A phobia is a persistent, irrational fear of an object, activity, or situation. Fear is a normal response to danger. It can be helpful in preparing to escape from or confront a threat. Because fear causes the heart and the lungs to work faster, you are better able to fight or flee, whichever makes sense under the circumstances.
Fear becomes a phobia only when a person alters his or her lifestyle in order to manage that fear. A phobia is a fear that is out of control—far beyond what is reasonable under the circumstances. The fear is no longer an aid to survival and it can hinder leading a normal, healthy life.
There are two general categories of phobia: specific and social. When people are afraid of particular things, they are said to be suffering from specific phobia. Objects or situations that may act as a trigger for phobia include contact with snakes or insects, being in a storm or an airplane, or being on a bridge or in a small space.
Social phobia is marked by a persistent fear of being in a situation where one may be embarrassed. For example, a person with social phobia might imagine standing in front of a room full of classmates and suddenly discovering an obvious stain on his or her shirt. A person with social phobia might panic at the idea of eating in a restaurant for fear of spilling food or stumbling into a table. If the phobic condition is severe enough, the situation may set off a panic attack.
The fear of social situations experienced by those with a social phobia is not simply a result of low self-esteem. Increasing one's self-confidence does not rid a person of a social phobia. He or she is also unlikely to "grow out of if The fears associated with social phobia are irrational and uncontrollable, but knowing they are irrational does not make them go away. In fact, the inability to get rid of the fears may lead to low self-esteem. Some people who suffer from the disorder may be overly critical of themselves if they are unable to rid themselves of fears they know are unwarranted.
A social phobia can be thought of as a false alarm. Despite logic and even a recognition that a situation isn't dangerous or life-threatening, the body reacts as if there is a serious threat and prepares for a fight or flight Recent research indicates that specific chemical systems in the brain may be responsible for the signs and symptoms of social phobia.
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Thursday 18 December 2008
Treating Depression by Feeding Your Spirit
Overcoming depression is a matter of healing your physical and emotional self, but another part of you may be damaged, too— your personal spirit. When you're depressed, a place inside you feels empty. This place, that holds your personal spirit, needs attention.
Feeding your spirit is like having your own personal pep rally—where you shout out "Hurray for me!" You need to feel proud of who you are and what you're trying to do. You need to want yourself to win.
Instead of yelling at yourself, yell for yourself. Show compassion for yourself when you make a mistake. Pat yourself on the back when you succeed at something. Realize that you may have a bad day once in a while, but you can get through it and move on.
Ways to feed your personal spirit:
• Write your thoughts and feelings in a journal. Don't edit what you write—you don't have to show it to anyone.
• If you play a musical instrument or sing, make up a song.
• Write a poem, short story, or any other creative piece.
• Walk on the beach and listen to the waves and birds, or take a long walk through a forest or park. Hug a tree. (Come on, try it!)
• Volunteer your time at your local Red Cross, senior center, or another organization. Helping others is a great way to help yourself.
• Collect something you love. Think of a unique way to display your collection.
• Go to an art gallery and spend time looking at the paintings and sculptures.
• Paint, draw, or sketch a picture.
• Be creative in any way you like. Use a needle and thread, paper, ink, flowers, music, cloth, words, glue, or wood. Borrow ideas from magazines, other people, art books, hobby shops, or nature. See what's inside you, waiting to come out.
Spend time with an animal friend. Petting your dog or watching your fish swim around can make you feel very peaceful. If you don't have a pet, visit a humane society or help out at one.
Buy a plant that's easy to care for, put it in your room, and watch it grow.
If you're comfortable with praying, say a prayer.
Because you want good friends, be a good friend.
Make cookies or a meal for someone who has been kind to you.
Join a support group and go at least once a week. Learn everything you can about depression and your treatment. Become an expert about your own depression so you know how to get better.
Set a goal to do something you've always wanted to do. Plan it out in simple steps, write them down, and do step #1. After you've completed one step, you'll have the confidence to tackle the next step.
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Feeding your spirit is like having your own personal pep rally—where you shout out "Hurray for me!" You need to feel proud of who you are and what you're trying to do. You need to want yourself to win.
Instead of yelling at yourself, yell for yourself. Show compassion for yourself when you make a mistake. Pat yourself on the back when you succeed at something. Realize that you may have a bad day once in a while, but you can get through it and move on.
Ways to feed your personal spirit:
• Write your thoughts and feelings in a journal. Don't edit what you write—you don't have to show it to anyone.
• If you play a musical instrument or sing, make up a song.
• Write a poem, short story, or any other creative piece.
• Walk on the beach and listen to the waves and birds, or take a long walk through a forest or park. Hug a tree. (Come on, try it!)
• Volunteer your time at your local Red Cross, senior center, or another organization. Helping others is a great way to help yourself.
• Collect something you love. Think of a unique way to display your collection.
• Go to an art gallery and spend time looking at the paintings and sculptures.
• Paint, draw, or sketch a picture.
• Be creative in any way you like. Use a needle and thread, paper, ink, flowers, music, cloth, words, glue, or wood. Borrow ideas from magazines, other people, art books, hobby shops, or nature. See what's inside you, waiting to come out.
Spend time with an animal friend. Petting your dog or watching your fish swim around can make you feel very peaceful. If you don't have a pet, visit a humane society or help out at one.
Buy a plant that's easy to care for, put it in your room, and watch it grow.
If you're comfortable with praying, say a prayer.
Because you want good friends, be a good friend.
Make cookies or a meal for someone who has been kind to you.
Join a support group and go at least once a week. Learn everything you can about depression and your treatment. Become an expert about your own depression so you know how to get better.
Set a goal to do something you've always wanted to do. Plan it out in simple steps, write them down, and do step #1. After you've completed one step, you'll have the confidence to tackle the next step.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
Two Problems that Are Associated with Depressed Moods
Sometimes teens experience depressed moods that are associated with other problems such as medical problems or psychological problems. It does not mean that their symptoms are not serious or concerning, it means that they are caused by different factors. In order to treat the problem accurately and effectively, it is important for it to be properly diagnosed.
Drepressed Mood Related to Medical Problems
Several specific medical conditions can result in depression. In addition, struggling with any chronic illness can become discouraging and depressing over time.
Recognizing medical conditions that cause depression is important because treating them appropriately may avoid long, ineffective courses of psychotherapy or antidepressant therapy. Most can be ruled out by a family doctor doing a history physical examination, and (in some cases) blood tests.
There is no physical test for depression itself, however. There are literally hundreds of diseases and medications that can affect mood, so only some of the more common ones found in teens will be listed here:
• Hypothyroidism (low function of the thyroid gland) can mimic depression. Weight gain, sluggishness, sensitivity to the cold, and dry skin often accompany this condition.
• Infectious mononucleosis (the so-called "kissing disease," caused by a virus) is another common cause of fatigue and low mood in teens.
• Poor eating habits can result in anemia (not enough red blood cells), with associated fatigue and low mood.
• A variety of drugs (whether prescription, over-the-counter, or street drugs) can affect mood. Teens who are drinking alcohol regularly, for example, often go through cycles of intoxication and withdrawal that disturb their moods.
• Starting the birth control pill can result in hormonal changes that induce depressed moods in some girls. For similar reasons, premenstrual depressed mood occurs in others.
• Chronically ill teens taking corticosteroids (for example, for rheumatic diseases or chronic kidney or liver conditions) can experience mood disturbance, with either elation or depression.
• Finally, medical conditions resulting in disability can be depressing. Accidents that result in sudden disability (for example, diving accidents resulting in paralysis) can be especially devastating because they rob the teen of previously cherished hopes and dreams.
Depression Mood Related to Other Psychological Problems
Certain problems cluster together in families, suggesting that children vulnerable to one may be more vulnerable to the others. Depression, anxiety, and alcoholism have all been linked in this way Therefore, teens with anxiety or alcohol problems often manifest depression as well. Other psychological problems can also overlap, when they are chronic and untreated. Children with undiagnosed attention problems or learning disabilities, for example, can become increasingly discouraged over me as they are unable to succeed academically. Children with behavioral problems often receive negative feedback, until they come to see themselves as "nothing but trouble." This negative identity certainly predisposes teens to depression.
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Drepressed Mood Related to Medical Problems
Several specific medical conditions can result in depression. In addition, struggling with any chronic illness can become discouraging and depressing over time.
Recognizing medical conditions that cause depression is important because treating them appropriately may avoid long, ineffective courses of psychotherapy or antidepressant therapy. Most can be ruled out by a family doctor doing a history physical examination, and (in some cases) blood tests.
There is no physical test for depression itself, however. There are literally hundreds of diseases and medications that can affect mood, so only some of the more common ones found in teens will be listed here:
• Hypothyroidism (low function of the thyroid gland) can mimic depression. Weight gain, sluggishness, sensitivity to the cold, and dry skin often accompany this condition.
• Infectious mononucleosis (the so-called "kissing disease," caused by a virus) is another common cause of fatigue and low mood in teens.
• Poor eating habits can result in anemia (not enough red blood cells), with associated fatigue and low mood.
• A variety of drugs (whether prescription, over-the-counter, or street drugs) can affect mood. Teens who are drinking alcohol regularly, for example, often go through cycles of intoxication and withdrawal that disturb their moods.
• Starting the birth control pill can result in hormonal changes that induce depressed moods in some girls. For similar reasons, premenstrual depressed mood occurs in others.
• Chronically ill teens taking corticosteroids (for example, for rheumatic diseases or chronic kidney or liver conditions) can experience mood disturbance, with either elation or depression.
• Finally, medical conditions resulting in disability can be depressing. Accidents that result in sudden disability (for example, diving accidents resulting in paralysis) can be especially devastating because they rob the teen of previously cherished hopes and dreams.
Depression Mood Related to Other Psychological Problems
Certain problems cluster together in families, suggesting that children vulnerable to one may be more vulnerable to the others. Depression, anxiety, and alcoholism have all been linked in this way Therefore, teens with anxiety or alcohol problems often manifest depression as well. Other psychological problems can also overlap, when they are chronic and untreated. Children with undiagnosed attention problems or learning disabilities, for example, can become increasingly discouraged over me as they are unable to succeed academically. Children with behavioral problems often receive negative feedback, until they come to see themselves as "nothing but trouble." This negative identity certainly predisposes teens to depression.
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Two Types of Chronic Depressive Conditions
"Chronic depressive conditions" is a term for conditions that involve longstanding depressed mood not directly related to a specific incident or set of circumstances. Two examples of chronic depressive conditions will now be described in the following.
Difficult Temperament
Some children seem to be born with the proverbial "cloud over their heads." They rarely smile, have trouble controlling themselves emotionally and physiologically (for example, sleeping and eating irregularly), and seem to be constantly making demands on others. Perhaps in response to their poor internal control, they try too hard to control their environments, resulting in inflexibility and difficulty dealing with change. This so-called difficult temperament can persist, to a degree, for most of their lives unless they learn alternative ways of coping. Children with difficult temperament can do very well in certain circumstances. For example, stubbornness that is appropriately channeled can contribute to success. Consequently, these children are not considered to have a disorder. Nevertheless, they suffer from their own difficulty adapting, and sometimes become depressed when faced with the challenges of adolescence.
Low Self-Esteem
Self-esteem may be defined as confidence in and satisfaction with oneself (Merriam Webster online dictionary). Self-esteem is an odd concept: those who have it, rarely think about it; those who don't, are preoccupied with their lack of it. Adolescence predisposes teens to self-esteem problems because teens are often self-conscious. They feel that others are watching them and evaluating them more than is realistic. This self-consciousness is part of the healthy adolescent quest for individual identity. For some teens, however, it can result in unfavorable comparisons with others. These teens suffer low moods related to their constant focus on self-worth or their perceived lack of it. Family problems or rejection by others can compound the problem.
