Part III. Mental health

TEXT 9. ANXIETY, FEARS AND PHOBIAS

Read the text and state the difference between anxiety, fears and phobias.

Everyone, from the youngest child to the oldest adult, experiences anxieties and fears at one time or another. Anxieties can prepare young people to handle the unsettling experiences and challenging situations of life.

Anxiety is defined as "apprehension without apparent cause." It usually occurs when there’s no immediate threat to a person’s safety or well being, but the threat feels real. Anxiety makes a person want to escape the situation fast. The heart beats quickly and the body might begin to perspire. However, a little bit of anxiety can actually help people stay alert and focused.

Having fears or anxieties about certain things can also be helpful because it makes kids behave in a safe way. For example, a kid with a fear of fire would avoid playing with matches.

The nature of anxieties and fears change as children grow and develop:

• Babies experience stranger anxiety, clinging to parents when confronted by people they don’t recognize.

• Toddlers around 10 to 18 months experience separation anxiety, becoming emotionally distressed when one or both parents leave.

• Children ages 4 through 6 have anxiety about things that aren’t based in reality such as fears of monsters and ghosts.

• Kids ages 7 through 12 often have fears that reflect real circumstances that may happen to them, such as bodily injury and natural disaster.

As a child grows, one fear may disappear or replace another. For example, a child who couldn’t sleep with the light off at age 5 may enjoy a ghost story years later.

Signs of anxiety. Typical childhood fears change with age. They include fear of strangers, heights, darkness, animals, blood, insects, and being left alone. Children often learn to fear a specific object or situation after an unpleasant experience, such as a dog bite or an accident.

Separation anxiety is common when young children are starting school, whereas adolescents may experience anxiety related to social acceptance and academic achievement.

Many adults are tormented by fears that stem from childhood experiences. An adult’s fear of public speaking may be the result of embarrassment in front of peers many years before. Or, a parent who was bitten by a dog as a child may consciously (or unconsciously) recognize and identify the signs and symptoms of their children’s anxieties.

Some signs that a child may be anxious about something may include:

• becoming clingy, impulsive, or distracted

• nervous movements, such as temporary twitches

• problems getting to sleep and/or staying asleep longer than usual

• sweaty hands

• accelerated heart rate and breathing

• nausea

• headaches

• stomachaches

Apart from these signs, parents can usually tell when their child is feeling excessively uneasy about something. Sometimes just talking about the fear can help the child.

What`s a phobia? When anxieties and fears persist, problems can arise. The anxiety becomes a phobia, or a fear that’s extreme, severe, and persistent.

A phobia can be very difficult to tolerate, both for kids and those around them, especially if the anxiety-producing stimulus is hard to avoid (e.g. thunderstorms).

"Real" phobias are one of the top reasons why children are referred to mental health professionals. But the good news is that unless a child’s phobia hinders his or her everyday ability to function, the child sometimes won’t need treatment by a professional because, in time, the phobia will be resolved.

Is the child’s fear and the behavior typical for his age? If the answer to this question is yes, the child’s fears will resolve before they become a serious cause for concern. This doesn`t mean that the anxiety should be ignored; rather, it should be considered.

Many children experience age fears, such as being afraid of the dark. Most kids, with some reassurance, and perhaps a night-light, will overcome it. However, if they continue to have trouble, or there’s anxiety about other things, the intervention must more intensive.

How to help the child. Parents can help children develop the skills and confidence to overcome fears. Here are some steps that may help the child deal with his or her fears and anxieties:

• Recognize that the fear is real and causes him or her to feel anxious and afraid. Talk about fears helps. If you talk about it, it can become less powerful.

• Never belittle the fear. Telling your child, "Don’t be ridiculous! There are no monsters in your closet!" may get your child to go to bed, but it won’t make the fear go away.

• Don’t cater to fears, though. If your child doesn’t like dogs, don’t cross the street deliberately to avoid one. This will just reinforce that dogs should be feared and avoided. Provide support and gentle care as you approach the feared object or situation with your child.

• Teach your child how to rate fear. If your child can visualize the intensity of the fear on a scale of 1 to 10, with 10 being the strongest, he or she may be able to "see" the fear as less intense than first imagined. Younger children can think about how "full of fear" they are, with being full "up to my knees" as not so scared, "up to my stomach" as more frightened, and "up to my head" as truly petrified.

• Teach coping strategies. Try these easy-to-implement techniques. Using you as "home base," the child can venture out toward the feared object, and then return to you for safety before venturing out again. The child can also learn some positive self-statements, such as "I can do this" and "I will be OK," which your child can say to himself or herself when feeling anxious.

