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Promoting the Health and Well-Being of Families During Difficult Times

Understanding Depression Following a Disaster

Marta Stuart
Extension Specialist Yavapai County, Arizona

The purpose of this fact sheet is to help families who are experiencing stressful times during a disaster develop an understanding about depression: what it is, what causes it, what are the symptoms, and how is it treated? According to the National Institute of Mental Health, an estimated 18.8 million Americans suffer from a depressive illness each year. Depression does not discriminate; it affects men and women, young and old, and people of all races, cultures, and incomes. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to the individual, but also to those who are close to him/her. Depression is a real illness and carries with it a high cost in terms of relationship problems, family suffering, and lost work productivity. However, it is a treatable illness.

What Is Depression?

Depression is not the same as a blue mood, which is a normal short-term experience of sadness or loss. Depression is an illness that involves the body, mood, and thoughts. Often referred to as the invisible disease, it affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Depression is not a sign of weakness or a condition that can be willed or wished away. People who are depressed cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Causes of Depression

According to the National Institute of Mental Health and the American Psychiatric Association, depression can affect anyone, even a person who is considered normal and healthy. The causes of depression usually relate to several factors. The following is a summary of factors that may lead to depression.

Environmental Factors
Environmental causes of depression are situations that occur outside of us. They are directly related to events that happen in the everyday course of life and may include stress at home, school, or work. Many people become depressed after they have experienced a traumatic and painful life event, such as a medical illness, death of a loved one, or financial crisis. A natural disaster such as a drought may be traumatic enough to cause depression. Additionally, continuous exposure to violence, neglect, abuse, or poverty may make a person more susceptible to depression.

Personality/Psychological Factors
People with low self-esteem, who consistently view themselves and the world with pessimism, or who are easily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

Genetic Factors
Depression can run in families; in some families, major depression seems to occur from generation to generation. However, genetic anomalies may also cause depression in people who have no family history of depression. Whether inherited or not, depression is often associated with changes in the brain structure or brain function.

Biochemical Factors
Deficiencies of two chemicals in the brain, serotonin and norepinephrine, are thought to be responsible for certain symptoms of depression, including anxiety, irritability, and fatigue.

Very often, a combination of environmental, psychological, and genetic factors are involved in the onset of depression.

Types of Depression

There are three main types of depression:

  1. Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy activities that were once pleasurable.

  2. Dysthymia is a less severe type of depression that involves long-term chronic symptoms , which do not disable the individual, but may keep him/her from functioning well or from feeling good.

  3. Bipolar disorder, also known as manic-depressive illness, is a serious brain disorder that causes extreme shifts in mood, energy, and functioning. The disorder typically emerges in adolescence or early adulthood, but in some cases appears in childhood.

Symptoms of Depression

Many people still believe that the emotional symptoms caused by depression are not real, and that a person should be able to shake off the symptoms. Individuals with symptoms of depression need to get professional help. Symptoms include the following:

  • a persistent sad mood
  • loss of interest or pleasure in activities that were once enjoyed
  • significant change in appetite or body weight
  • difficulty sleeping or oversleeping
  • physical slowing or agitation
  • loss of energy
  • feelings of worthlessness or inappropriate guilt
  • difficulty thinking or concentrating
  • recurrent thoughts of death or suicide

Brain imaging research reveals that in depression, neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly, and that the regulation of critical neurotransmitters is impaired (Journal of Psychiatric Research). Additionally, the hormonal system (HPA) that regulates the body's response to stress is overactive in many people with depression.

Treatment of Depression

Informal On-line Screening
The following websites offer a confidential test to help you identify depressive symptoms and determine whether further evaluation by a medical professional is necessary:

Professional Diagnostic Evaluation
The first step to getting appropriate treatment is a physical examination by a doctor. Certain medications and medical conditions can cause the same symptoms as depression, and the physician can rule out these possibilities through examination, interview, and lab tests. A good diagnostic evaluation will include a complete history of symptoms (i.e., when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and with what treatment). The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness. Treatment will depend on the outcome of the evaluation. (Source: National Institute of Mental Health, Publication #02-3561)

Certain types of psychotherapy, specifically cognitive-behavior therapy (CBT) and interpersonal therapy (IPT), have been found to be helpful for depression. Research indicates that mild to moderate depression often can be treated with therapy alone. However, a combination of psychotherapy and medication may be needed to treat severe depression.

There are several types of medications used to treat depression. It is important to keep taking medication until it has a chance to work. Never stop taking an antidepressant medication without consulting the doctor for instructions on how to safely discontinue the medication.

Alternative Medicine / Herbal Therapy / Integrated Medicine
In more recent years, the use of alternative medicine has been explored and has proven successful in treating depression. Much interest has risen in the use of herbs, massage therapy, acupuncture, and other natural healing for the treatment of depression. However, scientific studies have not been conclusive in this field. Any alternative medicine, herbal therapy or integrated medicine should be taken only after consultation with a doctor or other health care provider.

Internet Resources

National Institute of Mental Health - Depression: Free publications and other information from the National Institute of Mental Health on Depression http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm OR call 1-301-443-4513

How to Locate Mental Health Resources in Your Community: Provides a list of local resources for depression. http://www.allaboutdepression.com/res_07.html

Understanding Depression: Tips on signs to look for in a depressed person, information on what causes depression, and what people can do for victims of depression. http://www.extension.uiuc.edu/ruralroute/depression.pdf

A Checklist and Guide for Making Referrals: A checklist for assessing ranchers/farmers for stress and depression. http://www.ext.colostate.edu/drought/checklist.html

Resources for Depression: Online resources for depression. http://www.ext.colostate.edu/drought/depression.html

Clinical Depression in Later Life: Fact sheet on clinical depression in later life, including causes, treatments, and how to help older people with depression. http://www.ext.colostate.edu/pubs/consumer/10251.html

Supporting Families Following a Disaster: The University of Arizona College of Agriculture and Life Sciences Cooperative Extension has designed this series of fact sheets covering special needs of families during difficult times. http://ag.arizona.edu/fcs/supporting_families/


American Psychiatric Association-Public Information: Depression

Chevallier, A. (2000) Natural Health Encyclopedia of Herbal Medicine. Dorling Kindersley Limited, Great Britain.

Lazarus, J. (2000) Stress Relief & Relaxation Techniques. Keats Publishing, Los Angeles.

National Institute of Mental Health - Depression, NIH Publication No. 02-3561
The Invisible Disease: Depression, NIH Publication No. 01-4591 Let's Talk About Depression, NIH Publication No. 01-4162 http://www.nimh.nih.gov/publicat

Niven, D. (2000) The 100 Simple Secrets of Happy People, What Scientists Have Learned And How You Can Use It. Harper Collins Publishers, Inc. New York, NY

Soares, J.C., Mann, J.J. (1997) The functional neuroanatomy of mood disorders. Journal of Psychiatric Research.

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