Title: Depression in Children and Youth: Information for Families
1Depression in Children and Youth Information
for Families
- Compiled by
- Dr. Michael Cheng,
- Child and Family Psychiatrist,
- Ottawa, Ontario, Canada
- This presentation is available from
http//www.drcheng.ca
2What is Clinical Depression?
- A medical condition where a person has
- Body (physical) symptoms
- E.g. problems with energy, sleep, appetite,
concentration) - Mind (emotional, psychological) symptoms
- Mood problems (e.g. sad, irritable, or bored
mood) - Depressive thinking (e.g. low self-esteem,
magnifying negatives, difficulty seeing
positives, loss of hope) - Social symptoms
- Troubles functioning with school, work, or
relationships - Social withdrawal, or avoiding people
- Symptoms lasting at least 2-weeks
3Other terms
- Other terms used for depression may include
- Major depression
- Major Depressive Disorder (the official DSM-IV
term) - Euphemisms in common language include Burnout,
Stress, Mental breakdown, Blues
4Good and Bad News
- First, the bad...
- You have depression, which is a serious condition
- It will require hard work in order to get better
- It may be a very stressful time for you, your
family and friends as we try to overcome the
depression that has crept into your life
5Good and Bad News
- Now, the good news...
- Its not your fault
- You didnt cause your depression
- Depression is treatable, through various ways
- You will get better
- Bad news is that although it isnt your fault
for depression, you arent completely off the
hook you still have the responsibility to deal
with the depression - The good news is that you are not alone, and we
will help you through it...
6How Common Is Clinical Depression?
- At any one time (prevalence)
- 1-3 children have depression (M gt F, incidence
1) - 3-9 teenagers have depression (F gt M, incidence
3) - Over whole lifetime, 20-25 people will meet
criteria for depression
7What causes depression?
- Before we can talk about what causes depression,
it is important to first talk about what every
normal person needs...
8Everyone needs a healthy body, mind, spirit
- People have the following needs
- Biological/ Physical healthy Body, Brain
(Neurotransmitters) - Mind (Psychological health, e.g. good
self-esteem, good emotional state) - Psychological needs, include need for
- Sense of control
- Sense of connections (with people)
- Spiritual need for hope and meaning
9Everyone needs a healthy body, mind, spirit
Body
- Body (Physical, Biological Self)
- Mind (Psychological, Emotional Self)
- Spirit (Spiritual Self)
- Note Overlap, e.g. psychological interventions
can cause biological changes, and vice versa
Mind
Spirit
10What causes Depression?
- Any stresses can contribute to depression
- Body (Biological/ Physical) e.g. medical
illness, drug use, physical vulnerability (e.g.
strong genetic or family history of depression) - Mind (Psychological) needs
- Sense of control any events that lead to a
feeling of failure, e.g. failing a major exam or
test, not getting a job promotion - Sense of connections (with people) any events
that cause problems in relationships, e.g.
conflict with others, loneliness, stresses such
as death, breakups - Spirit any events that lead to loss of hope or
meaning
11Biological / Physical Strategies
- Staying physically healthy
- Sleep
- Diet / Nutrition
- Omega 3 with gt 1000 mg EPA daily
- ? Vitamin B12 1000 mcg daily
- Exercise
- Aerobic exercise
- Organized sports
- Martial arts
- Yoga (interestingly, many meditative
mindfulness techniques being incorporated into
various therapies) - Individual sports
12Biological Approach to Depression
- Traditional Medications
- may be indicated, but generally ONLY if various
non-medication interventions were tried first and
were unsuccessful - recent controversy about safety
- Alternative medications
- St. Johns Wort for mild depression
(controversial) - Omega 3 fatty acids (evidence still lacking)
13Biological Approach to Depression
- Medications
- safe as long as properly prescribed
- prescription glasses analogy
- Medications are like glasses
- If you use someones glasses without a proper
prescription, they probably wont work, BUT that
does not mean that ALL glasses are bad - If it doesnt work, then it simply means
different ones may need to be tried until the
right pair is found
14Biological / Physical Strategies
- Medications
- Should usually be tried only after other options
have been tried first - If other options have been tried and not been
successful, medications can often be very helpful
15Medications
- SSRI (Serotonin specific reuptake inhibitors)
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Fluvoxamine (Luvox)
- Sertraline (Zoloft)
- Others
- Mirtazapine (Remeron)
- Bupropion (Wellbutrin, Zyban)
16Are medications safe in youth?