Relaxation techniques are helpful as well, including visualization (of floating on a cloud or lying on a beach, for example) and deep breathing (imagining that the lungs are balloons and letting them slowly deflate).

The key to resolving fears and anxieties is to overcome them. Using these suggestions, you can help the child better cope with life’s situations.

TEXT 10. BRAIN INJURY

Read the text and make up your own summary of it.

What is it? These are some of the many causes of traumatic brain injury. Each year in the United States, about 1.5 million people sustain a brain injury. Brain injury is a major cause of death and disability for children and adults. More US children die of brain injury than of any other cause.

A blow or jolt to the head can cause traumatic brain injury. The blow causes damage to the brain. Some injuries are focal, or in one area of the brain. Others are diffuse, or in more than one area of the brain.

Injuries can range from a mild concussion to severe injury, coma, and death. If you have a mild concussion, you may have no long-term side effects. If you have a moderate to severe brain injury, side effects can range from headache and confusion to personality changes and seizures.

Fortunately, brain injury is one of the most preventable brain disorders. Improved use of car safety belts and child car seats has helped reduce the number of brain injuries. So has greater use of helmets in biking and other sports. Efforts to reduce drinking and driving have also helped.

There have been considerable efforts to recognize and prevent brain injuries in sports. Coaches and parents have learned the signs of concussion. They have also learned that student athletes must get quick medical care.

Severe brain injuries affect both the injured people and their families. It is a period of great trauma and change. Over time, often with the help of counseling, you begin to develop a new sense of self. Then you make decisions based on that new reality.

Types of traumatic brain injury. There are several types of brain injuries, depending on the type of force and amount of force that impacts the head.

In open head injury the skull is fractured or displaced.

In closed head injury there is no skull fracture.

Concussion is the mildest and the most common type of brain injury. Trauma from an impact or a sudden momentum or movement change can cause a concussion.

A contusion is a bruise on the brain caused by a skull fracture.

In a coup-contrecoup injury, bruises are both at the site of impact and on the opposite side of the brain. This occurs when the impact forces the brain to hit the opposite side of the skull. This can happen in car accidents after high-speed stops. It also happens in Shaken Baby Syndrome.

Shaken Baby Syndrome occurs when a baby is shaken forcefully. Different parts of the brain can be injured in this way. Shaking is so dangerous for babies due to their small size, large relative head size, and undeveloped necks, skulls, and brains.

Second Impact Syndrome can occur when a person sustains a second brain injury before the symptoms of the first injury have healed. The second injury can happen from days to weeks after the first one. It is also called recurrent traumatic brain injury.

What is the cause? Half of all brain injuries are due to transportation-related accidents. These can include car, motorcycle, and bicycle accidents, as well as injuries to pedestrians. About 20 percent of brain injuries are due to violence. This can include firearm use and child abuse. For people age 75 and older, brain injuries are most often caused by falls.

What are the symptoms? Symptoms of a brain injury can be mild to severe, depending on the amount of damage. Some symptoms show up right away. Others may not appear until several days or weeks after the injury.

Immediate Signs of Concussion (Seen within seconds/minutes):

• Any loss of consciousness

• Impaired attention: vacant stare, delayed responses, inability to focus

• Slurred or incoherent speech

• Lack of coordination

• Disorientation

• Emotional reactions out of proportion

• Memory problems

• Later Signs of Concussion

If the following symptoms occur, hours or even days or weeks later, consult a neurologist:

• Persistent headache

• Dizziness / vertigo

• Poor attention and concentration

• Memory problems

• Nausea or vomiting

• Fatigue easily

• Irritability

• Intolerant of bright lights and / or loud noises

• Anxiety and / or depression

• Disturbed sleep

People with moderate to severe brain injury may have these same symptoms, as well as:

• Seizures

• Physical, cognitive or behavioral impairments that last for months or are permanent

• Prolonged unconscious state

• Coma

How is it diagnosed? People with head injuries must get emergency medical treatment in the first few hours. This can make the difference between recovery and disability or death. It is helpful to have a neurologist involved early in the diagnosis and treatment. It is even more vital if symptoms continue for more than a few days or weeks.

After an injury, the patient is stabilized. Then doctors can assess the severity of the brain injury. They check the person’s level of consciousness and neurological functioning. They use the Glasgow Coma Scale. This measures eye opening, verbal response, and motor response. The test has 15 points. A score of zero is consistent with brain death. A total score of 3 to 8 is a severe brain injury. From 9 to 12 is a moderate injury. And 13 or 14 is a mild injury, with 15 being normal.

