Depression self-evaluation – Goldberg Depression Scale

Instructions

You might reproduce this scale and use it on a weekly basis to track your moods. It also might be used to show your doctor how your symptoms have changed from one visit to the next. Changes of five or more points are significant. This scale is not designed to make a diagnosis of depression or take the place of a professional diagnosis. If you suspect that you are depressed, please consult a mental health professional as soon as possible.

The 18 items below refer to how you have felt and behaved during the past week. For each item, indicate the extent to which it is true, by checking the appropriate response next to the item.

Responses:

• Not at all (0)


• A little (1)


• Somewhat (2)


• Moderately (3)


• Quite a lot (4)


• Very much (5)

Questionnaire

1. I do things slowly.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

2. My future seems hopeless.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

3. It is hard for me to concentrate on reading.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

4. The pleasure and joy has gone out of my life.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

5. I have difficulty making decisions.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

6. I have lost interest in aspects of life that used to be important to me.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

7. I feel sad, blue, and unhappy.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

8. I am agitated and keep moving around.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

9. I feel fatigued.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

10. It takes great effort for me to do simple things.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

11. I feel that I am a guilty person who deserves to be punished.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

12. I feel like a failure.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

13. I feel lifeless -- more dead than alive.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

14. My sleep has been disturbed -- too little, too much, or broken sleep.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

15. I spend time thinking about HOW I might kill myself.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

16. I feel trapped or caught.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

17. I feel depressed even when good things happen to me.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

18. Without trying to diet, I have lost, or gained, weight.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

Scoring

• If you score points was less than 9 then depression is not indicated.


• Between 10 and 17 – perhaps some slight depression.


• Between 18 and 21 – perhaps the brink of depression.


• Between 22 and 35 – less than indicated moderate depression.


• Between 36 and 53 – moderate to severe depression can be.


• Over 54 – maybe suffering from severe depression.

About Developer

Ivan K. Goldberg, M.D specializes in the treatment of individuals with treatment-resistant depression. The founder of Depression Central , he is a psychiatrist and clinical psycho-pharmacologist in private practice in New York City. Formerly on the staff of the National Institute of Mental Health and the Departments of Psychiatry of the Columbia- Presbyterian Medical Center, and Columbia University's College of Physicians and Surgeons, he now devotes his time to evaluating and providing advanced innovative treatment for individuals whose depression or bipolar disorder has not responded to standard drug treatments.

Sources and Additional Information:

http://counsellingresource.com/quizzes/goldberg-depression/index.html

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=973&cn=5

http://depressioninfos.com/blog/tag/dr-ivan-goldberg/

http://www.psycom.net/ikg8.html

Vagus Nerve Stimulation for treating Depression

Vagus nerve stimulation, an effective epilepsy treatment, has produced encouraging preliminary results for patients suffering from "treatment-resistant depression," and a study beginning at University Medical Center of Arizona and a handful of other U.S. sites may verify the promising new therapy. Approximately 18 million Americans suffer from depression, and about 1 million of whom have severe treatment-resistant depression.

FDA Approval

FDA approval for the Vagal Nerve Stimulator (VNS) came July 1997 as adjunctive treatment of complex partial seizures for patients over 12 years old. As with any approved treatment, "off label" use is permitted and epileptologists have already implanted children younger than 12 (three y.o.), and treated patient with other than complex partial seizures (absences, Lennox-Gastuat).

FDA approval for the VNS Therapy System as depression treatment approach was received on July 15, 2005. This device is indicated for the adjunctive long-term treatment of chronic or recurrent depression for patients eighteen years of age or older who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments.

How VNS works?

There's one vagus nerve on each side of your body. The nerve runs from your brainstem through your neck and down to your chest and abdomen. Information travels through this nerve to and from your central nervous system. The pulse generator sends electrical signals along your vagus nerve up into your brain, where it's hoped that these electrical signals will create a reaction that improves your mood and reduces depression symptoms.

The principal components of the VNS Therapy System are an implantable pulse generator and lead, and an external programming system. The procedure usually lasts about 50 to 90 minutes with the patient under general anesthesia. Sometimes a hospital stay of one night is required. Some surgeons have performed the procedure with local anesthesia and the patient has been discharged the same day.

The study patients are implanted with a NeuroCybernetic Prosthesis (NCP) System, which consists of a battery-powered generator implanted in the chest and a lead attached, at neck level, to the vagus nerve leading to the brain. The device delivers an automatic, periodic electrical stimulation to the vegus nerve. A physician can adjust the intensity, duration and frequency of the stimulation, which may be minimally noticeable by the patient, in follow-up visits.

The Vagus Nerve Stimulation device costs $12,000 and the cost of surgery to implant the device can run as high as $15,000.

