Wat sê. se oor depressie? PROFESSIONELE HULP VIR DEPRESSIE & ANGS webtuistes kontaknommers e-posadresse

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1 Wat sê se oor depressie? PROFESSIONELE HULP VIR DEPRESSIE & ANGS webtuistes kontaknommers e-posadresse 1

2 depressie101-projek Meer en meer mense word vandag met depressie gediagnoseer, meer mense oorweeg selfdood en dis mense wat ons ken. Ek is nie n sielkundige of depressie-ekspert nie, maar ek baklei al vir 35 jaar teen die siekte. Met n groot mate van sukses. Dit is my behoefte om ander wat elke dag teen die siekte baklei met hierdie projek te ondersteun, die stigma nek om te draai en vir depressievegters te sê: Práát oor jou siekte. Om depressie te hê, is nié n skande nie! Die doel van hierdie projek is dat jy die siekte (depressie) en die gedrag van familie/vriende (ook jou eie) met depressie beter kan verstaan. Hierdie gids (slegs basiese kennis van die siekte) is nie die resultaat van n kliniese navorsingsprojek nie. Die inhoud is saamgestel uit inligting wat deur kundiges op die gebied van depressie verskaf is. My waardering daarvoor aan Prof Piet Oosthuizen (Psigiater) Prof Lizette Rabe (Ithemba-stigting) Me. Janine Roos (Hoof: Mental Health Information Centre, Universiteit Stellenbosch) Mense wat vermoed hulle is depressief, móét deur n sielkundige of huisdokter geëvalueer word om met sekerheid te kan sê dat hulle wel depressie het. n Evaluasie kan nie op grond van hierdie gids alleen gemaak word nie. Depressie is nie n doodsvonnis nie. Met die regte behandeling kán n depressievegter se lewenskwaliteit verbeter. Onderwysers werk elke dag met die jong depressievegters, maar baie van die hulle baklei self teen die siekte. Die fokus van die gids is om tieners, hulle ouers en onderwysers oor die siekte in te lig sodat die siekte nie die oorhand kry nie. Daar is n magdom verwante onderwerpe oor depressie wat nie hier aangeraak word nie, dis doodeenvoudig te veel. Die inligting wat in die gids gedeel word, sal nie antwoorde bied op almal se uitdagings of omstandighede rondom depressie nie. Ek spreek die hoop uit dat dit tog vir jou van waarde sal wees. Johan Laten Depressie is n ernstige en algemene mediese toestand ( n siekte van die brein) met groot impak op persoonlike vlak. Suid-Afrika se grondwet mense wat teen depressie veg, het die reg op respek en toepaslike en doeltreffende behandeling. Ontsnap van depressie (prof Piet Oosthuizen) 2

3 Depressie worry nie of jy beroemd of onbekend is nie... jy? iemand wat jy ken? 3

4 Life is difficult * mense na aan ons gaan dood Pierre * die pressure om te het met sy long board teen die spoed van wit lig teen die bult presteer, raak net afgejaag. Hy het sy balans verloor en geval. Sy kop het hard te veel * ons het nie genoeg geld vir kos nie * ek is alleen * ons verhoudings & planne werk nie altyd uit nie teen die teer geklap en die vel van sy een arm afgeskraap. Hy het gegil van die verskriklike pyn. Op daardie oomblik unbearable. En toe is Pierre... lights out! Jacques se pyn is meer as net unbearable... Hy is al vir langer as 2 weke baie sad, permanent moeg, moedeloos. Hy kan niks daaraan doen nie en dit raak nie beter nie. Hy kan nie meer op sy eie met die pyn deal nie. Hy het dringend hulp nodig. 4

5 Jacques se gevoelens is alledaags, natuurlik & niks buitengewoon nie. Maar... sy battle van 14 dae + met hierdie intense emosies hou te lank aan. Jacques sal deur n sielkundige geëvalueer moet word om vas te stel of hy n depressief is. Simptome Depressievegters ervaar elkeen verskillende simptome van depressie en nie almal ervaar al die simptome of dieselfde intensiteit daarvan nie. Depressievegters kan die siekte sidestep. 5

6 SIMPTOME van depressie Voel dikwels geïrriteerd of kwaad Baie gespanne en bekommerd oor alles Huil baie minder/geen belangstelling in aktiwiteite wat ek love vergeet om goed te doen voel nutteloos en skuldig oor alles is die meeste van die tyd op my eie Ek is hartseer... 24/7 Dink baie aan die dood en om n einde aan my lewe te maak. Eet te veel of te min Slaap te veel of te min Is meeste van die tyd moeg en het baie min energie baie afwesig uit die skool kan nie op skoolwerk konsentreer moeilik om besluite te neem 6

7 Staan op en doen iets wanneer jou emosies en die simptome van depressie jou lewe begin beheer en later selfs oorneem. Dit gaan nie vanself weg nie. Wanneer n depressievegter nie hulp kry om hierdie simptome te hanteer of beter te manage nie, kan dit lei tot selfdood. 7

8 It s important to remember that no one sign means that there is a problem. It s important to examine the nature, intensity, severity and duration of a problem. Distimiese depressie Soorte depressie Die pasiënt moet twee of meer van die volgende simptome hê: 1. Swak of oormatige eetlus 2. Slaaploosheid of oormatige lomerigheid 3. Lae energievlakke en moegheid 4. Swak selfbeeld 5. Kan nie konsentreer of besluite neem nie 6. Gevoel van hopeloosheid *** Elke silwer randjie het n donker wolk. 1 Major (ernstige) depressie Simptome (bladsy 6) moet minstens 14 dae lank aanwesig wees om dit as n major depressiewe episode aan te dui. Die siekte kom in herhalende episodes voor, amper soos asma-aanvalle. 2 Distimiese depressie Net sommige (sien kassie) van die depressiesimptome is oor n lang tydperk aanwesig. Dis nie so erg soos die ernstige depressie nie, maar dit kan vir ten minste 1 tot 2 jaar aanhou sonder dat die persoon beter voel. Die nuwe normaal die toestand is nie so erg dat die persoon se lewe heeltemal uitmekaar val nie en baie mense leef daarmee saam. Hulle dink dis maar hoe die lewe is. 8

