Skip to main content

tv   Earth Focus  LINKTV  October 22, 2012 9:30pm-10:00pm PDT

9:30 pm
e mixed. there'no one cau of depression, e mieven for a single person. it's unlikely that there is one thing that causes their depression. we think of it as a risk factor model where depression develop in the context of risks. when those risks get high enough, thto develop this self-sustainindepression those risks might be divided into three categories-- psychological, enronmental, and biological. on the biological risk side, we have genetics, other physiological conditions, which give us a predisposition toward becoming depressed. on the psychological side, we have thinking patterns, cognitive ste, personality, and various factors like that that may leave us at greater risk for depression. on the environmental side, havand lack of social supports, which leave us at greater risk for depression. when the sum of these risk factors gets high enough,
9:31 pm
that pushes us over some threshold, and we go into a period of clinical depression. for some people, one of those factors may be stronger than the others, but it's unlikely that there is one cause. it's usually some balance with different weightson th. first of all, the development ofa clinical kia like depreion is a very mplex phenomon. it involves the development, psychologically and physically, of the individual, and then on top of that, the need to cope th the sometimes catastrhic social conditions that patients are exposed to. some of the conditions that garedelstein'clients are exposed to are d incrng aymen drugs, heof violence. bh he and dr. young point out, all the ri factors must be attended to.
9:32 pm
what wreooking at n'only thecute exposure to a particular soci problem, but the tendency of that individual to have been exposed to proble all through their lives. alof this sets up thsocial stressorwhen a rr isnflictedpon them, the patient unae cope. 's usually when ty esento us with clear diagnostic different populations seem to have fferent kinds of risk faors. to suffer from mor depression areas are men.ik dr. knafo and dr. fawcett discuss some of the theories about psychological,iologil, anenronmtal faors that may ctribute to thidifference. in addion to wen living in a long-standing that may ctribute social disadvanted role in our siety, to thidifference. we know, and research h shown, that for women,
9:33 pm
relationships armore significant than for men. nojustore significant-- and i'm not saying that for men relationships aren't significant-- but that women are more affected by relatnships, by the fate of their relionships. they define themselves very much according to the relationships that they're in. carol gillan, a researcher from harvard, has demonstrated that femininitd through relatedness, while masculinity is largely defined throh separateness. so if we take this logic further, any losses otraumas in a relationship will be experienced more... more seriously by a woman than by a man-- more depressing. the woman will tend to be md by a loss or a major change in a relationship than a man will be because she defines herself and her success in life
9:34 pm
through her relationships. i was a failure, i felt, because i uldn't have my own children. that was my first heartbreak. wh we adopted our children, i felt like a failure as a mother because i didn't know how to raise them, if i was raisinghem properly. i tried copying what everyone else had done, and it wasn't coming true fome. i loved their father so mh, i was willing do anything for him. um...it hurt. and, um... it's, like, i see him now,once , and i tell him now, "i love u, but it's not the same. "i know when to say no to you. "i can do for myself. i don't have to dend on you." re women come in for treatment than men. it may be as high as 3-1 in a clinic.
9:35 pm
women seek treatment more easily than men. men wait till they're much worse off before they'llet treatment, usually till they can't work. they have a much higher rate of suicide. why do more women have depression than men? it may be because less women are alcoholic than men. men are much more likely to have alcoholism. alcoholism and depression overlap a great deal, so men may become alcoholic as a way of treating their depression. it's a very poorreatment for depression. it makes it worse, but it alls the person to get by for a longer period of time. that may be one possibilit- the overlap between alcoholism and depressn. the other reasons may have to do with hormonal differences between men and women. there are considerable differences, and, you know, women frequently develop premenstrual depression.
9:36 pm
women with depression frequely get much worse premenstrually. this is not uncommon. so there may be a hormonal difference. the may be many social differences terms of social roles concerning women in our society that exert different pressures on them than on men that account for this. along with psychological and environmental factors, perts believe that biology plays a role in botmajor depression and bipolar disorder. there seems to be especially a stfor bipolar disorder. rodney belongs to a supportroup called mood challenge. rodney's mother discussed her first manic episode. atge 55, i my fst one. the ctor said that that was very unusual, abut i had been under a tremendous lot of stress with rodne and all he had to go through and otr things in o life.
