 Hi, my name is Tracy Tecajame Espinosa and this is a video on depression. This information is what's found in the book Making Classrooms Better and also supplemented by information that's cited at the bottom of each slide. Today we're going to look at the definitions of depression, some of the causes, how we diagnose depression, the symptoms, what are predictors or maybe risk factors for depressive states and treatments. Then we're going to look at this in the context of a tenant and as you all recall, tenants are things that are true about all human brains but they have a large range of human variation which is why it's so hard to pin them down and to say, well, you know, x equals y. You can't really do that because there's so much human variation there. So how do we define a depression or depressive states? Depression is both common and serious. It causes symptoms that affect how you feel, think, handle daily activities such as sleeping, eating and working. We only classify a person as having a major depressive disorder if the symptoms persist for more than two weeks. The good news is that it's also treatable but the key to treating depression successfully is also understanding its roots. So is this something that's rooted in chemical states or in the neurophysiological structure of circuits in the brain? Depending on the root causes and how we diagnose an individual's depression, there are different ways or different suggestions for treatment. And the reason this isn't just a clear cut thing, like you have a stuffy nose, okay, we do x. Depression is different. It has so many variations that it's really hard to nail down. And specifically in different individuals, it manifests differently. So we have persistent depressive disorder, which is also known as dysthymia. It's a depressive mood that lasts for years. Other types of depression, for example, postpartum depression is very serious, much more than just having the baby blues and maybe lack of sleep. But it's also caused by a change in hormones typically presenting about two weeks after delivery. Psychotic depression is a form of severe depression and it also includes psychosis, which can present such as delusions or hallucinations. And seasonal affective disorders, another type of depression that is typically related to the changing of the seasons to the lack of sunlight. You see there are multiple different types of depression, so this is why it's so complicated to diagnose. There's also something called bipolar disorder, which is a manic depressive illness that has both faces of depression and often hyper and even positive manic behavior. The frequency of depression is estimated to be about one in 15 adults in the United States. And at least one in six people will experience depression at some time in their lives. Depression can strike at any time, but on average it first appears in the late teens and mid-twenties. That is, childhood depression or depressive disorders are very rare. There's a big field of research that looks at depression as being something very much related to changes in hormonal structures, which is why it tends to present during early adolescence. Women are also more likely than men to experience depression, again related to hormonal changes. And studies show that one-third of all women will experience a major depressive episode in their lifetime. This sort of pushes our thinking that it must have to do with hormonal balances or differences between men and women in hormones. Some of the causes that have been researched very much relate to trauma and abuse, either sexual, physical, psychological, or emotional, as well as neglect. As we mentioned with anxiety disorder, also fear of the unknown, depending on the attachment style of the individual, sometimes fear of the unknown will manifest itself in depression rather than anxiety. So affective instability, which means that you're not reacting consistently from an emotional point of view to the same situation over time. Obesity, again, whether or not obesity is a cause or a consequence of depression is something still in the debate. And here's a very interesting link. Remember, we keep pushing the point that depression and anxiety are different. They're different neurotransmitters in the brain. They're different types of circuitry. But also what's interesting here, there are theories that anxiety sensitivity and rumination, being an anxious person and continually thinking over and over and over again about the problems that you have can be a cause of later depressive states. Other causes range from the physical, gastrointestinal disorders. Remember, we also talked a little bit about the gut brain access and how what happens in your gut really can change your emotive state, as well as other causes such as negative mood regulation expectancies. So some people habituate incorrect ways of doing a mood regulation or their general way that they react to different emotional states. So for example, if over time you have been highly stressed by your environment, you generally presume that when your father's going to come home, he's going to beat you. Okay. So sometimes some people create defenses against that natural negative stressful situation and they react with humor instead of deciding to feel stressed. That kind of negative mood regulation expectancy creates depressive states in an individual. An individual, because they realize they're just using this as a coping mechanism, it's not really a solution, can fall into depressive states because of that as well. So there's a lot of hints, not no clear definition yet, but we believe that certain neurotransmitters are related to depression. For example, lots of studies on sex hormones and female depression, basically, we know that changes around menstrual periods can also lead to depressive states. There's also research that looks into changes in amino acids and neurotransmitter response, believe it or not, to maybe to uptake of ketamine may treat depressive disorders. Also looking at type A, monoamine in oxidases and serotonin are also considered roots of depressive states. But again, mainly being studied in rats, so we have to be very careful about the information that we're taking in. And as we mentioned previously, this