The Nature of Depression: An Overview for Parents and Youth Daphne J Korczak MD, MSc , FRCPC (peds), FRCPC (psych) Head, Inpatient and Day Treatment Program Psychiatrist Hospital for Sick Children Psychiatrist, Hospital for Sick Children Assistant Professor, University of Toronto Helping Kids Cope with Anxiety & Depression Conference Helping Kids Cope with Anxiety & Depression Conference The Learning Institute, Hospital for Sick Children April 5, 2014
Pre-Test: True or False? Being depressed is a normal part of adolescence Sometimes it’s hard to tell when a child is depressed p When a child is depressed, parents are usually to blame When a child is depressed, parents often feel responsible Getting information and help for depression is more difficult than getting information and help about other difficult than getting information and help about other medical illnesses
Example: Paul 15 year old boy, previously well Feeling upset for the past 5-6 months, “everything annoys me”, Attends school daily but feels it’s “pointless, teachers are stupid, work isn’t hard but I don’t want y p , p , to do it” Difficulty concentrating Grades are not as high as before (60-70 now; 80-90 previously) Not interested in starting soccer as usual He has a few friends he enjoyed playing sports with, now doesn’t want to play with them. Not f f ’ interested, wants to be left alone. Tired, naps in the day a couple of times a week, sleeps 9 hrs per night, but takes him about 1.5-2 hours to fall asleep. Occasionally has had thoughts like “what’s the point, life is too hard” His parents say he has always been a sensitive child, but this is different. Over the last year he has been bullied at school by a couple of kids in particular, on and off, not happening recently. Paul’s father has a history of depression as a younger man, doing well over the last 7-9 years.
When is sadness excessive or developmentally inappropriate? developmentally inappropriate?
Depression: Factors to consider Prolonged Pervasive P i Associated features Impairing Impairing Out of keeping Note: “out of keeping” does not mean “for no reason” Note: out of keeping does not mean for no reason
Depression Rates and Global Impact 40 40 alence (%) 30 20 10 10 Preva 0 World Health Organization (WHO): Depression will be the 2 nd leading Depression will be the 2 nd leading cause of global burden of disease by the year 2020 (4 th in 2000)
Coping with depression p g p Depression is common. Many adolescents, parents 1. and families are facing similar challenges.
What causes depression?
What causes depression? A number of factors combine genetics to result in depression: environment environment Stressor Stressor is often “the final e g bullying e.g. bullying, straw” for an already straw for an already break-up vulnerable individual
Depression: Brain Changes p g 10 Single photon emission computed tomography g p p g p y (SPECT) images from a depressed person showing characteristic changes compared to a non-depressed person Depressed: less red, more green =Decreased cerebral blood flow and glucose metabolism frontal parts of the brain parts of the brain
Depression: Brain Changes 11 The longer that depression was untreated, the smaller the hippocampus volume measured
Coping with depression p g p Depression is common. Many adolescents, parents 1. and families are facing similar challenges. This is an illness. It’s real. 2.
Depression: Thought Patterns Self: Self: “I am worthless” “I am not good enough” “I am unloveable” Environment: Environment: Future: Future: “The future is bleak” “The world is hostile” “The future is hopeless” Depressed Mood
Effect of symptoms y p No motivation Social withdrawal D Decreased energy d Poor concentration Poor sleep Fatigue
Coping with depression p g p Depression is common. Many adolescents, parents 1. and families are facing similar challenges. This is an illness. It’s real. 2. Depressive symptoms make it more difficult than usual 3. to do the things that you want to do to do the things that you want to do. Trying counts. Trying counts
Treatment of Depression p A full assessment is needed to make a diagnosis Rule in/rule out other disorders Examine contributing factors that can be addressed Education about depression is an important first step Understanding the illness Understanding the risks associated with untreated depression U d t di th i k i t d ith t t d d i Treatment intensity is tailored to symptom severity Treatment intensity is tailored to symptom severity Early intervention is better, but not always possible Safety is paramount Embark on treatments that are likely to work y
Treatment of Depression p Mild symptoms can be highly responsive: Mood diary – readily available, can be a useful tool Healthy eating/sleeping (screen time) Addressing stressors – school, social, family Avoiding substances Increasing positive activities Increasing positive activities Exercise Possibly omega-3-fatty acid supplements Possibly omega 3 fatty acid supplements
Treatment of Depression Mild to Moderate Depression: Cognitive Behavioural Therapy Particularly if there is pre-existing anxiety + non-specific strategies, where possible Other psychotherapies may also be helpful, depending on the p y p y p , p g clinical picture
Treatment of Depression p Moderate to Severe Depression: Anti-depressant medication is more likely to be required +/- CBT + non-specific measures, where possible SSRI medications can be safe and effective in the right SSRI di ti b f d ff ti i th i ht circumstance and with proper medical supervision A few large studies of the treatment of depression in adolescents A few large studies of the treatment of depression in adolescents have found that the more severe the depression, the less likely that CBT will work on its own. Combination of medication +CBT better than either alone?
Coping with depression p g p Depression is common. Many adolescents, parents 1. and families are facing similar challenges. This is an illness. It’s real. 2. Depressive symptoms make it more difficult than usual 3. to do the things that you want to do to do the things that you want to do. Trying counts. Trying counts Depression is a treatable illness like any other. p y 4.
Questions ??
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