ADOLESCENT DEPRESSION

1. ADOLESCENT DEPRESSION

2. Types of Depression 1.Dysthymia is chronic ongoing mild depression and occurs when a child feels a little down most of the time for a year or more. 2. Major depression is an illness in which a person has a severely depressed mood and no longer enjoys his life. 3. Depression associated with bi-polar disorder (also called manic-depressive disorder) have moods with extreme ups and downs. Government of South Australia website. “Teenage Depression”. http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

3. Facts About Depression Major depression has been estimated at 1% to 3% in young children and between 3% and 9% in adolescents. These estimates are higher when young people with minor depression are included. http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm

4. Symptoms of Dysthymia A person with dysthymia may: • gradually lose interest in things they have enjoyed doing and appear to be more ‘down’ most of the time • have less energy and find it difficult to concentrate • have trouble with eating and sleeping patterns • the most common factor is feeling bad about themselves and having less confidence and enjoyment in their lives Dysthymia is more serious than just a depressed mood alone and may need professional assessment Government of South Australia: “Teenage Depression” http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

5. Symptoms of Major Depression:Adolescents with depression may display some of the following signs loss of interest or enjoyment in his usual activities: quitting favorite activities poor concentration with school work or other things missed school, poor school performance and/or a sudden decline in grades being sad or tearful anxious worrying and intrusive upsetting thoughts feeling guilty and to blame for things going wrong increasing drug and alcohol use not taking care of how he looks or of hygiene pains carelessness about physical safety behaviour problems and delinquency having thoughts about being better off dead or that life is not worth living preoccupation with death and suicide. • being angry or irritable a lot of the time • temper tantrums and shortness of temper • negative attitude a lot of the time • overreaction to criticism, irritability • excessive worry about physical health • unexplained aches and pains, such as headaches or stomach pain • difficulty thinking and making decisions • problems with sleeping or sleeping too much • changes in eating habits that lead to weight gain or loss or not making expected weight gains • low self-esteem • feelings of guilt and hopelessness • constant tiredness or lack of energy • feeling that nothing is worth the effort • social withdrawal, such as lack of interest in friends and not wanting to go out • hinking about death or feeling suicidal Compiled from: 1) Help Guide.org; “Teen Depression 2) Government of South Australia: “Teenage Depression 3) Psychology Information Online; “Depression in Teenagers”

6. Causes of Depression in Teens • Stress • Loss • Major disappointment • Chemical imbalance • Genetic disposition • Some medications (i.e. narcotics, steroids) may trigger depression • Traumatic events (violence, abuse, neglect) • Social problems • Unresolved family conflict http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm

7. Diagnosis • If a child or teen has mild or moderate depression, he or she may be diagnosed and treated by your family doctor, general practitioner, or pediatrician and a therapist or psychologist. A doctor who specializes in the diagnosis and treatment of mental health problems (psychiatrist) may be helpful for severe depression or other mental health problems that occur with depression. • Sometimes a stay in the hospital may be needed if the child or teen has suicidal thoughts and is likely to act on them or has other health conditions, such as a long-term disease, an eating disorder, or another mood disorder. Government of British Columbia- B.C. Health Guide: Depression in Childhood and Adolescence http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm

8. “Automatically, when the disorder “depression” is mentioned normally one directly associates it with sorrow. But it is significant to note that even if in adults, sorrow characterizes much of the “depressed” experience, in teenagers or those younger, depression does not necessarily emerge as sorrow. Feelings of anger may actually be manifested in hostile or defiant behavior in teenagers, as a way of expressing their depression. A bad temper may also serve as a sign of depression. ” • “If your child becomes depressed, he/ she is unlikely to talk about it. Your first warning signs will probably be changes in behaviour that may suggest a troubled and unhappy state of mind.” Parenting Advice for Troubled Teens; “Misdiagnosis of Depression http://www.troubledteensinfo.com/Mental_Health_Problems/Teen_Depression/Misdiagnosis_of_Depression_in_Troubled_Teens/