What these teens need to develop is a sense of being valuable and loveable just as they are (regardless of the latest comparison or competition). Thus, finding an activity they excel at is only part of the answer. Accepting them, laughing with them (never at them), and normalizing some of the self-absorption of youth are equally important. Taking the focus off comparisons with others, and instead emphasizing "being the best you can be" is helpful. Also, parents can show by example that it is possible to have fun regardless of whether you are "winning" or "losing" in a given activity. Teens can learn that life is much more enjoyable when we focus on the moment, rather than ourselves.
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Difficult Temperament
Some children seem to be born with the proverbial "cloud over their heads." They rarely smile, have trouble controlling themselves emotionally and physiologically (for example, sleeping and eating irregularly), and seem to be constantly making demands on others. Perhaps in response to their poor internal control, they try too hard to control their environments, resulting in inflexibility and difficulty dealing with change. This so-called difficult temperament can persist, to a degree, for most of their lives unless they learn alternative ways of coping. Children with difficult temperament can do very well in certain circumstances. For example, stubbornness that is appropriately channeled can contribute to success. Consequently, these children are not considered to have a disorder. Nevertheless, they suffer from their own difficulty adapting, and sometimes become depressed when faced with the challenges of adolescence.
Low Self-Esteem
Self-esteem may be defined as confidence in and satisfaction with oneself (Merriam Webster online dictionary). Self-esteem is an odd concept: those who have it, rarely think about it; those who don't, are preoccupied with their lack of it. Adolescence predisposes teens to self-esteem problems because teens are often self-conscious. They feel that others are watching them and evaluating them more than is realistic. This self-consciousness is part of the healthy adolescent quest for individual identity. For some teens, however, it can result in unfavorable comparisons with others. These teens suffer low moods related to their constant focus on self-worth or their perceived lack of it. Family problems or rejection by others can compound the problem.
What these teens need to develop is a sense of being valuable and loveable just as they are (regardless of the latest comparison or competition). Thus, finding an activity they excel at is only part of the answer. Accepting them, laughing with them (never at them), and normalizing some of the self-absorption of youth are equally important. Taking the focus off comparisons with others, and instead emphasizing "being the best you can be" is helpful. Also, parents can show by example that it is possible to have fun regardless of whether you are "winning" or "losing" in a given activity. Teens can learn that life is much more enjoyable when we focus on the moment, rather than ourselves.
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Wednesday 17 December 2008
Exercise: Promoting Healthy Peer Influences
Is your child or teen on medication? What type of medication (s)? What has your experience been with medication (s) so far? What problems have you encountered? Is it difficult to address your concerns with the prescribing physician? How could this be handled? (You may be surprised to know that even professionals sometimes respond remarkably well to a thoughtful L.E.A.P. Approach.)
Have you run into problems having the medication administered to your child or teen at school (if needed) or at camp? Are there other members of the family or extended family who question your teen's need for medication? How is this handled best?
Is your child insisting that others not know about the medication? Is this reasonable? Is it difficult to get your child or teen to take medication? What helps?
If your teen is not on medication and you think it might help, discuss this option with him objectively, including possible advantages and disadvantages. Make it clear that you respect his opinion on the subject, but would like to explore it further with a professional.
Then, see if he will go to the family doctor with you. Sometimes a check-up that addresses psychological as well as physical concerns is more acceptable to a teen initially than being sent to a "shrink." If your teen is agreeable, the family doctor can then prescribe antidepressant medication, or refer to a psychiatrist if this is preferred. If not, at least the doctor is aware of your teen's problems and can intervene quickly if he changes his mind.
In this week's L.E.A.R plan, focus on the most challenging situation you have encountered in relation to your teen's medication. If he's not on medication and you would like to pursue this option, check with the doctor to see if this is indicated. If so, do a L.E.A.R plan aimed at introducing the idea to your teen.
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Have you run into problems having the medication administered to your child or teen at school (if needed) or at camp? Are there other members of the family or extended family who question your teen's need for medication? How is this handled best?
Is your child insisting that others not know about the medication? Is this reasonable? Is it difficult to get your child or teen to take medication? What helps?
If your teen is not on medication and you think it might help, discuss this option with him objectively, including possible advantages and disadvantages. Make it clear that you respect his opinion on the subject, but would like to explore it further with a professional.
Then, see if he will go to the family doctor with you. Sometimes a check-up that addresses psychological as well as physical concerns is more acceptable to a teen initially than being sent to a "shrink." If your teen is agreeable, the family doctor can then prescribe antidepressant medication, or refer to a psychiatrist if this is preferred. If not, at least the doctor is aware of your teen's problems and can intervene quickly if he changes his mind.
In this week's L.E.A.R plan, focus on the most challenging situation you have encountered in relation to your teen's medication. If he's not on medication and you would like to pursue this option, check with the doctor to see if this is indicated. If so, do a L.E.A.R plan aimed at introducing the idea to your teen.
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Dealing with different opinions on medication
Teens are not the only ones who sometimes have concerns about taking medication for depression. Adults in the teen's life can influence his attitude as well. Many parents who recognize the benefits of antidepressant medication for their teen struggle with the conflicting opinions of school personnel, grandparents, and even spouses. Interestingly, when dealing with these adults, a problem-solving approach that includes some empathy often works well. It reduces the tendency for people to argue or to blame each other, by keeping the focus on the problem, and empathic comments invariably increase the level of trust in the relationship. Thus, you can do a L.E.A.R plan for these people, as well as for your teen.
In Izz/s case, for example, his mother was initially quite concerned about the risks of antidepressant medication. Her own mother had been hospitalized for psychiatric reasons many years ago, and she still remembered the horrible effects of insulin shock, large doses of antipsychotic drugs, and other pharmaceutical treatments of that era. Explanations of how much more specific, better studied, and less toxic current treatments are did little to reduce her fears. Fortunately, Izzy's father was able to discuss the situation with his wife. Here is his L.E.A.R plan:
Label thoughts and feelings: I'm so worried about Izzy. He's thin, he's not doing any school work, he's in his room with his music all day, and he doesn't sleep. We've tried counseling, but he just can't get his life back on track. Medication might make the difference, but Helen (wife) refuses to consider it. It's so frustrating!
Empathize with your teen: Maybe if I'd gone through what Helen went through with her mom I'd be skeptical of medication too. Whenever I try to convince her the newer treatments are better, she just feels pressured to give in, and gets more scared for Izzy. She must be really scared of reliving the past.
Explore ways to respond: Maybe I can get her to agree to a little bit of medication for a short period of time, just to make sure that Izzy is OK on it. Then, if she sees that he doesn't have horrible side effects, she may be willing to consider giving him a therapeutic amount. I could invite her to join us at the doctor's too, so she can ask about what happened to her mother, as well as what might happen to Izzy. She could get her mother's records from the hospital, and the doctor could help her make sense of them and explain exactly how things are different now.
Apply alternative ideas/plan: I'll make these suggestions to Helen, and see if she'd consider even one of them. (Helen agreed to see the doctor and maybe try Izzy on a small amount of medication with close supervision by herself, but declined to pursue her mother's medical record.)
Pick a follow up time and plan ahead: After a week on the smallest amount of medication, I'll talk to Helen again to see if she'll agree to another step.
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In Izz/s case, for example, his mother was initially quite concerned about the risks of antidepressant medication. Her own mother had been hospitalized for psychiatric reasons many years ago, and she still remembered the horrible effects of insulin shock, large doses of antipsychotic drugs, and other pharmaceutical treatments of that era. Explanations of how much more specific, better studied, and less toxic current treatments are did little to reduce her fears. Fortunately, Izzy's father was able to discuss the situation with his wife. Here is his L.E.A.R plan:
Label thoughts and feelings: I'm so worried about Izzy. He's thin, he's not doing any school work, he's in his room with his music all day, and he doesn't sleep. We've tried counseling, but he just can't get his life back on track. Medication might make the difference, but Helen (wife) refuses to consider it. It's so frustrating!
Empathize with your teen: Maybe if I'd gone through what Helen went through with her mom I'd be skeptical of medication too. Whenever I try to convince her the newer treatments are better, she just feels pressured to give in, and gets more scared for Izzy. She must be really scared of reliving the past.
Explore ways to respond: Maybe I can get her to agree to a little bit of medication for a short period of time, just to make sure that Izzy is OK on it. Then, if she sees that he doesn't have horrible side effects, she may be willing to consider giving him a therapeutic amount. I could invite her to join us at the doctor's too, so she can ask about what happened to her mother, as well as what might happen to Izzy. She could get her mother's records from the hospital, and the doctor could help her make sense of them and explain exactly how things are different now.
Apply alternative ideas/plan: I'll make these suggestions to Helen, and see if she'd consider even one of them. (Helen agreed to see the doctor and maybe try Izzy on a small amount of medication with close supervision by herself, but declined to pursue her mother's medical record.)
Pick a follow up time and plan ahead: After a week on the smallest amount of medication, I'll talk to Helen again to see if she'll agree to another step.
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What About Natural Options
Some people are averse to medications because they believe them to be "unnatural," as most have been manufactured in laboratories. They would prefer something derived from a plant or other natural substance. I usually advise evaluating the risks and benefits of both options. In terms of risks, the "naturals" are often touted as having fewer side effects, but it is also more difficult to determine their purity (important in deciding about dosage). There is often a great deal of variability from one brand to another, and the inactive ingredients (apart from the active substance itself) are often not spelled out. With a medication developed in a laboratory, you know more precisely what you are taking.
In terms of benefit, there are some individuals (including some in our practice) who have responded to herbal remedies and many who have responded to prescribed medication. One criterion for approval of prescribed medication, however, is that efficacy has been demonstrated above and beyond the efficacy of a placebo (sugar pill) in large numbers of people. Over-the-counter herbal remedies do not have to meet this standard.
The most commonly used herbal remedy for depression is St. John's Wort. Unlike many such remedies, St. John's Wort has been subjected to a number of studies in adults, both in Europe and North America. Results from Europe appeared very promising, but a large North American study recently could not demonstrate efficacy above and beyond the efficacy of a placebo. Still, if you or your teen is very concerned about the risk of side effects with pharmaceuticals and/or has failed to respond to one or more standard antidepressant medications, it may be worth considering. Studies tell you how hundreds of people respond on the average, but they cannot predict how a particular individual will respond. No studies to date have examined St. John's Wort in adolescents or children. St. John's Wort can interact with some prescription drugs, particularly other antidepressants, so check with your doctor or pharmacist first if your teen is already taking another medication.
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In terms of benefit, there are some individuals (including some in our practice) who have responded to herbal remedies and many who have responded to prescribed medication. One criterion for approval of prescribed medication, however, is that efficacy has been demonstrated above and beyond the efficacy of a placebo (sugar pill) in large numbers of people. Over-the-counter herbal remedies do not have to meet this standard.
The most commonly used herbal remedy for depression is St. John's Wort. Unlike many such remedies, St. John's Wort has been subjected to a number of studies in adults, both in Europe and North America. Results from Europe appeared very promising, but a large North American study recently could not demonstrate efficacy above and beyond the efficacy of a placebo. Still, if you or your teen is very concerned about the risk of side effects with pharmaceuticals and/or has failed to respond to one or more standard antidepressant medications, it may be worth considering. Studies tell you how hundreds of people respond on the average, but they cannot predict how a particular individual will respond. No studies to date have examined St. John's Wort in adolescents or children. St. John's Wort can interact with some prescription drugs, particularly other antidepressants, so check with your doctor or pharmacist first if your teen is already taking another medication.