- For up to date news, visit
- Food and Drug Administration (USA)
- www.fda.gov/cder/drug/advisory/mdd.htm
- www.fda.gov/cder/drug/antidepressants/default.htm
- Health Canada
- www.hc-sc.gc.ca
17Are medications safe in youth?
- Good news
- Epidemiological studies show that youth suicide
has declined in countries in which SSRIs are used - Recent study in summer 2004 showing that for
depression, youth did best with combination of
Fluoxetine AND Cognitive Behavioral Therapy
(March J TADS study, 2005)
18Importance of Tailoring Treatment to the
Individual
- Treatments are like prescription glasses need to
figure out which works with which person, at
which time
19General Support Strategies for Depression
- When supporting the other person
- Assertive, but firm Im worried about you. We
need to talk. Is now a good time? Or should we
talk later? - Ask for permission, I care about you. How can I
support you? - Do you want me to just listen?
- Or do you want my advice?
20Psychological / Coping Strategies
- Having positive coping strategies to deal with
various stresses - Usual stresses are
- Family
- Friends
- School
- Work
- Positive thoughts
- Positive behaviors
21Problem-Solving
- Figure out what the problem is AND what the
desired outcome/solution is - Brainstorm different possible strategies to get
to that outcome - Try one out (for a reasonable amount of time)
- Reassess
- If it doesnt work, then try something else!
22Interpersonal interventions
- Helping people regain their basic needs for
- Agency, autonomy, achievement or control over
ones life (as opposed to having no control or
power in ones life) - Affiliation, or connection with others (as
opposed to conflict or withdrawal from others) - Sense of meaning, or hope (as opposed to having
no meaning or hope) - Activity (as opposed to passivity)
23Interpersonal interventions
- Agency, Autonomy or Control
- Sense of control comes from being able to deal
with stresses and master them - Help the person identify what their stresses are,
and help them problem-solve them - E.g.
- If school work is a stress, then problem-solve
with the youth how to deal with their school work
24Interpersonal interventions
- Affiliation, or Connection with Others
- Help the person identify what their
relationship/social stresses are, and help them
problem-solve them
25Interpersonal interventions Conflict Resolution
- Conflict when one person has one set of
expectations, wishes, and when the other person
has a different set
26Interpersonal interventions Conflict Resolution
- Approach
- Figure out what each person wants
- Ensure what each person wants is healthy
- Figure out what they have in common
- With things that differ, negotiate and compromise
27Interpersonal interventions Conflict Resolution
- Example classic conflict with parents over rules
- Approach
- Jason wants more freedom, e.g. being able to stay
out later - Parents want more responsibility, e.g. being able
to get homework and chores done - Possible solution
- Increased privileges tied to ability to get key
chores done, with contract ON PAPER - Result less fighting/arguing/nagging over
chores, which leads to better relationship
28Cognitive Interventions in Depression
- Depression is maintained by various cognitive
distortions or depressive thinking patterns - Cognitive interventions, as seen in Cognitive
Behavioral Therapy (CBT) seek to change those
distortions, thus resulting in improvement in mood
29I dont want your help
- Having a good alliance makes it easier in helping
another person, e.g. for concerned parents to
help their youth - An alliance is based on
- Agreement on Goals
- Agreement on Tasks
- Bond
- Empathy, Understanding
- Competence
- Consistency, Reliability
- Acting in other persons interests
30How Families and Friends can Help a Depressed
Person
- Do
- Express your concern for the person
- E.g. Ive noticed that... Im worried about
you... - Express your support
- E.g. I know this may be a tough time, but I
support you. - Promote the persons autonomy by giving choices
whenever possible rather than simply telling the
other person what to do - E.g. How do you want me to support you? Spend
time with you? Listen to you? Give you my opinion
on things? - Promote the persons affiliations/connections
with people by encouraging social connections,
activities - Go step by step in making change if a person is
not yet able to accomplish a larger goal/task,
then set a smaller goal/task
31I dont want your help
- Dont
- Blame, or make the depressed person feel guilty
it usually backfires by making the person feel
worse - Just lecture or tell the other person what to do
- Say I told you so
32Helping Alliance Disagreement on Goals Not a
good situation
Task B
Point A
Point B (Your goal)
Task C
Point C (Other persons goal)
33Helping Alliance Agreement on Goals, but Not Yet
Tasks Not a good situation
Your Task
Point A
Point B (Shared Goal with you and other person)
Other Persons Task
34Helping Alliance Agreement on Goals and Tasks
The Ideal Situation
Agreement on Task
Point A
Point B (Shared Goal between you and other person)
35Helping Someone with Depression Deal with
Situations
- When you notice someone upset about a situation
- Ask about what happened
- How did that affect your mood?