idea between the gut-brain access, this is a whole other line of thinking, but could it be that maybe nutritional intake could change depressive states in some people? There's evidence that some people have depressive states triggered by things, for example, as common as wheat. So could it be that by changing the balance of probiotics in our system, we would change our mental state, our depressive states? There's also research looking into the role of polyunsaturated fats and folate and how that might lead to depressive states. But in a totally different angle, there is also very serious research going on, not looking at specifically how certain neurotransmitters change, but maybe the neural circuitry of the brain and how that might either cause or be changed by depressive states. So again, we don't know, is this something that is actually a cause or is it a consequence of depression? There's also a lot of research looking at inflammation, the different ways that that neuro-inflammation in the brain may cause abnormal structures creating depressive states. So all of these have something to do with chemical-based exchanges in the brain. Sometimes we're looking at particular neurotransmitters, chemicals that maybe you could change by having a medication, for example. Or does it have to do with the circuitry, the way that these different chemicals are triggering a distinct type of connectivity in the brain? Or could it be related to things such as neuro-inflammation? So having certain neurons actually being in an inflammatory state can actually trigger then other neurotransmitters or chemicals that cause depressive states. So how do we diagnose depression? Again, because it's one of those things that we have not nailed down as far as chemicals are concerned, you just can't do a blood test and say, oh yeah, you look depressed. Basically, diagnosis is done through interviews and the observation of certain symptoms. For example, a person relates to their feelings sad or they have, they feel like they have a depressive mood state. Or they can appear to have a loss of interest or pleasure in things that they once enjoyed doing. We know that oftentimes people who are depressed have changes in appetite. They have weight loss or sometimes weight gain. They may have trouble sleeping or they sleep too much. They appear to have a loss of energy or increased fatigue. Sometimes we see that they wring their hands or they pace when they're depressed. Or they have slowed movements or speech. They may report having feelings of worthlessness or guilt and difficulty thinking or concentrating or making decisions and even thoughts of death or suicide. Now, what's so complex is that many of us may feel some of these things some of the time. But remember that part of the diagnosis is that these things occur, multiple combinations of these symptoms occur. And over time. And again, remember that we always try to get rid of physiological basis of these problems. So for example, thyroid problems or brain tumors may be the cause, the physiological cause of these things. Also, lack of sleep may be the cause of certain behavior. It may not be the consequence of feeling depressed. So we have to tease out the different symptoms and realize what may be the causes of depression and what may just be the consequences of other physiological states. For example, lack of sleep. So there's different diagnostic tools that can be used. For example, the revised child anxiety and depression scale, as well as Quinn's review of correlated childhood adversity and the things that may lead in combination to depressive states. So when we look at diagnosis, we're looking at things that may have genetic causes, maybe chemistry imbalances, but also things that like poor nutrition, physical health issues, stress, sleep patterns are also indicators and help in the diagnosis of depressive states. If you're looking for specific tools, Suze sort of summarizes this and risk assessment. For example, there are certain screening tests like the patient health questionnaire for adolescents and primary care version of the BEC depression inventory. These are good tools that can be used. And a really interesting observation that they make, and that's also a big point, big red fly care, is that looking at diagnosing or calling a child under 11 depressed is actually something that there's really no tools out there to do that. And so having depressive states at this young age is really not something even entertained because we'll see different emotive states. We see kids balancing out this act. But because depression is primarily linked to chemical changes, different neurotransmitters and also understanding neurophysiological states like circuitry based on chemicals. And we see that those chemicals don't seem to be changing or lead to depressive states until early adolescence when chemical changes start to occur as the body starts to mature. It seems that most of these tools are looking at a diagnosis during adolescence. Now, what's very important is that even though this is a 2016 study, more recent research, 2019 actually, is showing that onset of adolescence can be as early as eight years old and females and nine year old and boys. So this earlier recommendation may indeed change. So it might be that the range for early diagnosis is not just 12 years old enough, but it may drop based on these newer recommendations. So again, we look at certain risk factors when we're trying to predict if whether or not somebody is actually in a clinically depressed state of mind. So biochemistry, genetics, also personality as well as environmental factors. We know that certain personality types of people with low self-esteem have a particularly high risk factor for depressive states rather than those people who sort of see the glass half full all the time, right? And other environmental factors such as being continuously exposed to violence or being neglected, abused, as we mentioned before, are key risk factors and indicators of people at risk for depression. And you'll find that predictors kind of tend to fall into maybe two big categories. For example, there's research that looks at demographics. For example, gender and genetic susceptibility and the age of onset of different