9 Drank & dwelms Susan van Breda help nie om n depressievegter Susan is in ons klas. Sy kerm en kla oor alles. Alles is altyd verkeerd. Wanneer ons pouses buite sit, sit sy eenkant. Wanneer ons haar vra wat fout is, sê sy niks. Sy s fine. Alles is altyd fine of OK. Sy s altyd so op haar eie. Ons het al moed opgegee en nooi haar nie meer saam wanneer ons uitgaan nie, want sy s gedurig moeg. Sy is deel van die top 10 en speel baie goed hokkie, maar Susan sê sy kan niks reg doen nie. Ons pelle sien nie meer kans om met haar te sukkel nie. Party dae is alles awesome, maar net die volgende oomblik is sy weer op mute. Ughh, ek wil die girl sommer met n besem bykom! Mitzi sê sy s seker Susan gebruik drugs of iets. As n mens haar mooi in die gesig kyk, dan kan dit waar wees ag, ek weet ook nie. Met die beskrywing wat haar maats van Susan gee, wil dit voorkom of haar uitdaging distimiese depressie is. n Sielkundige of huisdokter moet haar evalueer. Indien dit die geval is, kan sy terapie en die gebruik van medikasie oorweeg om haar lewenskwaliteit te verbeter. beter te laat voel nie. Wanneer dit oor n lang tyd misbruik word, kan dit tot depressie lei. kokaïen tik dagga mandrax Al hierdie middels is uiters gevaarlik vir mense met depressie. Die middels het n invloed op die biochemie van die brein en kan n episode van depressie begin. dwelms vs antidepressante Die kans is baie klein dat jou antidepressant reg sal werk as jy oormatig drink of dwelmmiddels misbruik. Louise du Preez (kliniese sielkundige) 9

10 Wat veroorsaak depressie? 1 NEURO-OORDRAERS dra met behulp van neuro-oordragstowwe die boodskap tussen die neurone (senuweeselle) oor. Probleme kan met die chemiese oordrag van die boodskappe van een neuron na n ander ontstaan. Die boodskap is dus onvolledig of verkeerd. As die neuron n verkeerde boodskap ontvang, stuur hy op sy beurt n verkeerde boodskap aan, totdat die hele sisteem naderhand wanfunksioneer. Wanneer daar n probleem met een of meer van hierdie boodskappers is, kan dit aanleiding tot depressie gee. 2 OORERWING n Mens erf die helfte van jou gene van jou ma en die ander helfte van jou pa. Die risiko van depressie word bepaal deur die kombinasie van jou gene en hoe dit by mekaar inpas. Dit is eerder n verskeidenheid gene wat elkeen n bietjie tot die risiko bydra. Wanneer jy n depressievegter is, kan jy ongelukkig niks hieraan doen nie. Gene dit bepaal ons kans op depressie, maar dis nie noodwendig die oorsaak daarvan nie. Gewoonlik is dit omgewingsfaktore wat veroorsaak dat die persoon depressief raak. 3 OMGEWINGSFAKTORE Wanneer daar in verband met depressie na stres verwys word, sal die meeste van ons dink aan emosionele stres, eksamenstres en groepsdruk. Dit is belangrik, maar dis belangriker om te weet dat n mens ook kan stres as gevolg van beserings, operasies, ernstige siektes, aanhoudende fisiek uitdagende omstandighede en (dwelm)middels. 10

11 Tieners: moody of regtig depressief? DYLAN... doen al slegter in sy skoolwerk moan oor alles is heeltyd moeg het skielik allerhande gedragsprobleme Probleem... Dylan se simptome is nie net eie aan depressie nie daar is baie tieners met gedragsprobleme, wat dwelms misbruik en swak presteer op skool as gevolg van goed wat met hulle gebeur het en wat nie depressief is nie. 1. Emosioneel Tieners is gewoonlik emosioneel (dikwels a.g.v. hormonale verandering). Dit is normaal wanneer tieners hartseer, angstig, gefrustreerd en nie in beheer voel nie. 2. Moody Dit is dus nie maklik om agter te kom of hulle gedrag net tiener moods of regtig depressie is nie. 3. Abnormaal n Tiener se gedrag is abnormaal wanneer hy/sy die simptome van depressie (bl. 6) ervaar en dit nie vanself beter raak nie. 4. Evalueer Wanneer hierdie gevoelens vir n lang tyd aanhou, moet hulle dit ernstig oorweeg om deur n sielkundige of huisdokter geëvalueer te word die probleem is moontlik baie erger as net n moody tiener. Jy kan depressie ontwikkel wanneer jy n ouer aan die dood afstaan geboelie word fisiek, seksueel of emosioneel mishandel word deel is van gesinsgeweld ouers het wat self depressief is of drugs misbruik n familiegeskiedenis van depressie het 11

12 Simptome hartkloppings droë mond ongemak op maag prikkels in ledemate oormatige sweet lighoofdig Angs Paniekaanvalle gebeur skielik, voel jy verloor beheer oor jouself, of jy mal word of selfs doodgaan. Waar? besige malls & plekke waar hulp nie maklik beskikbaar is nie (vliegtuie, snelweë) Andreas het n prank call gemaak: Teen 12:40 is daar chaos in julle skool. Be warned. Iemand het vermoed dit was Andreas en het sy naam vir die graadhoof gegee. Andreas sit en wag nou voor die hoof se kantoor. Hy weet hy is in ernstige moeilikheid, hy weet net nie hóé ernstig nie. Dis angs!! Lisa Wanneer? is verskriklik moeg en baie angstig oor toetspunte wat sy dink swak gaan wees, bang dat sy nie n date vir die matriekafskeid sal kry nie en dat sy haar driver s toets sal dop. Daarom is sy áltyd besig met iets. Sy kan nie stilsit nie. Dit maak haar nog moeër. ontmoet vreemdes praat voor mense Angs is soms n voorloper of vroeë simptoom van depressie. n Mens kan terselfdertyd angstig en depressief wees. Angstige onbekende omgewing mense bekommer hulle oor dinge wat gebeur nie. waarskynlik nooit sal vererger in hul gedagtes die moont- Hulle like negatiewe uitkoms van enige saak. 12

