1. Depression EXS- 486 Colleen McMullin

2. A very common, highly treatable, medical illness Affects physical, mental and emotional well-being. Affects basic, everyday activities like eating and sleeping. Affects how people think about things and feel about themselves.

3. What is Depression? ( Continued …) In contrast to life's normal emotions such as sadness, loss, or passing mood states, clinical depression is persistent and can significantly effect and individuals ability to function. Tendency to give up. Symptoms can last for months to years.

4. Who Is Effected by Depression? According to the American Psychiatric Association: Depression affects nearly one in 10 adults each year. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

5. Types of Depression Major Depression (Major Depressive Disorder): 5-9 symptoms Dysthymia: Low grade depression for minimum of 2 years Bipolar Disorder: High highs, Low lows Persistent Depressive Disorder Seasonal Affective Disorder Psychotic Depression Postpartum Depression Substance Induced Mood Disorder

6. The Scope of Depression According to The Journal of the American Medical Association(2014): Depression effects more than 121 million people around the world. Most common psychiatric disease or disorder in the United States. Depression is the leading cause of disability in America. Suicide is the 11 th leading cause of death, that being one of the major contributing factor. Everyone can fall victim to this disease. Woman are more likely to experience depression compared to men.

7. Causes of Depression Biological: These include imbalances in the brain’s neurotransmitters as well as hormonal imbalances. Examples of this are postmenopausal, post-partum depression. Neurochemical: Deficiencies in norepinephrine, serotonin, and dopamine can lead to a depressed state. Genetic: Depression runs in families. Depression can also occur in people who have no family history. Environmental: The body can shut down in response to a life event.

8. Symptom's of depression Feelings of sadness Thoughts of suicide Anxiety Hallucinations A lack of interest Disturbances in sleep patterns Disturbances of appetite Lack of energy Feelings of guilt/worthlessness Negativity Thoughts of suicide Hopeless

9. Diagnosis of Depression A number of self-report measurements are available to assess the prevalence and severity of depressive symptoms. - These consist of written and multiple choice responses - The measurements are used to categories ones type and severity. A true diagnosis is only through a trained medical provider. People with Major Depressive Disorder experience at least 5 symptoms all day, everyday, for at least 2 weeks.

10. Typical Treatment of Depression Antidepressant Medication: Most commonly used method to treat depression in the United States. Psychotherapy: - Cognitive behavioral therapy - Interpersonal therapy Psychotherapy coupled with Antidepressant Electroconvulsive therapy -Electrical impulses send through brain Patients who present with depression in the primary care setting are more likely to be offered medication than psychotherapy or a combination of medication and psychotherapy.

11. Medications Effect On The Body Elevated heart rate Increased blood pressure Sweating Indigestion Insomnia Nervousness Sexual Side effects Drowsiness

12. Can Exercise Decrease Depression? Yes!

13. The Role of Exercise on Depression Research is consistent and points to a positive relationship between exercise and depression. No definite conclusion has been reached as to how exercise serves as an antidepressant but both biological and psychological effects are present. Biological -↑ Body temperature -↑ Adrenal activity (better ability to counter stress) -↓ CV response to stress -↓ Muscle tension at rest -↑ Circulation Psychological -↑ Sense of achievement -↓ Stress - Social reinforcement - Provides a distraction for their negative state

14. Effect of Exercise on Depression Both aerobic and nonaerobic exercise training are associated with an antidepressant effect. Exercise can help those currently dealing with a state of depression as well as those who are in remission. -Through the release of : Endorphins- Promotes happiness and feeling of euphoria. Norepinephrine- Increases alertness and arousal. Serotonin- Affects mood, social behavior, sleep, appetite, memory, and sexual desire and function. Dopamine- Regulates movement and emotions.

15. Role of Exercise on Depression Continued… People with depression have decreased levels of norepinephrine and serotonin, therefore exercise will be beneficial with respect to the increase in serotonin, norepinephrine, and endorphins.

18. Special Considerations Before beginning an exercise program with an individual who is depressed keep in mind: -They many find it difficult to be engaged - Inactivity is common so begin at a lower intensity - Consider the side effects of medication they may be taking - People with depression are unlikely to present with depression alone, be sure to a complete pre-assessment.