Imaging tests may also be used to help in the diagnosis. These may include X-rays and CT (computerized tomography) scans.

What are the treatments? It’s important to remember that the treatment and recovery process is different for everyone. No two brain injuries are alike.

Treatment begins at the time of the accident or incident. A brain injury is an emergency. Medical personnel try to stabilize the person. They also work to prevent further injury. They make sure oxygen gets to the brain. They also make sure there is enough blood flow. Blood pressure must be controlled.

About half of all severely injured people will need surgery. This may be to remove or repair a hematoma. A hematoma is bleeding in or around the brain. Some people may need a ventriculostomy. This procedure drains fluid from the brain.

After the emergency treatment, people may receive care in an intensive care unit in a hospital. Once they are stable, they may move to the subacute unit of the hospital or to a rehabilitation hospital.

At this point, people follow many paths toward recovery. There are many options for rehabilitation. These can include:

• Day treatment

• Outpatient therapy

• Home health services

• Independent living programs

The goal of rehabilitation is to help people regain the most independent level of functioning possible.

The rehabilitation team may include:

• Neurologist

• Physiatrist (physical medicine specialist)

• Physical therapist

• Occupational therapist

• Rehabilitation nurse

• Speech/language pathologist

• Neuropsychologist

• Social worker/case manager

Medication is needed for some people. People with brain injuries can be at more risk for side effects. So doctors are careful in choosing and monitoring their patients’ drugs.

Rehabilitation should be tailored to each person. It should be based on the individual’s strengths and capacities.

There is much that is still unknown about the brain and how it heals and relearns tasks. As we learn, new treatment methods are being developed.

Prevention. Fortunately, brain injury is one of the most preventable brain disorders. In many cases, taking simple steps can prevent injury.

Falls. For children under age five, falls are the number one cause of brain injury. To help prevent falls:

• Never leave infants unattended on changing tables or other furniture where there is danger of falling.

• Never use baby walkers on wheels.

• Use safety gates at the top and bottom of stairs.

• Lock all unopened windows. Open windows from the top, not the bottom. Move chairs and other furniture away from windows. Consider installing window guards.

Motor vehicle crashes. Motor vehicle crashes are the number one cause of brain injury among children ages 4 to 14. To help prevent injury:

• Always place infants and children under 12 in the back seat of the car.

• Infants age one and under or children weighing less than 20 pounds should ride in a rear facing child safety seat.

• Children weighing 20 to 40 pounds should ride in approved car seats, facing forward.

• Children weighing 40 to 80 pounds should ride in approved car booster seats.

Pedestrian injuries. Each year, about 50,000 children are hit by motor vehicles. Many receive serious brain injuries. To help prevent injury:

• Children should hold an adult’s hand when crossing the street. They should cross only at designated crossing areas.

• Children should never cross between parked cars.

• Children should be taught to look left-right-left when crossing. They should also learn to watch for turning cars.

Sports and recreation injuries. There are an estimated 300,000 sports-related concussions in the US each year. To help prevent injury, wear a helmet, and make sure children wear helmets when:

• Riding a bicycle

• Playing contact sports such as football and hockey

• Using in-line skates or skateboards

• Batting and running bases in baseball or softball

• Riding a horse

• Skiing or snowboarding

Firearms injuries. Firearms are the number one cause of brain injury deaths in the US. Nearly all unintentional shootings occur in or around the home. To help prevent injury:

• Always keep guns unloaded and locked up. Make sure children do not have access to guns.

• Explain to children that guns are dangerous. Tell them never to touch guns. Tell them never to stay in a home where a gun is accessible.

Living With.The effects of a brain injury can last for months or even years. They can include:

• Problems with cognition, such as memory problems and difficulty concentratingCommunication problems, such as difficulty expressing yourself and understanding others

• Behavior or mental health problems, such as depression and personality changes

Treatments and help are available for many of these problems. For others, the goal may be to minimize the impact they have on your life.Many people find that support groups for people with brain injuries are a source of help, comfort, and information. They learn about coping skills and resources that can help.Over time, often with the help of counseling, people adjust to their new strengths and weaknesses and develop a new sense of self.

TEXT 11. BIPOLAR DISORDERS

Read the text and give a 2-minute summary of it.

Bipolar disorders are one of several medical conditions called depressive disorders. Depressive disorders affect the way a person’s brain functions.

Depressive disorders are widespread. In the United States alone, it’s estimated that more than 17.4 million adults have a depressive disorder each year. That works out to about one out of every seven people, so there’s a good chance that you or someone you know is dealing with a depressive disorder.