- Whats the worst part about what happened?
- What does it mean to you that this happened?
- How can I support you with this?
- What can we do to cope?
- What would you like to see different?
36Helping Someone See the Positive
- If the depressed person expresses a positive
thought - Validate it and reinforce it, e.g. I really like
what you said. - If its a negative thought, consider
- Reframing in a more positive way, like the way we
try to see the glass as being half full rather
than half empty - Reminding him/her of past strengths, or of past
happier times - Reminding him/her that you love and support
him/her - Reminding him/her that depression makes people
have sad thoughts, and it will be better when the
depression is gone
37Solution-, Interpersonal, Behavior Approaches
- What do you want? (Ensure its a healthy goal)
- What can you do to get there?
- Evaluating behaviors
- So, last night, you wanted Jessica to like you
more. Youre saying that you ignored her. Did
that help things? - What would be more helpful?
38Environmental / Social Interventions
- Eating dinner together as a family
- Fun activities with the depressed person, either
in one-on-one, or larger groups during these
times, avoid talking about problems - Regular talk-time with the depressed person
- Getting a pet, e.g. a dog
- Holistic/Alternative approaches include
- Feng Shu
- Way of arranging the environment believed by the
Chinese to foster positive energy - E.g. a depressed person may wish to dress all in
black, or make their room all black let them
express themselves, but insist on a balance of
positive energy by still having some bright, more
cheerful colors
39Spiritual Interventions Finding Hope and Meaning
- Find out what gives that person hope and meaning
- Fill their life with those things (as long as
they are healthy) - Specific examples include
- Helping others, e.g. volunteer work at local
veterinarians, old age home, hospital - Working with animals
- (Constructive) Hobbies, e.g. music
- Organized religion, e.g. Church, Synagogue,
Temple, Mosque
40Suicide
- Thoughts of ending ones life may often occur,
particularly if a person is feeling depressed, or
under stress - Two types
- Passive suicidal ideation person thinks about
dying, but has no intent nor plan occasional
passive suicidal ideation is common - Active suicidal ideation person has intent and
plan to die this requires a Crisis
Intervention, which may range from contacting a
Crisis Line, taking person to their doctor, or
going to the local emergency room
41Practical Tips on Preventing Suicide The Will
to Die
- Thoughts of harm are usually a means to solve a
problem - Types of problems usually involve
- Loss of Connection
- Loss of Control
- Loss of Hope / Meaning
- Help that person find other healthier ways to
solve their problem, or reach their goals
42Practical Tips on Preventing Suicide The Means
to Die
- Preventing the means to die
- Secure life threatening objects from the home
- Firearms
- Heavy rope
- Dangerous medications
43Practical Tips on Preventing Suicide The Will
to Die
- Communication
- Open communication
- Listen
- Empathize
- Be non-judgemental
- Help with problem-solving, What is the problem
that makes you think about suicide? - Offer support, How can I support you?
