The
North
Carolina
Office
on
Disability
y
and
Health
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(c) 2000 The North Carolina Office on Disabilityy and Health
is a partnership effort with the NC Division of Public Health and
the UNC-CH Frank Porter Graham Center to promote the health
and wellness of persons with disabilities in North Carolina.
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D epression is an illness that effects more than 17 million Americans each year. Many of those people are individuals with disabilities. Not everyone with a disability becomes depressed, and those who do become depressed may not be depressed because of their disability. However, people with disabilities face
unique challenges and stresses which place them
at increased risk for depression.
Depression is a common and serious health
problem. About 12% of all men and 20% of
all women are expected to have at least one
significant episode of depression in their
lifetime, and 5% of the general population
may be depressed at any given point in time.
Studies have shown that symptoms of depression
may be 2 to 10 times more common in
individuals with disabilities or chronic illnesses,
and depression is one of the most common
"secondary conditions" associated with
disability and chronic illness.
But the good news is that there are
effective treatments for depression available.
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About the Author Karla Thompson, Ph. D., is a Clinical
Psychologist and Clinical Neuropsychologist
with the Department of Physical Medicine and
Rehabilitation (PM & R) and Psychiatry at the
UNC-Chapel Hill School of Medicine. A graduate
of the University of Virginia and University of
South Florida, she completed her clinical
internship and post-doctoral training in the
Departments of Psychiatry and Neurology at
UNC. She has been a clinical assistant professor
with the UNC-CH Department of PM & R since
1996, and is a consulting psychologist with the
UNC Spine Center and the NC Jaycee Burn
Center. She is also the program coordinator
for the UNC Hospitals Day Rehabilitation
Program.
Dr. Thompson works with individuals with
a wide variety of disabling conditions, including
traumatic and non-traumatic brain injuries, spinal
cord injuries, multiple sclerosis, burns, and
chronic pain. She provides assessment as well
as individual and group treatment services to
individuals with chronic and/ or disabling
conditions, using cognitive-behavioral and
interpersonal approaches to support the efforts
of persons living with disabilities to maximize
their independence and quality of life.
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Contents What is Depression? . . . . . . . . . . . . . . . . . . . . . . . 1-4
Why Do People
Become Depressed? . . . . . . . . . . . . . . . . . . . . . . . 5-7
Why are People with Disabilityies
at Risk for Depression? . . . . . . . . . . . . . . . . . . . . 8-13
How is Depression Treated? . . . . . . . . . . . . . . . 14-15
What Should You Do if
You Think You Are Depressed? . . . . . . . . . . . . . 16-21
For More Information
about Depression. . . . . . . . . . . . . . . . . . . . . . . . 22-23
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What is Depression?
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Depression is not just feeling sad, blue,
or discouraged, and it is much more than
the normal downs that can be a part of
everyday living. It is an illness that affects
the whole person -their thoughts, feelings,
behavior, and physical health. In its
mildest form, depression can keep
otherwise healthy individuals from
enjoying their lives to the fullest.
When depressive symptoms are more
serious, they cause needless suffering
for the person who is depressed and
needless pain for the people who love
them. In its most severe form, depression
can be a life-threatening condition.
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Some of the symptoms of depression can include:
Feelings of sadness, anxiety, hopelessness,
or emptiness
Loss of interest in activities that
used to be enjoyable
Sleep problems, like sleeping too much,
having trouble falling or staying asleep, or waking very early in the morning
Changes in appetite with weight loss
or weight gain
Feelings of increased irritability,
restlessness, or frustration
Decreased energy or becoming tired
after normal activities
Difficulties with concentration, memory,
decision making, or mental slowing
Feelings of excessive guilt,
worthlessness, or helplessness
Decreased interest in interacting with others
Crying more often than usual
Recurring thoughts of death or dying
Thoughts of suicide or suicide attempts
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When someone is depressed, they have
symptoms nearly all day, everyday, that
last at least two weeks.
Not everyone who is depressed will have all
of these symptoms. The individual symptoms
of depression are very common. Occasional
changes in sleep or appetite, or feelings of
sadness, guilt, irritability, or fatigue are part of
the normal human experience. It is when many
of these symptoms occur together, cause
difficulties in day-to-day functioning, and last
longer than a few weeks that they may be signs
of a depressive illness.
All kinds of depression are treatable.
There is more than one kind of depression.