Out of the total number of people with depressive disorders, it’s thought that about 1 to 2 percent have bipolar disorder – a relatively small group.

What is it? Bipolar disorder goes by many names: manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder are other medical terms for the same condition.

Bipolar disorder is classified into four different types. These are Bipolar I, Bipolar II, Cyclothymic Disorder, or Bipolar Disorder Not Otherwise Specified. Mental health experts separate the condition into these four types because the symptoms of bipolar disorder show up differently in different people. When doctors know what type a person has, they can tailor treatment to that person’s specific needs.

Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: The condition often shows up in adolescence, and even children can have the disorder.

Recent research suggests that kids and teens with bipolar disorder don’t always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.

Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just "snap out of it," as if a person who is sick can become well simply by wanting to. Bipolar disorder isn’t a sign of weakness or a character flaw; it’s a serious medical condition that requires treatment, just like any other condition.

What are the signs and symptoms? A person with bipolar disorder will go through episodes of mania (highs) and at other times experience episodes of depression (lows). These aren’t the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, like a pendulum that keeps arcing higher and higher.

Symptoms of mania include:

• racing speech and thoughts

• increased energy

• decreased need for sleep

• elevated mood and exaggerated optimism

• increased physical and mental activity

• excessive irritability, aggressive behavior, and impatience

• poor judgment

• reckless behavior, like excessive spending, making rash decisions, and erratic driving

• difficulty concentrating

• inflated sense of self-importance

Symptoms of depression include:

• loss of interest in usual activities

• prolonged sad or irritable mood

• loss of energy or fatigue

• feelings of guilt or worthlessness

• sleeping too much or inability to sleep

• drop in grades and inability to concentrate

• inability to experience pleasure

• appetite loss or overeating

• anger, worry, and anxiety

• thoughts of death or suicide

In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day. Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.

Between episodes, a person with bipolar disorder usually returns to normal (or near-normal) functioning. For some people, though, there is little or no "break period" between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.

Some people with bipolar disorder turn to alcohol and drugs because they feel temporarily better when they’re high. But using alcohol and drugs can have disastrous results for people with bipolar disorder. Substance abuse can actually make the symptoms of bipolar disorder worse, as well as making the condition hard for doctors to diagnose.

What causes bipolar disorder? Doctors and scientists don’t know the exact cause of bipolar disorder, but they think that biochemical, genetic, and environmental factors may all be involved. It’s believed this condition is caused by imbalances in certain brain chemicals called neurotransmitters. If the neurotransmitters aren’t in balance, the brain’s mood-regulating system won’t work the way it should.

Genes also play a role in bipolar disorder. If a close relative has bipolar disorder, a person’s risk of developing the condition is higher. This doesn’t mean, though, that if you have a relative with bipolar disorder you will automatically develop it! Even in studies involving identical twins raised in the same home, one twin sometimes had bipolar disorder whereas the other did not. Researchers are now working on identifying the gene or genes involved in bipolar disorder.

Environmental factors may play a role in bipolar disorder. For some teens, stresses such as a death in the family, their parents’ divorce, or other traumatic events could trigger a first episode of mania or depression. Sometimes, going through the changes of puberty can set off an episode. In girls, symptoms can be tied to their monthly menstrual cycle.

How is bipolar disorder diagnosed? Most people with bipolar disorder can be helped – but a psychiatrist or psychologist must first diagnose the disorder. Sadly, many people with the condition are never diagnosed, or are not diagnosed properly. Without proper diagnosis and treatment, the disorder can become worse. Some teens with undiagnosed bipolar disorder can end up in a psychiatric hospital or residential treatment center, in the juvenile justice system, abusing drugs, or committing suicide.

Because children and teens with bipolar disorder do not usually show the same patterns of behavior as adults who have the condition, a mental health professional will observe a teen’s behavior carefully before making a diagnosis. Diagnosing the disorder means getting a complete history of a person’s past and present experiences. Family members and friends can also provide helpful insights into the person’s behavior. The doctor may also want a teen to have a medical exam to rule out other conditions.

Diagnosing bipolar disorder can be difficult. As yet, there aren’t any laboratory tests like a brain scan or blood test that will diagnose the condition. In teens, bipolar disorder can sometimes be mistaken for illnesses like schizophrenia and posttraumatic stress disorder, attention deficit hyperactivity disorder, and other depressive disorders. That’s why a complete, detailed history is so important.