9:37 pm
i hajust been der a lot of stress. i didn't know anything unusual was happening to me. there had been a few nights that i hadn't slept, but not too many nigs. and, um--i, um... i just felt like i was really into god, but during allhis time, i had ied to pretend that nothing was happening. i justri to shut it off. i thout,i have to do this," beusi had go toor you were really into god, and i thought i was god. [laughter] the idea of genetics, right now, is based mainly on the observation of family transmission. that means the occurrence of aillness being more likely if there's a family history of thellness. now, that doesn't prove genetic transmission. it just suggests it.
9:38 pm
somebody looking at the patient's environment could say, "well, the environment's also the same "in the family, and maybe that transmits the illness." we have reasons to believe from twin studies, where identical twins have the same genetic material, that the likelihood of transmission is much greater. and there's been efforts to identify the genes which have come up with findings which have not yet held up. so we don't have genetic proof, ultimate proof, but the evidence is very strong for genetic transmission in both bipolar and unipolar illness, but it's strongest in bipolar. so rodney probably inherited a predisposition for bipolar disorder from his mother, mostikely a dysfunction in how the brain works. in this highly schematic drawing, nerve cells in the brain carry information in the form of electrical impulses along the length of the cell. r the impulse to cross the synapse--
9:39 pm
the space between the cells-- a chemical called a neurotransmitter must be released into the synapse. the neurotransmitters move across the space and lock into specific receptor sites on the next cell. that's normal brain function. the theories of mood disorders-- that includes both depression and mania-- are dominated today in today's knowledge base by our knowledge of neurotransmitter function in the brain. in major depression, a person may not have enough neurotransmitt at the synapse. in a person who is manic, there may be too much neurotransmitter at the synapse. summing up, there is no single cause of major dression or bipolar disorder. there arvarious ntributing factors. one--the may be deep-rooted, unconscious conflicts. two--on the biological level, a deficit of neurotransmitters may result in depression, while an excess may prode manic states. ree--there istrong evidencetha-
9:40 pm
especially bipolar illness-- may be genetically transmitted from one generation to another. and four--some depressions may co aa reacti to life ents, so environmentalactors must be considered. unemplment, illness,rs or theeath of loved one may lead to depression. all some of these factors y be iolved. it is important to aess each person individually to determine what the causes are iand what treatmentsess ell be most effective.ly some people with major depression aren't treated because the episode runs its course, they aren't properly dgnosed, or thest d't seehelp. for threst, there are two general forms of treatment-- psychotherapyand medic. phyllis received both. the appropriate use of antidepressant medications has helpedany people with major depression. the treatment for depression would be a medicion
9:41 pm
which would increase the avlability of certain neurotransmitters-- perhaps norepinephrine, perhaps serotonin. we would use medications like the tricyclic antidepressants. for instance, elavil or tofranil are well-known medications. as dr. fawcett notes, antidepressants increase the level of certain neurotransmitters. there are two kinds of medications that accomplish this-- the tricyclics and the mao inhibitors. for a long-term mood disorder in which biology is a major causal component, such medications can often work wonders. the problem is they don't work for everyone who takes them. the dosage must be watched carefully. there can be dangerous physical and psychological side effects. any medication you may take will have side effects. the importan of the side effects has to be asured against the benefits of the medication,
9:42 pm
and the cooperation and motivation the patient is extreme important. i depend on too much of it at fir. i though "i'll never be sad again. i'll never havtoorry again."but. medication can on do so much. you have to start to make ur own recovery onk through the road, and yoha to go, and yohave to mend every brge that you've bron. for some people, medication ienough, and some get better without any treatment at all. many others need and can benefit from psychotherapy with or without medication. in therapy, people examine how their life experiences and early events have affected them. for some time, this has meant psychodynamic psychotherapy, a model in which unconscious conflicts considered to be at the heart of the depression are uncovered.
