n a Depression

lf that almost ha o been found ve a close use. It has als ab ha n sio ng es alo pr r de to occu ts with ases that tend of the subjec nt who There are dise ion problems. e with addict rally, the patie iv ne lat Ge re n. sio pressiones nc rie pe with depres ex tation of de es as e joint presen that the y of these dise Th ct an n fa th e tio wi th ua es to sit e liv du ch a nces is partly pelessness. Su alcohol ta ho to bs s d su e rn an th tu s , n es essio times sadn ected by depr sion. Other aff es c pain. n pr hi rso de yc pe ps to de ve can lead e presence of tances to relie s e opposite: th or other subs d other drug at an th ol d oh oo m alc process is th d h ye wever, althoug a state of deca they cause Ho es n us ru ca en ng n lo op sio e s, pres defense rt, in th complicahide discomfo ganism and its e most relationship weakens the or t. Here are th l, mental and en m ica ys ail ion. e ct ph th di to ad with ing the way m the risk of appear along tions, apart fro es that likely as d depresse an di e es bl nc ta ta no subs e presence of icide and Th su n: of sio k es depr increase the ris sion can also se anxiety. ? It is Substance Abu ing this problem rtain medthe abuse of ce to do when fac netic t or ge ha s, a W ug th dr wi l, ct le Alcoho nces that attra ed that, in peop ong the substa being confirm in substances o rta wh ce le n, op ications are am sio pe es ird of depr at precipipression. A th tendency to ain changes th or maintain de ession have er chemical br ment for depr gg at tri tre al e rm nc fo ta begin lved in subs ry or are invo a recent histo

• Say a short p rayer o God, th f thank ank you s to Go for the to get a d: “My energy head. T you giv hank yo and th em u

5 Depression in Women

enjoyed good health and was Phoebe is 50 years old and always recent weeks she has suffered a lot: always in good spirits. However, in feelings of inadequacy, uselessness nia, insom little appetite, weight loss, experience, she does it slowly and and hopelessness. When she tells her compared to her usual way of me volu her voice shows a very tenuous and permanent and, in her own expressing herself. Her sadness is deep lived or died. words, it does not matter whether she Summar y depression, she seemed to have Although she had never suffered from be Phoe does why But osis. diagn cal clini The Female Co enough symptoms to receive the ndition ............ ........................ do many other women of her age ........................

The Biological suffer from this condition, and why ........................

Factors ............ ? lems prob e ....... essiv .... depr out ........................ with stage this ugh thro go ........................

Th nces msta e Im circu pact of the Envir and ........................ that gh enou on not ment ................ is It ..... r. facto rtant impo an is se .... ........................

Coping with De The presence of menopau ........................ pression in Wo Depress Ion In Wom........ men.................... and in-laws in advanced age nts pare ren, child t en escen adol .... has ........................

Phoebe ....................... husband is a good man, but he does and her own work to look after. Her the and ren child the the affairs of not help her with domestic chores, so in their corresponding families, elderly parents. It has always been tion, but the reality is that, with and no one has objected to the tradi ed such Minr dlevel of stress, Phoebe would probably not have reach lowe ay HealtH Katia gave birth to a healthy an extreme situation. d pre

The Biological Fa ctors

86

ve that t, they belie fter the even s (friends, er h ot rejection. A by e ot been liked y cases ther they have n s...). In man ue t ag bu lle l, co va relatives, of disappro not ive evidence ct do je s er ob h o ot n is d that is convince the person . ted to accept them traits are rela e-mentioned ent in es pr lly All the abov ua are us tent that is, they a greater ex depression, epression to