13 take charge klap angs & vir n vat time out kry genoeg slaap luister na musiek haal stadig asem mediteer tel stadig tot by 10 kry n massering & herhaal doen net jou bes, nie- doen ontspannings- mand is perfek nie sien die groter prentjie oefeninge eet gebalanseerde etes, raak, moenie net op moenie maaltye oorslaan een klein dingetjie nie fokus nie lag! hard en dikwels aanvaar jy kan nie alles beheer nie beperk alkohol- & kaffeïeninname: dit dra by tot angstigheid en paniekaanvalle Haal asem. Dit reguleer jou hartklop, werk paniekaanvalle teen, help om in sport te presteer. Vir baie mense is asemhaal n leefwyse: tydens fisieke inspanning, in tye van hartseer, wanneer hulle gespanne en paniekerig is. Dis beskikbaar, doeltreffend en verniet. Dis my redding en my raad en my gunsteling-sêding: Haal asem. Nataniël 13

14 1 Haal asem en kalmeer asem stadig in deur jou neus hou vir 3 tellings asem stadig uit en ontspan die spiere in jou gesig, kakebeen, skouers en maag oefen die tegniek 10 keer n dag vir n paar weke 2 sit gemaklik Tel en kalmeer maak toe jou oë en haal diep asem asem die lug uit terwyl jy in jou gedagtes ontspan sê haal 10 keer na mekaar diep en gemaklik asem: begin by 10 fokus elke keer wanneer jy asemhaal op enige spanning in bv. jou kakebeen, skouers of maag; trek die spesifieke spier(e) styf saam, hou dit vir n paar tellings en ontspan maak jou oë oop wanneer jy by 1 kom 14

15 Kan depressie behandel word? Medikasie Ja... Dit word behandel met medikasie en korttermyn, doelgerigte terapiesessies met n sielkundige. Praat wanneer jy, of iemand naby aan jou, depressiesimptome ervaar. Die behandeling van depressie is nie straight forward nie. Dis nie net pille sluk nie. n Kombinasie No matter how hopeless things may feel today, people can get better with treatment - and most do. ( *** Gebruik medikasie wat vir jou voorgeskryf is, verantwoordelik. Dit kan die lewe wat depressie van jou gesteel het, aan jou teruggee. van medikasie en terapiesessies is beter vir die pasiënt: antidepressante: behandel die simptome terapiesessies: help identifiseer die oorsaak van die simptome 1 Medikasie Slegs mediese dokters en psigiaters kan die medikasie voorskryf. Die behandeling fokus altyd op die individu. Antide- pressante is nie lekkervoel-pille wat jou gelukkig maak nie. Jy alleen bepaal jou geluk. 2 3 Antidepressante help om normale emosies te ervaar is nie verslawend nie vat dae tot weke voordat dit begin werk bring aan die begin min verandering het almal newe-effekte Voorgeskrewe medikasie Praat eers met jou dokter voordat jy ophou om die medikasie te gebruik of die dosis daarvan te verander. 15

16 Terapie 1 Jou afspraak by die sielkundige Die sielkundige kan nie beheer van jou gedagtes oorneem nie. Dis nie n manier om jou dinge te laat doen of sê wat jy nie wil nie. Jy besluit self watter inligting jy met die sielkundige gaan deel en bespreek. 2 3 Gesprekke met die sielkundige sal jou help om jou manier van dinge doen, beter te verstaan eie gedrag te verander verhoudings te verbeter angs en/of depressie te verlig Wat sal dit help om met n sielkundige te gaan praat? Jy sal uitvind hoekom jy depressief is en wat dit veroorsaak. Hy/sy sal voorstelle maak oor dit wat jy kan doen om jou depressie beter te hanteer. Jy sal leiding kry om n plan van aksie saam te stel wat jy kan hanteer om die depressie beter te hanteer/bestuur. Terapie is nie n quick fix nie. geduld + tyd = verbetering Dis jóú journey hou aan baklei! 16

17 Dis jou verant- woordelikheid om iets te doen indien jy n depressievegter is. Depressie is n siekte On your marks... net soos kanker, asma of diabetes. Erken jy het die siekte. Praat daaroor. Dis nie jou skuld dat jy depressie het nie, maar dis jou probleem. Wanneer jy iets 1 As jy die depressie beter wil beheer en so jou lewenskwaliteit wil verbeter, moet jy minstens 3, maar verkieslik 4 of 5 keer per week oefening kry. Doen oefening waarvan jý hou! Kry vir jou n training partner. Dit sal jou help om gemotiveerd te bly. konstruktief doen om die depressie beter te bestuur, kan jy hulp kry en so jou lewenskwaliteit verbeter. *** Screen time Die báie ure (4 uur of meer) wat kinders daagliks TV kyk en op hulle selfone en rekenaars spandeer, word verbind met depressie en angs. (Public Health England) OEFEN oefen vir ten minste 30 minute op n keer: draf, stap, ry fiets, dans stel daaglikse doelwitte wat jy kan hanteer: loop elke dag vir 30 minute en moenie wag vir die naweek en dan ure aaneen probeer loop nie moenie die Comrades probeer hardloop wanneer jy met n oefenprogram begin nie - vermeerder bv. die afstand geleidelik luister na jou favourite musiek wanneer jy oefen lekker hard! 2 SLAAP As jy sukkel om te slaap, probeer die volgende: probeer om elke dag op dieselfde tyd te gaan slaap en op te staan moenie in die dag slaap nie as jy nie aan die slaap kan raak nie, staan op en gaan doen iets anders sorg dat die temperatuur in jou kamer gemaklik is hou jou kamer donker gebruik jou bed net om op te slaap moenie saans te laat eet of honger gaan slaap nie moenie koffie en alkohol kort voor slapenstyd drink nie verminder screen time voor slaaptyd 17