- Point out strengths
- Be ready to ask for help from non-professionals
and professionals
44Practical Tips on Preventing Suicide The Will
to Life
- The fact that person is still is proof that
despite the part that wants to die, there is
clearly a larger part that wants to live - Our goal is to magnify that part
- What makes you want to live?
- What keeps you living?
- What needs to change so life is more worth
living for you? - I love you how can I support you?
45Sequence of Interventions
- Self-help
- Mental, e.g. reading, music
- Physical, e.g. sports, walking
- Social, e.g. talking to others, going out
- Turning to others
- Friends, Neighbours
- Family (immediate family, relatives)
- Church / Spirituality
- Peers at school, work colleagues
46Sequence of Interventions
- Professionals
- School teachers, social workers
- Agencies
- Physician / pediatrician
- Private psychologists
- Private counselors, e.g. social workers
- Try non-medication interventions first
- If despite various other intervention(s),
depression persists, consider medication,
especially if strong family history of depression
47School Accommodations for Depression include
- Flexibility for missed time for doctors
appointments - Exact accommodations may need to be
individualized to the individual student - Closer supervision, and emotional support or
check-ins with staff (e.g. teachers, social
workers, vice-principals...) - Ensuring continued school attendance is
important, although may consider reducing
academic expectations in the interim, e.g. less
courses, more time in resource room
48Finding a psychologist
- Employee Assistance Program, or Student Health
Services (at University/College) - Ontario Psychological Association Referral
Service, 1-800-268-0069, www.psych.on.ca - Ottawa Academy of Psychology, (613) 235-2529,
www.ottawa-psychologists.org/find.htm
49Service Agencies Providing Counselling, Support
- Youth Services Bureau (for teens aged 12-20),
(613) 562-3004, www.ysb.on.ca - Family Service Centre, (613) 725-3601,
www.familyservicesottawa.org - Catholic Family Service Centre, (613) 233-8418,
www.cfssfc-ottawa.org - Jewish Family Service Centre, (613) 722-2225
- Ottawa Christian Counselling, (613) 729-8454,
www.christiancounsellingottawa.ca - Immigrant Services Organization (613) 725-0202,
www.ociso.org
50Service Agencies Providing Counselling, Support
- Centre for Psychological Services at U of Ottawa,
(613) 562-5289, www.socialsciences.uottawa.ca/psy/
eng/centre.asp - Centre Psychosociale pour enfants et familles,
(613) 789-2236, www.centrepsychosocial.ca
51Service Agencies Providing Counselling, Support
- For trauma
- Centre for the Treatment of Sexual Abuse and
Childhood Trauma. Tel (613) 233-4929. Web
www.centrefortreatment.com - Ottawa Rape Crisis Centre, PO Box 20206, Ottawa,
K1N 9P4, (613) 562-2334 Fax (613) 562-2291
52Resources for youth with problems with violence
or behavior
- For youth under age 12
- Crossroads Childrens Treatment Centre,
613-723-1623 - For youth above age 12
- Robert Smart Centre (during a crisis),
613-722-4591 - Youth Services Bureau, 613-729-1000
- For parents ? Parents Supporting Parents
- Irrespective of age
- Liaison with Ottawa Police Services, either
through School Resource Officers, Youth Division,
Ottawa Police Youth Centre
53Crisis resources include
- Distress and Telephone Aid Lines
- Distress Centre, 613-238-3311
- Kids Help Phone, 1-800-668-6868
- Parents Help Line, 1-888-603-9100
- During a crisis
- Ottawa Mobile Crisis Team (age 0-16),
613-562-3004 - Robert Smart Centre Crisis Unit, 613-722-4591
- Poison Control Centre, 613-737-7600
54Hospital Emergency Rooms
- Age 0-18
- CHEO
- Aged 16
- Ottawa Hospital (General or Civic Campus)
- Queensway Carleton Hospital
- Hôpital Montfort
55Support Group
- Parents Lifeline of Eastern Ontario, CHEO-based,
parent group providing support to parents whose
youth are struggling with mood and behavior
problems, www.pleo.on.ca
56There is Hope Depression is treatable!
57Acknowledgements
- Stock photo of sky from www.freestockphotos.com