19. Exercise Prescription for People With Depression Cardiovascular: F- 5 days a week I- Moderate (40%-60% HRR) T- 30-60 minutes a day of moderate intensity physical activity. T- Rhythmic using large muscle groups, (e.g. run, jog, swim, cycle) Resistance: F- 2-3 days a week I- Moderate (60%-70% 1-RM) T- 8-12 reps, 2-4 sets T- Involving major muscle groups. Multi joint and single joint exercises. (e.g. free weight, machines) Flexibility: F- 2-3 days a week I- stretch to the point on tension T-10-15 minute sessions T- Static, Dynamic, PNF

20. Medication and Management Medication, therapy, and exercise are all viable options for managing depression. Although Exercise is successful in dealing with depression, they should be cleared by an appropriate doctor.

21. Case Study Client: Female, 20 years old. No signs of risk or history of cardiovascular, pulmonary, or metabolic disease. Goals: To get active again. She used to be on the track and soccer team throughout high school but has been dealing with depression and for the past year has been living a sedentary lifestyle. She is 5’6” and 140lbs. All her blood work from a recent doctors visit came back normal, in addition, she was encouraged by this physician to begin a moderate workout regimen.

22. Exercise Testing Cardiovascular Endurance: 12 minute walk/run test. Muscular strength: 1RM upper body (bench press) & 1RM lower body (leg press). Muscular Endurance: The number of sit-ups & push-ups she can do in 1 minutes. Flexibility: Sit and Reach test.

23. Exercise Prescription Cardiovascular Endurance: F- 5days/week I- Moderate (40% - <60% HRR) T- 30-60 minutes/day T- Walking, jogging, running, swimming, step aerobics, and cycling Muscular Strength & Endurance: F- 2-3days/week for each muscle group I- 60%-70% 1-RM (moderate to vigorous) for strength <50% 1-RM(light to moderate) for endurance T- Strength: 8-12 repetitions and 2-4 sets Endurance: 15-20 repetition and ≤ 2 sets T- Free weight, machines, plyometrics involving all major muscle groups Flexibility: F- ≥2-3days/week I- Stretch to the point that she feels tension T- 10-15 minute stretch sessions, hold each stretch for 10-30 seconds, 2-4 repetitions of each stretch T- Static stretching

24. References Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Primary Care Companion to The Journal of Clinical Psychiatry,6(3), 104–111. Krucoff, C. (1998, Nov 17). Depression & exercise; can physical activity help make things better? The Washington Post Retrieved from http://search.proquest.com/docview/408407332?accountid=14971 http://search.proquest.com/docview/408407332?accountid=14971 Cooney, G. (2014, June 18). Full Text Electronic Journal List. Retrieved June 18, 2015. McKeag, D. (2007). The Role of Exercise in Treating Chronic Disease. In ACSM's primary care sports medicine (2nd ed., pp. 127-129). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. Thompson, W. (2010). ACSM's Guidelines for Exercise Testing and Prescription (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

25. Picture References 1)http://crossoverhealth.com/amp-wellness/wp- content/uploads/sites/2/2015/04/depression-1.jpg 2)http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0CAQQjB w&url=http%3A%2F%2Fwww.businessnlpacademy.co.uk%2Fimages%2Fuploads%2FDepres sion_1.jpg&ei=- hWGVZPnEIqggwT1oYKgAQ&bvm=bv.96339352,d.cWc&psig=AFQjCNGKvsOK27gd1zWn4N _7MuDCR5ix4w&ust=1434937081606167 3) http://www.deafcounseling.com/wp- content/uploads/2015/03/8f935ef26a10299ca8fc2a420583ce34.jpg 4) http://wellbody.net/wp-content/uploads/2013/01/brain1.png 5) http://www.satyasattva.com/wp-content/uploads/2014/11/Heart-and-Brain.jpg 6)http://www.namcp.org/Md_Resource_Centers/depression/images/functional.domains.p ng 7) https://s3.amazonaws.com/jamesclear/Posts/exercise-and-depression.jpg 8) http://letstalkbooksandpolitics.blogspot.com/2011/06/treating-depression-its-free- its.htmlhttp://www.deafcounseling.com/wp- content/uploads/2015/03/8f935ef26a10299ca8fc2a420583ce34.jpghttp://wellbody.net/wp-content/uploads/2013/01/brain1.pnghttp://www.satyasattva.com/wp-content/uploads/2014/11/Heart-and-Brain.jpghttps://s3.amazonaws.com/jamesclear/Posts/exercise-and-depression.jpghttp://letstalkbooksandpolitics.blogspot.com/2011/06/treating-depression-its-free- its.html