9:43 pm
at soundview clinic, where dr. bailliet is the medical director, rgarita is bwho uses psdymic principl. would y depression was real n only the anger turned inward, buit was theestof the conflict between heger, feio and depenncy on the hbandd soher confliing e, that creates a conflict whicis, for the paent, unresolvable and results in thejust psychologically ving up, and that's the clinical manifestation of depression. focuseson the identification of thiagessive impulse and thdetandin of how it's being rechneled and nflicted so twhen the pat understands atin a more clear wa
9:44 pm
e's able t that it's appropriaterstand and human feeling and doest mean tt she will deprive hself of that dependency object. today, iaddition to psychodynamic psychotherapy, the are some new short-term psychotherapies available. right. different individuals need different mixes and even different types of psychotherapy. we talk about psychotherapy as if it's one thing, but there are many different types of psychotherapy. not everybody should have psychoanalytic psychotherapy that has a depression. some people need it. have psychoanalytic psychotherapy some do better with a cognitive form of psychotherapy. it takes some expert judgment to decide what a person needs. anyone who evaluates people with depression should be familiar with the different types of therapy available and make a decision on an individual basis what a patient needs in each case. everybody wants simple answers to this question--
9:45 pm
either/or, one or the other. that's not how it works with human beings. there's been advancement in the past 1o, 15 years for psychotherapy and depression. the two that have emerged as being demonstrated by research to be effective depression are cognitive behavioral therapy and interpersonal psychotherapy. those are both types of therapy which were, at least originally, specifically developed for depression and were specifically developed to work in a prescribed period of time, usually two to three months. the theory of cognitive therapy is that our feelings and our behaviors are determined by the way we think about things. so, for example, if somne criticizes something i say, and en i might ask you, "how am i ing to feel when that happens?" it's impossible to answer that without knowing what i think about having been criticized.
9:46 pm
the depressed person has negative evaluations of theelves, tends to put a negative cast on ents that happen, a negative view of the world and future, and therefore feels and behaves in a depressed way. so the way we translate that into therapy is to identify with the person the thoughts that they're having, not an analysis of the psychodynamics or the psychological processes underneath like you might in traditional therapy, but just what their thoughts are. and then with them, we evaluate whether there are distortions in those thoughts, whether there are alternative ways of thinking about the situation, alternative beliefs that they might have, and alternative ways of behaving that might yield different results. with them, we evaluate those thoughts and beliefs, look for changes that can be made, have the people do behavioral experiments where they do something in a different manner than usual
9:47 pm
as a way of changing their evaluation of what's going on, changing their thoughts, and if their thoughts change, their feelings will naturally change in response. i now know that when stto thiabousomethg d, i say to myself-- i try to use the coping skills that my psychiatrist has given me along with the help that i've had from moodhallenge, like, uhyou'reeally not this bad person. you did this, i don't see psychotherapy the respoand medicationit now. as an either/or question. some patients that have more-severe depressions won't get better, in my opinion, without medication... in the more severe level. many patients need both psychotherapand medication to fully recover from their depression. there are a few people
9:48 pm
that can have even severe depressions who have intact personalities, who can be treated with medication and some supportive psychotherapy and recor without any further need for therapy. there are those people, but that is not to say that you can replace psychotherapy with medications in patients who need both. you simply can't do it. i would say that really looking at the whole person involves our r not falling into a particular ideological position, but utilizing all of the knowledge that's available to help our patient. when patients are so depressed that they can't function, or they're suicidal and haven't responded to drugs or other therapies, many professionals think that e.t.-- electroconvulsive therapy-- may be the only option left. how e.c.t. works isn't fully understood. a convulsion is produced by passing an electric current rough the brain.
9:49 pm
in 8o% of those who receive e.c.t., the depression lifts within weeks. e.c.t. was first used as a treatment for depression in 1938. the controversy that surrounds it is the result of its history of overuse and even abuse. in the 194os and 195os, e.c.t. was widely used in mental hospitals, often indiscriminately. patients experienced long-term memory loss, bone fractures, and heart attacks. in the 196os and 197os, e.c.t. fell out of favor, replaced by psychoactive drugs, but psychiatrists were faced with the problem of treating severely depressed patients who didn't respond to medication. e.c.t. has been making a comeback. there are changes. length and intensity of electrical charge have been reduced, as have the number of treatments. patients are given strong muscle relaxants to prevent broken bones, and they are carefully monitored.
