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Depression

Based on the movie "Garden State"
by

Aran Teeling

on 25 July 2013

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Transcript of Depression

Depression
Depression in the "Garden State"
Description
In the film "Garden State," Zach Braff plays Andrew Largeman, who suffers from clinical depression. The movie deals with his struggles in overcoming his dependence on his medication and confronting the factors which make him depressed.

Is this story a good representation of what real-life depression is like?

Fun fact: the soundtrack (featuring Coldplay and The Shins) was hand-selected by Braff and won a Grammy.
Clinical Depression: "feelings of sadness, loss, anger, or frustration [which] interfere with everyday life for weeks or longer." (NCTSI)


There are several types of depressive disorders:
Types of Depression
Major Depressive Disorder (MDD):
severe chronic depression that is disabling and usually requires treatment

Dysthymic Disorder (Dysthymia):
long-term (2+ years) of symptoms, not as severe as those of MDD, but which still prevent normal functioning. Generally accompanied by at least one episode of MDD.

Minor Depression:
symptoms for 2 or more weeks which, if they persist unchecked, can lead to MDD
Normal Function
Etiology
Biological:
Deficiency of the neurotransmitters dopamine or serotonin (can be a naturally occurring deficiency or influenced by alcohol/drug abuse).
Under-active thyroid, cancer, etc.
Pain medications, steroids, etc.

Social-stressful life events including:
school
splitting up with a significant other
death/illness of someone close
childhood abuse/neglect
job loss
social isolation (elderly)
Signs and Symptoms
agitation, restlessness, irritability, anger
becoming withdrawn; isolation
difficulty concentrating
dramatic change in appetite (weight gain or loss)
fatigue
feelings of hopelessness, helplessness, self-hate, guilt, or worthlessness
loss of interest or pleasure in activities once enjoyed
thoughts of death or suicide
trouble sleeping or too much sleeping
Treatments
Antidepressants
Serotonin re-uptake inhibitors (SSRIs)
Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Luvox), Citalopram (Celexa), and Escitalapram (Lexapro)
Serotonin norepinephrine re-uptake inhibitors (SNRIs)
Desvelapaxine (Pristiq), Venlafancine (Effexor), Duloxitine (Cymbalta)
Tricyclic antidepressants
Bupropian (Wellbutin)
Manoamine oxidase inhibitors
Lithium (type used by Largeman)
Talk Therapy
Cognitive Behavior Therapy
teaches how to fight off negative thoughts
learn to spot your own symptoms
avoid what makes them worse
problem-solving skills

Psychotherapy
understand the issues behind depressing thoughts/feelings

Support groups
Other
Electroconvulsive Therapy (ECT): was used to treat psychotic depression

Transcrainal Magnetic Stimulation (TMS): uses pulses of energy to stimulate nerve cells in brain believed to affect moods

Light Therapy: used to treat SAD
Successes
Antidepressants work for 30 to 40 percent of patients
Therapies usually help 80 percent of patients, but there is a greater risk of relapse
programs such as the "Uplift Program" are usually more effective (upwards of 90 percent success rate) because people believe they tend to focus more on curing the cause of the symptoms rather than just treating the symptoms themselves

Until the CAUSE of depression is treated, symptoms will not permanently abate
Outcomes
Largeman (Braff) accepts he was not to blame for his mother's death, and vows to turn his life around without his anti-depressants and mood stabilizers

In reality, 50 to 80 percent of patients do recover from depression, but most will relapse at least once

Around 30 percent defeat symptoms all together, while around 15 percent commit suicide

The majority will continue to combat symptoms their entire life
Depression is tricky to diagnose and even trickier to "cure." The only person who will know when it is really fixed is the patient. Generally, depression is not life-threatening, although some will commit suicide and others will develop diseases such as osteoporosis, which reflect an apathetic life-style. Although sometimes not considered a "true" disease because it is primarily a symptom-based diagnosis, it can be one of the most debilitating diseases in the world.
Resources
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/

http://www.nimh.nih.gov/health/topics/depression/index.shtml

http://psychcentral.com/disorders/depression/

http://www.thefreedictionary.com/Lithium+pharmacology

http://www.uptodate.com/contents/bipolar-disorder-in-adults-and-lithium-pharmacology-administration-and-side-effects

http://www.upliftprogram.com/depression_stats.html
Serotonin re-uptake is when excess serotonin is released at the synapse and then re-absorbed.

SSRIs prevent serotonin re-uptake causing an overabundance of the serotonin transmitter to build up in the system.

This causes feelings of pleasure, meant to alleviate depression symptoms.
Psychotic Depression: severe depression plus some type of psychosis (delusions, hallucinations, etc.)

Postpartum Depression: experienced by 10%-15% of women after childbirth due to hormonal imbalances. Also called the "Baby Blues"

Seasonal Affective Disorder (SAD): depression due to lesser amounts of sunlight in winter

Bipolar Disorder: those affected are prone to depressive mood swings
Other Types of Depression
After trauma, loss of a family member, etc., depression is considered normal, and even part of the healing process. It allows the body to successfully, deal with emotional harm.

Depression only becomes a "disease" when the symptoms appear chronically, for extended periods of time, or with little to no provocation.
Normal Function
Full transcript