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Newer Medications
The "third generation" of antidepressants (so-called because they are the newest, and were developed after the tricyclics and the SSRI's) include venlafaxine (Effexor), bupropion (Wellbutrin or Zyban), nefazedone (Serzone), and reboxitine (Remiron). These are usually reserved for children and teens who don't respond to SSRIs or cannot tolerate them. Bupropion targets mainly noradrenaline, while the others target noradrenaline and serotonin, but with fewer side effects than the old tricyclics. Experience with these medications in children and adolescents is limited.
Serzone was recently taken off the market in Canada because it was linked to liver damage in some people, and concerns about Effexor and suicidal ideation have been raised, as discussed above. Activation is sometimes a problem with bupropion. For bupropion, also note that it is used in smoking cessation under the name Zyban. It is important that people do not mix Zyban with other antidepressants unless this occurs under a doctor's supervision. Remiron is the newest of the group, and experience in young people is very limited. New antidepressants come on the market quickly, however, and some of the information in this paragraph may change within a year or two.
All antidepressants can be sedating in combination with other sedating drugs (such as certain antihistamines), so check with a doctor on these combinations. Another popular combination to avoid is antidepressant + alcohol (both sedating). If it's difficult to monitor this with your teen, at least stress the importance of having one drink only and someone sober to drive him home.
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Serzone was recently taken off the market in Canada because it was linked to liver damage in some people, and concerns about Effexor and suicidal ideation have been raised, as discussed above. Activation is sometimes a problem with bupropion. For bupropion, also note that it is used in smoking cessation under the name Zyban. It is important that people do not mix Zyban with other antidepressants unless this occurs under a doctor's supervision. Remiron is the newest of the group, and experience in young people is very limited. New antidepressants come on the market quickly, however, and some of the information in this paragraph may change within a year or two.
All antidepressants can be sedating in combination with other sedating drugs (such as certain antihistamines), so check with a doctor on these combinations. Another popular combination to avoid is antidepressant + alcohol (both sedating). If it's difficult to monitor this with your teen, at least stress the importance of having one drink only and someone sober to drive him home.
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How Long Should Teens Remain On Medication
Once your child is on the right dose and some benefit is observed, it is usually worth continuing the medication for at least six months to one year. There is some evidence that a year may be preferable, to reduce the risk of relapse if your child is still in a depressive episode at six months. Then, an attempt to taper the medication (decreasing the dose very gradually) can be made, especially if your child has developed coping skills from a cognitive-behavioral psychotherapy program. The goal is to have your child on the minimum dose needed. In some children, the medication can be discontinued at this point, while others require medication longer term. Tapering is usually best done at a time of average life stress, to minimize the risk of relapse. If your child grows or encounters a greater-than-average degree of life stress, a dosage increase may be needed.
Long-term effects of SSRIs in children and teens are not well studied. These medications have not yet been used in children long enough for such studies to have been done. Adults sometimes develop an apathetic state termed "amotivational syndrome" and there are case reports of this syndrome in adolescents, but it tends to resolve with dosage reduction. Several children and teens at our centre have required SSPds for more than a couple of years, and "so far so good." They seem to grow and develop normally. There is even some animal evidence that SSRIs may increase the body's ability to produce serotonin in the brain, but this has not yet been studied in humans.
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Long-term effects of SSRIs in children and teens are not well studied. These medications have not yet been used in children long enough for such studies to have been done. Adults sometimes develop an apathetic state termed "amotivational syndrome" and there are case reports of this syndrome in adolescents, but it tends to resolve with dosage reduction. Several children and teens at our centre have required SSPds for more than a couple of years, and "so far so good." They seem to grow and develop normally. There is even some animal evidence that SSRIs may increase the body's ability to produce serotonin in the brain, but this has not yet been studied in humans.
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Why Do Some Teens Repeatedly Harm Themselves
A variation on suicidal behavior (sometimes termed "parasuicidal behavior" or "suicidal gestures") occurs in teens who harm themselves repeatedly in ways unlikely to cause death. Common examples include superficial cutting of the forearms or other areas of the body, self-inflicted cigarette burns, hitting oneself with a fist or an object, or hitting one's head against a wall or hard object. It used to be thought that these displays represented part of an emerging personality disorder, but recent studies have shown that this is not always the case. Other reasons for such behavior can include:
• The teen has feelings of guilt or worthlessness that are part of depression.
• The teen is trying to regulate unpleasant feelings (see below).
• The teen is expressing anger or desire for someone's attention (for example, from a parent or a boyfriend).
Some teens engage in these behaviors only in the midst of a depressive episode, as in the example below.
For other teens, self-harm behavior represents a way of regulating unpleasant feelings. When the body is physically injured, endorphins are released. These are brain chemicals that are natural pain-killers, but they also have a mood-elevating effect. Thus, by inflicting physical pain on themselves, these teens numb their emotional pain. Some claim to eventually not feel the physical pain at all. For these teens, self-harm behavior can be decreased by helping them use alternative mood regulation strategies, such as those described earlier. Incidentally, regular physical exercise releases endorphins too, so encouraging a sports activity can also be helpful.
Finally, some teens harm themselves to demonstrate anger or gain attention. This is especially likely in those who engage in self-harm in front of other people (usually family most often during or after an argument). These teens often benefit from all of the strategies discussed in the chapter on anger. They usually need more consistent limits and a parent who can remain calm and not be drawn into arguments. It is important not to allow threats of self-harm to change your parenting decisions. This would simply reinforce your teen's negative behaviors. The exception would be if your teen was threatening serious self-harm in front of you (for example, brandishing a knife or firearm), in which case a call to emergency services would be indicated.
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• The teen has feelings of guilt or worthlessness that are part of depression.
• The teen is trying to regulate unpleasant feelings (see below).
• The teen is expressing anger or desire for someone's attention (for example, from a parent or a boyfriend).
Some teens engage in these behaviors only in the midst of a depressive episode, as in the example below.
- Brian: Brian was deeply depressed, but determined to continue attending school. He was suspended after repeatedly gouging his face with scissors. The teachers felt they could not monitor him closely enough to ensure his safety, and other students were very disturbed by witnessing his self-mutilation. Interestingly, Brian engaged in no self-harm at all after his mood improved with antidepressant medication. He went back to his fellow students and explained the nature of depression and how it affected him in a class presentation. He explained his previous self-harm behavior by saying, "At the time, I felt I deserved to be punished. I felt less guilty after I punished myself." The following year, he graduated as class valedictorian.
For other teens, self-harm behavior represents a way of regulating unpleasant feelings. When the body is physically injured, endorphins are released. These are brain chemicals that are natural pain-killers, but they also have a mood-elevating effect. Thus, by inflicting physical pain on themselves, these teens numb their emotional pain. Some claim to eventually not feel the physical pain at all. For these teens, self-harm behavior can be decreased by helping them use alternative mood regulation strategies, such as those described earlier. Incidentally, regular physical exercise releases endorphins too, so encouraging a sports activity can also be helpful.
Finally, some teens harm themselves to demonstrate anger or gain attention. This is especially likely in those who engage in self-harm in front of other people (usually family most often during or after an argument). These teens often benefit from all of the strategies discussed in the chapter on anger. They usually need more consistent limits and a parent who can remain calm and not be drawn into arguments. It is important not to allow threats of self-harm to change your parenting decisions. This would simply reinforce your teen's negative behaviors. The exception would be if your teen was threatening serious self-harm in front of you (for example, brandishing a knife or firearm), in which case a call to emergency services would be indicated.
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Teen's Suicidal Threats
Threats of suicide or attempts at suicide are usually the most difficult crises for families of depressed children. It's important to remember, however, that although thoughts of self-harm are almost universal among depressed children, attempts are far fewer. About 20 to 25 percent of teens with major depression attempt suicide at some point before age 20. Children or teens who actually die by suicide are rare (less than 4 percent of teens with major depression, most of these in the late teens). These figures are still much higher than in the general population, though, so threats of suicide must be taken seriously. Depressed girls are more likely to attempt suicide, but depressed boys more often complete suicide (they often use more lethal methods).
Some books have long lists of "signs" to look for in assessing children's suicidality. Unfortunately, these create the false impression that you can evaluate this risk yourself. This is simply not true. Even experienced professionals have difficulty predicting who will attempt suicide and who will not, and even the correct predictions are rarely accurate for more than the next 24 to 48 hours. Trust your instincts. Go to the nearest hospital emergency department if you believe your child is at risk. Be extra suspicious if:
Your child has a friend who talks about suicide or has recently engaged in suicidal behavior (in this case, there is potential for a suicide "pact" among peers);
Your child starts to give away her possessions; or
There has been a recent loss of a close relationship or a source of pride (for example, losing a major competition or failing an examination).
Conversely, if your child has a habit of threatening "I'll kill myself if you don't give me what I want," recognize this for what it is: an expression of anger. On its own, this means little. If there are other recent changes in your child's behavior, however, it may be worth checking with a professional.
Also, beware of the impulsive child who takes a handful of pills in front of you to "make a statement." Depending on the pills, they could result in an inadvertent fatality (for example, Tylenol can destroy the liver). Following up with an emergency visit is often a good idea. The experience of being made to swallow charcoal (to neutralize stomach contents) or having a tube inserted down the throat can also be noxious enough to deter children and teens from repeating this behavior.
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Some books have long lists of "signs" to look for in assessing children's suicidality. Unfortunately, these create the false impression that you can evaluate this risk yourself. This is simply not true. Even experienced professionals have difficulty predicting who will attempt suicide and who will not, and even the correct predictions are rarely accurate for more than the next 24 to 48 hours. Trust your instincts. Go to the nearest hospital emergency department if you believe your child is at risk. Be extra suspicious if:
Your child has a friend who talks about suicide or has recently engaged in suicidal behavior (in this case, there is potential for a suicide "pact" among peers);
Your child starts to give away her possessions; or
There has been a recent loss of a close relationship or a source of pride (for example, losing a major competition or failing an examination).
Conversely, if your child has a habit of threatening "I'll kill myself if you don't give me what I want," recognize this for what it is: an expression of anger. On its own, this means little. If there are other recent changes in your child's behavior, however, it may be worth checking with a professional.
Also, beware of the impulsive child who takes a handful of pills in front of you to "make a statement." Depending on the pills, they could result in an inadvertent fatality (for example, Tylenol can destroy the liver). Following up with an emergency visit is often a good idea. The experience of being made to swallow charcoal (to neutralize stomach contents) or having a tube inserted down the throat can also be noxious enough to deter children and teens from repeating this behavior.
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What Can The Non-Depressed Parent Do?
Having a depressed spouse, and perhaps a depressed teen as well, can be a tremendous burden on the "healthy" parent. Supporting the family may have to take precedence over career and other priorities for the time being, if everyone is to get through their depression without long-term problems. Beyond supporting your spouse and children as described above, consider obtaining some extra support for yourself. Even if it's just the occasional conversation with a good friend or individual or family counseling, it can make a dramatic difference at such a trying time. If you are religious, members of your faith community may also be supportive. As your spouse's depression begins to lift, resuming family activities may be both therapeutic for the depressed family member(s), and a source of hope and recreation for yourself.
Occasionally, you may also be in a position to recognize and address unhealthy interaction patterns occurring around the depressed individual (s) in your family. Returning to the example of Amanda, let's look at a L.E.A.P. plan her father could develop at the time when both Amanda and her mother were depressed.