9. Consider….. • It was once thought that only adults developed depression and that children and teens could not. • Symptoms of depression in children and teens can be difficult to recognize. • Mood swings and other emotional changes caused by depression may be overlooked as unimportant or as a normal part of growing up. • At one time it was a common belief that depression is "all in the mind" and that a depressed person should be able to snap out of it. We now know that depression is an illness that requires treatment—not a character flaw or weakness. • Prolonged or severe depression can lead to problems making and keeping friends, difficulty in school, substance abuse, suicidal behaviour, and other problems that may carry into adulthood. Government of British Columbia- B.C. Health Guide: Depression in Childhood and Adolescence http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm

10. Myths About Depression Myths about depression often prevent people from doing the right thing. Some common myths are: • Myth: It's normal for teenagers to be moody; teens dont suffer from real depression. FACT: Depression is more than just being moody, and it can affect people at any age, including teenagers. • Myth: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it. FACT: Depression, which saps energy and self-esteem, interferes with a person's ability or wish to get help. It is an act of true friendship to share your concerns with an adult who can help. • Myth: Talking about depression only makes it worse. FACT: Talking through feelings with a good friend is often a helpful first step. Friendship, concern, and support can provide the encouragement to talk to a parent or other trusted adult about getting evaluated for depression. Psychology Information Online; “Depression in Teenagers” http://www.psychologyinfo.com/depression/teens.htm#Myths

11. Remember…. • Having depression doesn't mean that a person is weak, or a failure, or isn't really trying...it means they need treatment.1 • By getting to the root of a teen’s depression the likelihood of it resulting in suicide is greatly reduced, if not eliminated.2 • Do not wait and hope that symptoms will go away on their own.3 • Parents need to recognize when their adolescent is distressed. They must be careful not to disregard real emotional difficulties and mistakenly assume that these are due to physical changes associated with adolescence.4 Columbine Video

12. How is Teenage Depression Treated? Physical exercise is helpful in lifting depression, as it causes the brain's chemistry to create more endorphins and serotonin, which change mood. Creative expression through drama, art or music is often a positive outlet for the strong emotions of adolescents. Volunteer work is sometimes helpful for adolescents. Helping someone else whose problems are greater than one's own offers a perspective and also an opportunity to be helpful, which can increase one's sense of purpose and meaning. Medication for depression should be used with great caution, and only under careful supervision. Recent studies by both the UK government and the FDA have led to warnings that not all psychiatric drugs may be appropriate for teenagers and children. Seek a physician who works specifically with teenagers. Hospitalization may be necessary in situations where a teen needs constant observation and care to prevent self-destructive behavior. Hospital adolescent treatment programs usually include individual, group and family counseling as well as medications. Depression is commonly treated with therapy or with therapy and medication. A combination of approaches is usually most effective: • Cognitive-behavioral therapy focuses on the causes of the depression and helps change negative thought patterns. • Group therapy is often very helpful for teens, because it breaks down the feelings of isolation that many adolescents experience (sometimes it helps just to know that "I'm not the only one who feels this way"). • Family therapy as an adjunct to individual therapy can address patterns of communication and ways the family can restructure itself to support each member, and can help the teenager feel like others share the responsibility for what happens in the family. Helpguide.org: “Teen Depression” http://www.helpguide.org/mental/depression_teen.htm#symptoms

13. Special schools, wilderness challenges, or "boot camps" are sometimes recommended for troubled teens. These alternatives are intended to help adolescents learn coping skills, develop confidence, learn to trust and work with others, improve academics and/or deal with negative behaviors. Whether or not they are good options largely depends on the staff running the program. In many cases, they are not trained mental health professionals and may use confrontation, humiliation and punitive measures designed to break down resistance rather than build up internal strengths. Sometimes these programs do more harm than good, and can even result in worse outcomes for adolescents. Before considering such alternatives, do careful research on their philosophy, methods, and the background of their employees. Helpguide.org: “Teen Depression” http://www.helpguide.org/mental/depression_teen.htm#symptoms

14. What parents can do for their teen: • Respond with love, kindness, and support. • Repeatedly let your child know that you are there, whenever she or he needs you • Be gentle but persistent if your adolescent shuts you out (depressed teenagers do not want to feel patronized or crowded). Do not ask a lot of questions, but make known your concern and your willingness to listen. • Do not criticize or pass judgment once the adolescent begins to talk (the important thing is that he or she is talking and communicating feelings). • Encourage activity and praise efforts to socialize and be active. • Seek help from a doctor or mental health professional if the adolescent's depressed feeling doesn't pass with time. Be prepared to list behaviors, note how long and how often they have been occurring, and how severe they seem. • Do not wait and hope that symptoms will go away on their own. When depression is severe—if adolescents are thinking about hurting themselves or about suicide—seek professional help as soon as possible. Helpguide.org; “Teen Depression http://www.helpguide.org/mental/depression_teen.htm#symptoms

