Depression in the Congregation A Presentation at EMU at Lancaster Congregational Health Ministries September 21, 2011 Presented by Beth A. Mull, Psy.D. Licensed Psychologist Clinical Neuropsychologist I. STEPS OF SUPPORT Step 1: Recognizing Depression • Depressed mood or low pleasure • Behavior change; irritability • Changes in appetite or sleep • Difficulty concentrating & making decisions • Low energy or fatigue • Low self-esteem • Feelings of hopelessness • Thoughts of death or suicide Step 2: Determining need for help. Need for treatment increases as: • Number of symptoms increases • Severity of symptoms increases • Duration of symptoms increases (> 2wks) • Level of functioning decreases • Ability to guarantee safety decreases Step 3: Getting into Treatment - Entry Points • Primary Care/Medical      o Medication • Psychotherapeutic      o Counseling • Emergency      o Safety Step 4: Maintaining Treatment • Therapeutic alliance and trust • Setting goals together • Assessing progress • Altering treatment goals as needed • Collaboration with other treatment providers II. MEDICATION • Selective seratonin reuptake inhibitors (SSRI’s)      Increase seratonin in the synapse      o Citalopram(Celexa, Cipramil)      o Escitalopram (Lexapro, Cipralex, Seroplex, Lexamil)      o Fluoxetine (Prozac, Sarafem, Symbyax)      o Fluvoxamine (Luvox)      o Paroxetine (Paxil, Aropax)      o Sertraline (Zoloft) • Serotonin-norepinephrine reuptake inhibitors (SNRI’s)      Increases levels of seratonin and norepinephrine      o Desvenlafaxine (Pristiq)      o Duloxetine (Cymbalta)      o Milnacipran (Ixel)      o Venlafaxine (Effexor) • Norepinephrine-dopamine reuptake inhibitors      Inhibit the neuronal reuptake of dopamine and norepinephrine      o Bupropion (Wellbutrin, Zyban) • Serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI)      o Nefazodone • Serotonin antagonist and reuptake inhibitor (SARI)      o Trazadone • Norepinephrine-dopamine disinhibitors (NDDIs)      Antagonizes the serotonin receptor to promote release of norepinephrine and dopamine.      o Agomelatine (Valdoxan, Melitor, Thymanax) • Tricyclic antidepressants      Block the reuptake of norepinephrine and serotonin.      o Amitriptyline (Elavil, Endep)      o Clomipramine (Anafranil)      o Doxepin (Adapin, Sinequan)      o Imipramine (Tofranil)      o Trimipramine (Surmontil) III. PSYCHOTHERAPY • Cognitive Behavioral Therapy (CBT)      o Restructuring negative thoughts about:        • Themselves        • The world        • The future      o Behavior Plans and Experiments      o Structuring daily activities      o Trying out new behaviors and evaluating outcomes • Dialectical Behavior Therapy (DBT)      o Mindfulness        • Observe and describe non-judgmentally      o Distress tolerance        • Distract from distressing thoughts      o Emotion regulation        • Problem solving and letting go      o Interpersonal effectiveness        • Assertiveness training and listening skills • Play therapy (children)      o Play themes reflect their experience      o Family sessions      o Parent consultation IV. LIGHT THERAPY • Seasonal Affective Disorder • Full spectrum light • 15 – 30 minutes/day V. ELECTROCONVULSIVE THERAPY (ECT) • Used for severe depression which has not responded to other treatments • Can be an alternative to medication during pregnancy VI. SOCIAL SUPPORT • Sense of genuine concern • Safety in sharing feelings • Promoting a positive attitude • Reliability • Traditions • Support groups through Mental Health America (free) VII. RISK FACTORS FOR DEPRESSION • Family history of depression or bipolar disorder • Stress (job, financial, social, family) • Substance abuse or dependency • Childbirth (post-partum) • Traumatic brain injury • Unresolved grief VIII. RISK FACTORS FOR SUICIDE • Current suicidal thoughts and plan • Past suicide attempts • Psychosis • Recent loss (job, relationship) • Suicide of friend or family member • Helplessness, hopelessness • Perceived burden to others • Substance abuse IX. PROMOTING EMOTIONAL HEALTH • Finding meaning in stress • Exercise and nutrition • Value oneself • Positive thinking • Time management and goals • Social activities • Humor! and expressing other feelings X. RESOURCES PSYCHOTHERAPY SERVICES • Samaritan Counseling Center. . . .560-9969 • MH/MR. . . .393-0421 • Catholic Charities. . . .299-3659 • COBYS Family Services. . . .392-0504 • CONTACT Help Line. . . .299-4855 EMERGENCY SERVICES • Attempting to Carry Out Suicide Plan      EMERGENCY RESPONSE. . . .Call 9-1-1 • Cannot Guarantee Safety & Refusing Emergency Treatment      LANCASTER COUNTY CRISIS INTERVENTION. . . .394-2631 • Willing to Get Emergency Treatment:      HOSPITAL EMERGENCY ROOM      PHILHAVEN (ask for Access Center). . . .273-8871
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