Label thoughts and feelings: I'm getting really frustrated with Amanda. She used to do so well in school, but now she seems to be just average. How does she expect to make anything of herself at this rate? To be honest, I also miss being proud of her and being able to brag a bit to the neighbors about her. I'm irritated with my wife too. She doesn't seem to realize how important an education is. All she wants is for our daughter to sit around and listen to her complaints
Empathize with your teen: What the neighbors think isn't that important. It's Amanda's happiness and her future that matter. I wonder if Amanda is getting discouraged. After all, high school is harder than elementary school. Those constant talks with her mother may be draining her energy as well. Both of them seem rather unhappy.
Explore ways to respond: I wonder if Amanda could use some time away from her mother. She needs something enjoyable to focus on. Maybe I could get her back into the choir she used to enjoy. Maybe she'd like to go skating with me on the weekends, or play some tennis in the summer. If her schoolwork is too hard, maybe a tutor for the subjects she's finding difficult would help. Her teacher might also be able to tell me more about what she should be doing in this grade. If she still struggles and looks unhappy, maybe I should arrange a check-up with the doctor. My wife's problems go way back, and I don't understand them completely. She should probably see a therapist, if I could just get her to go! On the other hand, maybe she'll be more agreeable to seeing someone if Amanda is occupied with other things after school and stops listening to her so much. Alternatively, maybe if I offered to see someone with her, she would agree.
Apply alternative ideas/plan: I'll talk to Amanda's teachers and get her the best academic support I can. Then, I'll insist on at least one nonaca-demic after-school activity, and offer to take her out skating on weekends. I'll ask the doctor if she can recommend a therapist who could see my wife, or see my wife and me together
Pick a follow up time and plan ahead: I'll stay in touch with the teacher regularly, and keep my eyes open at home. If Amanda is still unhappy and struggling at school in a month, I'll have her see the doctor as well. I'll see if the therapist has any other suggestions.
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Occasionally, you may also be in a position to recognize and address unhealthy interaction patterns occurring around the depressed individual (s) in your family. Returning to the example of Amanda, let's look at a L.E.A.P. plan her father could develop at the time when both Amanda and her mother were depressed.
Label thoughts and feelings: I'm getting really frustrated with Amanda. She used to do so well in school, but now she seems to be just average. How does she expect to make anything of herself at this rate? To be honest, I also miss being proud of her and being able to brag a bit to the neighbors about her. I'm irritated with my wife too. She doesn't seem to realize how important an education is. All she wants is for our daughter to sit around and listen to her complaints
Empathize with your teen: What the neighbors think isn't that important. It's Amanda's happiness and her future that matter. I wonder if Amanda is getting discouraged. After all, high school is harder than elementary school. Those constant talks with her mother may be draining her energy as well. Both of them seem rather unhappy.
Explore ways to respond: I wonder if Amanda could use some time away from her mother. She needs something enjoyable to focus on. Maybe I could get her back into the choir she used to enjoy. Maybe she'd like to go skating with me on the weekends, or play some tennis in the summer. If her schoolwork is too hard, maybe a tutor for the subjects she's finding difficult would help. Her teacher might also be able to tell me more about what she should be doing in this grade. If she still struggles and looks unhappy, maybe I should arrange a check-up with the doctor. My wife's problems go way back, and I don't understand them completely. She should probably see a therapist, if I could just get her to go! On the other hand, maybe she'll be more agreeable to seeing someone if Amanda is occupied with other things after school and stops listening to her so much. Alternatively, maybe if I offered to see someone with her, she would agree.
Apply alternative ideas/plan: I'll talk to Amanda's teachers and get her the best academic support I can. Then, I'll insist on at least one nonaca-demic after-school activity, and offer to take her out skating on weekends. I'll ask the doctor if she can recommend a therapist who could see my wife, or see my wife and me together
Pick a follow up time and plan ahead: I'll stay in touch with the teacher regularly, and keep my eyes open at home. If Amanda is still unhappy and struggling at school in a month, I'll have her see the doctor as well. I'll see if the therapist has any other suggestions.
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What Should A Parent Who Is Depressed Do?
• Talk about the illness and its effect on your family. Just having a name for the problem can be very helpful to some families.
• Pay extra attention to adolescent emotional development and your teenager's need for stronger connections to peers and increasing autonomy from your family.
• Don't assume that because your child says nothing, he doesn't have concerns.
• Help children learn self-soothing strategies when upset (especially if your child was young when his parent was depressed), and model non-depressed ways of coping. Relaxation techniques, writing down your feelings, taking a bath, going for a walk, listening to (or playing) a favorite piece of music, spending time with a pet, or working on a favorite hobby or artistic pursuit can all be helpful in soothing yourself.
• Take care of yourself. Avoiding relapse is the most therapeutic thing you can do for your family. Involve yourself in activities, as recommended for your teen, and maintain mental health follow-up if necessary.
• Be honest with your family about how you feel, but emphasize what you are doing to overcome depression. This will reduce the chances that your children will worry about you.
• Resist the temptation to use a child or teen as a confidante. Youngsters have enough to do dealing with their own problems; they don't need to be burdened with yours.
• Talk to your spouse or a trusted friend. He or she may be able to better handle some aspects of childrearing while you are depressed. Setting appropriate limits with children, for example, can be very difficult when you are depressed. Don't be afraid to modify "traditional" roles, if needed.
• Focus on recovering from depression and gradually resume your usual responsibilities as you are able to. Just like academic expectations have to be modified for depressed teens, your expectations of yourself in the work and family environments may have to be modified as well.
• Ask for help outside the immediate family, if needed. Sometimes it can feel as if having a depressed child can add to your own depression or make you feel responsible and guilty. Talk about these feelings with someone you can trust so they don't become burdensome and overwhelming.
• Be prepared for times of crisis. Create action plans with your family about how to handle "down" times or hospitalizations.
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• Pay extra attention to adolescent emotional development and your teenager's need for stronger connections to peers and increasing autonomy from your family.
• Don't assume that because your child says nothing, he doesn't have concerns.
• Help children learn self-soothing strategies when upset (especially if your child was young when his parent was depressed), and model non-depressed ways of coping. Relaxation techniques, writing down your feelings, taking a bath, going for a walk, listening to (or playing) a favorite piece of music, spending time with a pet, or working on a favorite hobby or artistic pursuit can all be helpful in soothing yourself.
• Take care of yourself. Avoiding relapse is the most therapeutic thing you can do for your family. Involve yourself in activities, as recommended for your teen, and maintain mental health follow-up if necessary.
• Be honest with your family about how you feel, but emphasize what you are doing to overcome depression. This will reduce the chances that your children will worry about you.
• Resist the temptation to use a child or teen as a confidante. Youngsters have enough to do dealing with their own problems; they don't need to be burdened with yours.
• Talk to your spouse or a trusted friend. He or she may be able to better handle some aspects of childrearing while you are depressed. Setting appropriate limits with children, for example, can be very difficult when you are depressed. Don't be afraid to modify "traditional" roles, if needed.
• Focus on recovering from depression and gradually resume your usual responsibilities as you are able to. Just like academic expectations have to be modified for depressed teens, your expectations of yourself in the work and family environments may have to be modified as well.
• Ask for help outside the immediate family, if needed. Sometimes it can feel as if having a depressed child can add to your own depression or make you feel responsible and guilty. Talk about these feelings with someone you can trust so they don't become burdensome and overwhelming.
• Be prepared for times of crisis. Create action plans with your family about how to handle "down" times or hospitalizations.
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Panic Attack And Worried Teenagers
Depressed children have distorted ways of seeing the future, themselves, and others. Do you remember the depressive triad (worthless self, uncaring world, hopeless future) ? Now, how would you see the future, yourself, and the world if you were anxious? Probably, you would see a weak self, a dangerous world, and an uncertain future. Now, imagine how you would see things if you were both depressed and anxious. This would be quite a load on your mind! In Tammy's case, her view that she risked attack just by leaving the house was an anxious distortion. The danger outside her home was overestimated in this case.
All of the same ideas we discussed for depressive distortions apply to anxious ones too:
• Help your child examine the evidence for or against the worry.
(Usually, things aren't nearly as dangerous as what we anticipate.)
• Because worries often concern uncertain future events, you may have to look at probabilities as well. (What are the chances this will happen? What else could happen? What are the chances of that?)
• Try to emphasize personal competence. (Can you do anything to reduce the risk? If not, can you do anything to limit the worry time so worries don't control your life?)
• See if your teen can identify the worried state (for example, before bed is a common time when worries take hold). If so, encourage "catching yourself worrying" and then either doing something distracting or writing down the worry. Although it's not easy, some teens can learn to write down bedtime worries and then let them go until the morning. Also, if every worry must be written down, the activity becomes fatiguing and eventually induces sleep.
• At a calm time, you may want to discuss the pros and cons of worrying. (For example, occasionally, people can find new solutions to a problem after worrying about it, but more often worrying just causes distress and wastes time, so on balance it's not worth it.)
• Some teens will agree to a "worry time," which is usually a few minutes to half an hour where they can worry as much as they want. The deal is, however, that you must postpone worries to your "worry time" the rest of the day.
• Remember to also model good coping with anxiety-provoking situations. This is particularly helpful if your teen doesn't voice his worries to you. For example, if you are driving in snowy conditions, you could say, "This is not good. It's really starting to come down heavily, but then I've driven in this kind of weather before. I can slow down and still get to where I'm going. I can always pull over if it gets worse." Interestingly, you are not modeling fearlessness, but coping well despite your fears. Thus, you are modeling both acknowledging worry and good coping, thereby encouraging your teen to discuss worried feelings.
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All of the same ideas we discussed for depressive distortions apply to anxious ones too:
• Help your child examine the evidence for or against the worry.
(Usually, things aren't nearly as dangerous as what we anticipate.)
• Because worries often concern uncertain future events, you may have to look at probabilities as well. (What are the chances this will happen? What else could happen? What are the chances of that?)
• Try to emphasize personal competence. (Can you do anything to reduce the risk? If not, can you do anything to limit the worry time so worries don't control your life?)
• See if your teen can identify the worried state (for example, before bed is a common time when worries take hold). If so, encourage "catching yourself worrying" and then either doing something distracting or writing down the worry. Although it's not easy, some teens can learn to write down bedtime worries and then let them go until the morning. Also, if every worry must be written down, the activity becomes fatiguing and eventually induces sleep.
• At a calm time, you may want to discuss the pros and cons of worrying. (For example, occasionally, people can find new solutions to a problem after worrying about it, but more often worrying just causes distress and wastes time, so on balance it's not worth it.)
• Some teens will agree to a "worry time," which is usually a few minutes to half an hour where they can worry as much as they want. The deal is, however, that you must postpone worries to your "worry time" the rest of the day.
• Remember to also model good coping with anxiety-provoking situations. This is particularly helpful if your teen doesn't voice his worries to you. For example, if you are driving in snowy conditions, you could say, "This is not good. It's really starting to come down heavily, but then I've driven in this kind of weather before. I can slow down and still get to where I'm going. I can always pull over if it gets worse." Interestingly, you are not modeling fearlessness, but coping well despite your fears. Thus, you are modeling both acknowledging worry and good coping, thereby encouraging your teen to discuss worried feelings.
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Avoidance
Avoidance of feared situations reduces anxiety initially, but makes it worse in the long run. For example, a child with social phobia may avoid making telephone calls, fearing that he will become embarrassed or "tongue-tied" during the call. For similar reasons, he may also avoid picking up the telephone when it rings. The more the telephone is avoided, however, the more frightening the prospect of making a call becomes. As avoidance continues, conversation skills are lost, making it even harder to change. Without intervention, the problem becomes self-perpetuating.