18 3 EET Die kos wat ons eet, kan ook help wanneer ons teen die depressie baklei. Die volgende inligting is bloot voorbeelde van kossoorte wat in jou dieet oorweeg kan word. Vitamien B-12 & foliensuur Foliensuur: blaargroente en boontjies Vitamien B-12: vleis, vis, suiwelprodukte Foliensuur en Vitamien B-12: eiers, spinasie, salm Selenium Volgraan bv. hawermout, bruinrys Brasiliaanse neute, seekos bv. mossels, oesters Vis (omega 3) Salm, tuna Vrugte en groente Vitamien C: aarbeie, bloubessies Beta-karoteen: wortels Vitamien E: neute, sade, koringkiem Begin jou dag gesond met n heerlike smoothie! Vitamien D Gaan sit in die son, dis ryk aan vitamien D! kaas, eiergele What s for breakfast? n Omelet wat jou mond laat water! Chocolate What s for dessert?! Yummy donker sjokolade (donker sjokolade het n uitwerking op die endorfiene wat feel good hormone in die brein vrystel) 18

19 Help jouself 1 2 Een dag op n slag Stel vir jouself doelwitte wat jy kan hanteer en realisties is. Beloon jouself wanneer jy jou doelwitte bereik. Bou aan n support netwerk Maak staat op die ondersteuning van vriende/familie, al is jy te moeg om te praat of voel jy skaam oor jou siekte of skuldig omdat jy jou vriende afskeep. Dis nie n teken van weakness nie en jy s nie n las vir ander nie. Praat met iemand persoonlik. Dit sal baie meer help as om met Whatsappboodskappe, Facebook of selfoonoproepe oor jou siekte te praat. Die persoon met wie jy praat, hoef nie jou probleme op te los nie. Hy/sy moet iemand wees wat met aandag na jou luister en jou nie sal judge nie Kuier saam met vriende, al voel jy nie lus daarvoor nie. Wanneer n mens tussen ander mense is, sal jy minder depressief voel. Sluit aan by n ondersteuningsgroep vir depressie. Hulle verstaan presies hoe jy voel. Julle kan mekaar aanmoedig, ervarings met mekaar deel en waardevolle raad kry om die siekte beter te hanteer. Delete jou negatiewe gedagtes Niemand kan sommer begin om positief te dink nie, wees minder krities op jouself en daag jouself uit om minder op die negatiewe gedagtes te fokus. Fokus eerder op alles wat reg verloop, as op die een ding wat verkeerd verloop het. Hou op veralgemeen Ek kan niks reg doen nie. Fokus net op goed wat jy moet en nie moet doen nie. 19

20 6 Maak jou eie wellness toolbox vir n quick mood boost (Probeer om elke dag n paar van die goed te doen, al voel jy goed) 7 Doen n kort hiking trail Skryf neer hoekom jy van jouself hou. Lees n goeie boek, gaan slaan gholfballe, lê en ontspan in die bad of ry op jou long board Kyk n komedie fliek of TV-program en lag hard en uit jou maag uit! Doen n paar klein takies maak n back up van jou files op jou rekenaar Gaan stap of speel met jou hond Luister musiek en sing saam hárd! Doen iets wat jy nie beplan het nie Wat van n mani of n pedi!? Professionele hulp Wanneer jy alles probeer het om jouself te help en jou depressie raak net erger, moet jy professionele hulp kry. Doen dit vir jouself. is nié n failure, n idioot of n loser nie. Ruk al hierdie labels af wat jy op jouself geplak het! Glo in jouself. Jy is uniek! 20

21 Ek blý depressief... Wat is die moontlike redes? Is die diagnose korrek? Neem jy die medikasie reg? Gebruik jy die regte dosis? Gebruik jy die medikasie al lank genoeg? Gebruik jy ander medikasie wat die antidepressant se werking benadeel of die depressie aan die gang hou? Middelmisbruik soos alkohol en ander (dwelm)middels Is daar leefstylfaktore wat die siekte in stand hou: Slaap jy genoeg? Oefen jy gereeld? Raak die druk om te presteer dalk te veel? back to the drawing board... Jy en jou huisdokter/sielkundige moet weer na jóú groter prentjie kyk wanneer die depressie nie beter raak nie sodat jou behandeling (medikasie en terapie) aangepas kan word. 21

22 Jou ouers is bekommerd oor jou. Praat met hulle wanneer jy depressief is of onseker is of jy wel depressie het. *** Hulle sê sulke random goed (wat my só kan irriteer) om uit te vind wat aangaan: Ek kom agter jy gaan nie meer saam met JP hulle uit nie. Jy ignoreer ook al jou selfoonoproepe. Jy eet al minder. *** Moenie sê dis niks nie. Praat. Wees eerlik. Sê vir hulle hoekom jy so optree. Hulle is nie net nuuskierig nie. Hulle wíl jou help & ondersteun. Ek ken n depressievegter Wanneer jy met met n depressievegter praat... 1 Praat en luister Dit sal nie iemand se depressie gesond maak nie, maar dit kan (al is dit tydelik) verligting bring en die persoon sake in perspektief help sien. Praat met die bedrukte persoon oor sy depressie en luister na sy storie. Moenie die persoon onderbreek nie. Vermy sarkasme, persoonlike aanvalle en woorde soos altyd, nooit. Onthou: die raad wat jy gee, is nie die enigste antwoord/ oplossing nie. Fokus op dit wat nóú gebeur, nie die verlede nie. 2 Die ondersteuner hoef nie al die antwoorde/oplossings te gee nie, luister en moenie veroordeel nie. sal soms kwaad en moedeloos word, dis normaal. moet ook genoegsame support hê om in beheer van sy eie lewe te bly. moet die siekte ken om die simptome van die siekte te help raaksien. 22

