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Jordan Vanhaerents

Eng 1201

Prof. Slanker

11/24/19

Brighter Future

Depression is a common and serious mental illness that negatively affects how you feel, how

you think and act. Depressive disorders can range from mild to severe, but still have the same

outcomes when it comes to a person’s physical and mental well-being. I personally struggle with

depression and I often wonder where these feelings manifest from and why I’m feeling this way

when my life is great. Feelings of absolute hopelessness and despair, crying day in and day out

for no apparent reason. When someone asks, “Are you okay?” I struggle with finding the words

to say and I’m sure there’s more people like that. Knowing the answers to this research will not

only help myself, but others that struggle day to day. This essay will establish a better

understanding of how and why depression manifests and how severely depression affects a

person’s life. This essay will also talk about a variety of treatments that could be the best solution

in severe cases. Depression manifests based on a person’s experiences and severely affects a

person’s day to day life, knowing the signs, symptoms, and some treatment options, can

potentially save a person’s life.

Depression can influence a person’s mental functioning such as cognitive functioning. So

how one thinks and acts towards themselves. Cognitive function deals with how and what one is

thinking. In Emily Durbin’s book, The Psych 101 Series: Depression 101, it states when people

who are experiencing overwhelming thoughts of sadness are given a positive outlook regarding
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themselves, they then tend to argue and confirm their negative self-views are correct (i.e., shared

by others; Swann et al., 1992). This is called Negative self-verification. Another example from

the book, rumination refers to a common response to negative emotions by having lingering

hurtful thoughts about themselves and repetitively running over and over negative feelings in the

mind, with a constant thought on the negative outcome that may come from these feelings. As

reviewed by Nolen-Hoeksema, Wisco, and Lyubomirsky (2008), rather than using their mindset

of negative feelings to look at their causes and come up with some potential solutions,

rumination tends to lead to less effective problem solving and reduced motivation to enact

potential solutions. Another example, evidence from studies and a number of different kinds of

chores, concluded that depression is characterized by problems in people that have a common

way of thinking negatively, which interferes with the processing of other, more task-relevant

chore, and increases the likelihood that a negative feeling will persist by causing the person to

continue processing this material. Specifically, a negative feeling will remain in their memory

for too long because they are not thinking of ways to make room for more relevant impulse like

motivation. This is consistent with evidence that those who tend to forget negative events and

remember more positive events from the past have greater well-being over their life span

(Charles, Mather, & Carstensen, 2003). These theories have been proven through studies that

show how the mindset of a depressed individual can be. Knowing how a mind thinks in such

pain can be beneficial in being more sympathetic towards people struggling. Being educated in

how a person can directly think about themselves can go as far as impacting their recovery.

Depression is a constant negative strain on the mind and the constant wheel of pain is not easy to

stop.
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This pain can also have an impact on an individual’s social and personal life. Depression can

affect the way a person interacts with people or lack of thereof. The book, The Psych 101 Series:

Depression 101 covers this as well by talking about multiple studies that have been done by

theorists focusing on impact of depressive symptoms that may sever some important key

behaviors that are necessary for keeping a relationship. Behaviors like loss of interest in sex in

one depressed partner may decrease the feeling of being close between the partners, depressed

partner's willingness to join in shared hobbies, lack of energy in the depressed partners may lead

them to become lazy and not help out much with household tasks that puts a burden on the other

partner, and lack of sleep may disturb the other partner. The book also goes into parent-child

relationships, most of the research examining the effects of depression on the parent–child

relationship has focused on women and how they play their roles as mothers, with fathers and the

paternal–child relationship is mostly neglected. There is considerable evidence that women with

depressive disorders and more depressive symptoms report themselves as experiencing more

problems in parenting and with the quality of their relationships with their children in

comparison to nondepressed mothers (Downey & Coyne, 1990; Rutter, 1990). An article posted

by Villines, Zawn titled “How Does Depression Affect the Body?” lists symptoms that affect

social life as well. The article lists loss of pleasure in previously enjoyed activities, too little or

too much sleep most days, and physical agitation or feelings of sluggishness. This evidence was

pulled straight from The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These

symptoms explain why individuals who are affected by depressive disorders struggle with

maintaining personal and social relationships. Being a potential partner of someone who is

struggling it’s important to notice these signs in loved ones so relationships can have a better

chance of staying connected.

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Work and education performance can also be affected by depressive disorders. Again, in the

book The Psych 101 Series: Depression 101 it has several studies conducted to show poor

performance. Those with depression often take more sick days than those with chronic medical

conditions (nearly 10 days per year versus 7 days per year for conditions such as diabetes, high

blood pressure, back pain; (Druss, Schlesinger, & Allen, 2001). Other studies have focused more

on work productivity on the job. One long lasting study’s (Wang et al., 2004) measured work

performance using ecological momentary assessment; participants were electronically alerted at

five random times over a 7-day period, asking them to state where their mind was at on

concentration, task at hand, focus, efficiency, and productivity. This study found that MDD was

associated with poorer task focus and work performance, whereas other medical conditions (such

as arthritis, back pain, hypertension) were not. Another study linked depressive disorders to

poorer academic functioning and educational outcomes in adolescence and people nearing

adulthood (Birmaher et al., 1996; DeRoma, Leach, & Leverett, 2009). Which means early

depressive disorders may show a long-term effect on functioning by their negative impact on

academic performance and advancement. In fact, in two articles one written by Villines, Zawn

titled “How Does Depression Affect the Body?”, the other written by Cagliostro, Dina, titled

“Depression Types, Causes, Symptoms, Statistics, & Treatment.” both lists difficulty thinking

clearly, remembering, concentrating, or making decisions as symptoms of depression. Having

the ability to make coherent and effective decisions plays an important role in education and

work. Knowing this information and noticing that someone is struggling to keep concentration or

stay away during class over long periods of time are clear indicators of a depressive disorder. If

public schools were to take this knowledge and give the option to students to be heard or treated

within the school system, the impact would be jaw-dropping. Graduation rates would go up,
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people would be able to focus better, social life would improve, people in general being happier

and calmer. Depression is becoming more common generation after generation so understanding

the condition can be beneficial for everyone.

There has been a correlation linked between depressed individuals and overall quality of life.

The way people live day to day is affected by depression. There was a study done based on the

Korea National Health and Nutrition Examination Survey (KNHANES), a cross-study health

examination and survey conducted by Ministry of Health and Welfare, Korea Centers for

Disease Control and Prevention, and Division of Health and Nutrition Survey. This study found

that depression has been a key factor to the development of several severe medical diseases,

including heart disease and diabetes, resulting in more disability and low quality of life. Mental

health was assessed in adults ≥ 19 years of age based on their answers to a self-administered

questionnaire. Quality of life measured consists of a self-describing health system (EQ-5D) and a

visual analogue scale (EQ-VAS). Subjects were questioned about the following items: mental

stress, melancholia, suicidal ideation, experience of consulting professionals, and suicide

attempts. One of the tables displays the sociodemographic characteristics and health behaviors of

the study, indicating lower perceived quality of life in older age groups. Sex, place of residence,

and smoking did not show definite statistical correlation in terms of quality of life. Drinkers had

higher EQ-5D scores and those who regularly exercise had higher EQ-5D and EQ-VAS scores.

Higher EQ-5D and EQ-VAS scores were noted in subjects with a higher social status. Education

level, income, and marital and current employment status were positively correlated with quality

of life. Physical health showed significant differences with respect to quality of life. Patients with

a worse perception of health had lower EQ-5D and EQ-VAS. Subjects with body mass index

(BMI) ≥ 25 or general obesity (weight circumference ≥ 90 cm for men and ≥ 85 cm for women)
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had lower EQ-5D scores. In terms of mental health, an experience of an overwhelming mental

stress, depressive mood, clinical consultation, suicidal ideation, and suicide attempts all led to

significant decreases in EQ-5D and EQ-VAS. Among these, depressive mood and suicidal

ideation led to difficulties in every dimension of EQ-5D (mobility, self-care, usual activities,

pain/discomfort, and anxiety/depression). Another table presents sociodemographic

characteristics as independent variables. Impaired mobility, higher age, lower level of education,

low income, worse subjective perception of health, unemployment, and BMI ≥ 25.

