Depression is not a disease or disorder that someone chooses to have, in fact, anyone can be affected by it no matter the age, gender, race, ethnicity, etc. In order for someone to be diagnosed with depression they have to have had the signs or symptoms for at least a consecutive two-week period. Depression affects the mind, body, and soul of each individual that experiences the disorder. According to Screening for Symptoms of Depression by Physical Therapist Managing Low Back Pain, “Depression is a common and costly health problem.
The term “depression” can refer to a mood or an illness diagnosed according to various criteria” (Haggman, Maher, Refshauge 2004, p. 1157). Depression affects clients in many aspects of their life it causes clients to face difficult challenges and it affects their biological and psychosocial processes.
Clients with depression are facing difficult challenges not only everyday but also every hour, every minute, and every second of each day. The challenges clients face because of depression often vary from person to person, but because of these difficult challenges it hinders every aspect of their daily life.
Clients with depression often face many stereotypes that are not necessarily always true. Some of the stereotypes that clients hear include things like: “depression is a sign of mental weakness”, “real men do not get depressed”, “talking about what makes you depressed only makes it worse”, or “depression always come after the experience of a traumatic event”. Hearing these types of things are not good for any of the clients dealing with depression because it can lead to the clients holding everything in and not seeking help because they do not want to be considered mentally or physically weak.
Another challenge that some clients deal with is the future predisposition of depression. Although genetic predisposition increases the chances of a person having the depression disorder it does not guarantee that the person will have it. According to Testing Positive for a Genetic Predisposition to Depression Magnifies Retrospective Memory for Depressive Symptoms, testing for depression in clients can be faulty if they know they have the genetic gene for depression and here is a brief take on the experiment they conducted explaining what caused them to believe that: ‘In two experiments, some participants were told that they were genetically susceptible to depression, while others were told that they were not. Then, participants rated their experience of depressive symptoms over the prior 2 weeks by answering items taken from the Beck Depression Inventory-II (Dozois, 2010). We hypothesized that people who were led to believe that their genes predisposed them to depression would recall having experienced more depressive symptoms than would those who were told that they did not have such a genetic predisposition. In both experiments, we also included a condition in which participants were told that they were genetically susceptible to depression, but then viewed a video explaining that genes make only a nondeterministic contribution to the development of major depression, to counteract the genetic determinism espoused by many laypeople (Dar-Nimrod & Heine, 2011). In work by Lebowitz and Ahn (2015), this brief video successfully restored feelings of agency over depression, even among people who strongly attributed depression to biological causes’ (Lebowitz, Ahn 2017, p. 1053). Clients with depression disorder sometimes lose their jobs which leads them to becoming financially unstable mainly because they are no longer motivated to go to work and they stop doing everything they need to do that is required in their job description. Being financially unstable causes the client to become stressed and being stressed will lead to an increase of their depression. Clients dealing with depression are typically not good at planning things because they are no longer motivated to do things that usually excites them.
Patients experiencing depression often times become depressed after experiencing a traumatic event that has happened directly to them or to someone very close to them, or even by mishaps as small as a breakup. Depression affects everyone differently some people may experience episodes once in their lifetime or multiple times within their lifetime. Even the episodes vary from person to person, for example some people may start eating more as way to cope with their depression or some people may stop eating completely, some people may start partying a lot thinking that will help cope with their depression and some people may isolate themselves from everyone and close themselves in a room, etc. Similar to other diseases and disorders depression can be acute or it can be chronic. If the proper steps are not taken to help cope with the depression the acute depression can turn into chronic depression. “The DSM – IV classifies depression into 4 main categories: major depressive disorder, dysthymic disorder, adjustment disorders, and depressive disorder not otherwise specified (NOS)” (Haggman, Maher, Refshauge 2004, p.1157). When dealing with depression some of the signs and symptoms the clients experience includes loss of interest in activities they usually love, change of sleep pattern, self-esteem issues, unwanted weigh loss or gain, suicidal thoughts and many more.