15. Never treat depression as if it is simply teenage 'blues' - always take it seriously. • Encourage your child to seek help by providing a list of contacts for her to choose from. • If your teenager won't go for help and you are really worried, go by yourself first and get some advice about how to best handle the situation. • Show love and concern - this doesn't mean that you have to agree with everything your child does or wants to do, but young people need to know that you still love them no matter who they are or what they do. • Take time to listen when your teenager wants to talk about her feelings. • Show her that you are available without being 'pushy'. • Encourage her to do things you know she enjoys. • Notice the little things she does that you approve of. • Make sure that you do not keep a gun in your home or shed. (Farmers need to be very careful about where they store guns because this is the method often used in youth suicides in country areas.) • Take seriously any talk about suicide and actions such as giving away special things. Do whatever is needed to protect your child's safety - even if it is against her wishes. Government of South Australia: “Teenage Depression” http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

16. More helpful actions…. • The first thing to do is to help your teenager set realistic short-term goals. Ask him for suggestions on how he would like to improve his life. Then help him identify some simple steps he can take to achieve these goals. Remember not to set goals, which are unattainable, as this will just reinforce his belief that he is a failure. On the other hand, do not aim for things that are easily attainable. The whole idea is that your teenager must feel that he has been equal to the challenge.  • Make sure that you encourage him at every step and help him in every way possible without actually doing his work for him. For instance, if he wants to audition for a play, help him rehearse and boost his confidence without giving him false hope. • If he fails to reach his set goals, do not try to sweep it under the carpet and smooth it over with inanities like "you'll do better next time." Acknowledge his failure and discuss why it happened. Maybe he gave up too easily or didn't study hard enough or had a panic attack. It's important to get this out in the open so that you know what your teenager attributes his failure to and correct any misconceptions that he may have. India Parenting Pvt. Ltd.; “Helping you Teenager Overcome Depression” http://www.indiaparenting.com/raisingchild/data/raisingchild058.shtml

17. Do not compare your teenager to his peers and find him wanting. Don't say things like "why can't you be like that?" You will just be reinforcing his belief that he's not good enough the way he is, even for you. You have to teach him that he can admire others without necessarily envying them. If he comments in an envious tone about another teenager's attributes, admit that the other child is good, but point out something that your teenager is good at. • Depressed teenagers tend to vacillate over every decision. This is because they don't trust their own judgement and need to be constantly reassured that they are doing the 'right thing.' You have to help your teenager make decisions in a way that he will learn to trust his own judgement. It is also important that you insist that once he has made a choice, he must go through with it and cope with the consequences, whatever they are. • Short-term measures like buying your teenager tickets to a concert or taking him for a holiday are not going to alleviate his depression. You are going to have to sit down and talk to him about what exactly it is that bothers him and how he can overcome it. You have to take steps to make him feel empowered so that he feels that he can effectively accomplish the things he sets out to do. India Parenting Pvt. Ltd.; “Helping you Teenager Overcome Depression” http://www.indiaparenting.com/raisingchild/data/raisingchild058.shtml

18. Encourage your child to: • Get regular exercise, such as swimming, walking, or playing vigorously every day. • Avoid alcohol and illegal drugs, non-prescription medications, herbal therapies, and medications that have not been prescribed (because they may interfere with the medications used to treat depression). • Get enough sleep. If your child has problems sleeping, he or she might try: • Going to bed at the same time every night. • Keeping the bedroom dark and quiet. • Not exercising after 5:00 p.m. • Eat a balanced diet. If your child lacks an appetite, try to get him or her to eat small snacks rather than large meals. • Be hopeful about feeling better. Positive thinking is very important in recovering from depression. It is difficult to be hopeful when you feel depressed, but remind your child that improvement occurs gradually and takes time. Government of British Columbia- B.C. Health Guide: Depression in Childhood and Adolescence http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm

