Friday 9 January 2009

Depression On Teens - Three Rare but Possible Causes

Past Experience - Depression on teens

In some forms of psychotherapy, the focus is on uncovering or exploring events in the past that may have led to the person's depressed state. This information can be helpful in better understanding the current situation, but it does not necessarily change the individual's depressed mood.

The past is relevant to the extent that it affects current thoughts, feelings, and behav­iors. If repeating destructive patterns can be found, these are worth examining and chang­ing. In depression on teens, however, such patterns are not always evident, and if they are, they often take time to change. Nevertheless, it is surprising how many people are effectively treated for depression with no need to re-examine the past or find the psychological "roots" of their depression. Many depressed people do better looking forward than looking back, focusing on changing current behaviors and thoughts (a so-called "cognitive-behavioral'' perspective) is a forward-looking approach to depression that has been shown to be helpful in adolescents and adults alike.

Hormones

Some girls and women experience depressed mood consistently at certain points in their menstrual cycle. Currently termed "premenstrual dysphoric disorder," this condition can respond to antidepressant medications. In girls with irregular cycles (common the first year or two after menstruation begins), birth control pills that regulate the cycles may regulate associated mood problems as well. Given that most girls' cycles eventually become more regular, however, our practice is to advise pa­tience, and only provide medication when depressive symptoms are severe or do not resolve when the cycles become regular.

Sudden hormonal changes—as occur after giving birth, for example—can cer­tainly trigger depression. Therefore, depression is particularly common in women after having a baby (so-called "postpartum depression"), especially if there has been a previous depressive episode. Because this form of depression can be particularly severe, early contact with a mental health professional is essential.

Lack of Sunlight

There is a subtype of depression on teens called Seasonal Affective Disorder (SAD) that has been linked to the lack of sun exposure people in the Northern Hemisphere expe­rience in the winter months (and people in the Southern Hemisphere experience in the summer months). For people who consistently get depressed during seasons that lack sunshine and not at other times of the year, this diagnosis may apply. Some of these people experience improved mood when treated with photo therapy (bright lights, brighter than ordinary room lighting).

If you think your child or teen may have Seasonal Affective Disorder, talk to the doctor. However, don't leap to conclusions if your youngster is depressed in the win­ter. Remember: winter is associated with less sun, but also with more school. Any stress at school, whether it's academic problems, a tough teacher, or a peer problem, can contribute to depression. For this reason, talk to a professional before considering photo therapy, and only use an approved bright light device. Don't risk sunburn or eye damage by exposing your child to extra sunlight.



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Thursday 8 January 2009

Anxiety described by Wordsworth's Margaret

My apprehensions come in crowds; I dread the rustling of the grass; The very shadows of the clouds Have power to shake me as they pass.
William Wordsworth, The Affliction of Margaret

Wordsworth's Margaret suffered from a problem with which many of us can identify today. He describes a general anxiety disorder, a disproportionate sense of fear and apprehension induced without good reason. Millions of people in the world go through life feeling that there is something terribly wrong with them because of the constant anxiety that pervades their lives. It may be a state of galloping panic, it may be continuous feeling of uncertainty and conviction that something is not quite right.

Anxiety is the permanent companion of so many of us. The Latin word anxius means to press tightly or to strangle; the dictionary defines 'anxiety' as 'a state of chronic apprehension’. Men and women are blessed - some may say cursed with imagination; they can project their thoughts into the future and anticipate what might happen rather than what actually will happen ... and what misery this can cause. Too often anxiety develops into a chronic condition where the sufferer is afraid of the anxiety itself and is then caught in a vicious circle which is difficult to break.

Some people are naturally timid, going through life trying to avoid confrontations that they feel might upset their equili¬brium. Rude behaviour from a stranger or a family row will set them for days and they will avoid arguments at all costs, i is now accepted that many of us are born with a predispo¬sition towards anxiety; others, as we shall see later in this book, ay become oversensitised as the result of some traumatic event, psychological or physiological, and find that they not cope with the stresses of everyday life. In their highly sensitised state these people may experience chronic, nagging anxiety which can disrupt their lifestyles r, in more severe cases, become overwhelmed by sudden devastating attacks of acute anxiety, commonly called panic attacks.

Many people will experience a panic attack at some time in their lives. The after-effects of a serious illness, seeing or being involved in an accident, or experiencing some other traumatic event may result in a one-off panic attack - and that's understandable. Almost everyone at some time feels sick, weak, faint or over-anxious, but these feelings are soon shaken off and we are reassured because we know there was a reason for them. However, there are some people who can experience four or more panic attacks every month without any obvious reason, and this is when the anticipatory anxiety builds up.. the ‘what if?' syndrome. What if I have a panic attack at work? ... at school? ... in the cinema? Anywhere? Now the sufferer is faced with the most crippling phobia of them all: fear of fear itself. We know this as agoraphobia. For many years agoraphobia was understood to be a fear of open spaces, but you will see that this was a misnomer.