through a norm tty girl tion, pregnancy, al delivery with childbirth, postp no complications. However artum and menopause. In , a week later she addition, if the began to experience sympto woman takes con traceptives or fol ms that she had low ne ver felt bes a treatment for fore: an inexplica tility, the horm inferble sadness, an onal activity var unwillingness to do anything ies even more. , easy tears witho Depression is, in ut knowing why and a gen part, a product eralized apprehe of hormonal activity. Durin nsion towards the future. She g times of stress slept poorly an , the adrenal glands secrete a d felt nervous and irritable. It hormone called is an example of cortisol. This chemical increa how biology can cause depres ses the metaboli c activity and sive symptoms strengthens the : the placenta stops producin immune system g estrogen, pro . The reaction is ideal when on gesterone and endorphins an e is faced with d the levels beg moments of intense and iso in to return to the pre-gestatio lated stress, bu nal state. t when stress is prolonged (w hich is normal Fortunately, Ka in the current lifestyle), the lev tia only suffered el of cortisol con blue postpartum and the dis tinues to rise and the pituitary comfort dissipate gland begins to d in a couple of days. In other work to reduce high levels cases, this is the of cortisol. As a beginning of a postpartum dep con sequence, stress is accentua ression that may ted and prolon require serious treatment and ged , bringing the subject clo which lasts for ser to depressio months. In thi unit, we outlin n. s e the biologica According to Ell l peculiarities present in wome en Leibenluft, n that help us a researcher at the Universi understand their greater vu ty of London, lnerability to dep this process is experienced dis ression. tinctly according to gender. The biology of female Biological Diffe s reacts in a mo re startled way rences of Gend er Kenneth Kendler , a professor of psychiatry at the Universi ty of Virginia in the US, has carried out mu ltiple investiga tio ns, several of them tracking hu ndreds of twin women with and without a fam ily history of dep ression.

When he obser ved how they reacted to stressful events that arose, he fou nd only 6% of the total group of parti cipants were affected with depressive is persationsym toms while the conv e stressors cau ntly. The sam ueres a eq h fr it dep er w e ht sio n in 14 bypartic sed goofod her daug the say % nts d bo with r cloth he se depressive rel sant an y,ipa ea da pl ne lly O ati ua n. ves us io . This poan fect intd afhe s to reditary patte th to m er ar ef w pr rn I of s that affect the w on feeling omrseno of the om, frcou e, at andm ys: “M iny a very special wa u kndis oweasth daughter sa Yoy, in wo u; men. yo lls ca ho w e On on e e fac t that is very be th clear is the gender differen ce in terms of hormonal changes . These affect the mood directly. Men an d women are sub ject to these variation s, but only wome n experience premenst rual symptoms , menstrua-

6 n o i s s e r p e D in Old Age

ffer symptoms of t he began to su bu d, ol s ar ye s that predisposed Arthur is now 75 family background ral ve se d ha d, each He . different stages an depression at 19 He went through ss. e way. HealtHyMind ne bl ill ssi e po siv es st pr 0 him to de 12 ptoms in the be m sy e th th wi e withs to liv erapy and drug th ho time, he learned yc ps th wi s and riods of drug ent that were good He experienced pe ges without treatm sta h ug ro th nt Box out it. He we Research ion bad. n of cases tio or op others that were pr d D e p re ss all n sm a a r fo s ts s un e co ac n pression ession—usuLoneli Arthur’s type of de stigations suffer from depr many inve cases ral. While many , e ne es th ge liv f in eir o n th e sio in n es of depr egree o 1 resents o —once or twice , he sure the d Aylaz rep th difficult times spite of everything red to mea of Rukuye In te y . ally associated wi d is ng u in sti st -la m e . Fort y ng h ad lo e) T many relaresistant and 112 HealtHyMind ars of ag ries were s. Invento like Arthur’s are is a widower with 0 and 98 ye es he 6 y in n da el To n ee ll. w lo ble te a f we et lia o s illness he lives with d very re cipants (b learned to take hi passed away, but f 913 par ti ely used an dy o id ea le alr w p n a ve m , ion rso ha o st sa pe at a wh endable for a savage te igh correl tives and friends r survival comm n in the Ye relatively h fo e io d e sir ss S an siv de re a u es d ve pr m ep ti epre an de d si d m e ofary to banish th ssed, a po hopeful attitude ority of the riables cro th thur has learned Resolving Doubts at the maj wi Ar va th le n. o s op sio n tw pe ss es ea e pr to g de m es th prone to ghts, relatin ee of depre s, which Dep sseive Sy mpt nc general, fr d lonelines catastrophic thou riere in pe ng an di ex e, n ar us io sc er om io di ss w lig s s by re re in at gher es Am I th ep the Eldelorly in... atreHi nel... e. Finally, his tivg Ridskstaofying ........................ d d ants Haacvin Aitly empt from lmen quen a he fre Heprar dck ...................... oseDex Rewlahte AtGo ta ayts to good humor an iledthto ? le: ep ab re lu ss va io n ely ... m ... exam ... tre ... ex ... be .....................es to s I am a 70 year old co elderly and inue Pr in ... ntand ev s en ... tiv lin ... man e and Palliative ne ...............