19. Parenting a teenager who is under severe stress or suffering depression can be very stressful. At times it may seem as if your child is deliberately not trying or misbehaving. When you find yourself feeling angry or frustrated (and you will!): Government of South Australia: “Teenage Depression” http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

20. Ask people close to you for support. Ask someone the young person is close to (eg another relative) to help provide support - but make sure your child knows that you're not rejecting her. Make sure you do things for yourself - you need to take care of your own needs if you're to help your child. Get professional help for yourself if you feel you are struggling. • Take a step back and think about what is happening before you react. • Remember to hang in there, your child needs your love even if she seems to reject it. • Think about your own views: • Are you wondering "Why should I have to put up with this terrible behaviour?" This thinking will make the situation worse. • Are you thinking "Something must be wrong for my child to be behaving like this"? This thinking will lead to a search for the cause. Government of South Australia: “Teenage Depression” http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

21. Recognize your own feelings about your child's depression. you might find that you are feeling guilty or frustrated. Without wanting to, you may let your child know this and make him / her feel rejected and misunderstood. • You should also be honest with brothers and sisters, and other family members about your depressed child's needs. That way, he / she will have several sources of support and understanding. Canadian Mental Health Association; “Children and Depression” http://www.cmha.ca/bins/content_page.asp?cid=3-86-87-90&lang=1

22. Suicide Most people who are depressed do not commit suicide. But depression increases the risk for suicide or suicide attempts. Psychology Information Online; “Depression in Teenagers” http://www.psychologyinfo.com/depression/teens.htm#Myths

23. Myths about Suicide • People who talk about suicide won't do it. Almost everyone who commits suicide gives some clue or warning. • Anyone who tries to commit suicide must be crazy. It isn't as simple as this. Suicidal thinking isn't necessarily a sign of mental illness. In young people depression is almost always behind suicidal thinking. Often no one has realized that the young person was depressed. • If people really want to kill themselves nothing will stop them. What they usually want is for the pain to stop. The feeling of wanting to end it all doesn't last forever. In fact, sometimes it doesn't last for long at all, particularly if things in the person's life change. • People who complete suicide don't seek help before their death. More than half of the people who commit suicide have been to their doctor for help in the six months before their death, though they may not tell their doctor they are thinking of suicide. • Talking/asking about suicide may give someone the idea. The opposite is true. Discussing suicide openly helps people talk about their feelings and to look for other ways to stop the pain. Government of South Australia website. “Teenage Depression”. http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

24. Facts about Suicide • Teens with depression are at particularly high risk for suicide and suicide attempts. • In Canada, approximately 400 teens commit suicide each year. • While teen girls attempt suicide almost twice as often as teen boys, boys are more likely to succeed because girls usually use less lethal means and survive the attempt. • Suicide attempts in children younger than age 12 are uncommon. Government of South Australia: “Teenage Depression” http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

25. Suicide is the leading cause of death among youth in British Columbia and the 2nd leading cause of death among youth overall (ages 15-24) in Canada • Teen/youth suicide rates have tripled since 1970. • Approximately one-third of teens who die by suicide have made a previous suicide attempt. The Kelty Patrick Dennehy Foundation http://www.thekeltyfoundation.org/index.html

26. Nine out of ten suicides take place in the home. • For every completed suicide there are an estimated 30 to 50 attempts. • 70% of suicides occur between the hours of 3 p.m. to midnight (when they could be saved). • Males complete suicide 4 times more often than females. • Females account for 75% of the attempted suicides (mainly with drug overdoses). The Kelty Patrick Dennehy Foundation http://www.thekeltyfoundation.org/index.html

27. Approximately one-third of teens who die by suicide have made a previous suicide attempt. • Males use more violent means, e.g. guns, hanging. • Only 33 to 50 % were identified by their doctors as having a mental illness at the time of their death and only 15 percent of suicide victims were in treatment at the time of their death. The Kelty Patrick Dennehy Foundation http://www.thekeltyfoundation.org/index.html

28. Spring and fall are the months of highest risk. • An estimated 80% of all those who commit suicide give some warning of their intentions or mention their feelings to a friend or family member. • In 1996, more teenagers and young adults died of suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease combined. The Kelty Patrick Dennehy Foundation http://www.thekeltyfoundation.org/index.html