For younger children, one of us (KM) has written a parenting book on helping with anxiety symptoms and overcoming avoidance. It is called Keys to Parenting Your Anxious Child (see Bibliography). The same principles used with young children can be adapted to teens. Basically, the teen must face each feared situation, starting with the easiest and working up to the most difficult, in order to desensitize to the fear.
Just like younger children, teens benefit from encouragement, praise, and positive reinforcement when trying to face a fear. Unlike younger children, however, teens' reinforcements for progress tend to be different. (Money or a special privilege may motivate teens, whereas stickers, prizes, or special time with a parent motivates younger children; praise is appropriate for all age groups.) You probably know better than anyone else what motivates your child or teen! To encourage desensitization:
• Help your teen approach the situation in gradual steps with positive reinforcement for every little step. In Tammy's case, several "levels" could be developed to overcome her avoidance. The first level would consist of spending time on her front porch, the second of venturing into the garden, the third of standing on the sidewalk, and so on. She should spend at least half an hour a day practicing leaving the house (a minimum for desensitization), with graduated rewards for progressing to higher "levels." For the socially anxious child mentioned above who won't talk on the telephone, a different system of levels would apply. In this case, having someone else place the call (to a familiar, non-threatening person previously informed of the exercise) and then asking the child to provide a whispered, one-word response to a specific question on the telephone may be the first step. You need to use the same principle: gradual approximations. Setting up appropriate desensitization systems is a whole course (or book) in itself.
• Gradually withdrawing support in a situation can also be a step. For example, one mother of a young teen encouraged her daughter to travel on the public transit system to her appointments by accompanying her at gradually increasing distances until they were essentially traveling independently. She praised this "grown up" behavior throughout the process (no other reward was needed).
• Relaxation and coping self-talk (see below) can also help children go into avoided situations with less fear.
• Because going into a feared situation is an activity, you may also wish to review the earlier chapter on motivating teens to engage in activities.
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For younger children, one of us (KM) has written a parenting book on helping with anxiety symptoms and overcoming avoidance. It is called Keys to Parenting Your Anxious Child (see Bibliography). The same principles used with young children can be adapted to teens. Basically, the teen must face each feared situation, starting with the easiest and working up to the most difficult, in order to desensitize to the fear.
Just like younger children, teens benefit from encouragement, praise, and positive reinforcement when trying to face a fear. Unlike younger children, however, teens' reinforcements for progress tend to be different. (Money or a special privilege may motivate teens, whereas stickers, prizes, or special time with a parent motivates younger children; praise is appropriate for all age groups.) You probably know better than anyone else what motivates your child or teen! To encourage desensitization:
• Help your teen approach the situation in gradual steps with positive reinforcement for every little step. In Tammy's case, several "levels" could be developed to overcome her avoidance. The first level would consist of spending time on her front porch, the second of venturing into the garden, the third of standing on the sidewalk, and so on. She should spend at least half an hour a day practicing leaving the house (a minimum for desensitization), with graduated rewards for progressing to higher "levels." For the socially anxious child mentioned above who won't talk on the telephone, a different system of levels would apply. In this case, having someone else place the call (to a familiar, non-threatening person previously informed of the exercise) and then asking the child to provide a whispered, one-word response to a specific question on the telephone may be the first step. You need to use the same principle: gradual approximations. Setting up appropriate desensitization systems is a whole course (or book) in itself.
• Gradually withdrawing support in a situation can also be a step. For example, one mother of a young teen encouraged her daughter to travel on the public transit system to her appointments by accompanying her at gradually increasing distances until they were essentially traveling independently. She praised this "grown up" behavior throughout the process (no other reward was needed).
• Relaxation and coping self-talk (see below) can also help children go into avoided situations with less fear.
• Because going into a feared situation is an activity, you may also wish to review the earlier chapter on motivating teens to engage in activities.
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Anterior Cingulate Gyrus Functions
• allows shifting of attention
• cognitive flexibility
• adaptability
• helps the mind move from idea to idea
• gives the ability to see options
• helps you "go with the flow"
• cooperation
Problems Associated with the Anterior Cingulate Gyrus
• worrying
• holds on to hurts from the past
• stuck on thoughts (obsessions)
• stuck on behaviors (compulsions)
• oppositional behavior
• argumentative
• uncooperative, automatic tendency to say no
• addictive behaviors (alcohol or drug abuse, eating disorders, chronic pain)
• cognitive inflexibility
• Obsessive-Compulsive Spectrum Disorders
Running lengthwise through the deep aspects of the frontal lobes is the anterior cingulate gyrus. It is a major switching area in the brain, with many fibers traveling through it to other destinations in the brain.
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• cognitive flexibility
• adaptability
• helps the mind move from idea to idea
• gives the ability to see options
• helps you "go with the flow"
• cooperation
Problems Associated with the Anterior Cingulate Gyrus
• worrying
• holds on to hurts from the past
• stuck on thoughts (obsessions)
• stuck on behaviors (compulsions)
• oppositional behavior
• argumentative
• uncooperative, automatic tendency to say no
• addictive behaviors (alcohol or drug abuse, eating disorders, chronic pain)
• cognitive inflexibility
• Obsessive-Compulsive Spectrum Disorders
Running lengthwise through the deep aspects of the frontal lobes is the anterior cingulate gyrus. It is a major switching area in the brain, with many fibers traveling through it to other destinations in the brain.
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The deep limbic system
The deep limbic system is also intimately involved in bonding and social connectedness. It influences how you connect with other people on a social level; your ability to do this successfully in turn influences your moods. When we are bonded to people in a positive way, we feel better about our lives and ourselves. This capacity to bond then plays a significant role in the tone and quality of our moods.
The deep limbic system, especially the hypothalamus at the base of the brain, is responsible for translating our emotional state into physical feelings of relaxation or tension. The front half of the hypothalamus sends calming signals to the body through the parasympathetic nervous system. The back half of the hypothalamus sends stimulating or fear signals to the body through the sympathetic nervous system. The back half of the hypothalamus, when stimulated, is responsible for the fight-or-flight response. This "hardwired response" happens immediately upon activation, such as seeing or experiencing an emotional or physical threat. The heart beats faster, breathing rate and blood pressure increase, the hands and feet become cooler to divert blood from the extremities to the big muscles (to fight or run away), and the pupils dilate (to see better). This "deep limbic" translation of emotion is powerful and immediate. It happens with overt physical threats as well as with more covert emotional threats. This part of the brain is intimately connected with the prefrontal cortex and seems to act as a switching station between running on emotion (the deep limbic system) and rational thought and problem solving with our cortex. When the limbic system is turned on, emotions tend to take over. When it is cooled down, more activation is possible in the cortex. Current research on depression indicates increased deep limbic system activity and shutdown in the prefrontal cortex, especially on the left side.
Do you know people who see every situation in a bad light? That actually can be a deep limbic system problem because, as mentioned, this system tends to set our emotional filter, and when it is working too hard the filter is colored with negativity. One person can walk away from an interaction that ten others would label positive, but which he or she considers negative. Because the deep limbic system affects motivation, people sometimes develop an "I don't care" attitude about life and work. They feel hopeless ibout the outcome, don't have the energy to care, and have little willpower in fellow through with tasks.
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The deep limbic system, especially the hypothalamus at the base of the brain, is responsible for translating our emotional state into physical feelings of relaxation or tension. The front half of the hypothalamus sends calming signals to the body through the parasympathetic nervous system. The back half of the hypothalamus sends stimulating or fear signals to the body through the sympathetic nervous system. The back half of the hypothalamus, when stimulated, is responsible for the fight-or-flight response. This "hardwired response" happens immediately upon activation, such as seeing or experiencing an emotional or physical threat. The heart beats faster, breathing rate and blood pressure increase, the hands and feet become cooler to divert blood from the extremities to the big muscles (to fight or run away), and the pupils dilate (to see better). This "deep limbic" translation of emotion is powerful and immediate. It happens with overt physical threats as well as with more covert emotional threats. This part of the brain is intimately connected with the prefrontal cortex and seems to act as a switching station between running on emotion (the deep limbic system) and rational thought and problem solving with our cortex. When the limbic system is turned on, emotions tend to take over. When it is cooled down, more activation is possible in the cortex. Current research on depression indicates increased deep limbic system activity and shutdown in the prefrontal cortex, especially on the left side.
Do you know people who see every situation in a bad light? That actually can be a deep limbic system problem because, as mentioned, this system tends to set our emotional filter, and when it is working too hard the filter is colored with negativity. One person can walk away from an interaction that ten others would label positive, but which he or she considers negative. Because the deep limbic system affects motivation, people sometimes develop an "I don't care" attitude about life and work. They feel hopeless ibout the outcome, don't have the energy to care, and have little willpower in fellow through with tasks.
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Problems Associated with the Basal Ganglia
• anxiety, nervousness
• panic attacks
• physical sensation of anxiety tendency to predict the worst Let avoidance
• muscle tension
• tremors
Lie motor problems headaches
low/excessive motivation
The basal ganglia are a set of large structures located near the center of the brain. They help integrate feelings, thoughts, and movement, which is why you jump when you're excited, tremble when you're nervous, freeze when you're facilitate the integration of emotions, thoughts, and physical movement
The Basal Ganglia—The Brain's Idle
They take in sensations from (he body (emotions and thought!*), assist with putting feelings together with the correct body movements, and then help coordinate smooth outflow of motor (or body) movement. When they are working correctly, they keep input and output flowing smoothly, and emotions and body movements match each other. What happens when they don't work correctly? Panic disorder patients have basal ganglia that react correctly but to the wrong situations. Their basal ganglia incorrectly activate fight-or-flight body movements and a host of other body responses in response to the wrong sorts of emotional and environmental input. The fight-or-flight response is a primitive state that gets us ready to fight or flee when we are threatened or scared.
When a person has too much baseline tension or their i too high, we see too much activity in the basal ganglia ana orten enrome anxiety, tension, fear, and the tendency to have a negative or pessimistic outlook on life. Chronic states of anxiety and tension can increase the level of stress hormone production, and this in turn can lead to physical problems such as tension headaches, upset stomach, nausea, diarrhea, ulcer disease, and muscle soreness.
The basal ganglia have a range of optimal performance. You won't feel your best when they are performing above their optimal range or if they are underactive. People with under active basal ganglia frequently have problems with energy, motivation, and decision making.
Of note, some of the most highly motivated individuals that we have scanned, such as CEOs of companies, have had significantly increased activity in their basal ganglia. One of our theories is that excessive basal ganglia activity may be associated with heightened anxiety or, alternatively, with increased motivation. If you do not use increased basal ganglia activity to get things done, you are more likely to feel anxiety and tension. Some people can harness this increased energy and channel it productively to become the "movers" in our society, but they may also suffer from strong inner turmoil.
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• panic attacks
• physical sensation of anxiety tendency to predict the worst Let avoidance
• muscle tension
• tremors
Lie motor problems headaches
low/excessive motivation
The basal ganglia are a set of large structures located near the center of the brain. They help integrate feelings, thoughts, and movement, which is why you jump when you're excited, tremble when you're nervous, freeze when you're facilitate the integration of emotions, thoughts, and physical movement
The Basal Ganglia—The Brain's Idle
They take in sensations from (he body (emotions and thought!*), assist with putting feelings together with the correct body movements, and then help coordinate smooth outflow of motor (or body) movement. When they are working correctly, they keep input and output flowing smoothly, and emotions and body movements match each other. What happens when they don't work correctly? Panic disorder patients have basal ganglia that react correctly but to the wrong situations. Their basal ganglia incorrectly activate fight-or-flight body movements and a host of other body responses in response to the wrong sorts of emotional and environmental input. The fight-or-flight response is a primitive state that gets us ready to fight or flee when we are threatened or scared.