I have been diag life. al wit rn nos sion and lo ete ed es in M pr h ea maj pe depression I have ha de or su ho dep n re m ress ee s firr risk of suff ion. Is it true that by hav s aate a gre p betw............... . ............

Situing ering a heart attack? ations That Ca ........................ . Relationshi , 55: 548-554 (2012)...

R. et Yes, it is true. The risk is cs triio . e alyDanep 1 Aylaz,us ria re four times higher than that d Ge ss n ..................... og ol nt of the general population.

Gero based on large samples ...

H ... ow ... ... to ........................

Now, the statistics are Regain Hope of hundreds of thousands in Old Age....... of subject s. These data are not necessarily for each ........................ valid for the group but individual. For example, ........................ among the par ticipant s, treatment for depression there are those who follo ..... and there are those who w do not. There are obese pati with normal weight. The ents and there are those re are smokers and drin kers and there are also abs with family history of coro tainers. There are those nar y heart disease, and the re are the ones who do not In short, while it is true . that depression places you at high risk, it is equally passive subject at the mer true that you are not a cy of statistics.

What can you do to preven t that kind of “prophecy” from coming true in you For example: r life? You can do a lot.

• Fully immerse yoursel f in everything that has to do with the treatment of symptoms and processes depression so that the of it do not favor heart pro blems: 1. Take antidepressant med ications on a regular basi s according to the guidelin the doctor or psychiatrist. es of 2. Attend psychotherapy to acquire the necessary skills and get rid of depressive symptoms.

3. Practice self-help and the general recommend ations of this book and similar ones.

4. Reduce the stress of you r life by maintaining a pos itive and hopeful attitude; learn to be happier every day.

• Put into practice all the preventive resources of heart diseases. In fact, these measures would be equally recommendable to you even if you do not have depression: 1. Diet. The most heart-h ealthy food consists of veg etables, fruits and cereals and moderate amount s of nut s and legumes. Any other food that you add should be low in fat, salt and sugar. Such a diet will help you maintain normal weight, which is a stro

7 Depression and Suicide

130

of depression at 19. His Andrew began to suffer from symptoms Instead of despair, this e. suicid father was an alcoholic and died by not to end up like his ew Andr for enge chall a as d misfortune serve des with thoughts episo ssive depre father. Today, at 50, he still suffers known how to use has he up, make tic gene his te despi of death. But ugh he has occasional difficulall the resources at his disposal. Altho ssfully and keeps himself out succe toms symp his ages ties, he man ind HealtHyM of the risk of suicide.

0 14 gh ological treatment throu activity is From a young age, he received psych physical e ed to govern his thoughts av learn h and ed studi to he e wher le d other m ersity b the univ of this an so favora toms govern him. He vowed gs. It is al nce of se ru S d u ab d m adole e and behaviors, instead of letting the symp m an th ar l alcoho y When the stem and ice ol or drugs. He learned to oris ne The pract health sy it from a very young age not to try alcoh y s. , d n it o io al h u at and et q ive in a blem of The Pro incl dships and have a posit icide m su protecSu al so ici : de th al .... es le e ganize his time, choose healthy frien .... d ar .... si to .... e o ........ p .................... s of o.... cess om tw he follows a plan of purposeful Suicideac ligious h ie................fr....

Risks........ d re us stud.... ....an n .................128 hopeful attitude. Up to the present, io ........ o ar gi .... v li .... e . .... re years .... f th y .... man o y ............................ nue like this for Signs of Suicide ors as shown b tion of y. The ad physical exercise and intends to conti am ct............................id F.... the popula .................... ....il...... 132 • .... triumph would not have been Suicide tive fa ............................ suic ....e....in f o ce elings w fe en ....

He admits that even with all that, his in d .... er........ ................ h.... inci scence................ w ole loAd great empathy, who . 136 r with an .... wom ous .... religi .... . a .... wife, th his .... ut u ............................

