Kendal, Sarah

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University of Huddersfield RepositoryKendal, SarahDifferentiating between depression and sadnessOriginal CitationKendal, Sarah (2010) Differentiating between depression and sadness. In: 4th National Conference: Current Issues in Palliative Care, 6th - 7th May 2010 , London, UK. (Unpublished) This version is available at http://eprints.hud.ac.uk/22894/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not-for-profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/Differentiating between depression and sadness Dr Sarah Kendal 4th National Conference: Current Issues in Palliative Care  6th and 7th May 2010, Institute of Physics, London. Content  •  Concepts of depression  •  Sadness, depression in history, culture and art •  Relevance of patient-clinician communications in palliative care •  Mental health-illness continuum  •  Clinical guidelines  •  Practical tools Depression The mental and physical experience of lowness of spirits …melancholy…hypochondria… despondency…gloom The Before Depression project, Northumbria and Sunderland Universities http://www.beforedepression.com/images/HogICD10 definition of depression •  Lowering of mood  •  Less: energy, activity,capacity for enjoyment, interest, concentration self-esteem and self-confidence  •  Marked tiredness after even minimum effort.  •  Disturbed sleep, appetite •  Ideas of guilt or worthlessness are often present.  •  Little change day to day, unresponsive to circumstances. accompanying somatic symptoms:  –  loss of interest and pleasurable feelings,  –  waking in the morning several hours early  –  depression worst in the morning,  – marked psychomotor retardation,  –  agitation, loss of appetite, weight loss, loss of libido.  Nursing definition •  Depression: umbrella term used to describe an experience that affects the whole person in terms of feeling, thoughts, judgements and behaviour.  •  May be characterised by: sadness, anxiousness, hopelessness, pessimism, guilt, worthlessness, loss of confidence, low self esteem, fatigue, decreased interest in activities, disturbance of sleep, changes in appetite.  •  Occasionally, psychosis and sometimes, tragically, suicide. •  Norman and Ryrie 2009: 429 Impact of comorbid depression •  Risk – many health conditions increase the risk for mental disorder •  Recognition – comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. •  Prince et al. 2007    Even patients with symptoms not severe enough to qualify for a diagnosis of either anxiety or depression alone have impaired working and social lives and many unexplained physical symptoms, leading to greater use of medical services.    Hale 1997:43 Impact of subclinical depression Risk factors for depression across the lifespan (Pickin and St Leger 1993)  •  15-24 yrs: family, violence, self injury, risk taking, sexual activity, homelessness, social + academic pressure, employment, physical illness •  25-44: family, special needs, work stress, relationships, physical illness •  45-64: family, work and relationship stress, carer roles, loss, physical illness •  65-74: family, relationship stress, carer roles, loss, dementia, dependence, social isolation, physical illness •  75 +: relationship stress, carer roles, loss, multiple morbidity, dementia and depression, dependence, social isolation, housing, bereavement  Health-illness continuum  sadness              depression Horace: satires Then too you cannot spend an hour alone;  No company's more hateful than your own;  You dodge and give yourself the slip; you seek  In bed or in your cups from care to sneak:  In vain: the black dog follows you, and hangs  Close on your flying skirts with hungry fangs. Edvard Munch:  The Scream Van Gogh: Social isolation? Underlying depression, have to crawl into my room  Underlying depression don’t want to know about the moon in june  Outside there’s a cavalcade of clowns but they`re bringing me down  With underlying depression  –  Van Morrison Ophelia: romantic suicide Sylvia Plath  I am afraid, I am not solid, but hollow. I feel behind my eyes a numb, paralysed cavern, a pit of hell, a mimicking nothingness, I never thought, I never wrote, I never suffered. I want to kill myself, to escape from responsibility, to crawl back abjectly into the womb. I do not know who I am, where I am going - and I am the one who has to decide the answers to these hideous questions.  Amy Winehouse I told you I was trouble Yeah, you know I’m no good Daily Mail They wanted me to go to rehab  but I said no no no Depression or sadness? Unwell or emotional?  Clinical decision making •  Health-illness continuum •  Identify norm for the individual •  Identify mental health priorities •  Identify what helps •  Patient is expert on their feelings •  You are expert on your feelings DH: End of life care strategy  Consultation with patients and carers: Fear (of being admitted to hospital) Loss of identity Feelings of guilt Feeling abandoned or unsupported Circumstances liable to change Clinicians not honest when news is bad Psychological and emotional support in palliative care  •  Burnout: avoiding emotional engagement –  von Gunten 2008: ‘Type II oncologist’ –  Griffiths et al. 2007: Leaving it to the specialists •  Protecting staff from burnout –  Jones 1997: clinical supervision can enhance wellbeing of patients, family and staff Simple interventions •  Brief psychological intervention for cancer patients (Pitceathly et al. 2008) •  Practical communication tool for palliative care (Connolly et al. 2010) •  PHQ-2: Two item screening tool for depression: (NICE CG91 2009) – During the last month, have you often been bothered by:  –  feeling down, depressed or hopeless?  –  having little interest or pleasure in   doing things? Stepped Care SMI  crisis common  mental healt h  problems  recognit ion,  assessment ,   monit oring,  referral,   int ervent ions NICE Depression Guidel ine CG 23 (2007).   PCMHT GP,  communit y nursing CMHT Inpat ient s,   crisis t eams high  risk Care (NICE CG 91)  •  Sleep hygiene •  Active monitoring •  Psychosocial interventions •  Drug treatments •  Do not use antidepressants routinely  Second line treatment •  For patients with persistent subthreshold depressive symptoms or mild to moderate depression who have not benefited from a low-intensity psychosocial intervention individual CBT:  •  An antidepressant  •  or  •  A high-intensity psychological intervention (group CBT, or behavioural couples therapy) –  (NICE CG 91) Differentiating sadness from depression •  Sadness not an illness- may require support but not treatment •  Clinical depression a social construct but has recognisable set of features •  Validated clinical instruments can help to guide decisions 

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