23 Dewald weet hy moet dokter toe gaan om uit te vind of hy depressief is. Hy is so pathetic hy kan nie eers self die spreekkamer bel en n afspraak maak nie. Ek kerm nou al dae by hom om die afspraak te maak. Wat moet jy dan doen? 1 Aanmoediging... dis al wat nodig is om iemand tot aksie te laat oorgaan. Soms is die persoon egter so deur sy depressie verlam dat iemand namens hom moet optree en die afspraak maak. Iemand wat vir die eerste keer depressie ervaar, sal moontlik glad nie weet waar om hulp te gaan soek nie. Vra iemand wat al by n sielkundige/psigiater was om te help. Om daar te wees vir iemand en bloot erkenning aan sy swaarkry te gee, is dikwels nodiger as om voorstelle en oplossings te gee Plaas n bietjie druk (binne perke) op die persoon om uit te kom en veral fisiek aan die gang te kom, al is hy ongelooflik moeg, lusteloos en sonder dryfkrag. Gaan stap Die moegheid wat met depressie gepaard gaan, word nie beter van rus nie, maar sal verbeter wanneer jy aktief is. Help met praktiese goed soos skooltake, beplanning van n hersieningsrooster enige iets wat vir die persoon soos n berg lyk. Doen dinge sáám met die persoon. Moenie beheer oor sy lewe oorneem nie. Gee erkenning vir dit wat die depressievegter regkry. Dinge wat vir jou as vanselfsprekend lyk, is vir die siek persoon baie moeilik om te doen. 23

24 ! Wanneer iemand hom in n ondraaglike situasie bevind en hy geen uitkomkans daarvoor sien nie, voel dit asof selfdood die enigste moontlike uitweg uit sy huidige situasie is. Dit kan die gevolg wees van n depressiewe gemoed, fisieke pyn, armoede, verliese, liggaamlike of emosionele mishandeling. 1 Niémand kies om selfdoodgedagtes te hê nie. Wanneer die persoon selfdoodgedagtes erken, vind uit hoe ernstig dit is: 1. Het hy al n plan en n datum? 2. Het hy toegang tot die instrument/ voorwerp wat hy wil gebruik? *** *** Jy vermoed iemand na aan jou wil sy eie lewe neem. 2 Moet nooit iemand ignoreer wat sê hy wil sy lewe beëindig en jou van sy gedagtes vertel nie. Kry onmiddellik hulp. Vorige selfdoodpogings mense wie se selfdoodpogings al vantevore misluk het, kan dit beslis in die toekoms weer probeer doen. Gedrag en persoonlikheid dit verander in die tyd voordat hulle n selfdoodpoging aanwend: sommige sal ewe skielik onverklaarbaar positief wees, asof hulle verlig is dat hulle die finale besluit geneem het. Ander weer sal ál meer kanse vat en gevaarlike dinge aanpak in die hoop dat hulle per ongeluk sal sterf. Besittings die gevaarligte brand wanneer iemand met ernstige depressie sy aardse besittings begin weggee. Wat moet ek doen as ek vermoed iemand oorweeg selfdood? Vra direk, luister sonder om te judge en moenie kritiseer nie. Moenie die persoon se terapeut probeer wees nie. Moenie belowe om sy selfdoodplanne geheim te hou nie. As jy bekommerd is, roep ander se hulp in. Probeer die persoon oorreed om professionele hulp by n dokter, sielkundige of psigiater te kry. 24

25 SUID-AFRIKA SA Federation for Mental Health Adcock Ingram Depression and Anxiety Helpline Suicide Crisis Line SMS South African Depression and Anxiety Group Soek n ondersteuningsgroep naby jou Mental Health Information Centre Navrae: mhic@sun.ac.za (021) Health24 Namibië Lifeline

26 BRONNE Boeke Ligdans. Jeanne Els, Lux Verbi.BM Ontsnap van depressie. Prof Piet Oosthuizen, Tafelberg Artikels Geestesgesondheid. Die Burger, Gesond! 8, 22 Julie 2016 Webtuistes

27 The teacher s job becomes difficult more and more. The learner s circumstances too Therefore, teachers have to deal with so much more than just teaching. Hence the additional information. The main purpose is to give teachers a start-up kit on the topics mentioned knowledge if you like, because one can fill a library with all the available information. Hopefully the information will help to start or manage the journey with the learner who is desperate for the much needed support. Maybe it helps you fighting depression daily. 27

28 Additional information for teachers 1. Discuss depression in the classroom? 2. What teachers should know about depression 3. Depression fighters in the classroom 4. Accommodate depression fighters in the classroom 5. The anxious learner in the classroom 6. Generalised Anxiety Disorder (GAD) 7. Suggested student intervention language for teachers 8. Protocol for immediate intervention in the case of harm to self or others 9. Depression toolbox for teenagers 10. Depression Awareness Campaign (DAC) for learners 11. Teachers with depression 12. Bullying Part of being a teacher is to put the learner s needs first. Never give up nagging parents when they don t take your input regarding their child s academic work and behaviour at school seriously. The learner s well-being is far more important than your popularity with the parents. 28

29 NB 1. Discuss depression in the classroom? A cancer patient is given a lot of attention and support. A depression fighter must not be treated any differently. We have to talk about depression. When we do, it will reduce the stigma When myths are broken and facts are shared about depression, stigma is reduced and teens are empowered to talk openly. promote early identification When learners understand what depression at their age looks like, depression fighters can be identified and get proper help much earlier. encourage early intervention When everyone has the same mental health language and understands that, like other medical conditions, depression requires professional support, help-seeking behaviour takes place. protect lives When the stigma is reduced and early identification and intervention occurs, we manage depression and protect precious lives. It is a very good indication that people (despite their age) are depression fighters when they have an intense experience of 5 or more of the general depression symptoms for a period of at least 14 days and longer. Should that be the case, they must be evaluated by a professional therapist before they can be seen as depression fighters. 29