Measures toliBe possible witho old him fo uskeyno.... re gioTa .............. 13 ............................ ult moments. e ............sc id ic der8stan u n S u .... encourages him during the most diffic .... e so .... c ............................ al ...................is14 t and Fa n e ura ev p re es , P and d co2 ays good How to t. res are alw inat en su cl sc ea in le m o d e n ad v a le Preventi ally unstab d e fa e emotion nce of goo taken. Th cially for th measure is the prese “suic ship n as o ti ch t la HealtHyMind su re an ily An import s ptimal fam express but rather s and an o and free to fe sa friendship is t atic en “This sc em e: le st p o o Sy h ad e s. n where th p d emotio at your dis elings an his/her fe e port you b o s ge sa es m thing is comp acce

HELP

Suicide can occur at any time after 10 years of age, although it is tru e that its incidence is

products are available in rural areas where

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psycHologIcal treatme

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8

ence that people have their peculiar way of Cognitive Restruc seeing themselves and the world around them.

These beliefs are sometim This technique, des es illogical and lead to mental imbalances; aims to identify the th beliefs such as “I have no control over my hap stress and depression piness.” The therapy helps the subject iden more precise, less rigid tify and discard those thoughts and replace them To achieve this goal, we with more healthy ones from the mental poin uses the English acrony t of view. To do this, he proposed the ABCDE amounts to the followi model which we will n describe later.

• Identify the activati Aaron Beck proposed a thoughts. It is a fund similar mode of action, which has finally beco the immediate root o me more frequently used in clinical sett tivating agents can b ings than Ellis’. Beck also believes that negativ person, a memory, a p e and catastrophic thoughts can precipitate an activity... Knowi depressive symptoms.

The line of action of this agents makes it easier therapeutic approach is to attack what Beck call the problem. s the cognitive triad: (a) negative thoughts towards oneself, (b) • Identify the Beliefs (t negative thoughts tow ards the world and to discouragement a (c) negative thoughts tow ards the future usexample: “So and so h ing various techniques from which we offer able to use that compu examples at the end of this unit. will never be able to fi life” or “Everything go How This Therapy Wo rks not help it”.

The basic principle is that thoughts and • Ob ser ve the con seq feelings directly affect beh aviours. By repeating thoughts. For examp them, they can take roo t and affect the way discouragement and m one thinks and feels. The examHo psyc plelog they are a barrier in my of a spec Icalific treatm case is presented in the ent of epress clinical case table. they prevent D me from gro re the birth of her first befo tly shor ie Debb ded job inva n at risk, and so on. A Depressio ed reach d moo her but h, healt tal is men not fully aware of th daughter. She always enjoyed Self

Psychological Treatment of Depression

could lp Box g care of her daughter. She-He the point of losing the energy in takin ul. tearf and etic apath was She OutdThe oor not sleep, eat, or focus on anything. psychologist. Activity a to her sent e he/sh and ist, hiatr doctor sent her to a psyc very. risin ie was a surp Alth ouggh disco the light box is effective The psychological treatment for Debb and safe, the effect can be she but of, isted even better if we go freq doctors conswhere ther uently to pla e is sun She knew what the treatment of the Ion light and abundant natu 151 out medicine (her s s re. It was the result of rese s with t e men r treat cal p clini e tal men D arch done by Beyer, Szabo a ined f imag r 1 o neve Nattinger in the US. The t n e m t a y studied the correlation l tr).e Icamild bet ween the depressive log was case symptoms and the t the affected ones spe psycHo togethernt in the middle of nature. The loped deve was h whic plan gical results showed that a sign Debbie followed a psycholo ificantly high ind bet of n botdaug h varihter her ables, that is, the longer help her take carewee time in the natural environ with the therapist. Her sister came to ment, the lower the num with ng playi and ing, inte cook nsit ng, y readi of depressive symptoms and vice versa. and Debbie had to do outdoor activity, l readings, husband, and devo If youtiona are prone to depression— her daughter, conversation with her especially depression with ic mist pessi in certa g take to a seasonal pattern —spend Above all, Debbie had ox cturs.in r thing as you can in natural ligh ngeothe as much tim st r u e all, t outdoors and with surroun eR ivamo positive ones. Abov it n ce them with ding vegetation. Perhaps g repla o and mind C her r of f out fo o ideas y , it can be much mo ar y effeand ss ctiv lt ce e than of u ss ne the succe c the is lam fi p. it Of course, if natural ligh if l rule,rol over her happiness neracont t is not available, phy toth ed thatsshe a gehad she learn n ofcan erapy with artificial lig Her n.rnat essio bedepr self-help. A a goo n-ladeout her d alte otiocame , she rm of ive.