29. Risk Factors for Suicide • Current suicidal thoughts. • Other mental health or disruptive disorders, such as conduct disorder. • Impulsive or aggressive behaviours. • Feelings of hopelessness. • A history of past suicide attempts. • A family history of suicidal behaviour or mood disorders. • A history of being exposed to family violence or abuse. • Access to firearms or other potentially lethal means. • Social isolation/alienation, including because of being gay or being bullied Government of British Columbia- B.C. Health Guide: Depression in Childhood and Adolescence http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm

30. talk or threats of suicide • hints such as "I won't be a problem for you much longer" • previous attempts - especially if the person was alone at the time • careless, risk taking, behaviour • self-destructive behaviour • sad or angry mood that does not go away • giving away personal possessions • suddenly clearing out belongings and getting them in order • becoming suddenly cheerful without reason after being depressed. Government of South Australia: “Teenage Depression” http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

31. Precipitating Events for Teen Suicide • “Suicidal behavior in adolescents is commonly precipitated by events or challenges that the teenager finds too difficult to tolerate. Even things that seem minor to an adult can be major to a young person, who does not have the life experience to put them into perspective or the coping skills that an adult has honed.” Helpguide.org: “Teen Depression” http://www.helpguide.org/mental/depression_teen.htm#symptoms

32. Some common precipitants of suicidal behavior in teenagers include: • death of a family member or close friend (particularly if by suicide) • loss of a romantic relationship or good friendship • loss of a parent through divorce or separation • loss of a pet, treasured object, job or opportunity • fear of punishment • physical, sexual or psychological abuse • unwanted pregnancy • poor grades • fight or argument with family member or loved one • belief one has harmed or brought harm to a family member or friend • embarrassment or humiliation • concerns about sexuality • suicide of a friend, acquaintance, or celebrity ("copycat" suicide) Helpguide.org: “Teen Depression” http://www.helpguide.org/mental/depression_teen.htm#symptoms

33. If your child exhibits any warning signs: Call 911

34. Crisis Intervention and Suicide Prevention Centre of British Columbia • Greater Vancouver 604-872-3311 • Toll free - Howe Sound & Sunshine Coast 1-866-661-3311 • TTY 1-866-872-0113 • BC-wide1-800-SUICIDE (784-2433) • Help for Youth Online www.YouthInBC.com

35. REMEMBER • Depression is treatable • You are not alone, help is available • Don’t delay. If you suspect your child is depressed, seek help.

36. References Advanced Behavioral Consultants: “Let’s Talk About Depression”; retrieved March 5, 2007; http://www.healthsurvey.com/teendepression.htm Canadian Mental Health Association; “Children and Depression”; retrieved February 15, 2007; http://www.cmha.ca/bins/content_page.asp?cid=3-86-87-90&lang=1 BC Helpguide: “Depression in Childhood and Adolescence”; retrieved February 15, 2007; http://www.bchealthguide.org/kbase/topic/major/ty4640/cause.htm

37. Health Canada; “Attachment to Parents and Adjstment in Adolescence”; retrieved April 5, 2007; http://www.phac-aspc.gc.ca/dca-dea/publications/pdf/attachment_e.pdf Help for Troubled Teens; “Misdiagnosis of Depression in Troubled Teens”; retrieved March 2, 2007; http://www.troubledteensinfo.com/Mental_Health_Problems/Teen_Depression/Misdiagnosis_of_Depression_in_Troubled_Teens/ Helpguide.org; “Teen Depression”; ; retrieved February 15, 2007; http://www.helpguide.org/mental/depression_teen.htm#parents

38. India Parenting; “Helping your teenager Overcome Depression: retrieved March 3, 2007; http://www.indiaparenting.com/raisingchild/data/raisingchild058.shtm The Kelty Patrick Dennehy Foundation: “Teenage Depression and Suicide-the Facts”; retrieved April 8, 2007 http://www.thekeltyfoundation.org/depression-facts.htm Psychology Information Online; “Depression in Teenagers”; retrieved March 2, 2007; http://www.psychologyinfo.com/depression/teens.htm#suicide South Australia Government Children, Youth and Women’s Health Service; “Teenage Depression: retrieved March 2, 2007; http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1751

39. Crisis Suicide Prevention Centre of British Columbia website http://www.crisiscentre.bc.ca/