Straight Talk on Depression. Joseph P. Wiedemer MD Peter D. Rainey MS

Transcription

1 Straight Talk on Depression Joseph P. Wiedemer MD Peter D. Rainey MS

2 .. 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?

3 Why did you come tonight? Lets go to the phones!!!

4 What do you hope to receive? Lets go to the phones!!!

5 WHAT IS DEPRESSION?

6 Depression is Mental Disorder.

7 There are many dimensions in our lives. Spiritual/Moral Biological / Physical Social Psychological & Emotional Depression can be associated or be exacerbated by duress in any one of or combination of these domains.

8 Biologic and Genetic Explanation

9 Building Blocks of a Mood Disorder Emotions & Affect Biological /Neurobiology Interpersonal Relationships Intrapersonal Land Scape Depression impacts and is impacted reciprocally by any one or combination building blocks.

10 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 ).

11 Mood Disorders Manic Hypomanic Stable Depressed Severely Depressed Normal Major Depressive Disorder Dysthymia Bipolar

12 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

13 Interpersonal Social/family withdrawal Increased discussion of relational problems Reduction/lack of personal cleanliness Lowered school/work productivity

14 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

15 Biological Diminished ability to think/concentrate or indecisiveness Psychomotor agitation/retardation Aches and pains that don't get better with treatment

16 Biological Insomnia or hypersomnia nearly everyday Decrease or increase in appetite nearly everyday Significant unintentional weight loss or gain

17 Suicidal Ideation Recurrent thoughts of death, suicidal ideation, or suicide attempt 1,300 PA residents complete suicide each year. An average of 3.5 lives each day. Suicide is 3 rd leading cause of death for youth ages

18 WHAT CAN I DO IF A CHILD IS EXPERIENCING DEPRESSION?

19 Avenues for Help Medical Counseling Help Home School

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

21 Balloon Activity

22 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.

23 COUNSELING

24 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

25 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)

26 Factors Contributing to Successful Treatment Comorbid Conditions Genetics and Biochemistry Resources Risks Resources & Coping Acute and Chronic Stressors Family Dynamics & History Physical Health Personality & Temp.

27 What has been your experience? Lets go to the phones!!!

28 GOING TO THE DOCTOR

29 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.

30 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)

31 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

32 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

33 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

34 Moderate =Treatment Options Moderate to severe depression OR if mild to moderate depression not improving after 6 weeks of supportive care. CBT IPT Individual Therapy Family Therapy Systemic benefit Resilience Medication SSRI Switching Meds

35 Thoughts about medications? Lets go to the phones!!!

36 Treatment Options Severe depression: Individual psychotherapy Cognitive Behavioral Therapy Interpersonal Psychotherapy Family therapy Medication Psychiatry

37 HOME

38 Identify what works for the youth Meditation Prayer Religious & Family Rituals Crafts & Keep sakes= memory making and recording Writing Spiritual/Moral Biological / Physical Dancing Exercising Go for a walk Playing a sport Breathing exercises Progressive relaxation Psychological Social & Family Activity Night Text a Friend Face time a Family Social activity (sports, clubs, community) Talk to someone Emotional Imagine a relaxing place Listening to music Read Do a puzzle or game Check your thoughts Meaning making (journal, emotional calendar)

39 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

40 HOW CAN I HELP?

41 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?

42 Healing & Healthy Relationships Appreciation = short & sincere on regular basis Affection = Love languages/ Currency Communication +???

43 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. Validate feelings Don t try to talk your teen out of his/her depression Resist any urge to criticize or pass judgment once your teenager begins to talk. Avoid offering unsolicited advice or ultimatums as well. Simply acknowledge the pain and sadness he or she is feeling.

44 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

45 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.

46 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)

47 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

48 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.

49 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.

50 Developing Fondness and Admiration 2) Recall happy events from the past from the past 3) List each other s positive qualities and share it.

51 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

52 How Many Deposits? So the question is, how many positive deposits do we need to make for every negative withdrawal?

53 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

54 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

55 QUESTIONS

56 The Black Dog of Depression What is it like to live with depression: For those who care for those with depression: