DEPRESSION & CHRONIC ILLNESS Robert Postlethwaite Clinical Psychologist

Major Depressive Illness Five (or more) of the following symptoms have been present during the same two week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. –depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful –markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation made by others). Loss of motivation to be involved in things.

–significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day –insomnia (not able to get to sleep, waking through the night, waking very early in the morning) or hypersomnia (sleeping excessively) nearly every day.

- psychomotor agitation or retardation nearly every day - fatigue or loss of energy nearly every day. Feeling that you don’t have the energy to do things and can’t do things. - feelings of worthlessness or excessive or inappropriate guilt nearly every day - diminished ability to think or concentrate or indecisiveness nearly every day, irritability, memory lapses - social withdrawal, social isolation - recurrent thoughts of death (not just fear of dying); recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide. Thoughts of self harm.

The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism). The symptoms are not better accounted for by Bereavement i.e. after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms or psychomotor retardation.

Some possible effects of the onset of a chronic illness Grieving process resulting from the numerous losses associated with chronic illness including:- -Changes in the future you expected/hoped to have -Changes in the level of control you feel you have over your life -Changes in friendships -Changes in employment -Changes in identity/self esteem/self confidence

Managing Depression Attitudinal issues are important – Never ever give up because if you give up you lose. Maintain as much of your lifestyle as possible or ensure that you find ways to maintain quality of life. (Activities are important but relationships are a key issue in this) Antidepressants are often important and can make a dramatic difference Often practical solutions to problems make a significant difference to our emotional state. Ask for assistance – there are many places to obtain assistance for depression.

Obtaining Assistance for Depression Family doctor Community Health Centres Public Hospitals Beyond Blue – Psychiatrists Psychologists – Australian Psychological Society Referral Service Social Workers

None of the time A little of the time Some of the time Most of the time All of the time 1.In the past 4 weeks, about how often did you feel tired out for no good reason? 2.In the past 4 weeks, about how often did you feel nervous? 3.In the past 4 weeks, about how often did you feel so nervous that nothing could calm you down? 4.In the past 4 weeks, about how often did you feel hopeless? 5.In the past 4 weeks, about how often did you feel restless or fidgety? 6.In the past 4 weeks, about how often did you feel so restless you could not sit still? 7.In the past 4 weeks, about how often did you feel depressed? 8.In the past 4 weeks, about how often did you feel that everything was an effort? 9.In the past 4 weeks, about how often did you feel so sad that nothing could cheer you up? 10.In the past 4 weeks, about how often did you feel worthless?