Stress, Anxiety and Depression

1. Stress, Anxiety and Depression Presentation for Youthnet, Cottage Boardroom, Nov 16, 2005 Michael Cheng, Psychiatrist http://www.drcheng.ca

2. This presentation is protected under a Creative Commons Deed (http://creativecommons.org/licenses/by-nc-sa/2.0/ • You are free to copy, distribute, display and perform this work, as long as this work is not used for commercial purposes

3. Goals • An overview about stress, anxiety and depression in youth • What is it • What causes it • What can you do about it • Where to get help (in Ottawa)

4. Top Questions from Youthnet Facilitators • What is the meaning of life? • What is bipolar? • Common causes of teenage depression? • What to do when having an anxiety attack? • Where to refer someone with mood/anxiety problems (in Ottawa)?

5. It’s All About Balance

6. Q. What do normal people need in life?

7. Everyone 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

8. The Triple A Agency / Autonomy / Achievement Activity (as opposed to passivity) Affiliation (Relationships)

9. The Triple C Control “Chipper” (or being active) Connections with Others

10. Three P’s Power Proactive People

11. Point A Point B (Goals)

12. Obstacles such as stress (at home, school, work), depression, anxiety Point A Point B (Goals)

13. Life is full of things that cause imbalance (in mind, body, spirit)

14. Typical stresses in our modern society • Body • Medical / physical illness • Lack of sunlight / Drug Use • Mind / Social • School / Work • Classmates / co-workers • Family • Friends • Boyfriends/girlfriends • Spirit

15. Life is a balance between coping and stress Demands / Expectations / Stresses Coping Ability

16. Problems if demands, expectations or stresses outweigh coping Coping Ability Demands / Expectations / Stresses

17. There are two solutions to restore the balance...  Coping Ability Demands / Expectations / Stresses

18. Stress can lead to: • Physical problems • Emotional or mood problems such as • Depression • Anxiety • Eating Disorders • OCD • Any problems with mood/coping...

19. Prevalence of Mental Disorders in Children and Adolescents in Canada (Stats Can, 2002, age 0-19)

20. Mood Disorders: What is It? • Everyone gets sad from time to time • Just enough sadness is good because it alerts people to do something to change their situation • Mood disorders are when people’s moods are so extreme that it gets in the way of life • It is not normal, and is not something that someone can easily ‘snap out of’

21. Mood Disorders: To Diagnosis or Not to Diagnosis? • Classified according to the DSM-IV • For formal DSM-IV criteria for disorders, visit www.mentalhealth.com • Although imperfect, the DSM-IV nonetheless reflects an improvement from the past, when there was no common language in talking about what was, or was not a mental condition • Each version of the DSM gives us a greater understanding of mental conditions

22. Mood Disorders: To Diagnosis or Not to Diagnosis? • Pros • Gives us a common language • Allows people to learn and get support about their condition or problems • Cons • Being ‘labelled’ may carry a stigma (perhaps stigma is the true problem?) • The fact that people may misuse a diagnosis to avoid responsibility for a problem • Being put into a box

23. My personal bias... • Appropriate use of a ‘diagnosis’ in the right situation can be helpful

24. Example of How To Use a Diagnosis • “You’ve told me that before having these problems with your mood, you were always a happy, high achieving, outgoing person.” • “You’ve mentioned having problems with your mood, sleep, appetite, concentration and energy, and that you’ve been feeling hopeless.” • It sounds like you may have a medical condition called depression. The good news is that this condition is very treatable and we can help you feel better again.”

25. Example of How To Use a Diagnosis (Cont’d) • “You are not responsible for causing this condition.” • “However, it is mainly up to you to get better.” • “But the good news is that you are not alone – we will support you in overcoming the depression.”

26. Mood Disorders: Types • Major Depression (aka Clinical Depression, Major Depressive Episode) • Dysthymic Disorder (aka low grade depression) • Adjustment Disorder (mood problems following a stress, but not severe enough to be major depression • Bipolar Disorder

27. Major Depression • Problems with mood (sad, angry, irritable), PLUS • Physical problems with • Sleep, Energy, Appetite, Concentration • May also have problems with • Thoughts • Low self-esteem • Hopelessness / Suicidal thoughts • Behaviors • Social withdrawal, loss of function

28. Dysthymic Disorder • Problems with mood (sad, angry, irritable), PLUS • Some physical problems • Some problems with • Thoughts • Behaviors • BUT is not as severe as Major Depression

29. Adjustment Disorder • Problems with mood (which are not severe enough to meet for depression or dysthymic disorder) following a stress • Does not involve significant changes

30. Bipolar Disorder • A condition with severe highs and lows where one’s moods are like a roller coaster, to the point it causes problems • During highs • Mood high or irritable, excessive energy, less need for sleep, excess talking, excess activities • During lows • No energy, depressed mood, more need to sleep, i.e. essentially like being depressed

31. Anxiety Disorders • Everybody has worries and gets anxious from time to time • Just enough anxiety is helpful because it keeps us cautious and safe • Anxiety Disorders are when one has so many worries that they get in the way of life

32. Types of Anxiety Disorders (or Conditions) • Generalized Anxiety Disorder • Constant worries with physical symptoms that cause problems • Panic Disorder • Out of the blue feelings of panic that cause problems • Obsessive Compulsive Disorder • Repetitive thoughts or behaviors that cause problems • Social Anxiety Disorder • Extreme shyness that causes problems

33. Restoring the Balance

34. A General Approach to Helping Others • Figure out the person’s goals • “What would you like to get from coming here to see me/us?” • Figure out what to do to get to that goal • “What do you think we need to do to get to your goal?”

35. A General Approach to Helping Others • Figure out what stress is causing (or contributing to) the anxiety or depression • Usual stresses include • School • Family • Friends • Problem-solve and find ways to deal with that stress

36. Approach to Conflicts • Conflict is when two parties want or expect different things • Solution • Figure out what each party wants or expects from the other • Ensure it is reasonable • For things that each party wants in common, great! • For things that each party disagrees on, negotiate and compromise

37. Everyone 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

38. Body • Ensure healthy amounts of • Sleep • Diet/nutrition • Exercise • Individual exercise • Group / social exercise • Yoga / Martial Arts • Sunlight (in the case of winter depression)

39. Body • Medications may be a helpful ‘body’ or physical intervention in certain circumstances • For anxiety and depression, in general • Non-medication strategies are tried first • Medications are used if non-medication strategies are unsuccessful

40. Body • Common types of ‘self-medication’ • Sweets, carbohydrates, chocolates • May possibly be a way of getting serotonin • Exercise • May be a way of getting adrenaline / dopamine • Caffeine • May be a way of getting adrenaline / dopamine • Street drugs

41. Mind • Ensure good coping strategies and ways to deal with stress • School / work • Family • Friends and • Boyfriends/girlfriends

42. Mind • Psychotherapy such as cognitive behavior therapy • Anxiety or depression is caused by cognitive distortions • Fixing cognitive distortions will overcome the anxiety or depression

43. Thoughts

44. Spirit • Figure out what gives meaning to the person’s life • Ensure those things are in the person’s life

45. Types of Help for Anxiety and Depression • Speaking with friends • Speaking with family • Speaking with religious supports (e.g. chaplain, priest, rabbi, iman, etc.)

46. Types of Professional Help for Anxiety and Depression • School personnel (teachers, guidance counselors, vice-principal, social workers, coach, etc.) • Medical Doctors (family physicians, pediatricians, psychiatrist) • Psychologists • Counselors • Social Workers

47. Questions?