When a person has too much baseline tension or their i too high, we see too much activity in the basal ganglia ana orten enrome anxiety, tension, fear, and the tendency to have a negative or pessimistic outlook on life. Chronic states of anxiety and tension can increase the level of stress hormone production, and this in turn can lead to physical problems such as tension headaches, upset stomach, nausea, diarrhea, ulcer disease, and muscle soreness.
The basal ganglia have a range of optimal performance. You won't feel your best when they are performing above their optimal range or if they are underactive. People with under active basal ganglia frequently have problems with energy, motivation, and decision making.
Of note, some of the most highly motivated individuals that we have scanned, such as CEOs of companies, have had significantly increased activity in their basal ganglia. One of our theories is that excessive basal ganglia activity may be associated with heightened anxiety or, alternatively, with increased motivation. If you do not use increased basal ganglia activity to get things done, you are more likely to feel anxiety and tension. Some people can harness this increased energy and channel it productively to become the "movers" in our society, but they may also suffer from strong inner turmoil.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
Tuesday 16 December 2008
Anxiety Relaxation Techniques - Tips To Encourage Relaxation
Although anxiety relaxation techniques were originally developed for those with anxiety disorders, teens with depression can also benefit from them. The most basic technique is called "diaphragmatic breathing," to indicate that the muscle at the base of the lungs (diaphragm) is involved. Because this muscle is connected to nerves that are part of the body's autonomic (involuntary) nervous system, stretching this muscle triggers a natural relaxation response.
To do this technique, start by breathing slowly: allow the air to go in through the nose and out through the mouth, either while lying or sitting straight with shoulders down. Put a hand on your belly. If the air is going to the diaphragm, your hand should move out a little on the in-breath, and fall back on the out-breath. Count to four on every in-breath if it's hard to slow down. If you feel dizzy or get a pins-and-needles sensation, you're breathing too fast. When you've practiced this technique yourself, see if your teen is willing to do it with you.
Here are some anxiety relaxation techniques:
• Eli Bay has excellent relaxation tapes to listen to, if your teen is willing to try these.
• Activities that include relaxed breathing (martial arts, yoga, singing) are great too.
• Doing relaxation techniques with your child or teen makes it less of a chore, and may be helpful to you, too!
• A few minutes a day of regular practice is needed for two to three weeks to master the technique. Bedtime is usually the best time to practice, as it can improve quality and quantity of sleep in some teens as well.
• Once this type of breathing comes naturally to you and your teen, encourage breathing this way during the day whenever she is starting to feel tense. It doesn't work when very "worked up," but is good for anticipatory anxiety (i.e., worrying about something ahead of time) or mild irritability.
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To do this technique, start by breathing slowly: allow the air to go in through the nose and out through the mouth, either while lying or sitting straight with shoulders down. Put a hand on your belly. If the air is going to the diaphragm, your hand should move out a little on the in-breath, and fall back on the out-breath. Count to four on every in-breath if it's hard to slow down. If you feel dizzy or get a pins-and-needles sensation, you're breathing too fast. When you've practiced this technique yourself, see if your teen is willing to do it with you.
Here are some anxiety relaxation techniques:
• Eli Bay has excellent relaxation tapes to listen to, if your teen is willing to try these.
• Activities that include relaxed breathing (martial arts, yoga, singing) are great too.
• Doing relaxation techniques with your child or teen makes it less of a chore, and may be helpful to you, too!
• A few minutes a day of regular practice is needed for two to three weeks to master the technique. Bedtime is usually the best time to practice, as it can improve quality and quantity of sleep in some teens as well.
• Once this type of breathing comes naturally to you and your teen, encourage breathing this way during the day whenever she is starting to feel tense. It doesn't work when very "worked up," but is good for anticipatory anxiety (i.e., worrying about something ahead of time) or mild irritability.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
The Basic of Menopause and How to Diagnose It
Menopause is defined as the absence of menses for one year and most American women enter menopause at 51.4 years of age. Menopause is caused by the rather abrupt withdrawal from a woman's system of the very potent estrogen estradiol, as ovarian function ceases. There are many bothersome symptoms that herald the withdrawal of estrogen, including hot flashes, mood disturbance, weight gain, night sweats, fatigue, and sleep disturbance. These are not simply annoying symptoms, nor are they peripheral effects of hormone loss; they are warning signals that brain function is disturbed by the absence of estrogen. Sleep is regulated by the brain, and in the absence of estrogen a woman in menopause may have her sleep disturbed every fifteen seconds to eighteen minutes. The hypothalamus reacts to a lack of estrogen by causing engorgement or dilation of blood vessels, which results in hot flashes.
Evidence is mounting that lack of estrogen is bad for the brain. This discovery began with rat studies. Rats that have their ovaries removed have a huge estrogen deficit just like menopausal women. Estrogen-deficit rats have trouble learning, and they have deterioration of their temporal lobes, the area of the brain that is responsible for learning and memory. When rats were given estrogen replacement, the number of connections between cells in their temporal lobes improved, and so did their ability to learn new tasks. There have since been many studies showing the same pattern in human females. Women who have undergone surgical removal of their ovaries or who have gone through natural menopause often have difficulty with memory, concentration, and attention span. They have more trouble learning skills, they have more word-finding difficulty, and they feel overwhelmed by complex tasks that were previously easily mastered. These same women have marked and rapid reversal of these symptoms with estrogen replacement.
SPECT and PET scans of postmenopausal women who have not taken estrogen replacement show deactivation of the prefrontal cortex and temporal lobes. Neuropsychological testing of these women indicates impaired cognitive functioning in the areas of attention span, concentration, and learning. When these women are treated with estrogen replacement therapy or Evista, a selective estrogen receptor modulator, their performance on testing markedly improved. Of great interest, the SPECT and PET scans of the treated women also showed greatly improved brain function.
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Evidence is mounting that lack of estrogen is bad for the brain. This discovery began with rat studies. Rats that have their ovaries removed have a huge estrogen deficit just like menopausal women. Estrogen-deficit rats have trouble learning, and they have deterioration of their temporal lobes, the area of the brain that is responsible for learning and memory. When rats were given estrogen replacement, the number of connections between cells in their temporal lobes improved, and so did their ability to learn new tasks. There have since been many studies showing the same pattern in human females. Women who have undergone surgical removal of their ovaries or who have gone through natural menopause often have difficulty with memory, concentration, and attention span. They have more trouble learning skills, they have more word-finding difficulty, and they feel overwhelmed by complex tasks that were previously easily mastered. These same women have marked and rapid reversal of these symptoms with estrogen replacement.
SPECT and PET scans of postmenopausal women who have not taken estrogen replacement show deactivation of the prefrontal cortex and temporal lobes. Neuropsychological testing of these women indicates impaired cognitive functioning in the areas of attention span, concentration, and learning. When these women are treated with estrogen replacement therapy or Evista, a selective estrogen receptor modulator, their performance on testing markedly improved. Of great interest, the SPECT and PET scans of the treated women also showed greatly improved brain function.
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Monday 15 December 2008
Factors Linked To Resilience In Teens
Recently in attempts to better understand mental illness, mental health professionals have identified certain factors that help protect individuals from illness such as depression. Resilience factors, or things that help people stay healthy in the presence of risk factors (Kaufman, 2000), may prevent a depressive episode from occurring or prevent depression from getting worse. Resilience has been defined as the "ability to persevere and adapt when things go awry" (Reivich, K. & Shatte, A., 2002). However, if resilience is offset by substantial risk factors (for example, a strong family history of depression), your teen may still get depressed. On the positive side, though, resilience factors can improve coping and recovery from the illness. They may even reduce the risk of recurrence. Therefore, they are still important to keep in mind, and to enhance if possible. Research has identified the following as resilient factors for depression
• Feeling cared for by at least one other person;
• Parents get along reasonably well and are relatively consistent in relation to how they deal with the teen (expectations and limits set by each parent are similar);
• Adults model a positive perspective on situations;
• Social connections (i.e., the teen has friends);
• The opportunity to learn from life sometimes;
• A coherent system of values/meaning;
• Temperamental "fit" with the family is reasonable (for example, a highly athletic teen may feel out of place in a family of sedentary academics, and vice versa);
• Routines and clear rules at home;
• Authoritative parenting (basically, setting clear limits but in a thoughtful way that takes the child's feelings and developmental needs into account, providing explanations when needed, and allowing more input from the child with greater maturity).
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• Feeling cared for by at least one other person;
• Parents get along reasonably well and are relatively consistent in relation to how they deal with the teen (expectations and limits set by each parent are similar);
• Adults model a positive perspective on situations;
• Social connections (i.e., the teen has friends);
• The opportunity to learn from life sometimes;
• A coherent system of values/meaning;
• Temperamental "fit" with the family is reasonable (for example, a highly athletic teen may feel out of place in a family of sedentary academics, and vice versa);
• Routines and clear rules at home;
• Authoritative parenting (basically, setting clear limits but in a thoughtful way that takes the child's feelings and developmental needs into account, providing explanations when needed, and allowing more input from the child with greater maturity).
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What Does A Psychiatric Health Assessment Consist of?
There are other conditions besides depression that sometimes produce symptoms such as grief, adjustment reactions, and trauma. As they occur in response to specific events your teen reports, these conditions can generally be ruled out by a physician examining your teen. However, there are other psychiatric disorders that can show symptoms similar to depression which need to be considered by the mental health professional you consult. For example, anxiety disorders can be associated with depressed mood, particularly if they have persisted untreated for several years. The social isolation resulting from social phobia, for example, can look like social withdrawal associated with depression. Similarly, Oppositional Defiant Disorder (a condition in which the child or teen consistently refuses to cooperate with authority, to the point where it interferes with important daily activities) can mimic the negativity and irritability characteristic of teen depression. Unlike major depression, however, both of these conditions tend to persist for years, and do not change dramatically from month to month.
Teens who consume alcohol or illicit drugs can also appear depressed or withdrawn, either from drug withdrawal or from attempts to hide their habit. If you suspect this possibility, look into it, even if it means breeching your teen's privacy. The risks associated with drugs are often even greater than those associated with depression. When in doubt, check with a professional. Many teens suffer from more than one problem, and it can't hurt to have a thorough diagnostic assessment.
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Teens who consume alcohol or illicit drugs can also appear depressed or withdrawn, either from drug withdrawal or from attempts to hide their habit. If you suspect this possibility, look into it, even if it means breeching your teen's privacy. The risks associated with drugs are often even greater than those associated with depression. When in doubt, check with a professional. Many teens suffer from more than one problem, and it can't hurt to have a thorough diagnostic assessment.
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Things to keep in mind to help you help your depressed child
Listed below is a "snapshot" of things to keep in mind to help you help your child. We will be discussing these ideas throughout the blog in more detail but provide some highlights here to provide an introduction to what helps.
• Focusing on realistic positives—This week, use the table provided at the end of the chapter to record some areas in which your child is already showing some positive abilities, even if they are small positives (for example, getting dressed in the morning).
• Getting active—Activity counteracts the tendency for depressed people to withdraw and ruminate, and physical activity can actually prevent relapse in some people.
• Taking medication (if needed)—Medications can normalize the levels of the brain chemicals mentioned above.
• Reducing unnecessary stress—For example, if your teen is feeling overwhelmed by three after-school activities in addition to regular courses, see if even one can be eliminated until she is feeling better. Family conflict can also constitute "unnecessary stress." Chapters 12 and 13 are devoted to addressing family interactions.