The most severe kind of depression, called
Major Depression, involves a specific
combination of the symptoms described
on page two. Sometimes Major Depression
is part of another mood disorder called
Bipolar Disorder, in which periods of
depression alternate with periods of
elevated mood, increased energy,
agitation, and other symptoms.
People who are experiencing an episode
of Major Depression often feel hopeless and
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overwhelmed. They may have trouble getting
out of bed in the morning or taking care of
themselves in other ways. For people with some
kinds of disabilities, neglecting even the most
routine aspects of self-care can lead to other,
potentially life-threatening medical conditions,
and depression is believed to be a contributing
factor in many preventable deaths among
individuals with disabilities. Suicide rates are
also higher among some groups of people
with disabilities.
Less severe kinds of depression include
adjustment reactions and Dysthymia, a chronic,
low-grade depression lasting two years or more.
While Dysthymia is less likely to lead to suicide,
it can be associated with persistent feelings
of dissatisfaction, discouragement, and
disappointment that contribute to a poor
quality of life.
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Why do People
become Depressed?
Depression isn t all in your head.
It is not a sign of personal weakness,
and it is not caused by laziness or a lack
of willpower. It is a real illness with
real causes. Some of these causes
include biology, heredity, personality,
and/ or life experiences.
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Depressive disorders involve chemical
changes in the brain. People with depression
typically have too much or too little of certain
brain chemicals, called "neurotransmitters."
Whether these chemical changes are always
the primary cause of depression or occur after
someone becomes depressed is a question that
has yet to be answered. However, treatments
that restore these chemicals to their normal
levels help to cure symptoms of depression.
Some symptoms of depression can be caused
by chronic medical conditions or the medicines
used to treat them. For this reason, a complete
physical examination and medical work-up
should always be conducted before someone
begins treatment for depression. Alcohol or drug
abuse can also cause depressive symptoms.
Depression tends to run in families, and if
anyone in your immediate family has problems
with depression, you are at increased risk.
Women are twice as likely as men to experience
depression. The reasons for this may include
hormonal changes associated with the female
reproductive cycle or the stresses associated
with being a woman in today's society.
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Some personality characteristics and coping
styles are also associated with depression.
For example, having low self-esteem or feeling
that you have no control over events in your life
are common traits in people with depression.
However, not everyone agrees whether these
personality characteristics cause depression or
are simply symptoms of depression.
Any of these factors, alone or in combination,
may place an individual at increased risk for
depression. Certain life events may also trigger
one or more episodes of depression.
Some theories about the causes of depression
suggest that people who become depressed
have had too many negative life experiences
(like serious illness or the loss of a job) or
too few positive, pleasurable experiences
(like rewarding relationships with others).
While some symptoms of depression are a
natural response to stress or loss, the suffering
and feelings of hopelessness associated with a
clinical depression are typically more intense,
last longer, and have a much greater impact on
an individual's day-to-day functioning than the
feelings associated with any one particular loss
or life crisis.
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Why are People with
Disabilityies at risk for
Depression?
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Having a disability doesn t automatically
mean that you are going to become
depressed. Not all people with disabilities
suffer from depression, and for those who
do, their depression may have little to
do with their disability. However,
depression is associated with certain
life experiences that are more common
among individuals with disabilities.
In addition, people with disabilities face
many unique problems and challenges
which may place them at increased
risk for depression.
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Some of the Challenges that People with Disabilityies can face:
Mobility
Many persons with disabilities have trouble
walking or getting round, both in their own
home and in the community. This can effect how
they take care of everyday activities, like dressing
or bathing, as well as how often they get out of
the house. Sometimes having mobility problems
means needing help from others to do things
that most people can do on their own, which
can be frustrating or embarrassing. Being unable
to drive may further limit one's ability to
participate in important life activities like work
and play, as well as taking care of everyday tasks
like grocery shopping or visiting with friends.
Not having the strength, endurance, or other
abilities necessary to do what you want to do,
when and how you want to do it, may cause
you to feel frustrated, angry or helpless.
Accessibility
Because most homes and many buildings and
businesses still do not meet the Americans with
Disabilityies Act guidelines for accessibility,
individuals who move slowly or use wheelchairs,
scooters, walkers, or canes may find it more
difficult to shop, dine, work, or access health
care and other professional services.