30 The difficulties of diagnosis 2. What teachers should know about depression Depression can be exceedingly difficult to spot, because it can manifest in many different forms. Many depressed people work hard to cover up their depression not to be a burden to others. Parents and teachers often dismiss depression as a teenager s laziness, shyness or insubordination. Taking a closer look Parents and teachers can sometimes mistake a teenager s change in mood as a case of "the blues" when in fact the he/she has a medical illness called depression. "The blues" will only affect the learner's mood briefly and will improve after talking with a good listener. Depression will only improve with professional therapy. General symptoms complaints of feeling sick (headaches, stomach aches) missing school significant change in appetite or weight [See page 6 & 32 for a more complete list of symptoms] At school failing to complete assignments, or doing so poorly working slowly sleeping in class Behaviour Suicide actual suicide attempts (wants to join a person in heaven) recurrent thoughts of death or suicide, "I'm going to kill myself." gives away personal possessions asks if something might cause a person to die Sleep patterns significant changes in sleeping habits gets too much or too little sleep takes more than one hour to fall asleep wakes up in early morning hours fatigue or loss of energy too tired to work or play leaves school exhausted too tired to cope with conflict decreased participation in classroom and extracurricular activities social problems e.g. including isolation, irritability, problems making friends being quick to express emotions through crying or anger sulking poor eye contact acting out through theft, drug and alcohol abuse or unsafe sexual activity consistently disobedient attitude with authority figures frequently making self-belittling and pessimistic comments an obsession with morbidity changes in personality and friend groups decreased concentration or indecisiveness often responds "I don't know" always trying to please others listens to depressive or violent music decline in hygiene The causes of depression can be complex A Changing Brain Adolescence is a time of rapid change in the brain and the body. Key hormones like estrogen, progesterone, and testosterone increase their flow, though they do so at varying rates, which can lead to significant mood swings. Even more important are the changes that occur to the physical structure of the brain s prefrontal cortex (it plays an essential role in decision making, planning, understanding other people s emotions and perspective, inhibiting inappropriate behaviour and being self-aware). 30

31 This means that the brain strengthens important connections while getting rid of anything it considers unnecessary - and it does so at a massive scale. This is at the heart of why teenagers exhibit so many personality changes, as well as shifting interests and friend groups. Pressure to Perform In his book, Doing School, leading Stanford educator, Denise Clark Pope, followed five high achieving learners throughout the school year, noting their efforts to lie, cheat and manipulate their way to the top. The conclusions are damning: schools that place such high value in future outcomes and test-based successes foster anxiety, dishonesty and hostility rather than intellectual curiosity, cooperation and engagement. Test anxiety has expanded along with it, leaving many learners feeling anxious and exhausted for extended periods of time, if not the whole of their educational careers. Lifestyle Issues There are many elements that may lead to depression: death in the family or a divorce inactivity poor diet lack of sleep Inactive lifestyles can lead to depression and depression can lead to increased inactivity, which in turn can create a negative feedback cycle. To put an end to this cycle the following might help: improvements to a student s diet adding exercise into their routine providing access to psychological counselling 3. depression fighters in the class room Warning signs of depression should never be ignored when present in the learner s behaviour. Make short notes on the change in the learner s behaviour. It will help the professional therapist with the diagnosis. Compare the learner s behaviour in your class with that in other teachers classes. [You might find this time consuming, but in doing so, you can save a learner s life.] [ ] Use the following checklist as a guide to determine whether the learner is being at risk for depression and can only be considered as a depression fighter. 31

32 Learner s mental health checklist [behaviours/moods observed for two weeks or more] Name Date 1 Sad/crying in class, depressed or irritable mood 2 Loss of interest in favourite activities 3 Significant weight loss or gain 4 Restlessness, agitation or anxiety 5 Fatigue or loss of energy, including sleeping in class 6 Feelings of guilt 7 Low self-esteem 8 Trouble concentrating or making decisions 9 Repeated thoughts of death or suicide, expressed verbally or in writing 10 Frequent headaches and stomach-aches 11 Cutting or other form of self-injury 12 Extreme aggressiveness 13 Neglect appearance 14 Excessive risk-taking behaviour 15 Drop in school performance 16 Low tolerance for frustration 17 Lack of motivation, apathy 18 Social withdrawal 19 Misbehaviour 20 Unable to store or retrieve information 21 Frequent absenteeism 22 Forgotten materials/assignments 32

33 SUPPORT STRATEGIES The depression fighter still attends lessons. Try to create a peaceful atmosphere. If not, the depression fighter s absence from school can increase. Possible strategies Show them you accept them (and not necessarily their behaviour) unconditionally. Make time to listen. Keep the depression fighter part of the group. Try humour instead of sarcasm. Keep your suggestions to parents on supporting their child constructive, short and specific. Use when, where, how and why when feedback regarding school work and behaviour is given. Avoid using words e.g. always and never. Give structure Depression fighters struggle with remembering things: make sure the learner diarises specific tasks e.g. test dates, deadlines of projects etc. Help them organise their books, school bags, etc. Learners in your class who understand the depression fighter can assist. Difficult tasks and positive self-talk Make them breath properly telling themselves, I can do this. OR It is important to try. OR It is OK to make mistakes. (Say it in front of the whole class to avoid singling out the depression fighter. OR Make posters of these sayings and put it up in the class.) Use a problem solving approach: First, circle the keyword in the question. How many marks? How many facts must be given? Structure works well for depression fighters. Teachers are not the therapists but can develop a relationship to express unconditional support avoid generalisations and singling out the student for criticism be specific in providing feedback keep the tone positive. Alternatively, encourage the student to draw, write, or practice music in their downtime as an outlet for their emotions. Give them more breaks throughout the day, breaking up larger assignments, and providing extra time whenever you feel doing so will help their educational and emotional development. Special concessions Be patient. Do not insist on detail e.g. But Learner writes tests, exam papers etc separately and gets extra time. Be patient - give the learner more time to answers questions. It will reduce the pressure and anxiety. Check regularly if learner s work is up to date. Use different assessment methods. family problems or other personal information. Find out what motivates the learner, what he/ she enjoys doing, whether the learner has specific study problems. Talk to the depression fighter after the lesson otherwise they will never talk to the teacher. 33