As stated above everyone deals with depression differently, but how each person handles it is vitally important. One way that many clients deals with depression is by doing some type of physical activities. In some cases, the physical activities are very helpful because it allows the clients to take their minds off the certain issues/problems that they are having. In other cases where individuals try to use physical activities to help cope with depression it has a negative affect on them. According to ‘Crawling Out of the Cocoon’: Patients’ Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression an experiment was conducted to see how physical therapy affected clients that was dealing with major depression disorder and as a result they came up with four possible categories that each client could fall under: “struggling toward your healthy self, challenging the resistance, feeling alive but not euphoric, needing someone to be there for you” (Danielsson, Kihlbom, Rosberg 2016, p. 1247). Each category has its’ own meaning that was created by the experimenting physical therapists. The struggling toward your healthy self category “reflects the participants’ experiences that the exercise intervention sparks a sense of being capable, as physically active people, in contrast to feeling entrapped in their depressed state” (Danielsson, Kihlbom, Rosberg 2016, p. 1245). The challenging the resistance category “captured the experience of exercise as a challenging act of doing, understood both as a possibility and as a barrier, relating to depression’s resistance and vagueness” (Danielsson, Kihlbom, Rosberg 2016, p. 1245). The feeling alive but not euphoric category “had to do with the direct physical responses and sensations of exercise, described as various expressions of vitality. The experiences represented a contrast to the numb and fatigued feeling in depression” (Danielsson, Kihlbom, Rosberg 2016, p. 1247). The needing someone to be there for you category “concerned the participants’ experience that exercise is something that they could not do by themselves during depression” (Danielsson, Kihlbom, Rosberg 2016, p. 1247). Each category also had 4 subcategories and with these categories and subcategories the physical therapists were able to develop codes for each individual based off of their results and how they felt and some of the codes were “recognition, vulnerable, work hard, no fun, achievement, vitalization, unhappy, good tired, motivator”, etc (Danielsson, Kihlbom, Rosberg 2016, p. 1246). In this experiment it shows how differently everyone viewed physical therapy as a coping tool for their depression and literally everyone had different answers and reasons for why they felt either good or bad after the physical therapy session. In this experiment it talked about how some people felt better as they were doing their session(s) around/with other people and there were some people who did not like doing their session(s) because they did not like the idea of being watched. This experiment was perfect to show the individuality amongst each person because it showed that even though people had the same disorder nobody handled the same way.
The role of the physical therapists and physical therapist assistants is to make every client feel comfortable, motivated, and to help boost the clients’ confidence levels. When clients come into the outpatient clinics, inpatient settings, skilled nursing facilities, etc depressed it also affects the physical therapist and physical therapist assistant that is working with them. The physical therapist or physical therapist assistant working with a client that has depression must have great communication and motivational skills. The physical therapist or physical therapist assistant must also be aware of the things they do and say because even the smallest things can be triggers that set off a depressive episode for the client. When working with a client that has depression the therapist needs to be very encouraging when communicating with the client. The therapist needs to pay close attention to how the client responds verbally and nonverbally to each exercise because in some cases with clients that have depression disorder they tend to be weaker than normal so the weight or resistance that they usually exercise with may be to heavy which could lead to the client becoming less motivated to continue therapy. According to Standard 2 of the PTA Handbook: Keys to Success in School and Career for the Physical Therapist Assistant, “Physical Therapist Assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients” (Curtis, Newman 2015, p. 297). This means the physical therapist assistant should pay close attention to the clients that come in and do what is in the best interest of the client. This is very critical especially for clients with major depression disorder because the physical therapist or the physical therapist assistant needs to know if they need to modify the treatment parameters for that client. The rehabilitation settings vary from client to client. In some cases where the clients are in an inpatient rehab setting or skilled nursing facility setting it is hard for the therapist to change the setup to suit the needs of the clients dealing with major depression disorder. This is difficult because every client that comes in to those two settings are different and the things that make one client happy can also upset another client, so in situations like this it comes down to how the clients respond to doing therapy around other people, in group settings, or alone with the therapist. It also depends on the type of equipment the client needs access to. In outpatient settings and home health settings it is easier to accommodate clients with different disorders because the therapist can adjust the treatment area for the clients. If it is an outpatient clinic the therapists can arrange a private room with certain things like bright colors, pictures, etc that can all give off a happy vibe to clients once they enter the room. Also, with outpatient settings if arranging a private room to accommodate the client is not possible the therapists can schedule that client at a certain time where they can accommodate the needs of the client. In the home health setting the therapists can help decorate the client’s home to promote a happier environment. No matter the setting the physical therapist and physical therapist assistant should make sure that the environment is set to help the clients be as successful as possible and promote positive energy.
Furthermore, depression causes people to face many challenges and it affects their biological and psychosocial processes. Depression is a disorder that can affect every aspect of a person’s life. As a physical therapist or physical therapist assistant always promote a healthy and happy environment. Also, as therapists talk with the clients, show them that someone cares for them and is there for them in their time of need. Sometimes people that are dealing with depression just needs a listening ear to express themselves. Remember to encourage and motivate the clients to be successful each and every day no matter their circumstances.
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