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Social Barriers and Social Isolation
Not all of the obstacles and barriers individuals
with disabilities face are physical. Many people
without disabilities don't understand what it's
like to have a disability or don't know how to
act around someone with a disability.
In addition, some people feel uncomfortable
or harbor prejudices and negative attitudes
toward individuals with disabilities. These are
social barriers that can make it more difficult for
people with disabilities to form friendships
and other relationships. Not having good social
support increases anyone's risk for depression.
Employment
In general, people with disabilities may have
more difficulty finding and keeping jobs.
Sometimes this is because of the individual's
physical or other limitations, and sometimes it is
because of social prejudices and misconceptions.
Whatever the reasons, difficulty finding and
keeping work can lead to financial problems,
which are an additional source of stress. Work is
also an important source of self-esteem for many
people. Not being able to work when you want
to work may lead to feelings of worthlessness
or guilt.
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Health
Many people with disabilities enjoy good health,
but some kinds of disabilities are associated with
more health problems, and sometimes persons
with disabilities have trouble getting the health
care they need. Even people who don't have
disabilities are more likely to become depressed
if they have many medical problems, and people
with more symptoms of illness tend to suffer
from more severe depression. Finding ways to
pay for health care can also be especially difficult
for people with disabling conditions.
Not all Disabilityies are Obvious
Some individuals with disabilities look and move
just like non-disabled people but have trouble
hearing, speaking, seeing, reading, thinking,
paying attention, or remembering. Other people
with chronic illnesses may look well but have
problems with pain, fatigue, or other disabling
physical symptoms. These kinds of problems can
make it difficult to work, go to school, take care
of yourself, and communicate with others.
They may be especially hard to deal with
because people may not recognize that you
have a disability or understand what you
are going through.
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Any of these challenges are difficult to
deal with. When someone has to deal with
several of these at the same time, the risk
for developing a depressive illness is
greater. However, regardless of the cause
or contributing factors, depression can
be treated.
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How is Depression
Treated? There are many effective treatments for depression available. With appropriate
treatment, the majority of people with
depression can feel better, often within
a matter of weeks.
Counseling or talk therapy, ,
medications, or a combination of
the two are the most common and
effective treatments.
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Counseling or psychotherapy helps people
learn to cope with depression and to deal
with personal and external factors that may be
contributing to their depression. Some therapies
focus on helping people identify and change
attitudes or ways of thinking that contribute to
their depression, while other therapies are
designed to help people change their behavior.
Antidepressant medications are an important part
of treatment for depression. These medications
aren't "happy pills" or tranquilizers.
They do not elevate mood by changing your
personality or making you lose touch with
reality, and they are not habit forming.
They work because they help restore the
chemical balance in the brain that is altered
when someone becomes depressed.
Although the combination of talk therapy
and antidepressant medication is an effective
treatment for the majority of people with
depression, sometimes more severe and
persistent depressions require more aggressive
treatments. These may include hospitalization
and/ or electroconvulsive therapy.
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What Should
You Do?
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What Should You Do If You Think You Are Depressed?
Depression is very treatable, but too often,
people with depression don't get help.
This may be because they don't recognize
that they are depressed, have trouble asking
for help, or are embarrassed or blame
themselves for how they feel.
Other people mistakenly think that they
will just "snap out of it," and some don't know
that help is available.
If you think that you or someone you care
about may be depressed, get help. Have yourself
evaluated for depression so that you can get
treatment if you need it.
People and places you can contact for help
include your family doctor and your local
hospital, public health clinic, or mental
health center.
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If your depression is so severe that you are
thinking about suicide, don t wait around
hoping to feel better. GO TO YOUR LOCAL
EMERGENCY ROOM.
Sometimes people get so depressed that
they can't make themselves get the help they
need. If you think someone you care about is
severely depressed, don't leave it up to them
to get help. Help them make an appointment
to talk with their doctor or a mental health
professional, and make sure they keep
that appointment.
What Else Can You Do to Feel Better?
If you have a serious depression you should
seek help from a competent mental health
professional. However, there are also a number
of things you can do to help yourself feel less
alone, discouraged, or blue. If you don't think
you are depressed but do feel down at times,
these are things you can do to feel better and
reduce your risk for developing a serious
depression.
Talk to friends or family about what you are
feeling. Feeling sad or disappointed in life is
nothing to be ashamed of, and sometimes just
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letting people know that you are feeling down
can help you begin to feel better. The people
who care about you can't help you if they don't
know what you're going through. If you can't
get out of the house to see friends and family,
write a letter or talk with them on the telephone.