Thus em fo rs. othe e or with th ips te onsh in lu relati g her so in ab ur d, ct te ru ghts. or thou st e st essiv l, di e her stronger and less of to 1depr resist Beyer, K. M., Szabo, A., and cognitive re senceant , parteiamad icalrienc expe Natt e illog ch. The pre American Journal of Preventive inger, A. B. Time spent outdoors, depressive symp identify thos them as su t e toms, and variation by race en iv Medicine, 51: 281-290 (201 ti ce pa ry er e p ve and ethnicity. a lly 6). to elp th ua s us ad t le no one does sible which al os ct p je is b ys su al an e iv ct since the je ob e makes an is techniqu ologist in th s. e symptom ement of th

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HealtHyMind

Self-Esteem One of the diagnostic criteria for major depression is personal undervaluation or the feeling of being useless and worthless. It is a very common emotional experience in people suffering from depression . It can be explained by saying that a depress ive state undermines the mood towards eve rything especially toward oneself. It can also be interpreted as saying that insufficient self -esteem can be a trigger for depression when oth er symptoms already exist. It is not strange, then, that many strategies for the treatment of depression include the enhancement of self -esteem.

We dedicate this unit to describe ways of action to prevent and remedy the impoverished self-esteem that, in turn, will affect the improvement of depress HealtHyM ion. ind

you send yourself: “You lose; nobody likes you; y slow...” and say “ENOU rein to those ideas, you them completely.

In moments of calm adverse thoughts and an true or partially delirio u thoughts, ask yoursel f: I need to correct som et it? This analysis transfo thoughts into something patient towards solution s the problem.

If you find this analysis 170 should seek help from so Together with that per Watch Your Thoughts so includes your strenghts There is a lot of empha a sis in this boo greatsynd k Ma on ny people with weak me nts the rome of orta imp younce ty nest achieve r frieof emp nds the ed , tho col rienc leag ugh expe t. ues and We husb ll, her this Dev plays otea som and reladista bye carr Mary, 50, and daily yin g ae list tim thin key role k abo to sile of stre inutself nceng you ed to a tives,nt ,m -est r stre eemngt . Ifhs you got married and movdo and have tion this ,pro rea b-dingOth somethwith com ersfor when the last of their three children ing pla lem cegitbib to tin , em try onlica pow to thel pa er ide ref ly the ntif poor m. y those negativeThi very dealt Mary but ted; me affec ssag not nk ofesthe plea waysan thet ymo city. Her husband was rem me em nts ber ofthe theirpt al depressive began to suffer sever say a prayer of thanksgiv Bu ild Your Environment the absence of all her offspring and ing.

Maintain a pleasant and symptoms. attractive environAct an ingist. was a psycholo me nt. In Often tidy up your roo Mary had a friend from school who m or home and that so ures meas Keep yourself active in enjoy a clean and well-de on some self-help 16 everything yo 9 resolve this corated place. You do formal meeting, she instructed her oDs ures This will have a positiv tohav not etHmeas mtake e to move in an expens could call, lp e e phon e impact on the q l siona -H occa an lf ive with she, and sophisse of you ticated place. A simple, r self-esteem. The secret comfortable and clean is finding marked discouragement. ties that make you fee placeregu willlar marelake you feel good. l happy. For exa and hy healt a ng taini main if Mary set herself the goal of you like crafts, do a manual pro On etc.). ce the net, plaAt ce is the way you like it, ject nce (telephone, inter enjoy makes you feel satisfied tionship with her children at a dista it, and not for the task comp had do she som that eth liked ing she ities you activ to like , for example, If the re is the same time, she gave herself in an obligation that you hav take a soo little thin ned g herbal tea, put your e is, to which she has retur favorite postponing (for examp practiced since her youth, like tenn mu sic, le, organizing som go for bora wal neigh x her k, in r me Bo dita cente ly p te elder el in an at a -H bea help to utif per ted ul s, enlis visi she ting Also, . a little relative or cleaning the landsced by e? , anding enjoy the sunrise or sun think ho avoid ape M . She kept herself busy most of the time and thus The set. designate a generous tim ood in hood se things are not only ple e and prepare you asu W hat Is G ren. rab child le in themher ” “lost me ng nta havi of lly ne” to do fortu selv “mis it and es, but they can also ma then do it. about her ke you feel satisfied ul for: thing every inghin I feel gratef balanced thinkwit Think of some task in you rself.

