Depression and Rare Neuroimmune Diseases: Q&A with Dr. Lana Harder and Angie Fayad
What is Depression?
Depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. Studies have estimated that 6.6% of the U.S. adult population suffers from a depressive disorder, whereas about 2% of school-aged children and about 6 to 8% of adolescents in the United States have either major depression or other depressive disorders. While everyone may have occasional moments of feeling sad or “blue,” or a temporary period of sadness in response to stressors such as a major loss, a depressive disorder causes those feelings to continue for an extended period of time. Depression affects each person in different ways, so symptoms caused by depression vary from person to person. For some, depression can be very debilitating. Compared to the leading medical causes of chronic disability, depression is second only to heart disease in terms of its impact on daily functioning. Genetics, age, gender, and cultural background all play a role in how depression may affect each individual.
What does Depression look like?
Depression often affects how an individual thinks, feels, and behaves and can cause emotional, functional, and physical problems. Among the most pronounced symptoms is extreme sadness and loss of interests or pleasure that often interferes with daily activities and relationships. Depression can also be a lethal disease, resulting in suicide in up to 15% of those severely affected. Anyone who expresses suicidal thoughts or intentions should be taken very seriously. Warning signs that someone may be thinking about or planning to commit suicide may include behaviors such as always talking or thinking about death, self harming behaviors, putting affairs in order, saying things like “it would be better if I wasn’t here” or “I want out” or a sudden, unexpected switch from being very sad to being very calm or appearing to be happy.
Although mood disorders, such as depression, can occur at any time in life, presentation of symptoms are likely to differ between adults and pediatric individuals. Adults with depression typically feel sad most of the day, experience increased fatigue, markedly diminished pleasure or loss of interest in activities, significant changes in sleep and/or appetite, and feelings of worthlessness or excessive guilt. Depression can also result in increased work absenteeism, short-term disability, decreased productivity, and a tendency to isolate oneself. Children or adolescents with depression may exhibit changes in sleep and/or appetite, and may look sad, withdrawn or tearful more frequently than they had previously. In other cases, they may be irritable, tired, listless, or uninterested in favorite activities. Children with depression may also report persistent boredom, problems at school and may complain of somatic symptoms such as stomachaches and headaches. In general, depression is an episodic condition in which an individual has symptoms for several weeks or months, which may then gradually resolve. Adults and adolescents may have recurring depression or a single episode. Variations in the course and presentation of depressive episodes can make diagnosing depression a challenge.
What do we know about depression and rare neuroimmune diseases like Transverse Myelitis?
Little is known about the prevalence of depression among patients with TM. Results of a recently published study revealed that 29% of pediatric TM patients experienced elevated depression symptoms according to parent report on standardized measures. Based on survey data from a study conducted at a family camp for patients with CNS demyelinating diseases, pediatric patients with TM did not differ significantly from sibling controls in their endorsement of depression symptoms on standardized measures. However, results showed that children and adolescents with TM reported these symptoms at a rate higher than the average population. Such results suggest that patients with TM may be at greater risk for developing symptoms of depression as compared to unaffected individuals; however, additional research is needed to more fully understand such symptoms in the context of TM.
Depression can adversely affect the course and outcome of chronic conditions. When depression is present in conjunction with chronic health problems or long-term conditions, studies have shown that these individuals experience greater reductions in health status. These reductions in health status are associated with poorer self-care, noncompliance with medical treatment, and disengagement from lifestyle and behavioral changes known to be protective in people with chronic conditions. If depression is suspected, it is recommended that you consult with your physician or a mental health care provider for evaluation.
What treatment options are available for individuals diagnosed with depression?
Treatment for depression usually speeds the process of reducing symptoms as well as the chances of recurrence, and diminishes the time an individual may be at risk for consequences that may be associated with the depressive episodes (i.e., work or school failure, social withdrawal, or family conflict). There are two main groups of treatment for individuals with depression with well-documented evidence of efficacy: Psychotherapy and Pharmacotherapy (i.e., medication). Additionally, recent research has found family psychoeducation, exercise, and social support to be beneficial for reducing some symptoms in individuals with depression. The care and quality of life for those with depression, regardless of particular treatment type, are optimized when there is open, collaborative communication between the patient/patient family and clinicians. It should be noted that suicide is a tragic and preventable consequence of severe depression and that a person who is at immediate risk for attempting suicide requires emergency evaluation and prompt treatment for depression.
Individual psychotherapy is generally recommended as the first line of treatment for individuals with mild to moderate depression. Psychotherapy is also helpful when ongoing stressors exacerbate the symptoms. Cognitive behavioral therapy (CBT) is a common therapy treatment option, as its effectiveness has been well established for treating depression. CBT can teach new skills to reduce some symptoms of depression, particularly the negative thoughts or feelings accompanying depression.
Pharmacotherapy: While psychotherapy may be sufficient to treat some individuals with depression, for others, symptoms do not improve significantly with psychotherapy alone. These individuals may benefit from medications. The most commonly prescribed antidepressants belong to a group of medications called selective serotonin reuptake inhibitors, or SSRIs. In most cases, these medicines begin to take effect after a few weeks. Medications should only be initiated, discontinued, or adjusted when a person is under the direct supervision of a trained clinician.
As noted above, if depression is suspected, it is recommended that you consult with your physician or a mental health care provider for evaluation.
REFERENCES
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., test rev.). Washington, DC.
Bennett, D.S. (1993). Depression Among Children with Chronic Medical Problems: A Meta-Analysis. Journal of Pediatric Psychology, 19(2), 149-169.
Centers for Disease Control and Prevention. https://www.cdc.gov
Fayad, A. D., Holland, A. A., Greenberg, B. M., Graves, D., Desena, A., Hughes, S., & Harder, L. (2013, June). Self-report of attention and psychological functioning among pediatric transverse myelitis patients and sibling controls. Poster presented at the Annual Conference of the American Academy of Clinical Neuropsychology, Chicago, IL.
Harder, L., Holland, AA, Frohman, E., Graves, D., and Greenberg, B. (2012). Cognitive functioning in pediatric transverse myelitis. Multiple Sclerosis Journal, 0(0), 1-6.
Kaplin, A. (2013). Depression in TM. Transverse Myelitis Association, 5(2). https://wearesrna.org/symptoms-conditions/depression/depression-in-tm/
Katon, W. and Sullican, M.D. (2010). Depression and chronic medical illness (Review article). Journal of Clinical Psychiatry, 29(2), 3-11.
Katon, W. and Ciechanowski, P. (2002). Impact of major depression on chronic medical illness (Review article). Journal of Psychosomatic Research, 53, 859-863.
Kovacs, M. (1997). Presentation and Course of major Depressive Disorder During Childhood and Later Years of the life Span. Journal of Health and Social Behavior, 33(3), 187-205.
~ Angie Fayad, BA & Lana Harder, PhD, ABPP, University of Texas
Southwestern, Dallas