34 Support network Encourage learners to stay in contact with friends. participate in activities even if they are too tired or don t feel like doing anything at all. be assertive rather than fighting, shouting or withdraw, I don t like it when you call me names. Stop it. find someone to sit with (the learner will not feel excluded then). Set goals It gives direction in the learner s life. Set short term goals when the learner is depressed which he/she can manage/reach easily e.g. get up in the morning and go to school is a major achievement for a depression fighter. Praise the learner when he/she reaches such a simple goal. Positive self-talk Teach depression fighters to avoid using words like never, always, terrible, horrible, I háve to, I cannot. Sleep! Sleep! Sleep! Remind depression fighters to get enough sleep, over weekends too. Improved sleeping habits: try to go to bed at night at the same time drink a glass of warm milk before going to bed read it helps to calm you down and keep your mind off things play soothing music do relaxation exercises focus on positive self-talk e.g. I will be OK when I get up. OR I can do this. Talking to the family After you have identified a student as being at risk for depression or suicide, the next step is to talk to the learner s family. If you've noticed warning signs of a major depressive episode, the one thing you should never do is ignore these symptoms (and change in behaviour) and hope your learner will "get over it". Some of the ways you can step in and help prevent youth suicide: Be available. Connect with your learner, but set boundaries when needed. Always take suicidal and homicidal talk seriously. Share these statements with appropriate teachers. To the parents Share your care and concerns about their child. Discuss specific suicidal or homicidal statements. Indicate that these statements need to be taken seriously. Recommend their child have an immediate evaluation by a mental health professional. Families should be made aware that depressed youth should not have access to firearms or any other objects which they can harm themselves with. If parents are doubtful/undecided, ask why. 34

35 Some parents may hesitate about having their child referred for an evaluation. Their reasons may include: A belief their child is experiencing "normal" adolescence. Clinical depression is not normal and causes ongoing problems until their child receives sufficient treatment. A concern that their child might be viewed as "crazy." It is important to help the family recognise depression as a medical illness with physical causes, similar to diabetes or asthma or cancer. Hope that their child will "get over it." It cannot be emphasised enough that depression unfortunately persists until treated. The earlier depression is evaluated and treated, the easier it is to treat and the less likely it is for further complications to develop (e.g. death by suicide or homicide). Getting treatment for the learner is critical. Treatment options Taking immediate and sufficient steps to ensure safety, including eliminating access to firearms. taking steps to relieve or improve parental ability to deal with stress. THE CHILD Developing interests in their child Good nutrition and exercise Complete physical exam by the child's GP ELIMINATE any abuse or domestic violence alcohol and drug use Therapy & support Individual/family/group therapy School and community support Antidepressant medication [ the parent handbook for children and depression Use the following link to download this valuable handbook for free: ] 35

36 4. Accommodate depression fighters in the classroom When a teenager is struggling with depression, there should be an expectation of a certain level of disorganisation, forgetfulness and trouble concentrating. The good news is, there are accommodations we can make in order to help reduce some of those setbacks. flexibility Be flexible to reduce classroom stress on due dates or attendance allow extra time for homework or tests send them to take a message to the secretary This doesn t mean eliminate expectations or rules, it simply means when a learner is having a particularly hard time, a little flexibility can go a long way. Find the good Depression is a constant state of hopelessness and discouragement. When you see a student doing well, make a point to say something. Show compassion Basic human kindness is always a good idea, but is vital for a kid who is struggling. Try checking in with them, ask how their day is going or what they may need from you to feel supported in class. 36

37 symptoms 5. The anxious learner in the classroom During a panic attack, some or all of the following symptoms occur: Sense of being overwhelmed by fright and terror, with accompanying physical distress for between four and six minutes racing or pounding heartbeat chest pains dizziness nausea difficulty breathing tingling or numbness in the hands flushes or chills sense of unreality fear of losing control going crazy or doing something embarrassing fear of dying HOW CAN I TELL IF IT'S PANIC DISORDER? Is the leaner troubled by repeated, unexpected "attacks" during which he/she suddenly is overcome by intense fear or discomfort, for no apparent reason? YES NO During this attack, did he/she experience any of these symptoms? repeated, unexpected "attacks" during which he/she suddenly are overcome by intense fear or discomfort, for no apparent reason? YES NO pounding heart YES NO sweating YES NO trembling or shaking YES NO shortness of breath YES NO choking YES NO chest pain YES NO nausea or abdominal discomfort YES NO "jelly" legs YES NO dizziness YES NO If the answers are yes to at least 8 of the above questions the learner should take the results to his/her medical doctor. Treatment for panic disorder is usually therapy or a combination of therapy and medication. 37

38 consider the following ways to help anxious learners [even if you think they do not suit your circumstances at all]: 1. Proper breathing When people slow down their breathing, they slow down their brain. Lead the whole class [in a fun way] in a breathing exercise when you notice a learner is very anxious. It helps the learner who is overwhelmed. It also helps when learners need to focus. Slow, deep breaths are the key. exercise 4. Think positive: gratitude journals If you can trigger a positive train of thought, you can sometimes derail the anxiety. Suggests to these learners to keep gratitude journals. They are responsible for recording at least one thing they are thankful for every day. When the learner seems overwhelmed by negativity or stuck in anxiety, encourage them to re-read their journals. 2. Get outside When possible, take learners outside. It can also calm an anxious brain. Breathing the cool air and observing their environment can help them turn the focus away from their worries, and on to something more tangible. 5. Healthy eating For the most part, teachers don t really have a lot of control over what students eat and how much they sleep, but these things do matter when it comes to managing anxiety. Encourage you learners to eat more healthily e.g. ask learners to make small posters about healthy food to put up in your classroom. Try to organise (with people at the tuck shop) a healthy snack/ meal for children struggling with anxiety who cannot afford anything else than bread etc. 6. Share a story Discuss how one can manage anxiety with the entire class. Some learners may not be receptive to direct, one-on-one intervention but will respond if they know the whole class is receiving the same information. 3. Get learner moving Exercise helps anyone who is feeling anxious. All of the endorphins that come with exercise are calming to the anxious brain. Anxiety can end up looking like anger. Ask the learner to run an errand for you e.g. empty the waste paper bin, take an announcement to the secretary s office etc. What is the purpose? 1. The learner is removed from the situation. 2. He/she might feel they have a purpose. 3. It gets the blood pumping which clears out the anxiety producing energy and brings in the positive exercise endorphins. turn focus away from learners worries 7. Consider accommodations Many students struggle with performance anxiety, especially when it comes to tests, doing orals etc. When a student is feeling anxious, their brain simply can t function as effectively. Extended time, writing in another room may help these learners to stress less. 38