She also learned to use positive and which you are e person, even without the cially skilled (for examp ities rtunod th develop as a le, drawing, sew e atributtes and focused on oppo healto go ve ha Nu cooking or carpentry rture Spiritually • I s work...) and enth presence of her children. ional friend astically devote yoursel Two except Put on paper (or electro e • nc f to such an acti r tie he pa ot ve m nic y dev m ice ) you to s r Do something with your han positive thoughts and My closenes • ds and give em l pha el size w the things ng someone. In general, if for which you are gratefu you can do someth l: health, loved ones, y • My job for som rite creativel eone in need, it will be work, environment... s of others cat very usefu Inspire yourself in the to the need • My dog/ your self-esteem and wil self-help box attached. m sensitive l provide you with g tin ra ant co ide de pre ssant mood. l m good at ities, as wel rsonal qual ibutes or pe tr at e ud cl is list may in lf- esteem. Th urish your se no to s ea id grateful. ch you are ngs for whi

Self-Help Methods

10 l a u t i r i p S e Th Factor and n o i s s e r p De

cal church, member of a lo d an r ne sig de ade full use of sful graphic s of age and m ar Rhoda, a succes ye 30 at on essive conditi ver. suffered a depr munity to reco ivaher church com of s ce ur she lacked mot so re e th church because to gago re to t ng an co w e not wards th At first, she did tive attitude to ga or ne ct a fa d us ha io d lig ed an t of the re tion, felt asham out the suppor so al ab e ng Sh ni t. ar en le r afte uragem co en tle lit 195 ith tion. However, w Ion en ss re lo ev go or anD Dep n to ed her a t. gaal fact e be Itu shpIr n, s tHe n, and this help tio ua in depressio sit r he ld to whom she to am with you; trusted a friend “Fear not, for I 0: :1 41 ah ai Is text in s, I will Rhoda read the ngthen you, Ye God. I will stre ur yo am I r fo , Be not dismayed ning Box e repeated it help you, right hand.” Sh us eo ht rig y erate M ommunity SupporI twill uphold you with cially when she was harassed by desp p of ou pe gr ry often es an, d a small ntly nsta coship God in her mind ve er with ay pr tion out rela t l ed ima us en opt e w an of ts. Sh the ghlack redou side group that is con r th ed ayou inhat mbe jo d so even anion e ; “W gious communities, depress ed” Sh in vert r. con y he tly r trul ea not fo gr are g r e you ayin auspr ed he was er depression dsbec is he l th stilllp y.’sAl you ed why messages such as: “You suffclose frien ne e that e th and th of God t to t trus ou od not e fo do u ; orgi“Yo ion”to ve out lf etook m dep mse hibec larly odure aus guress s pray more to get out of re pict ms:ive“G ai ress cl dep e the sh ate , plic en com y th , the inst . Since very coead her ;re re advisable to S These statements do not help ummar n!”inted. It is much mo bein sioppo up s end prgesdisa and de ates of isol t es, pi y dark 206them cult for d self-incriminat diffi are t tha s H vitie ealtHyM acti in m the y pan om acc ind P pray for them and offer to

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Our mind is the engine that pushes us to live a full and happy life.

By managing our emotions, our mind can make us live the best moments in life. On the other hand, it can drain all our energy.

Thus, it is crucial to have a HEALTHY MIND. One of the most common health problems that affect our mind is depression. According to WHO, depression affects more than 300 million people. We usually say or hear the phrase “I am depressed,” but on many occasions we are not provided with the proper tools to deal with this situation.

In HEALTHY MIND, Dr. Julián Melgosa explains what depression is and how to prevent it in a simple, pleasant and practical way.

Furthermore, Dr. Melgosa presents different prevention strategies which are the result of many studies and experiments around the world.

It is equally important to know what to do when symptoms of depression have already occurred. Therefore, you will discover various treatments and ways of overcoming depression.

Throughout the entire work, you will find different tables with a wide range of helpful information on the subject. Thus, you would deeply understand them, and you could implement the strategies in more efficient ways. We invite you to take control of your mind and become happier!