Though sufferers have often been unwilling to admit to being agoraphobic, the condition has been recognised for a long time. Richard Burton wrote in 1621 of:
one that durst not walk alone from home for fear he should swoon or die ... if he be in a throng, middle of a church or multitude, where he may not well go out, though he sit at ease he is so misaffected.



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Understanding your nerves

The old English word faer meant 'sudden danger’. Fear is what we experience when something unpleasant or dangerous is happening to us; without any conscious effort our body immediately reacts by producing sensations which are often as unpleasant as the cause. The heart beats faster, blood is shifted from other areas of the body to the limb muscles and to the brain, encouraging quick thinking and vigorous activity. Adrenalin and related chemicals which are released-into the bloodstream provide additional strength, stamina and the ability to respond rapidly. These chemicals help soldiers to survive in battle, athletes to perform better and all individuals to respond more effectively when faced with dangerous situations.

There are people who actually enjoy these sensations, finding them exciting and stimulating, and they frequently seek a career or hobby where there is an element of danger, indulging in hair-raising activities in the name of adventure, exploration or sport. (Think bungee-jumping, white-water rafting and even some of the gut-wrenching rides found in amusement parks.)

Most of us are ashamed to admit that we might be nervous or fearful, since courage has always been considered to be a superior virtue and from childhood we are told to be brave and not show our fears. There can be a backlash, though, because some children - particularly boys - are so conditioned to be 'brave’ that they become over-confident, foolhardy and accident-prone.

Many of the world's great heroes killed in battle might have lived to fight another day if they had been less fearless and more cautious. At the Battle of Trafalgar, Lord Nelson insisted on wearing all his medals and decorations so that the enemy could identify and marvel at the bold British admiral ... they made a great target for a French sniper, and the man who in his youth had remarked, Tear, what is that?' returned to his homeland pickled in a keg of brandy.

Our forebears had good reason to be fearful. In order to survive it was necessary for people to be continually on the alert for danger. Marauding tribes and dangerous animals on the prowl were a constant threat when you had only a club for a weapon and the sparse shelter of a cave to retreat into. When nger threatened, these people, their survival at risk, would e 'tensed up' and ready for action - to stand and fight or to run for their lives.

Over the centuries, as we have become more or less civilised, survival has become easier and most of the earlier dangers have disappeared. Of course, modern humanity has its problems - mainly of our own making - but apart from those people for whom danger is a normal way of life, either in their profession or for entertainment, most of us are fairly assured of our survival to a ripe old age, bar accident or illness. The danger response is not now a necessary daily part of our bodily functions, so when it does occur it is likely to have longer-lasting disturbing effects. The cave people, victorious in battle or having escaped from a woolly mammoth or a sabre-tooth tiger for the umpteenth time, would relax and sleep by the fire, forgetting their nerve-racking experience until the next time. Nowadays, the emotional consequences of a bad shock or accident will persist for much longer, and being unused to such experiences we resent the effect they have on our well-being.

A certain amount of fear is healthy and it prevents us from risking ourselves in dangerous situations. There are, however, many of us who because of our personalities are more prone to fear than others. We can all understand being terrified when onfronted with a dangerous situation, though in these days, apart from being attacked by a mugger or injured in a car accident, life isn't all that dangerous. If we are faced with a life-threatening situation, however, the 'flight or fight* response that our cave people experienced is perfectly normal. In fact, it is imperative that our automatic system goes into overdrive in order that we may tackle the emergency or retreat from the scene as quickly as possible.

But sometimes we get the wrong signals. A sudden surge of fear, even when no danger exists, causes bodily changes. Adrenalin pours into the system, the body prepares itself for action ... but no action follows. If the nervous energy could be discharged, the body would settle down. But when this does not happen there is physiological confusion. I'm sure you recognise the sensations: racing heart, dry mouth, clammy hands, overbreathing, dizziness, a 'tight band round the head', vision disturbance, a 'lump' in the throat and buzzing in the ears. The feelings build up until they seem unbearable and the sufferer, clinging to the nearest static object to support her 'jelly legs', thinks, 'I can't stand it. My system won't take any more. I'll have a heart attack, a stroke, a burst blood vessel. I'll drop down dead, I know I will….’

This is the classic description of a panic attack as experienced by Jane in the previous chapter. Unfortunately the word 'panic' suggests a loss of control resulting in the person screaming and running round in circles. The usual panic attack sufferer does not behave like this. She (or he) feels overcome by feelings of acute fear, but most shrink at the thought of drawing attention to themselves. The struggle to appear calm increases the tension and terror as they fight to conceal their distress. The feelings build up until they seem unbearable and the sufferer, clinging to the nearest static object for support, waits for some dreadful climax. There is no climax. The sensations can only reach a certain level and then they subside.