Side Effects

The possible side-effects that have been reported at some time during treatment that were significantly increased, were

• voice alteration/hoarseness,


• cough,


• throat pain,


• nonspecific pain,


• dyspnoea,


• paraesthesia,


• dyspepsia,


• vomiting and


• infection.

However, VNS does not cause the side effects normally associated with depression medications, such as weight gain, loss of sexual function, cognitive impairment and insomnia.

Medical Coverage

In May 2007, US Department of Health and Human Services issued a memo, claiming that there is sufficient evidence to conclude that vagus nerve stimulation is not reasonable and necessary for treatment of resistant depression. Accordingly, it has been issued the following national coverage determination: Vagus nerve stimulation is not covered for treatment resistant depression.

During the surgery

Surgery to implant the vagus nerve stimulation device is done either on an outpatient basis, allowing you go to home that same day, or on an inpatient basis, requiring an overnight stay in the hospital. The surgery usually takes one to two hours. It may be done under local or general anesthesia. The FDA recommends that the surgery be done by a neurosurgeon with expertise in implanting the device.

The surgery doesn't involve your brain. The pulse generator is surgically implanted in the upper left side of your chest. The device is meant to be a permanent implant, but it can be removed if necessary. The pulse generator is about the size of a stopwatch and runs on battery power. A lead wire is connected to the pulse generator. The lead wire is guided under your skin from your chest up to your neck, where it's attached to the left vagus nerve through a second incision.

After the procedure

The pulse generator is activated during a visit to your doctor's office a few weeks after surgery. The pulse generator can be programmed to deliver electrical impulses to the vagus nerve at various durations, frequencies and currents. Vagus nerve stimulation usually starts at a low level and gradually increases, depending on your symptoms and side effects.

Stimulation typically lasts for 30 seconds and occurs every five minutes. You may have some tingling sensations or slight pain in your neck during episodes of nerve stimulation.

You are given a hand-held magnetic device so that you can control the stimulation yourself at home. This enables you to temporarily turn off the vagus nerve stimulation, which may be necessary when you engage in such activities as public speaking, singing or exercising, or when you're eating if you have swallowing problems.

You must visit your doctor periodically to make sure that the pulse generator is working correctly and that it hasn't shifted out of position.

Maintenance of the Device

The device comes with a programming wand and software, which are used to program the device or turn it off if necessary. You will eventually need surgery to replace the generator when the battery wears out. How quickly the battery wears out depends upon its settings, but on the average it lasts about six years. Replacement of the generator is generally an outpatient procedure under local anesthetic that takes about one hour to complete.

What can you expect?

Vagus Nerve Stimulation hasn't been on the market that long, so long-term studies aren't available. That's why it's extremely important to discuss the pros and cons of VNS Therapy with your psychiatrist and other doctors. As mentioned earlier, the FDA advises that VNS be used only along with traditional depression treatments such as antidepressants and psychotherapy.

It may take several weeks to months before a VNS patient notices improvement in their depression symptoms. And since VNS didn't perform any better than a placebo in clinical trials, it's possible a patient won't experience any improvement at all. In fact, the FDA advises that, in some cases, depression could worsen with VNS therapy. The most common adverse effect (side-effects) associated with VNS is voice alteration or hoarseness, throat pain and cough. Dyspnea and paresthesia are also reported side-effects of Vagus Nerve Stimulation. Vagal nerve stimulation has not been reported to cause cognitive impairment.

One Happy Customer

One news report cites Lauri Sandoval, 42, a participant in the pilot study, who has tried almost every antidepressant available and was set to start electroconvulsive therapy: "I was so desperate and depressed that I wasn't even scared of it, even though it hadn't been studied before."

Lauri had suffered from depression for 30 years and was having trouble holding down a job. It took her three months after receiving the implant to feel the change, and 18 months later, she reported feeling dramatically better: "I used to be a hermit and I tried to pretend that I wasn't depressed. I would stay in bed as long as I could. I would get up to go to work, or to walk my dogs, but after a while that would even be difficult."

Video Presentation

Sources and Additional Information:

http://www.depression-guide.com/vagus-nerve-stimulation.htm

http://www.bcm.edu/psych/mdoc/research/vnsintro.pdf

http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=195&

http://www.mayoclinic.com/health/vagus-nerve-stimulation/MY00183

http://www.healthyplace.com/depression/vns/vagus-nerve-stimulation-for-treating-depression/menu-id-68/

When Hospitalization for Depression is Needed?

In cases of severe depression or treatment-resistant depression, some people need to stay in the hospital for a short time. You might check into the hospital yourself. Or you could be hospitalized under a doctor's order.

There is a powerful stigma associated with being hospitalized. Many people feel ashamed, as if it's a sign that they are "crazy." Some people fear that being hospitalized is the same thing as being institutionalized or sent to an asylum.