Get in touch with other people with
disabilities. As much as they may try, non-disabled
people can't always understand what
it's like to live with a disability. If you are
feeling alone or misunderstood, talking with
someone who has a similar disability can make
all the difference in the world. Your health care
provider may be able to give you the names
of other individuals who have had similar
experiences. Support groups for individuals
with specific disabilities can also be an
important source of information on how to cope
with disabling conditions. In North Carolina, you
can call the Family Support Network of North
Carolina for information about local support
groups for brain injury, stroke, spinal cord injury,
spina bifida, multiple sclerosis, and other
disabling conditions. Public libraries in some
areas have computers which can be used to
search the Internet for groups and agencies
that provide education and support for
individuals with disabilities.
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Become an Advocate
If you think that environmental and social
barriers are causing you to feel discouraged,
down, angry, or bad about yourself, find out
what you can do to make a difference. Call the
Family Support Network of North Carolina to
ask about local advocacy groups. Talk to store
managers who make the aisles in their stores too
narrow for wheelchairs. Tell your doctor or the
local hospital that they need more handicapped
parking spaces. Write your congressman about
the problems with health care and health
insurance that individuals with chronic
disabling conditions can face. And respond
directly -but with dignity -when people who
don't know better behave poorly or use
language that offends you when talking
with you about your disability.
Exercise
Physical activity can be one of the most effective
ways to combat depression. Even if you have
significant physical limitations, increasing your
level of physical activity even just a little bit will
help improve your mood.
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Volunteer
Volunteering can be a meaningful and
rewarding way to spend your time. It can get
you out of the house and provide opportunities
for interacting with others. If you can't get out
of the house, you can still make telephone calls,
write letters, or do other kinds of volunteer
activities from your home. Spending time and
energy helping others can help take your mind
off your own troubles and make you feel
appreciated by others.
Stress Management
Although stress doesn't always cause depression,
stress tends to make depression symptoms
worse. Finding stress management techniques
that work for you -relaxing, meditating, praying,
watching funny movies, doing crafts, keeping a
journal, or any other activities that make you feel
less stressed -can make you less vulnerable
to depression.
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North Carolina Resources
Family Support Network of North Carolina
UNC Chapel Hill School of Medicine
CB# 7340
Chapel Hill, N. C. 27599-7340
(800) 852-0042
http:// www. med. unc. edu/ commedu/ familysu
NAMI NC
309 W. Millbrook Rd. Suite 121
Raleigh, N. C. 27609
(800) 451-9682
http:// www. naminc. org
Mental Health Association of North Carolina
3820 Bland Road
Raleigh, NC 27609
(888) 881-0740
http:// www. mha-nc. org
For more information about depression. Please contact any of the
organizations listed on the
following pages
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National Resources
National Mental Health Association
(NMHA) Center
1021 Prince Street
Alexandria, VA 23314-2971
1-800-969-6642
http:// www. nmha. org
National Foundation for
Depressive Illness, Inc. (NFDI)
P. O. Box 2257
New York, NY 10116-2257
1-800-248-4344
http:// www. depression. org
National Depressive and
Manic Depressive Association (NDMDA)
730 North Franklin Street, Suite 501
Chicago, IL 60610
1-800-826-3632
http:// www. ndmda. org
National Institute of Mental Health
Depression Awareness, Recognition,
and Treatment (DART) Program
2235 Cedar Lane
Vienna, VA 22182
1-800-421-4211
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For additional copies and information
on alternative formats, contact:
NC Office on Disabilityy and Health
UNC-CH, Campus Box 8185
Chapel Hill, N. C. 27599-8185
(919) 966-2932 FAX: (919) 966-0862
http:// www. fpg. unc. edu/~ ncodh
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Design & Photography É McCollum
Frank Porter Graham Child Development Center
Fonts used in this booklet É Garamond, Impact
2000 copies were printed at a cost of $ 1.12 per copy
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DEPRESSION
AND DISABILITY
(c) 2000 The North Carolina Office on Disabilityy and Health This publication was made possible by a grant from the Centers for
Disease Control & Prevention, Division of Birth Defects, Child Development,
and Disabilityy and Health, Disabilityy and Health Branch (U59/ CCU403365-11).
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