indicators tend to clearly correlate with depressive states and certain populations. For example, in this Hankan study, they found that genetic vulnerability for stress combined with chronic peer stress was a very good indicator of people who fell into depression, right? And almost always, girls who experienced greater peer stress were more likely to develop depression. So there's one group of studies that looks at these types of demographics, age, gender, as well as genetic susceptibility to try to predict who may be susceptible to depression. But there's also a second set of studies that are really looking at the genetic and the ambiental triggers for depressive states. For example, there's some newer research being done on depression, self-esteem, and childhood abuse among Hispanic men residing in the U.S., Mexico border region, and how that leads to depression. So this combination of personal self-esteem as well as home situations that related to abuse and how does that lead to depression issues. And this is primarily looking at this idea that when you have little control over the situation around you, then depressive states set in. So luckily, there are also lots of treatments, right? Remember, we said before that it was very difficult to diagnose or to do any kinds of tests or observational studies on children? Well, you now have some other books coming out. For example, Growing Up Sad by Citron and McNeugh. They look at childhood states, but they're basically saying, you know, before teen years. Now, this is where this big crossover comes in. Adolescence, as we mentioned before, is a period of time or development. It is not a certain set of years. Teenagers are 13, 14, 15, right? That's easy to label. That is not the same thing as adolescence, which could be as early as eight years old and go as late as 25 or so. So we know there's this spread, but different people have different times that they go through adolescence, right? So when they talk about childhood depression and its treatment, these guys are actually looking more at early adolescence phases, OK? So remember, we said that good diagnosis is half the cure, right? So understanding if childhood trauma or abuse is really at the core of the depressive states, there's different ways that you can approach this. Others have evaluated, basically, looking at different types of therapy that are used to compare, for example, cognitive behavioral therapies with child center therapies and which seem to be better for actually, believe it or not, different personality types respond differently to those different types of therapy. And there's some studies, for example, this wonderful systematic review and meta-analysis, really, of all of these different approaches to treating depressive states in children and adolescents. Which of these types of therapies were best in terms of reliability, validity, diagnostic utility, how they were best used? So this global overview by Sockings and his colleagues is actually a wonderful macro view of treatments if you're interested in looking at different therapies. So once again, a good diagnosis is half the treatment and half the cure, right? So if you have an individual whose depressive state is clearly rooted in adverse childhood experiences, in interviews, in neglect, therapies are definitely a wonderful way to go. However, if you have a depressive state that is rooted in a chemical imbalance, then you really have to look at different types of medication. So we have research that looks into therapy, cognitive behavioral treatment, other things that are family focused efforts and therapeutic interventions, and other things that have to do with longitudinal studies that look at how people may relapse into depressive states and why. So these things would be because of adverse childhood experiences or triggers that led to depressive states. There are other studies that look at medications. So could a change in omega three or looking at neuroinflammation or serotonin imbalances be the cure for depressive states? Well, everything depends on what was the diagnosis. If the diagnosis has to do with something that had to do with an experience, maybe therapies are the best way. If it has to do with a chemical imbalance, then medication would be the way to go for treatment. So that's our global overview. But now as teachers, let's think about this. You know, we know that depression influences learning outcomes, right? But what causes depression in one individual may not cause depression in another individual, which means that we as teachers have to know our students very well, but also understand how these very complex issues come into our classroom. How do we work with kids with depressive states? Is there even anything we may be able to influence? For example, if we know the depressive state maybe has roots in this negative mood regulation expectancies, could our modeling in the classroom to change the different ways that kids react to emotive states be a way out for those kids? Or could we as teachers sort of break this cycle of rumination and this anxiety they have that leads to depression? Is that something that we actually have a role in? I think it becomes very, very clear, though, we can do very little without actually understanding the root causes. And we don't want to become part of the problem, right? We want to be part of the solution that that kid would receive. So in order to do this, though, we actually have to have a very clear diagnosis. And this is where we in our own practice in classroom settings has to be complemented with other professionals in the learning sciences who could complement what we know with what they are able to do. But it is up to us being on the front line to be able to, you know, red flag a kid and call attention to the counselor that it's been more than two weeks. He has showed us these types of symptoms. I really think that he needs to have a thorough evaluation. And if he is depressed, what caused that so that we can make an appropriate intervention and work with families and other health professionals to be able to do our jobs in our classrooms? OK, so looking forward to talking to you with you more about this, more about depression when we meet together. See you soon.