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.
There are many dimensions in our lives. Biological / Spiritual/Moral Physical Psychological Social & Emotional 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
Building Blocks of a Mood Disorder Emotions & Biological Affect /Neurobiology Interpersonal Intrapersonal Relationships Land Scape 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 …).
Mood Disorders Manic Hypomanic Stable Depressed Severely Depressed Normal Major Depressive Disorder Bipolar Dysthymia
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 Recurrent thoughts of 1,300 PA residents complete suicide each death, suicidal ideation, year. or suicide attempt An average of 3.5 lives each day. Suicide is 3 rd leading cause of death for youth ages 15-24.
WHAT CAN I DO IF A CHILD IS EXPERIENCING DEPRESSION?
Avenues for Help Medical Counseling Help Home School
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) “ Capacity to cultivate strengths to positively meet the challenges of life.” (Silliman, 1994 ) “ Capacity to rebound from adversity strengthened and more resourceful” (Walsh,1998) “ Ability to bounce back from adversity” (Stuart, 2004) Ability to bounce forward by adapting to of adversity. (Walsh & McGoldrick, 2006 )
Factors Contributing to Successful Treatment Resources Risks Genetics and Biochemistry Comorbid Conditions Acute and Resources & Chronic Coping Stressors Family Physical Dynamics & Health History Personality & Temp.
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 Severe depressive Moderate to severe symptoms: depressive symptoms: Mild depressive to moderate symptoms: Start medication and Begin evidence based therapy. Contact therapy or medication or Active support and psychiatry for consult. both and monitor for 6-8 monitoring for 4-6 weeks Treatment duration week. Treatment duration for 9 to 12 months. 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 M oderate to severe depression OR if mild to moderate depression not improving after 6 weeks of supportive care. Family Individual Medication Therapy Therapy • CBT • Systemic benefit • SSRI • IPT • Resilience • Switching Meds
Thoughts about medications? Lets go to the phones!!!
Treatment Options S evere depression : Individual psychotherapy – Cognitive Behavioral Therapy – Interpersonal Psychotherapy • Family therapy • Medication • Psychiatry
HOME
Identify what works for the youth Dancing Meditation Exercising Prayer Go for a walk Religious & Family Rituals Playing a sport Crafts & Keep sakes= memory making and Breathing exercises recording Progressive relaxation Writing Biological / Spiritual/Moral Physical Psychological Social & Emotional Imagine a relaxing place Family Activity Night Listening to music Text a Friend Read Face time a Family Do a puzzle or game Check your thoughts Social activity (sports, Meaning making (journal, clubs, community) emotional calendar) Talk to someone
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 Resist any urge to criticize or pass judgment once your teenager The important thing is that your begins to talk. child is talking. Avoid offering unsolicited advice or ultimatums as well. Validate feelings Don’t try to talk your teen out of Simply acknowledge the pain and sadness he or she is feeling. his/her depression
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
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