Straight Talk on Depression

Joseph P. Wiedemer MD

Peter D. Rainey MS

…..

• What is Depression?

• How Can I Recognize it?

• What can I do if I believe a child has it?

• How can I help youth who are experiencing depression?

Why did you come tonight?

Lets go to the phones!!!

What do you hope to receive?

Lets go to the phones!!!

WHAT IS DEPRESSION?

Depression is…

Mental Disorder.

Biological / Physical

Psychological

&

Emotional

Social

Spiritual/Moral

There are many dimensions in our lives.

Depression can be associated or be exacerbated by duress in any one of or combination of these

domains.

Biologic and Genetic Explanation

https://www.youtube.com/watch?v=GOK1tKFFIQI

Biological /Neurobiology

Intrapersonal Land Scape

Interpersonal Relationships

Emotions & Affect

Building Blocks of a Mood Disorder

Depression impacts and is impacted reciprocally by any one or combination building blocks.

Depression is… Depression is mental disorder category.

Depression encompasses 126 diagnostics variations.

Depression is a "whole-person" illness.

Depression involves the body, mood, and thoughts.

Depression is a relational experience.

Depression impacts and is impacted by relationships (family, peers, ect…) and social context (SES, bullying, gender, ect…).

Manic

Hypomanic

Stable

Depressed

Severely

Depressed

Normal

Dysthymia

Bipolar

Major Depressive Disorder

Mood Disorders

Depression Diagnosed At least 1 of the following symptoms must be clinically significant for depression to be present:

• Depressed/sad mood

• Loss of interest/pleasure

5 or more of symptoms present during same 2-week period

Symptoms are present everyday or nearly everyday

Interpersonal

Social/family withdrawal

Increased discussion of relational problems

Reduction/lack of personal cleanliness

Lowered school/work productivity

Emotion and Affect

Crying easily or for no reason Feelings of guilt or worthlessness Feeling restless, irritated, and easily annoyed nearly everyday Feeling sad, numb, or hopeless nearly everyday Blunted or Constrained Affect

Biological

Diminished ability to think/concentrate or indecisiveness

Psychomotor agitation/retardation

Aches and pains that don't get better with treatment

Biological

Insomnia or hypersomnia nearly everyday

Decrease or increase in appetite nearly everyday

Significant unintentional weight loss or gain

Suicidal Ideation

1,300 PA residents complete suicide each year.

An average of 3.5 lives each day.

Suicide is 3rd leading cause of death for youth ages 15-24.

Recurrent thoughts of

death, suicidal ideation,

or suicide attempt

WHAT CAN I DO IF A CHILD IS EXPERIENCING DEPRESSION?

Avenues for Help

Medical

Counseling

Home

School

Help

Which treatment(s) are best for treatment for my family?

Balloon Activity

What Did We Learn?

1) Setting Priorities Requires collaboration.

2) If we don’t work together, balloons our priorities will fall!

3) Collaboration require communication, balance, patience, and effort.

COUNSELING

Mental Health A state of well-being in which youth realize their own abilities by:

1. coping with the normal stresses of life

2. working productively and fruitfully

3. making a contribution to their community

4. harnessing personal and family resilience

Definitions of resiliency

“The path a family follows as it adapts and prospers in the face of stress.” (Hawley and DeHaan, 2003)

“Ability to bounce back from adversity” (Stuart, 2004)

Ability to bounce forward by adapting to of adversity. (Walsh & McGoldrick, 2006)

“Capacity to cultivate strengths to positively meet the challenges of life.” (Silliman, 1994)

“Capacity to rebound from adversity strengthened and more resourceful” (Walsh,1998)

Factors Contributing to Successful Treatment

Genetics and Biochemistry

Acute and Chronic

Stressors

Physical Health

Personality & Temp.

Family Dynamics &

History

Resources & Coping

Comorbid Conditions

Resources Risks

What has been your experience?

Lets go to the phones!!!

GOING TO THE DOCTOR

Priority= the Goal of Treatment

The 3 Rs of Treatment Goals

• Response – significant reduction in symptoms or no symptoms for 2 weeks

• Remission – period of > 2 weeks and < 2 months with few symptoms

• Recovery** – absence of symptom patterns for > 2 months

**We Believe Recovery is the Goal for Most Families. Recovery is the Goal for Most primary care providers as well.

Why should we visit the PCP

• 10% -20% of adolescents in the last year were depressed

• Over 70% of adolescents report a willingness to talk with their PCP about emotional distress

• Many youth at-risk for suicide are also at risk for other medical concerns (e.g. HIV, chronic illness, family planning, substance abuse)

What do PCPs usually do to help?

Positive screening for depression

Education & treatment planning

Mild depressive to moderate symptoms:

Active support and

monitoring for 4-6 weeks

Moderate to severe depressive symptoms:

Begin evidence based

therapy or medication or both and monitor for 6-8 week. Treatment duration

for 9 to 12 months.

Severe depressive symptoms:

Start medication and

therapy. Contact psychiatry for consult.

Treatment duration for 9 to 12 months.

AACAP practice parameters 2007 and GLAD-PC 2007

Experience at the Clinic

Patient centered experience:

– Collaborative discussion of treatment options

– Opportunity to ask questions and recommendations

Psychoeducation:

– Information about the illness and symptoms

– Information about typical course of treatment

– Physicians plan for follow up

– Red Flags to watch for

Mild =Supportive Treatment

Meeting frequently to monitor progress Active listening and reflection Problem solving Efforts to help your family find hope

If not improving in 6 weeks, more intense treatment

Moderate =Treatment Options

Moderate to severe depression OR if mild to moderate depression not improving after 6 weeks of supportive care.