This does not mean that there are no after-effects of such an experience; a severe panic attack can leave you in a highly sensitised state, weak and exhausted, but it cannot damage you, either physically or mentally.



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What is panic attack?

The ambulance arrives at the A 8c E Department and a young woman is helped through the hospital doors. She is pale and shaking, and breathing erratically... a suspected heart attack. Hospital staff gently encourage her to calm down as they spend the next couple of hours putting her through a number of tests. Jane is terrified; such feelings as she has just experi¬enced have never affected her before and she is convinced there is something terribly wrong - pains in her chest, ringing in her ears, faintness and dizziness and difficulty in getting her breath. These could be symptoms of a number of serious disorders.

'You can go home now, Jane,' the doctor tells her eventually. 'You have just experienced a severe anxiety attack. Nothing else wrong, just visit your GP in the next couple of days and he will prescribe something to settle your nerves.'

Jane sits and waits for her husband to collect her and take her home. Her mind is spinning, and although she is partially comforted by the doctors assurance that there is nothing seriously wrong, surely the frightening feelings she experi¬enced can't be as harmless as the doctor said? She has always been so healthy and now in her mid-twenties she is happily married with a toddler and a young baby. She feels there was no reason for her to have gone through such an overwhelming experience and is mortified at the thought of having made such a fool of herself in public.

By the time Mike collects her, Jane is almost back to her normal self. 'What came over you?' he asks. 'I was told you fainted in the street. You’ve never fainted in your life!

'I felt faint,’ Jane admits. 'But I didn't actually pass out. I was so frightened, my legs turned to jelly and I just sat down on the pavement. That's when someone sent for an ambulance - they thought I was having a heart attack. Surely anxiety couldn't have had such a devastating effect? Why did it happen? What if it happens again?

Next day Jane visits her GP. 'Lots of people may have an anxiety or panic attack,' she is told as she is prescribed a week's supply of tranquillisers, given a pep talk and told to relax and stop worrying.

The family is reassuring, reminding her that she has recently got over a bad cold which hung around for a couple of weeks. 'You're just a bit run down,' her mother tells her. How comforting. A few days resting at home with her mother and sister helping with the children, and Jane feels she will be back to normal.

A week later Jane has almost forgotten her frightening experience in the High Street. She leaves the children with her mother while she and Mike visit the supermarket and do the weekend shopping. What a relief, she thinks ... no unpleasant symptoms, everything is back to normal. She goes with her mother to buy clothes for the children. Nothing untoward happens and Jane feels confident enough to make the next trip to the supermarket on her own.
The supermarket is warm and bright; the usual crowd of weekend shoppers bustle about. Suddenly the lights seem to flicker, Jane's eyes are playing tricks and the noise of the people around her is overwhelming. It's happening again, she thinks, as she tries to fight the rising fear which is becoming difficult to control. Oblivious of the other shoppers she abandons her shopping trolley and escapes through the nearest checkout to get to the car park, where to her relief the frightening feelings subside almost immediately.

The way to stop these feelings recurring must be to avoid the supermarket altogether for the time being. Jane feels that the constant worrying is beginning to affect her in other ways and she feels on edge and jittery all the time. Shopping locally seems to be the answer, and all goes well at first until one day as she is walking along the street the dreaded feelings start building up once again. She feels unsafe and afraid - but what is she afraid of? Not of the shops nor the street, but of the feeling of fear itself.

Time to return to the GP. This time Jane breaks down and cries in the surgery as she tells him she is afraid she is going out of her mind.

A course of antidepressant drugs will help, the doctor tells her, but he will refer her to a psychologist for therapy — unfortunately there is a long waiting list and it could be several months before she can get the help she needs to overcome her panic attacks. In the meantime she should contact one of the self-help groups and learn to manage her recovery.

Perhaps you can identify with Jane and need to know what is the next step to managing your fears. You may not be suffering from panic attacks but have other deep-seated problems such as chronic anxiety; you may suffer from one or many phobias or some other nervous problem that you are desperate to overcome.

Where do you start? First of all you have to learn to face your fears and not be frightened by them. Fear of the fear is the shadow that hangs over you, and once you have mastered that fear you can then tackle the other problems. It wont be easy, but remember: if you had a broken leg you would have to face weeks of physiotherapy, often painful, before you could walk properly again.

Many anxious people cannot bear to read descriptions of symptoms, but you do not 'catch' feelings you read about, even if your imagination makes you feel uncomfortable. Keep reading and you will be surprised at your relief at knowing you are not alone or different from everyone else.



