The social workers / psychologist Forum: depression and EB

Yvonne Westheide-Sellies (consultant Debra Netherlands), Ida Mollema (Social worker University Hospital UMCG Groningen)

The forum was introduced with a PowerPoint presentation and a YouTube movie about depression.

Everyone experiences "blue moods": temporary sadness, irritability, loss of energy, mild feelings of "what's the point?"

But depression may be defined as a more serious and prolonged case of the blues with the following features (symptoms):

  • Cognitive disturbance: negative evaluations of self (I'm a failure. I am no good. Why should anyone like me? I'm so mediocre. There's no hope for things working out. I feel bad, and nothing will change.
  • Mood disturbance: deep sadness, hopelessness, aloneness, rejection (no one cares), indifference, suicidal desires.
  • Behavioural disturbance: decrease in activity, limited self-initiated activities, little activity for the sake of fun, in attendance to responsibility: reduced sociability appetite loss, reduced sexual interest, sleep problems. Sometimes depression will take the form of no decrease in activity or responsibilities, but there is indifference in all the person does; no sense of vitality about life.
  • Physical problems: chest pains, joint stiffness, headaches, dizziness.

Why do people experience depression?

The person has experienced some form of loss, insult, injury, or disillusionment and responds to it with self-pity rather than acceptance. Depression is the result responding to a "down period". People feel "the blues" from time to time either because of "own mistakes" in their life (guilt) or because of unpleasant events (sickness, loss of job, death of a loved one, etc.). Depression is the deep, pervasive sadness, which results from responding to these events by letting responsibilities and interests slide. The pressure from being behind, the guilt from avoiding responsibility and the loss of good feelings from doing fewer "fun things" results in less motivation to live responsibly. The downward spiral produces depression.

People become depressed when they (1) fail to reach a goal, which they believe they must reach to establish their worth. (2) They perceive that continuing efforts to reach that goal may never be successful. (3) They therefore quit trying to work toward a goal.

With EB it may be: (1) I am never going to be well. Therefore my life is worth very little. (2) It doesn't matter how hard I work on myself, I will not get out of this. (3) I quit trying. Why bother with an education, being friendly, doing stuff, etc. etc.

When is it time to intervene?

When there are mood swings – up for weeks or months, then down for weeks or months; then into the cycle again.

Depression is severe to the point where you can't get a relationship going – sits blankly and stares, responds to questions with no emotion in monosyllables, seem unable to make any decision.

You should consider that depression is serious enough to warrant medical attention if at least five of the following eight signs are present:

  1. Poor appetite/weight loss OR increased appetite/weight gain
  2. Sleep difficulty.
  3. Major loss of energy, tiredness.
  4. Marked slowness of movement OR inappropriate agitation (jumpy, fidgety).
  5. Loss of interest in usual activities.
  6. Feelings of self-reproach, excessive inappropriate guilt.
  7. Complaints or evidence of diminished ability to think or concentrate.
  8. Recurrent suicidal thoughts or wishes.

Steps in counselling with a depressed person:

  1. Briefly empathize with his/her feelings.
  2. Get a history of the depression
  3. Zero in on the emotional response to the loss or experience that triggered the depression.
  4. Identify wrong goal based on wrong tape (what they are telling themselves).
  5. Insist on appropriate behaviour

More information or

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