Individual Therapy

• CBT

• IPT

Family

Therapy

• Systemic benefit

• Resilience

Medication

• SSRI

• Switching Meds

Thoughts about medications?

Lets go to the phones!!!

Treatment Options

Severe depression:

Individual psychotherapy

– Cognitive Behavioral Therapy

– Interpersonal Psychotherapy

• Family therapy

• Medication

• Psychiatry

HOME

Identify what works for the youth

Dancing

Exercising

Go for a walk

Playing a sport

Breathing exercises

Progressive relaxation

Biological / Physical

Psychological

&

Emotional

Social

Spiritual/Moral

Family Activity Night

Text a Friend

Face time a Family

Social activity (sports, clubs, community)

Talk to someone

Imagine a relaxing place Listening to music Read Do a puzzle or game Check your thoughts Meaning making (journal, emotional calendar)

Meditation

Prayer

Religious & Family Rituals

Crafts & Keep sakes= memory making and

recording

Writing

Relaxation Strategies • Deep breathing

– Inhale for count of 5 & hold briefly

– Exhale for count of 5

– Repeat 5 times

• Progressive muscle relaxation

– Begin with feet, contract muscles for count of 5 and slowly release.

– Move up the body through all muscle groups

• Meditation

HOW CAN I HELP?

Old Saying…

• There is an old saying that says, “The grass is always greener on the other side.”

• However, the reality is, “The grass is always greener where you water it.”

• The Question is… where are you watering, and providing an environment for your relationship to grow?

Healing & Healthy Relationships

Appreciation = short & sincere on regular basis

Affection = Love languages/ Currency

Communication +???

Tips for Talking to a Depressed Teen

Offer support Let depressed teenagers know that you’re there for them, fully and unconditionally. Ask questions important to you but make it clear that you’re ready and willing to provide whatever support they need.

Be gentle but persistent Don’t give up if your adolescent shuts you out at first. Talking can be very tough for teens. Be respectful of your child’s comfort level while still emphasizing your concern and willingness to listen.

Listen without lecturing The important thing is that your child is talking.

Resist any urge to criticize or pass judgment once your teenager begins to talk. Avoid offering unsolicited advice or ultimatums as well.

Validate feelings Don’t try to talk your teen out of his/her depression

Simply acknowledge the pain and sadness he or she is feeling.

Healing & Healthy Relationships

• Time=Quality vs Quantity (Quality is function of Quantity)

• Creative problem solving (purpose of the task is to strengthen the relationship)

• Commitment= follow through & follow up

• Spirituality = helps in the tough times and to

motivate you to do things that help relationships when you do not want to

Words of Affirmation

• One of the deepest human needs it to feel appreciated.

• Words of affirmation fulfills this need for many individuals. It requires:

– Complements & words of appreciation

– Words of encouragement

– Kind words

• This is not flattery, to get what you want.

Quality Time

This is giving your undivided attention and engagement to each other.

Spend time together enjoying meaningful activities (Daddy Daughter date/ Girls night out)

Quality Time…

• Some Actions may include: – Quality conversation (talking and listening).

– Dead Sea and the babbling brook

– Spend time together enjoying meaningful activities (Daddy Daughter date/ Girls night out)

• Result – There is a sense of enjoyment of each other

– Increased bonding through deeply sharing and knowing each other.

– Common family pattern

Increasing Fondness and Admiration

• Find ways to admire your child.

• There is an increase in frequency and spontaneous expression of fondness toward your child.

– i.e. your beautiful, I’m so grateful that you are a great mother…etc.

Developing Fondness and Admiration

• Developing Fondness and Admiration requires practice:

1) Recall happy events from the past from the past

2) Shift your perspective from looking for mistakes to looking for what your child is doing right.

• Highlight these positive things and tell your child why you appreciate them.

Developing Fondness and Admiration

2) Recall happy events from the past from the past

3) List each other’s positive qualities and share it.

Understanding Our Relationship

Emotional Bank Accounts

• Every relationship needs efforts…in some ways we often treat them like basic economics. Relationships flourish when people contribute and suffer when they do not.

• Deposits vs. Withdrawals

How Many Deposits?

• So the question is, how many positive deposits do we need to make for every negative withdrawal?

Summary • Major depression occurs in adolescents

• There are treatment options

– Treatment begins with psychoeducation

– Mild depression can respond to support

– Moderate depression tx starts with talk therapy or meds. Reassess the plan at regular intervals

– Severe depression treatment likely to use meds or combination meds + therapy as first step

• You can do things at home that help.

– Remember AACTCC

Summary

• Things that can help while attempting to find the best treatment for your child: referral or in supportive period include:

– Scheduling pleasant activities

– Relaxation

• SSRIs are effective medications for MDD

– Common SEs include GI upset, headache, agitation and sleep disturbance

– Be careful of combining with other serotinergic medications

• Monitor for suicidality

QUESTIONS

The Black Dog of Depression

What is it like to live with depression: https://www.youtube.com/watch?v=XiCrniLQGYc

For those who care for those with depression: https://www.youtube.com/watch?v=do8mqz6XmTE