• Increasing perceived support—Perceived support (that is, the child actually feels supported) ameliorates the effect of stress, reduces learned helplessness, and offers hope. Empathy is perceived as particularly supportive, but it's one of the most difficult things to give a depressed teen. Depression constricts the range of emotional expression, making depressed teens "hard to read." Teens' tendency to shut down and withdraw while depressed adds to the problem.
Sometimes, you will have to take an educated guess about what is going on, based on the circumstances. Then, put it into words for your teen. For example, "If that happened to me, I would feel terribly angry. Is that how you're feeling?" The expression on her face will give you the answer. Expressing confidence in your teen is another aspect of perceived support. Many children and teens do better when those close to them expect that they can. Siblings may need a little extra attention too, to reduce the chances of increased sibling rivalry as you focus on helping the depressed teen.
• Mourning major losses (if any)—Several books on helping children and teens with grief are listed in the Bibliography.
• Having a chance to make a difference—Making a difference (no matter how small) helps to overcome feelings of learned helplessness. For example, something as simple as being able to continue looking after a pet can provide a sense of "making a difference."
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• Focusing on realistic positives—This week, use the table provided at the end of the chapter to record some areas in which your child is already showing some positive abilities, even if they are small positives (for example, getting dressed in the morning).
• Getting active—Activity counteracts the tendency for depressed people to withdraw and ruminate, and physical activity can actually prevent relapse in some people.
• Taking medication (if needed)—Medications can normalize the levels of the brain chemicals mentioned above.
• Reducing unnecessary stress—For example, if your teen is feeling overwhelmed by three after-school activities in addition to regular courses, see if even one can be eliminated until she is feeling better. Family conflict can also constitute "unnecessary stress." Chapters 12 and 13 are devoted to addressing family interactions.
• Increasing perceived support—Perceived support (that is, the child actually feels supported) ameliorates the effect of stress, reduces learned helplessness, and offers hope. Empathy is perceived as particularly supportive, but it's one of the most difficult things to give a depressed teen. Depression constricts the range of emotional expression, making depressed teens "hard to read." Teens' tendency to shut down and withdraw while depressed adds to the problem.
Sometimes, you will have to take an educated guess about what is going on, based on the circumstances. Then, put it into words for your teen. For example, "If that happened to me, I would feel terribly angry. Is that how you're feeling?" The expression on her face will give you the answer. Expressing confidence in your teen is another aspect of perceived support. Many children and teens do better when those close to them expect that they can. Siblings may need a little extra attention too, to reduce the chances of increased sibling rivalry as you focus on helping the depressed teen.
• Mourning major losses (if any)—Several books on helping children and teens with grief are listed in the Bibliography.
• Having a chance to make a difference—Making a difference (no matter how small) helps to overcome feelings of learned helplessness. For example, something as simple as being able to continue looking after a pet can provide a sense of "making a difference."
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Sunday 14 December 2008
Defining Depression
Compare Janice (in the Introduction) and Timothy for a moment. Although both suffer from low moods and are about the same age, there are significant differences between them (apart from gender). Janice functioned very well, until a relatively sudden decline in her mood occurred over a couple of months. Timothy, on the other hand, had always struggled to a degree, but developed increasing difficulties over a year or so. Once depressed mood set in, however, Janice had many more symptoms than Timothy. Her appetite, sleep, energy level, and ability to concentrate were all affected by depression. She expressed feelings of worthlessness and no longer enjoyed her previous activities. Timothy's sleep was disturbed and he made some self-deprecating remarks, but the change in his mood and behavior was far less dramatic than that of Janice.
Janice exemplifies major depression, a diagnosis made when people become dramatically impaired by depressed moods over a relatively short period of time. Timothy, on the other hand, exemplifies dysthymic disorder, a diagnosis given when people have some impairment, but to a lesser degree than in major depression. They typically experience a chronically low mood and their problems occur over a longer time period (usually a year or more). A third consideration in teens is whether changes in mood or behavior are part of a disorder or part of normal adolescence.
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Janice exemplifies major depression, a diagnosis made when people become dramatically impaired by depressed moods over a relatively short period of time. Timothy, on the other hand, exemplifies dysthymic disorder, a diagnosis given when people have some impairment, but to a lesser degree than in major depression. They typically experience a chronically low mood and their problems occur over a longer time period (usually a year or more). A third consideration in teens is whether changes in mood or behavior are part of a disorder or part of normal adolescence.
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Cause And Treatments of Depression - An Overview
Timothy: Timothy, age thirteen, had always been more difficult to raise than his siblings. He was very demanding of his parents and often picky about the foods he would eat and the clothes he would wear. He was easily irritated by minor changes in routine. He had temper "blow-ups" on a regular basis, despite his parents' administration of calm, consistent time-outs. He made friends without difficulty, but had trouble keeping them because his peers perceived him as being too bossy.
Timothy had never been a good student, but lately his grades had been worse than usual. Last year's teacher suggested an assessment for Attention-Deficit/'Hyperactivity Disorder (AD/HD) or a learning disability. The psychologist who saw Timothy clearly did not think either of these diagnoses explained his difficulties. Timothy was not particularly distractible or impulsive, and his academic ability was above average in all areas. He did, however, become frustrated very easily when he was unable to master a task on the first try, responding with "I'm no good at anything!" and slamming the book shut. Timothy's difficulty was thought to be due to an emerging mood disorder.
Timothy's main risk factor for mood problems was his very difficult temperament. His parents were sympathetic, but they found his behavior frustrating at times. "The parenting courses helped, but they're not enough for dealing with this one!" reported his mother. As Timothy's temperament began to affect his functioning at school and with peers, his mood declined.
Interestingly, there was no major stress that seemed to prompt his deterioration in the previous year. More likely, he was simply struggling with society's increased expectations of more "mature" behavior with increasing age. For most people, maturity is seen as the ability to persevere despite adversity, and show a certain amount of flexibility and consideration for others. These behaviors would be difficult for Timothy to develop, given his rigid temperament and low frustration tolerance.
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Timothy had never been a good student, but lately his grades had been worse than usual. Last year's teacher suggested an assessment for Attention-Deficit/'Hyperactivity Disorder (AD/HD) or a learning disability. The psychologist who saw Timothy clearly did not think either of these diagnoses explained his difficulties. Timothy was not particularly distractible or impulsive, and his academic ability was above average in all areas. He did, however, become frustrated very easily when he was unable to master a task on the first try, responding with "I'm no good at anything!" and slamming the book shut. Timothy's difficulty was thought to be due to an emerging mood disorder.
Timothy's main risk factor for mood problems was his very difficult temperament. His parents were sympathetic, but they found his behavior frustrating at times. "The parenting courses helped, but they're not enough for dealing with this one!" reported his mother. As Timothy's temperament began to affect his functioning at school and with peers, his mood declined.
Interestingly, there was no major stress that seemed to prompt his deterioration in the previous year. More likely, he was simply struggling with society's increased expectations of more "mature" behavior with increasing age. For most people, maturity is seen as the ability to persevere despite adversity, and show a certain amount of flexibility and consideration for others. These behaviors would be difficult for Timothy to develop, given his rigid temperament and low frustration tolerance.
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What if your teen appears to be deteriorating?
Importantly none of the conditions described above are permanent states. Any one of them can change over time and progress toward more serious depression or toward emotional health. If you think your child may be more depressed than the teens profiled in this chapter, or if you think your child is deteriorating in that direction, see the next chapter for a fuller discussion about assessing teens for depression. If your teen is experiencing depression, you will need to seek professional help. Start by checking with your family doctor to determine whether a medical condition might account for your teen's mood. If not, ask the doctor to refer your teen to a mental health professional in your area.
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Depressed mood related to difficult life curcumstances
Benny: Benny's family lived on social assistance. His father had left the family years ago because of alcohol problems. His mother had not been able to find work, and had three young boys to raise. They didn't have medical insurance, so he and his siblings often suffered through ear infections or sore throats without antibiotics. Their sneakers were often falling apart by the time their mother could replace them. Benny was embarrassed by all this, and lied to his friends about his home life. His mother was upset that he was ashamed of his family, and smacked him roughly when she heard. Unlike his two younger brothers, he always seemed to be in some sort of trouble. When there was a fight among the boys, Benny usually got blamed. He often thought he should run away from home, but there was nowhere safe to go. He didn't want to end up in a gang like some of the other boys in his neighborhood, but he often wondered how else to find a place to fit in.
Benny's life has been difficult from the start. He is not faced with adjusting to a sudden change, but rather coping and trying to make a good life for himself despite the odds. His environment poses a combination of several risk factors for maladjustment. Poverty, a rough neighborhood, a stressed single-parent household, limited access to medical care, less than optimal parenting, and being made the scapegoat in the family can all contribute to emotional problems. Benny does not necessarily need counseling. Benny needs a source of hope for the future. The ability to excel in some area that would allow him to escape his circumstances would strengthen this. A successful male role model that took an interest in him (for example, a big brother) could also be helpful. Emotional support for his mother could also, indirectly, benefit Benny and his brothers. Although helpful interventions in this case are more social than psychiatric, they are no less important if Benny is to have a chance to make it.
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Benny's life has been difficult from the start. He is not faced with adjusting to a sudden change, but rather coping and trying to make a good life for himself despite the odds. His environment poses a combination of several risk factors for maladjustment. Poverty, a rough neighborhood, a stressed single-parent household, limited access to medical care, less than optimal parenting, and being made the scapegoat in the family can all contribute to emotional problems. Benny does not necessarily need counseling. Benny needs a source of hope for the future. The ability to excel in some area that would allow him to escape his circumstances would strengthen this. A successful male role model that took an interest in him (for example, a big brother) could also be helpful. Emotional support for his mother could also, indirectly, benefit Benny and his brothers. Although helpful interventions in this case are more social than psychiatric, they are no less important if Benny is to have a chance to make it.
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Difficult Temperament And Low self-esteem
Difficult Temperament
Lexy: Lexy had always been considered a "high maintenance" child. She made frequent, loud demands for attention as an infant, and had continued to do so for much of her life. She ate irregularly and slept irregularly, despite numerous attempts by her family to establish routines. She pouted miserably when things were the slightest bit different from what she expected. She insisted on being in charge when playing with her friends. She had difficulty adjusting to high school, where she had to rotate from class to class and had a different teacher in each subject. She became preoccupied with her teachers' different teaching styles, insisting that some were simply wrong. Similarly, her peers could never measure up to her exacting standards, and she soon had a very small circle of friends. If anyone commented on how she was making herself miserable, she blamed that person for the problem.
Low self-esteem,
Carlos: Carlos always seemed to live in the shadow of his older brother, Joe. Joe was an excellent basketball player, top student, and popular among his peers. Carlos was none of these. He was constantly trying to impress his friends with feats of daring, often injuring himself in the process. They merely laughed. Carlos bragged about his computer game system. The other boys thought he was showing off. Their families couldn't afford the latest systems. Inside, Carlos was miserable: constantly comparing himself to others and feeling that he didn't measure up. His stunts and bragging were ineffective ways of looking for praise.
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Lexy: Lexy had always been considered a "high maintenance" child. She made frequent, loud demands for attention as an infant, and had continued to do so for much of her life. She ate irregularly and slept irregularly, despite numerous attempts by her family to establish routines. She pouted miserably when things were the slightest bit different from what she expected. She insisted on being in charge when playing with her friends. She had difficulty adjusting to high school, where she had to rotate from class to class and had a different teacher in each subject. She became preoccupied with her teachers' different teaching styles, insisting that some were simply wrong. Similarly, her peers could never measure up to her exacting standards, and she soon had a very small circle of friends. If anyone commented on how she was making herself miserable, she blamed that person for the problem.