9:50 pm
[electrical humming] in spite of these changes, there remain critics who think that the possibility of long-term memory loss is a high price for relief of severe depression. the percentage of people with major depression who require e.c.t. is small. for the majority, psychotherapy and medication prove effective. for bipolar disorder, the same is true. here, treatment usually involves thadministtion of the drug lithium carbonate and some fof psychherapy the patient o has manic-depressive illness asar as we know, has it for life. like diabetes or any other metabolic illness that's genetic, they have it for life, which means they could have an episode anytime during their lifetime if they're unprotected. there is protection to prevent episodes in the vast majority of cases,
9:51 pm
and the most standard protection is lithi carbonate, although there are other new medications we have for patients who aren't protected by lithium carbonate. i think the quality of my life today has never been any better. lookg back, even a year ago, i was unemployed. any better. i didn't know what i was going to be dog. it's just kind of evolved. i'm spiraling up, anit just has worked out great. i take 1,2oo milligrams a day. um, you know, with lithium. the likelihood of recurrence with just average treatment-- that includes people who don't take their medicine-- the 5-year risk of recurrence is close to 8o%. for those who take their medication as prescribed, only 2o% to 3o% will have a recurrence over a two-year period. even with medication, psychotherapy may be an important part
9:52 pm
of their overall treatment. dr. knafo relates the history of lester, a bipolar patient. he had a long history of depression. he'd had several manic episodes for whh he'd been hospitalized. so here he was hospitalized this time. he was about the age that his father was when the father had committed suicide. in the hospital, lester was treat th lithium carbonate anparticat in psychodic psychothera with dr.na. work had to be de in terms of separating lester's identity from that of his father's and in allowing him to mourn his father's death. in his family, emotions weren't tolered. he was never allowed to grieve his father's death. eventually, ster resnded to the treatment, moved out of the hospital and back io society. in addition to medication anpsychotherapy, self-help groups, like mood challenge in peoria,
9:53 pm
can offer social support to those who are coping with mood disorders. what you have to remember is that the illness affect different people differently. just because you have certain sensations doesn't mean that it affects other people the same way. we tend to tunnel vision from our viewpoint. rod's mania may have been entirelyifferent than mine. there's an awful lot of similarities, don. there's a lot of simirities, i think, from just talking with you about yours. my son, unfortunately, isn't in as good shape as rod or you. he's still struggling with trying to get this under control, and right at this moment, he's in a depressed state. he's functioning, going to work, but that's all he's doing. he comes home from work and goes to bed. the other members of the group
9:54 pm
have been through what i've been through. they know what i'm feeling. they know the questions that i face, uh, about the medication, about treatments, about reestablishing my life in the community, um, because the majority of them have been there, and...and you just can't get that anyplace else. we have talked about two types of mood disorders-- major depression and bipolar disorder. for both cegories, the episodes can range from mild to severe. when mild, other people wouldn't know that there's anything wrong. when severe, total incapacitation can occur. ere are many theories about what causes depression and manic-depression. one-dimensional explanations are inequate. we must evaluate risk factors-- psychological, biological,
9:55 pm
and environmental-- and the complex ways they interact, and then assess each person individually to determine which treatment or treatments would be the most beneficial. 1 in 1o americans will experience a mood disorder. the good news is that in most cases, mood disorders can be successfully treated. whoa. whoa. night and day. i mean, that's a real easy way of saying that "before, we lived in darkness, and now we live in light." it's a real easy way of sing that because it's like, ok, it's like this is-- once there's a name, once there's a label, it's like, "it's not me. it's not her." you can let it go. you don't have to ell on what could have been. it's kind of like a catharsis in the cocoon. it's like, "ok, we're free."
9:56 pm
she's happy. i mean, i could never disagree with her at all, and now i can disagree with her, tell h i disagree with her, and she still likes me. it's like, "all right!" i think i'll keep her! stick around! i do a number of things, i guess, just when the mood strikes, and it's n the mood disorder. i like to... just two weeks ago, i went scuba diving down in my parents' lake and really did my first open-water dive there, and, uh...that was a great experience. uh, you know, i like to bicycle ride, and i'm involved in competitive volleyball at the "y." that usually carries over for about nine months. it will start again shortly, and i'm excited about that.
9:57 pm
i just really-- i mean, i love life. i think i have such a positive outlook. uh, there's-- i can't think of anything i don't like to do. if i haven't done it, i'll try it, you know? captioning performed by the national captioning institute, inc. captions copyright 1991 alvin h. perlmutter
9:58 pm
annenberg media ♪ for informion about this d other annenberg media programs call 1-800-learn and visit us at www.learner.org.
9:59 pm

134 Views

info Stream Only

Uploaded by TV Archive on