39 Classroom interventions for learners with anxiety disorders 1. Create a safe place for the learner to go when he/she is very anxious. E.g. the learner must inform the teacher they need a few minutes to calm down, and a set time limit. 2. Be aware of physical symptoms of anxiety and provide activities to distract the learner Calming activities e.g. reading or listening to music may help to alleviate some of the physical symptoms and allow a learner to return to class work after a few minutes. 7. Decrease situations that cause stress E.g. instead of having a learner stand in front of the class to do an oral task, find creative ways to do it. Allow students to make posters or record presentations at home on their cell phones. 8. Discuss anxiety symptoms privately with the student Never single out a learner or call attention to their anxiety in front of the class. This can cause humiliation or embarrassment and increase anxiety symptoms. 3. Allow a few minutes at the start of the day for the learner to ease into the school day E.g. allow five to ten minutes for the learner to prepare his/her books and school supplies or simply a few minutes for the learner to sit quietly before the school day begins. 4. Ask the learner what interventions he/she would find helpful This also provides the learner an opportunity to talk about situations that cause anxiety symptoms as well as for them to be more aware of their symptoms. 5. Teach the learner relaxation techniques they can do at school E.g. deep breathing exercises. Talk with parents about the techniques used at home and try to incorporate them into the classroom. 6. Suggest that learners avoiding school due to anxiety coming to school for a shorter day Allowing them to come to school for shorter periods will give them a chance to face their fears but may make it easier if they know they will be able to return home at lunchtime. The longer the learner avoids going to school, the more difficult it is for them to return. 9. Teach positive self-talk to the entire class Change the I can t to I will try. 10. Discuss alternative ways of handling situations Talk to the learner after an anxiety attack about how the situation could have been different or what strategies could have been used (by both the student and the teacher) to make the situation better. 11. Inform learners in advance if there are any changes to the normal schedule For a learner with anxiety, a sudden change can cause a panic attack. Knowing in advance what the day will be like will be of tremendous help. 12. Help students break assignments down into smaller segments This can help to decrease feeling overwhelmed by large assignments and help a student work on each section. 13. Incorporate exercise into the school day Stop lessons for a few minutes or do stretching exercises. This can help reduce stress (loads of fun!! And chaos ) Teach positive self-talk: I will try. 39

40 6. Generalised anxiety disorder (GAD) People with GAD experience severe anxiety, which is excessive, chronic, and typically interferes with their ability to function in normal daily activities. Symptoms excessive anxiety and worry for a large portion of the day difficulty controlling worry restlessness or feeling on edge being easily fatigued difficulty concentrating or mind going blank irritability muscle tension sleep disturbance (difficulty falling/ staying asleep, or restless unsatisfying sleep) What can I do to help myself with GAD? Speak to your GP first. Join a support group who will understand you as they are going through the same thing. Family members can play an important role by offering support. Learn how to manage stress to stay calm and focused. Consider aerobic exercise e.g. jogging, bicycling and swimming. Avoid caffeine, illegal drugs, and some overthe-counter cold medicines they can worsen the symptoms of these disorders. Check with your doctor or pharmacist before taking any over-the-counter medicines. Treatment Anxiety disorders can persist for an extended amount of time, often improving then deteriorating, but with treatment you can get help to control your anxiety. Medication and Cognitive Behavioural Therapy* are often used in combination. [*A form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional emotions, behaviours and thoughts. CBT focuses on solutions, encouraging patients to challenge distorted thoughts and change destructive patterns of behaviour.] Risk factors for anxiety disorders There are biological and environmental risk factors for anxiety, which include the following: environmental stressors e.g. work, school, relationship genetics too little sleep or poor sleep financial worries health How do I know it is GAD? Excessive worry, occurring more days than not, for at least six months? YES NO Unreasonable worry about a number of events or activities, such as work or school and/or health? YES NO The inability to control the worry? YES NO Restlessness, feeling keyed-up or on edge? YES NO Being easily tired? YES NO Problems concentrating? YES NO Irritability? YES NO Muscle tension? YES NO Trouble falling asleep or staying asleep, or restless and unsatisfying sleep? YES NO Does your anxiety interfere with your daily life? YES NO Encourage the learner to visit his/her GP if the answers of the above questions are yes to 5 (or more). 40

41 7. Suggested student intervention language for teachers Take into account that this conversation could prompt a personal disclosure and should be scheduled during a protected time and location. It is vital that the teacher asks the learner s permission to disclose the information with someone else, who that person is and why it is important to do so (e.g. his/her parent(s) or other teachers). Keep in mind that it is normal to feel a little anxiety and discomfort when approaching a learner you are concerned about. Just remember the goal is not to take on the learner s problem or to have all of the right answers. Instead, focus on approaching the learner with honest inquiry, concern and compassion - and connecting the learner to the right kind of help. 1. Notice Is everything okay? I ve noticed you have been... State the behaviour that is concerning to you. 2. Care I m concerned. This isn t typical for you. You deserve to feel better. Let the student know you care and validate what they share with you. 3. Help What can I do to help? Let s come up with a plan together. Always wrap up with an action plan that both you and the learner develop together. Make sure the learner knows there is help available at school (if there is) and in the community and give the learner information on how to contact these resources. REMINDER: inform colleagues if children disclose plans to hurt themselves, someone else or if someone is hurting them. 41