How do doctors treat it? Although there’s no cure for bipolar disorder, treatment can help stabilize a person’s moods and help the person manage and control symptoms. Like other teens with long-lasting medical conditions (such as asthma, diabetes, or epilepsy), teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat the condition.

This team of medical professionals, together with the teen and family, develop what is called a treatment plan. Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor. A psychologist or other type of counselor will provide counseling or psychotherapy for the person and his or her family. Doctors will watch the person’s symptoms closely and offer additional treatment advice if necessary.

Living with bipolar disorder. Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. It’s not always easy to stick to a treatment plan, but in the case of bipolar disorder, taking care to follow treatment recommendations makes all the difference in how a person feels.

If you’ve been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life. In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help a person who is living with the condition. And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.

TEXT 12. DEPRESSIVE DISORDERS

Find the answer to the question: Who experiences depression more often: men or women?

In any given 1-year period, 9, 5 percent of the population, or about 18,8 million American adults, suffer from a depressive illness. The economic cost foe this disorder is high, but the cost in human suffering cannot be estimated. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. But much of the suffering is unnecessary.

Most people with a depressive illness do not seek treatment, although the great majority – even those whose depression is extremely severe – can be helped. Thanks to years of fruitful research, there are now medications and psychological therapies such as cognitive/behavioural, “talk” or interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people, the information presented here may help you take the steps that may save your own or someone else`s life.

What is a depressive disorder? A depressive disorder is an illness that involves the body, mind, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Types of depression. Depressive disorders come in different forms, just as in the case with other illnesses such as heart disease. This article briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep a person from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgement, and social behavious in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of depression and mania. Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

• Persistent sad, anxious, or “empty” mood

• Feelings of hopelessness, pessimism

• Feelings за guilt, worthlessness, helplessness

• Loss of interest or pleasure in Hobbies and activities that were once enjoyed, including sex

• Decreased energy, fatigue, being “slowed down”

• Difficulty concentrating, remembering, making decisions

• Insomnia, early-morning awakening, or oversleeping

• Appetite and/or weight loss or overeating and weight gain

• Thoughts of death or suicide; suicide attempts

• Restlessness, irritability

• Persistent physical symptoms that do not respond to treatment, such as headache, digestive disorders, and chronic pain

Mania

• Abnormal or excessive elation

• Unusual irritability

• Decreased need for sleep

• Grandiose notions

• Increased talking

• Racing thoughts

• Increased sexual desire

• Markedly increased energy

• Poor judgment

• Inappropriate social behaviour

Causes of depression. Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently, additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson`s disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

Depression in women. Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women – particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH (The National Institute of Mental Health) study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to OMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient “blues” are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family`s emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.

Depression in men. Although men are less likely to suffer from depression than women, 3 to 4 million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men`s suicide rises, reaching a peak after age 85.

Depression can also affect the physical health in men differently from women. A new study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.

Men`s depression is often marked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged, hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

Depression in the elderly. Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, most older people feel satisfied with their lives. Sometimes, though, when depression develops, it may be dismissed as a normal part of aging. Depression in the elderly, undiagnosed and untreated, causes needless suffering for the family and for the individual who could otherwise live a fruitful life. When he or she goes to the doctor, the symptoms described are usually physical, because the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.

Recognizing how depressive symptoms in older people are often missed, many health care professionals are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication the older person is taking for a physical problem, or they may be caused by a co-occurring illness, If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. Recent research suggests that brief psychotherapy (talk therapies that help a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression) is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication. Studies show that late-life depression can be treated with psychotherapy.

Improved recognition and treatment of depression in late life will make years more enjoyable and fulfilling for the depressed elderly person and the family.

Depression in children. Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, pr worry that the parent may die. Older children may sulk, get into trouble at school, be negative and feel misunderstood. Because normal behavious vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary “phase” or is suffering from depression. Sometimes the parent become worries about how the child`s behaviour has changed, ot a teacher mentions that “your child doesn`t seem to be himself.” In such a case, if a visit to the child`s pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a psychiatrist who specialized in the treatment of children. If treatment is needed, the doctor may suggest that another therapist, usually a psychologist, provide therapy while the psychiatrist will oversee medication if it is needed. Parents should not be afraid to ask questions: What are the therapist`s qualifications? What kind of therapy will the child have? Will the family as a whole participate in therapy? Will my child`s therapy include an antidepressant? If so, what might the side effects be?

The National Institute of Mental Health (NIMH) has identified the use of medications for depression in children as an important area for research. Among the medications being studied are antidepressants, some of which have been found to be effective in treating children with depression, if properly monitored by the child`s physician.