Pain/discomfort was linked to older age groups, worse self-perception of health, and BMI ≥ 25,

and anxiety/depression to worse self-perception of health, melancholia, and suicidal ideation.

The results of this study indicated various dimensions of mental health (stress, melancholia,

suicidal ideation, professional consultation, and suicide attempts) showed statistically significant

correlations with each EQ-5D item even after adjustment. This indicates that mental health

problems can affect quality of life by themselves, independent of other socially or health-related

factors (study from Cho, Yunji). This study explains the healthcare issues cause by depression

that affect individual’s quality of life through questionnaires. The study even goes into mental

strain a little bit, but mainly just explains how quality of life is affected. This study is important

because it’s shows just how much of an impact depressive disorders can cause strains on

healthcare.

Speaking of healthcare there are plenty of physical symptoms that are cause by depression.

Now when I say physical, I’m talking about the direct impact depression has on the body. The

article written by Villines, Zawn posted in Medical New today gives a list of common

symptoms. Weight gain or loss usually cause by stress eating or loss of appetite, chronic pain

such as joint and muscle pain and headaches. There been research done in 2015(Cohen) that
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correlates depressions to heart diseases, one in five people that have depression also have heart

failure or coronary artery disease. Sexual health problems like have trouble becoming aroused,

no longer have orgasms, or have less pleasurable orgasms, and worsening chronic health issues

that pre-existed. People also experience trouble sleeping, and gastrointestinal problems such as

diarrhea, vomiting, nausea, or constipation. Some people with depression also have chronic

conditions, including IBS. According to the research done in 2016(Karling, Pontus) this could be

because depression changes the brain's reaction to stress by lowering activity in the

hypothalamus, pituitary gland, and adrenal glands. In the article written by Cagliostro, Dina

posted on PSYCOM, it also states some of the same symptoms. Difficulty sleeping, sleep

disturbances or sleeping too much, lack of energy, appetite or weight changes, headaches,

stomachaches, or back pain. Both articles explain the severity of how/when these symptoms are

combined can have a toll on the body especially while suffering from mental symptoms too like

overwhelming sadness and thoughts of suicide. Knowing how such symptoms can affect the

body people can begin to understand why healthcare can be such a big issue within individuals

who struggle with depression.

Treatment for depression is still being widely researched, but there have been some proven to

work and could help certain individuals. The most popular and newest treatment option as of

now is the new club drug called ketamine. An article written by Benedict, Carey titled “F.D.A.

Panel Recommends New Depression Treatment,” talks about the voting decision on the new

drug ketamine developed by Johnson & Johnson, it’s aimed at people with severe depression,

mainly those who have thoughts of suicide. The panel, with 17 voting members, including

psychiatrists and consumer representatives, was nearly unanimous in deciding that the drug’s

benefits outweighed its risks. The Food and Drug Administration typically follows the
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recommendations of its expert panels. The article mentions a 2006 study, researchers at the

National Institute of Mental Health, led by Dr. Carlos A. Zarate, reported that 18 people who

received the drugs intravenously reported that their despair lifted within hours. They also share a

personal story about a woman who hasn’t receive relief from her depression and is desperately

wanting to give this new drug a try if it’s approved. There has been controversy on whether

ketamine should be used as a treatment option because there are safety risks such as impaired

cognition, delusions, and interstitial cystitis which has been researched by many scholars (see

additional references 1-4 regarding this research in citations). There has also been a study done

on the long and acute affects of ketamine which is based on their experience over 30 months of

providing ketamine as a clinical treatment to participants with severe and treatment-resistant

mood disorders. In total, 54 patients were treated with one or more ketamine infusions from

October 2014 through February 2017. In total, 518 infusions were given. The acute outcomes: Of

54 total patients treated, 44 patients had a primary mood disorder and began a 4-infusion

protocol, with treatment given twice weekly over 2 weeks. Using a self-report measure, patients

showed a significant reduction in symptoms over time and this is showed on a figure. Their

results showed at miraculous improvement between the first and second infusions. The next table

shows results for their long- term outcomes which was over two years for all patients from our

program who have received continuation/maintenance ketamine treatments for at least 14 weeks.

Overall, these patients have received 351 treatments, with an average treatment per patient of

25.1. Among the 14 longer-term patients, we observed 1 case of tachyphylaxis. A 16-year-old

male with MDD (Major depressive disorder) had recurrent hospitalizations showed remission

following four treatments. Two patients relapsed resulting in suicide attempts and

hospitalizations during long-term follow up. Both were able to regain response status after
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repeated ketamine course (infusions twice weekly). Seven additional patients relapsed

(depression score <25% improvement from baseline) during the two-year follow-up period but

were all able to regain response status. One patient relapsed after a 6-month hiatus (living in

another state) and was able to regain a partial but not full response to treatment after a repeat

acute series of ketamine treatments. Three patients did not relapse during longer-term follow-up.

Qualitatively, 7 of these long-term patients report that the antidepressant effect of ketamine starts

to fade approximately 3 weeks following exposure. The study also found that among the

subsample of patients receiving ketamine long-term, there was no correlation between number of

treatments received and paired change in cognitive measures of attention, processing speed,

working memory, verbal memory, and visual memory. When looking into treatment options

treatment varies from person to person depending on the severity of a person’s state of mind.

There are a multitude of opinions on what treatment is quote the “best”, but when doing research

ketamine is by far the drug that is getting the most attention at the moment because it’s a new

option that provides hope to the wide population of despaired people who haven’t had relief of

their suffering. Ketamine is something new and exciting that people are looking to try if the drug

gets approved.

Not all people feel sympathy for people when they say they have a certain depression or

anxiety disorder. An example is a conversation with a coworker of mine, she stated that

“Depression is a mindset that you can put yourself in” and to her for you to be considered

“strong” you need to overcome these feelings. “Dig yourself out of that hole that you’re spiraling

down in and overcome the sadness with self-worth and happiness.” I thought of the cliché

saying, “what doesn’t kill you makes you stronger,” but what some people don’t comprehend is

that sometimes people don’t get stronger just weaker and weaker till they fade away. Like this
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representation:

I showed this image to her to help along the argument that to just overcome an overwhelming

sadness is easier said then done for a lot of people. It’s like saying don’t stress about a final exam

for college or don’t worry about getting that promotion for that job. People are going to stress

and worry, and people will linger in that heart wrenching, stomach dropping moments because

they don’t know how to climb out of that hole. After seeing the image and sharing my own

experiences she saw my point of view.

Depression manifests based on a person’s experiences and severely affects a person’s day to

day life, knowing the signs, symptoms, and some treatment options, can potentially save a

person’s life. Depression affects different aspects of a person life such as how they personally

think, their social life, work and education and overall quality of life. Physical symptoms also

come along with the disorder that affect how a person lives their day to day life such as weight

gain or loss, sexual problems, trouble sleeping, etc. There are a variety of treatments for
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depression, but the treatment option that’s getting the most attention now is a club drug called

Ketamine. Its approval is pending by the FDA, but popular votes from the panel are shouting

“YES!” Although studies have shown there has been negative side effects with this drug such as

impaired cognition and delusions, but it’s a new option people are eager to try in hopes to relieve

some of their pain. Not all people believe that depression is a serious matter as the world tries to

make it seem. For example, my personal story with a coworker on page 9 where she feels it’s just

a sad feeling that you must overcome therefore that makes you a stronger person and more

people out there have the same mindset. Educating people that it’s a lot easier said then done is

an important aspect in creating a healthy environment where people who struggle with

depression on a day to day basis can heal. Life in college is a perfect example where people are

stressed out about classes, majors, and where their life is headed. Imagine where public schools

offered mental health education and treatment to help with that overwhelming and burdening

stress. Of course, stress wouldn’t completely go away, but imagine the difference knowledge

could make. Graduation rates would go up, people would be able to focus better, social life

would improve, people in general being happier and calmer. The mindset of a depressed person

is still being widely researched and so are the treatment options. Having an open mind and

staying educated can have a huge impact and direct the way to a brighter future.
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Citations