But that's not the case. Usually, a stay in the hospital is just a way for you to recover in a safe and stable environment. This allows you to take a break from some of the daily stresses that contributed to your depression. Your doctors can work with you to try different treatments and figure out which one is best.

Most people don't like being in the hospital. You may not like the routine, the food, or the other patients. It might be frightening. But look at it this way: Depression is an illness, as real and as serious as heart disease or cancer. And sometimes depression -- just like other serious diseases -- requires treatments that can only be provided in a hospital.

Who Needs to Be Hospitalized for Depression?

Hospital admission can allow an extremely depressed individual to receive higher and more detailed care than if they were treated on an out-patient basis. It allows for doctors and other hospital staff to better assess a depressive condition and make important treatment recommendations.

There are many people with depression who might benefit from a hospital stay. Here are some examples.

• People who are at risk of hurting themselves or others. Preventing suicide and violence is the most common reason for hospitalization. A stay in the hospital allows you to get back in control.


• People who are unable to function. Hospitalization makes sense if you are so depressed that you can't take care of yourself.


• People who need observation when trying a new medication. Sometimes, your doctor may be fine-tuning your depression medicine and may want you to check into the hospital. Since you will be under constant observation there, your doctor will be able to see more easily how well a treatment is working.


• People who need treatments that are given only in a hospital. Some treatments, like electroconvulsive therapy (ECT) are usually given in the hospital. A stay in the hospital allows you to recover from anesthesia and gives your doctors a chance to see how you're doing after treatment.

Relief From a Hospital Stay: Is It Possible?

Some people actually experience great relief from their time in a hospital and don't find it difficult to cope. Everyday challenges and worries involved in providing for home or career may be temporarily alleviated and a person might find they can better focus on getting well. For others, however, hospital treatment can be frightening and intimidating and the time away from regular support sources can be difficult.

What Are Your Rights Regarding Hospitalization for Depression?

Many people with depression check themselves into the hospital because they feel unstable or suicidal. But others are hospitalized against their will. The laws concerning hospitalization for depression vary from state to state. Generally, you can only be hospitalized against your wishes if you are considered to be a risk to yourself or others.

During an emergency, a health care professional or police officer may require you to be evaluated by a hospital. Once there, a hospital doctor will talk to you and decide whether you actually need to be hospitalized.

Note that hospitalization of an individual suffering from the severe depression is deemed absolutely necessary when that person has attempted suicide or has serious suicidal ideation or plan for doing so. However, such suicidal intentions must be carefully and fully assessed during an initial meeting. The individual must be imminent danger of harming themselves (or another). Daily, routine daily functioning will likely be negatively affected by the presence of a clear and severe major depression. Most individuals who suffer from major depression, however, are usually only mildly suicidal and most also often lack the energy or will (at least initially) to carry out any suicidal plan.

Care must be taken with regards to any hospitalization procedure. When possible, the patient’s consent and full understanding would first be obtained and you as a client would be encouraged to check yourself in. Hospitalization is usually relatively short, until you state becomes fully stabilized and the therapeutic effects of an appropriate antidepressant medication can be realized (3 to 4 weeks). A partial hospitalization program might also be considered.

Suicidal ideation will be assessed during regular intervals throughout therapy (every week during the therapy session is not uncommon). Often, as the individual who suffers from a depressive disorder is beginning to feel the energizing effects of a medication, they will be at higher risk for acting on their suicidal thoughts. Care should be used at this time and hospitalization may need to be again considered.

The length of your stay is set by the staff. If the doctors no longer think that you are in danger, you will be released within two to seven days -- depending on the laws in your state. Keep in mind, if you disagree with the hospital's assessment, you can take legal action. Talk to your state's Protection and Advocacy agency.

When you're in the hospital, you may face some tough restrictions. Even if you check yourself in, you may not be able to leave as soon as you want. The hospital may strictly control visits from family and friends, and limit the items you can take in with you. You may be on a locked ward for at least some of your stay. You may also be expected to follow a certain schedule. While the restrictions can be hard to accept, keep in mind that they are in place for the safety of you and the other patients.

Some health insurance policies will cover hospitalization for a limited amount of time. Others won't cover it at all. Before a person can be hospitalized, some insurers require that he or she be evaluated by an expert under contract with their company. Very few insurers will cover a hospital stay for depression that isn't an emergency.

Keep in mind that most hospital stays for depression are brief and voluntary. The goal is for you to stay until your doctors are confident that you are safe and stable.

Sources and Additional Information:

http://www.webmd.com/depression/hospitalization-needed

http://psychcentral.com/lib/2006/depression-treatment/

http://www.overcomedepression.co.uk/HowCopeWithHospitalAdmissionDueDepression.html

http://www.everydayhealth.com/depression-specialist/hospitalization-for-depression.aspx