Low self-esteem,
Carlos: Carlos always seemed to live in the shadow of his older brother, Joe. Joe was an excellent basketball player, top student, and popular among his peers. Carlos was none of these. He was constantly trying to impress his friends with feats of daring, often injuring himself in the process. They merely laughed. Carlos bragged about his computer game system. The other boys thought he was showing off. Their families couldn't afford the latest systems. Inside, Carlos was miserable: constantly comparing himself to others and feeling that he didn't measure up. His stunts and bragging were ineffective ways of looking for praise.
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Grief Reaction
Tyler: Tyler's parents had divorced when he was a toddler, and his mother remarried when he was ten. Now fourteen, Tyler had never gotten along with his stepfather, and his older sisters tended to pick on him. He always looked forward to Sundays, though. On Sundays, he visited his grandfather, Bill. Grandpa Bill knew more about baseball than anyone Tyler had ever met, and could describe key moments of every World Series going back to the '40s. Tyler shared his passion. Sometimes, they'd get to watch a game together. Other times, they just went through Grandpa's baseball cards, autographed balls, and other memorabilia and the stories they brought to mind. Grandpa Bill was determined to live alone, even though his health was failing.
One day, Tyler's mother looked very serious. Gently, she tried to break the shocking news to him: his grandfather had had a stroke. He wasn't expected to recover. Three days later, he passed away and Tyler was inconsolable. He had nothing to look forward to anymore. He pined in his room for days. Eventually, his mother suggested he write a tribute to his grandfather for the local newspaper. He was proud to do it. With more encouragement, he began to volunteer to pass out programs when his town's team played a home game. He had never been a great player, but his knowledge of the game soon made him a fixture behind the bench. He set a goal of becoming a sportscaster one day.
Like Nadine, Tyler had to adjust to a major life change. Loss of a key person in a is life can be devastating, especially if unexpected. For Tyler, his grandfather's was doubly important because of the more strained relationships he had with ?r family members. It was not going to be possible to replace his grandfather, as it ly is when the lost person is significant. Instead, he had to find a way to honor his memory, maintain an important aspect of the relationship in his life (in this case, the love of baseball), and go on. Fortunately, his mother was sensitive to these issues and helped him grieve appropriately
As adults, we should never assume that a loss is insignificant to a teen. Apparently distant friends or relatives, even pets, can be missed terribly. Even a famous person the teen admires (for example, a famous musician or actor) can be mourned, especially if that person symbolizes an important aspect of the teen's emerging identity. Don't be shy about asking how your teen's life is different, now that the person is gone. The answer may surprise you. If a grief reaction is prolonged or accompanied by symptoms suggestive of more serious depression, counseling should be sought.
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One day, Tyler's mother looked very serious. Gently, she tried to break the shocking news to him: his grandfather had had a stroke. He wasn't expected to recover. Three days later, he passed away and Tyler was inconsolable. He had nothing to look forward to anymore. He pined in his room for days. Eventually, his mother suggested he write a tribute to his grandfather for the local newspaper. He was proud to do it. With more encouragement, he began to volunteer to pass out programs when his town's team played a home game. He had never been a great player, but his knowledge of the game soon made him a fixture behind the bench. He set a goal of becoming a sportscaster one day.
Like Nadine, Tyler had to adjust to a major life change. Loss of a key person in a is life can be devastating, especially if unexpected. For Tyler, his grandfather's was doubly important because of the more strained relationships he had with ?r family members. It was not going to be possible to replace his grandfather, as it ly is when the lost person is significant. Instead, he had to find a way to honor his memory, maintain an important aspect of the relationship in his life (in this case, the love of baseball), and go on. Fortunately, his mother was sensitive to these issues and helped him grieve appropriately
As adults, we should never assume that a loss is insignificant to a teen. Apparently distant friends or relatives, even pets, can be missed terribly. Even a famous person the teen admires (for example, a famous musician or actor) can be mourned, especially if that person symbolizes an important aspect of the teen's emerging identity. Don't be shy about asking how your teen's life is different, now that the person is gone. The answer may surprise you. If a grief reaction is prolonged or accompanied by symptoms suggestive of more serious depression, counseling should be sought.
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Acute Depressive Conditions
Sometimes depressed mood starts suddenly, in response to a stressful event. There are two such "acute" depressive conditions recognized by mental health professionals. These are: Adjustment Disorder with Depressed Mood and Grief Reaction(s).
In this case, a teen is experiencing a very distressing event that is not extreme enough to be considered a trauma, but nevertheless profoundly affects her mood. School changes or breaking up with a boyfriend or girlfriend, for example, are common triggers of depressed moods. When the depressed mood persists for a month or more, this is called an adjustment disorder. Although unpleasant, adjustment disorders are usually not accompanied by the disturbances of sleep, appetite, energy and concentration, nor by the extreme hopelessness or extremely low self-worth characteristic of major depression. In an adjustment disorder, the change in mood is entirely related to the distressing event, and tends to resolve as the teen adjusts to the new reality (usually, a few days to a few weeks at the most) and finds new sources of enjoyment.
In Nadine's case, for example, she contacted some of her old friends and found out about the struggles they faced at their new school. Her predicament didn't seem so uniquely difficult, and she found comfort in commiserating with them. Eventually, she found a sympathetic teacher at the new school who encouraged her to write for the yearbook, and the peers involved in this activity became her friends. In some cases, supportive counseling is needed to help teens adapt.
If your son or daughter experiences mood changes related to a distressing event, try to provide comfort while maintaining normal routines. If the mood change persists for several months, or you think there might be a risk of self-harm, have him seen by a doctor to clarify the diagnosis and assess whether or not treatment is needed.
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In this case, a teen is experiencing a very distressing event that is not extreme enough to be considered a trauma, but nevertheless profoundly affects her mood. School changes or breaking up with a boyfriend or girlfriend, for example, are common triggers of depressed moods. When the depressed mood persists for a month or more, this is called an adjustment disorder. Although unpleasant, adjustment disorders are usually not accompanied by the disturbances of sleep, appetite, energy and concentration, nor by the extreme hopelessness or extremely low self-worth characteristic of major depression. In an adjustment disorder, the change in mood is entirely related to the distressing event, and tends to resolve as the teen adjusts to the new reality (usually, a few days to a few weeks at the most) and finds new sources of enjoyment.
In Nadine's case, for example, she contacted some of her old friends and found out about the struggles they faced at their new school. Her predicament didn't seem so uniquely difficult, and she found comfort in commiserating with them. Eventually, she found a sympathetic teacher at the new school who encouraged her to write for the yearbook, and the peers involved in this activity became her friends. In some cases, supportive counseling is needed to help teens adapt.
If your son or daughter experiences mood changes related to a distressing event, try to provide comfort while maintaining normal routines. If the mood change persists for several months, or you think there might be a risk of self-harm, have him seen by a doctor to clarify the diagnosis and assess whether or not treatment is needed.
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Adjustment disorder with depressed mood
Nadine: Nadine had a gift for music. Everyone encouraged her to nurture this talent. When the opportunity came along to attend a special high school for the performing arts, there was no doubt that this was where Nadine belonged. Unfortunately, none of Nadine's friends were able to join her at the new school. They all were enrolled in the college preparatory program at the local high school. She missed them terribly, and found it harder than she expected to fit in with her new, artistic peers. Furthermore, at her old school, she was praised regularly for her exceptional talent. At the new school, she actually lagged behind her peers in some areas. Many of them had performed in recitals for years and were already entering professional competitions. Rather than feeling privileged to attend the school, Nadine felt like a fish out of water. She regretted deciding to go there. She became sullen and discouraged as she dragged herself to school every morning. By October, she was skipping classes and withdrawing from peers and family.
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The spectrum of teen depression
Feeling sad from time to time is normal for people of all ages. Feeling depressed is not. What's the difference? Sadness is an unpleasant emotion in response to certain events in our lives. Loss of a loved one or close friend, disappointment at missing a hoped-for opportunity, or struggling to adapt to sudden unwelcome changes, all result in sadness for most of us. Even seeing someone else experience these events in a movie can bring us to tears. Often, the tears, the grieving, the process of getting through the sadness bring relief. V,"e take some time to stop our daily routine, reflect on what has happened, cry, and gradually replenish our energy so we can carry on. This is a healthy process.
Depression is not healthy. Depressed mood, a major symptom of depression, occurs when sadness is partnered with a change in how we perceive ourselves and others. We tend to think less of ourselves than usual. We can't forgive ourselves the slightest mistake. We see others as cold and uncaring. We can't appreciate partial success, or see the silver lining in the cloud. We feel helpless and defeated. We can't imagine facing life's challenges and going on. In short, sadness repairs while depression impairs.
We shouldn't expect our children to be free from sadness. In fact, denying sadness or grief in ourselves or others can cause emotional problems. We should, however, expect our children to be free from depression. The occasional down mood occurs in most teens. Ongoing depression does not. How, as a parent, can you tell the difference? In truth, there is no single test that will tell you. In part, this is because teens don't tell you everything that goes on in their minds. They shouldn't be expected to. A certain amount of privacy is part of growing up and becoming your own person. In part, this is because there is a whole range or "spectrum" of experiences between uncomplicated sadness and clinical depression.
This blog discusses teens all the way along that spectrum. The approach described applies to any teen whose sadness is complicated by feelings of low self-worth, overly negative appraisals of events, helplessness, or hopelessness. In more severe cases, it serves as an adjunct to clinical treatments. In milder depressive states, it may allow you to get your teen back to a more average frame of mind, appropriate to his or her stage of development. Before discussing how to do this, however, let's examine some of the depressive states along the spectrum. Think about which one (or ones) might apply to your teen. In this chapter, we illustrate some of the more common, milder depressive conditions. In the next chapter, conditions on the more severe end of the spectrum (Dysthymic Disorder, Major Depression, Bipolar Disorder) are discussed.
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Depression is not healthy. Depressed mood, a major symptom of depression, occurs when sadness is partnered with a change in how we perceive ourselves and others. We tend to think less of ourselves than usual. We can't forgive ourselves the slightest mistake. We see others as cold and uncaring. We can't appreciate partial success, or see the silver lining in the cloud. We feel helpless and defeated. We can't imagine facing life's challenges and going on. In short, sadness repairs while depression impairs.
We shouldn't expect our children to be free from sadness. In fact, denying sadness or grief in ourselves or others can cause emotional problems. We should, however, expect our children to be free from depression. The occasional down mood occurs in most teens. Ongoing depression does not. How, as a parent, can you tell the difference? In truth, there is no single test that will tell you. In part, this is because teens don't tell you everything that goes on in their minds. They shouldn't be expected to. A certain amount of privacy is part of growing up and becoming your own person. In part, this is because there is a whole range or "spectrum" of experiences between uncomplicated sadness and clinical depression.
This blog discusses teens all the way along that spectrum. The approach described applies to any teen whose sadness is complicated by feelings of low self-worth, overly negative appraisals of events, helplessness, or hopelessness. In more severe cases, it serves as an adjunct to clinical treatments. In milder depressive states, it may allow you to get your teen back to a more average frame of mind, appropriate to his or her stage of development. Before discussing how to do this, however, let's examine some of the depressive states along the spectrum. Think about which one (or ones) might apply to your teen. In this chapter, we illustrate some of the more common, milder depressive conditions. In the next chapter, conditions on the more severe end of the spectrum (Dysthymic Disorder, Major Depression, Bipolar Disorder) are discussed.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
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