Benedict, Carey “F.D.A. Panel Recommends New Depression Treatment.” The New York Times,

13Feb. 2019, https://www.nytimes.com/2019/02/12/health/depression-drugs-

ketamine.html

Cagliostro, Dina. “Depression Types, Causes, Symptoms, Statistics, & Treatment.” PSYCOM, ©

2019 Remedy Health Media, 12 Sept.2019,

https://www.psycom.net/depression.central.html.

Cho, Yunji, et al. “Factors Associated with Quality of Life in Patients with Depression: A

Nationwide Population-Based Study.” PLoS ONE, vol. 14, no. 7, July 2019, pp. 1–12.

EBSCOhost, doi:10.1371/journal.pone.0219455.

Cohen, et al. “State of the Art Review: Depression, Stress, Anxiety, and Cardiovascular

Disease.” OUP Academic, Oxford University Press, 24 Apr. 2015,

https://academic.oup.com/ajh/article/28/11/1295/2743312.

Colmen, Gabriel. Personal Interview. 11 October, 2019

Durbin, Emily C. “How Does Depression Affect Functioning?" The Psych 101 Series:

Depression 101, Springer Publishing Company, 1st edition, 2013. Credo Reference,

http://sinclair.ohionet.org/login?url=https://search.credoreference.com/content/entry/spd/

how_does_depression_affect_functioning/0?institutionId=6043. Accessed 17 Oct. 2019

Karling, Pontus, et al. “Hypothalamus-Pituitary-Adrenal Axis Hypersuppression Is Associated

with Gastrointestinal Symptoms in Major Depression.” Journal of Neurogastroenterology

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and Motility, Korean Society of Neurogastroenterology and Motility, 30 Apr. 2016,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819868/.

Villines, Zawn. “How Does Depression Affect the Body?” Medical News Today, MediLexicon

International, 9 July 2018, https://www.medicalnewstoday.com/articles/322395.php.

Samuel T. Wilkinson, MD, Rachel B. Katz, MD, Mesut Toprak, MD, Ryan Webler, BA, Robert

B. Ostroff, MD, and Gerard Sanacora, MD, PhD “Acute and Longer-Term Outcomes

Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital.” Europe PCM,

U.S. National Library of Medicine (NCBI/NLM), 24 July 2018,

https://europepmc.org/articles/PMC6296748.

“Sermo .” Sermo , HCP Insights , 16 Apr. 2018, https://www.sermo.com/depression-worse-

western-world/.

Additional References

1.Morgan CJ, Muetzelfeldt L, Curran HV. Ketamine use, cognition and psychological wellbeing:

a comparison of frequent, infrequent and ex-users with polydrug and non-using controls.

Addiction (Abingdon, England) 2009. January;104(1):77–87. [PubMed] [Google

Scholar]

2. Morgan CJ, Muetzelfeldt L, Curran HV. Consequences of chronic ketamine self-

administration upon neurocognitive function and psychological wellbeing: a 1-year

longitudinal study. Addiction (Abingdon, England) 2010. January;105(1):121–133.

[PubMed] [Google Scholar]

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3. Schobel SA, Chaudhury NH, Khan UA, et al. Imaging patients with psychosis and a mouse

model establishes a spreading pattern of hippocampal dysfunction and implicates

glutamate as a driver. Neuron 2013. April 10;78(1):81–93. [PMC free article] [PubMed]

[Google Scholar]

4. Morgan CJ, Curran HV. Ketamine use: a review. Addiction (Abingdon, England) 2012.

January;107(1):27–38. [PubMed] [Google Scholar]