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If You Are Depressed, Your Brain and Body Stop "Talking"

Why does depression affect your brain, body, moods, and behavior—everything about you? Because when you're depressed, your brain and body can't work together well enough to help you function normally. Your body depends on your brain to tell it to eat, drink, sleep, move, and feel. When your brain and body stop "talking," you're unable to process these important messages (it's like your brain is giving you the "silent treatment").

Your brain's limbic system helps regulate your emotions and your motivation. It's made up of several different areas, each responsible for certain tasks. Here are some examples:

• The thalamus screens and sorts messages from your senses (sight, smell, touch, hearing, and taste). If your thalamus doesn't receive the messages correctly, one result might be that foods don't look, smell, or taste appealing.

• The hypothalamus is the source of your feelings, including vein sexual feelings; it also controls your blood pressure and tells you when you're hungry and thirsty. If your hypothalamus is impaired, you may feel hungry a lot, lose your appetite, or have an increased (or decreased) interest in sex.

• The amygdala can activate anger and aggression, or make you feel calm, depending on the part that's stimulated. Overstimulation or under-stimulation of the amygdala may cause problems with anger and self-control.

• The hippocampus forms and stores new memories. If your hippocampus isn't working properly, you may have trouble learning new things or remembering what you've learned.

• The Reticular Activating System (RAS) alerts your brain that messages are coming from the five senses, then helps you concentrate by filtering this input. If this function fails, it may be hard for you to focus. The RAS is also responsible for regulating sleep.

• The cerebellum is responsible for posture, balance, and muscle coordination. If messages aren't transmitted properly in this area, you might have difficulty playing sports or just doing normal daily activities.

• The cerebrum, the largest part of your brain, does the "thinking" jobs like solving problems, making decisions, and receiving, storing, and retrieving memories. Your intellect, language skills, and ability to understand numbers and the alphabet are all based in your cerebrum. If the nerve cells in your cerebrum aren't functioning well, you may not be able to think clearly, use good judgment, or communicate effectively with other people.

In fact, when you're depressed, normal functions like eating, sleeping, walking, thinking, feeling, and remembering may seem like monumental tasks.



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Wednesday 7 January 2009

How to Deal with Normal Teen Behavior

For parents, adolescent development can challenge our ability to deal with strong emotions, and even affect our perception of ourselves (especially if we had difficulty with adolescence ourselves). Furthermore, parents often feel they have less influence over the behavior of adolescents than of younger children. Handling your teen's behavior may be especially problematic if she seems to be deliberately "pushing your buttons"—that is, reacting in ways that predictably make you upset.

When you feel a "button beeing pushed"

Many times, your teen's responses are less deliberate than they first appear to be. Think about these possibilities to understand underlying reasons you feel as if your buttons are being pushed:

• Maybe the teen's behavior reminds you of someone who hurt you in the past.

• Maybe her behavior elicits reactions from you that are like those of someone who hurt you in the past.

In both situations, a negative relationship from the past seems to be "replayed" between you and your teen. Also consider the following possibilities, which are more relevant to your own identity development:

• Maybe the teen's behavior reminds you of an undeveloped part of yourself. (For example, you may pride yourself in being strong and self-reliant, but your teen is repeatedly asking for help with the smallest thing—perhaps you envy her ability to rely on others.)

• Maybe the teen's behavior reminds you of a part of yourself you dislike.

• Maybe the teen's behavior reminds you of something you missed out on in your own adolescence (For example, your teen confi­dently speaks her mind, even when it annoys you, while you were too considerate of others' feelings to be so bold.)

• Maybe you miss being the mother or father of a child, and are irritated by reminders of the fact that she is now an adolescent. (For example, you are upset that your adolescent now does things alone or with others that you used to do with her.)

Consider whether one of the above may be intensifying your feelings about the situation. Then, give yourself a chance to calm down, separate your own feelings from those of your teen, and try to put yourself in her shoes. An empathic parental response should be easier in this frame of mind.

Dealing With Teen Behavior

Here are some parents' ideas for handling teen behavior, regardless of whether the teen has a diagnosis.

• Don't take it personally.

• Don't expect respect, but give it.

• Don't punish endlessly.

• Support independence by letting your teen do some things for herself. (For example, don't argue about why you won't get her a Popsicle from the fridge; just don't do it.)

• If your teen won't go to her room for a time out: give her space, send her to the store, go to your own room, or have an immediate consequence.

• Give her choices, but with limits. (For example, "Do you want to do your math first or your history?"—implying that some sort of homework will be done, but you're willing to negotiate on the order of subjects. Or, "Would you like to take the bus to school or walk?"—implying that school attendance is compulsory, but mode of transportation is negotiable.)



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Panic Attack 520