Tag: Depression

This article originally appeared in Macaroni Kid on February 23, 2021, by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine.  

Question: My son has battled depression and anxiety since late elementary school. He is 16 now. We have tried multiple medications for him, and he sees a therapist regularly. He seems to have gotten worse in the last six months which is no surprise given the difficulties of the past year. I am frustrated because I don’t feel like the meds he is on do enough. It feels like we have tried them all. Any advice would be appreciated.

Answer: Whatever you do, keep trying. I can just imagine how frustrated and hopeless you and he feel—you are doing the right things, and you are not seeing any change. Do not give up.

I hope I can give you some things to think about that might provide ways to further explore and treat his depression. Some people have what is called “treatment-resistant depression.” It means they are not responding as expected to the usual methods of treatment. That means it is necessary for everyone, both professionals and family, to look at other interventions. These are things which need to be considered:

Is the diagnosis correct? There are different kinds of depression which require different kinds of treatment. Since your son’s depression has gone on for this long, he should be treated by a psychiatrist and not a primary care physician.

Is the dose correct? Many psychiatrists are like artists and chemists, in a sense, adding some of this and tweaking some of that, until they get just the right combination. It can take time to find just the right formula of medications. Every person is unique and responds to medications differently.

Are there other mental health conditions complicating treatment? For example, if your son has Attention Deficit Hyperactivity Disorder (ADHD), he could be having trouble both socially and academically, which may contribute to him feeling bad about himself. Treating the ADHD could help with this.

Are there other medical conditions complicating treatment? Medical conditions such as thyroid disorders, mononucleosis, iron deficiency anemia and other vitamin deficiencies like Vitamin D, B2, B6, or folate (Treatment-Resistant Depression in Adolescents, David Brent, MD) can all contribute to depression. Lab work can help assess for these.

How well is your son sleeping? Adolescents are known to spend late night hours on screens and devices; this can interfere with a normal sleep cycle and greatly impact his mood. Medication is not a substitute for lifestyle deficits. Sleep, exercise, good nutrition, and social interactions make life better.

Is your son taking his medication regularly and as prescribed? Missing doses, for example, greatly reduces a medication’s effectiveness.

Is there depression in the family? Is there a family member’s depression, particularly a parent’s, which is not being treated or fully treated? This has a significant influence on how a child views the world.

Is your son currently experiencing bullying, or does he have a history of trauma or abuse? Medication does not treat these issues; however, they have a profound effect on mood. If he has these issues, is he working on them in therapy? Does he need additional assistance from parents, school officials or other professionals with these situations?

Is your son struggling with his sexuality or gender identity? Sexuality and gender identity are big and confusing to adolescents. Could his sexuality or gender identity lead him to family rejection or bullying by peers?

Is your son using substances like alcohol, marijuana or other drugs? Is there alcohol or drug abuse in the family? Using these substances or being affected by someone else’s use of substances alters normal emotional coping.

Is your son thinking about suicide or self-harm? This is so important. Ask him. Educate him that these choices are sometimes the result of feeling very depressed and hopeless. Help him know that there is hope, that as a family you will keep trying to help him feel better. Do not hesitate to take him to the hospital if he is doing things or saying things that make you think he is suicidal. He may be angry, but it is the safest thing to do. If you need help getting him there, do not hesitate to call 911.

Does he have a good relationship with his therapist? Not every therapist is right for every person. Check-in and make sure that he feels connected with and heard by his therapist.

It is very hard to have a child with prolonged depression. Parents feel hopeless and lost. Sometimes parents of depressed children need to talk to someone about it. Call a counselor to help you. Thank you for asking this question. You are not alone.

This and other helpful information on Treatment-Resistant Depression in Adolescents can be found here.

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine.

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Sad red-haired girl

The Emotional Ripple Effect of Someone’s Suicide

I have a tough subject to talk with you about: the extreme and extensive impact of a loved one’s suicide.

This article originally appeared in Macaroni Kid on November 20th, 2019 by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine

I have a tough subject to talk with you about: the extreme and extensive impact of a loved one’s suicide.

Suicide is always shockingly sad anytime we hear of it, whether we know the person or not.  When it happens to someone we care about, like our spouse, parent, a brother or sister, a child or teenager, a neighbor, cousin, uncle, aunt, coworker or friend, it knocks the wind out of us, like a punch in the gut.  It is hard enough to lose someone in the normal course of living, but to lose them to suicide is immeasurably hard to grasp.  It is an unexpected ending and our lives are suddenly changed.    

When someone is the one left behind by a suicide they experience so many emotions, unusual circumstances, awkward conversations, and they have so many questions, most of which have no good answers.  If this were to happen to you, here are some things you may experience:

You may have to endure a police investigation. A police investigation can be unsettling, especially when you’re grieving.  The police have to investigate and they are looking for information, but because of the shock and confusion, giving answers may be difficult.  

You may feel confused, forgetful, or exhausted. A typical reaction to traumatic events is to feel confused or forgetful. You may forget to do your usual routines, like eating or brushing your teeth.  You may feel like you can’t think straight.  You may experience extreme exhaustion (as is typical with emotional pain), yet sleep can be elusive.

You may feel abandoned, left alone by someone you thought cared.  You may wonder, “Didn’t they care about me?” and “Why wasn’t my loving them, enough? Why didn’t they come to me?” Children may wonder what they did wrong.

You may be in denial and not believe that this actually happened, and that it was actually a suicide. 

You may feel numb and feel nothing.  You may even think you have gotten over the event.  Then, suddenly, you are living it with intense emotion.

You may have regrets about not having known they were in serious trouble.  Some people present as fine on the outside and are torn-up with despair on the inside.  Sometimes they work really hard to hide these feelings from loved ones.  I have known many people who say “I wear a mask.”

You may feel guilt or responsibility.  “If only I had…” and “If I would have/could have done something, they would still be here.” 

You may be angry.  You may be very angry–at the person (“How could she do this?” “How could he throw away his beautiful life?”) or at those who you feel should have helped (“Why didn’t the doctor/the school/the counselor do something?”) It is no one’s fault, and certainly not yours.

Your faith may be rocked. “How could God let this happen?”

You may feel shame about it and not want it to be public knowledge.  There is stigma which makes us not want to share when we or a loved one struggles with mental illness.  Our society has equated emotional suffering with weakness.

You may feel relief, which often leads to feeling more shame because you do feel relief.  When someone is depressed to the point of suicide it affects everyone around them.  Their depression can make us feel hopeless and anxious.

You may feel depressed, and alone in your grief.

Emerging after someone’s suicide takes time.  It is best to allow yourself time to grieve, to feel what you feel, and to talk about your questions with a counselor, pastor, or a caring friend.  Don’t do it alone.  If you feel depressed, or in spiritual despair, seek help.  If you feel suicidal, seek help. 

This person you have loved was part of your world.  Talk about your loved one by remembering the good times, as well as the bad times.  This can help with healing.  Say their name.  It keeps them alive in your heart.  Eventually you will come to your own acceptance and peace.  Be gentle with yourself.

 

Suicide Hotline:  1-800-273-8255             Maine Crisis Hotline   1-888-568-1112

 

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine, a mental health and substance abuse treatment agency serving adults, adolescents, children and families. For more information or if you or someone you know needs help, call us at 877-888-4304 or visit our website www.healthaffiliatesmaine.com and click on “Referrals.”

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Teen’s Mood Has Mom Confused

How do you tell the difference between teenage moodiness and depression?

This article originally appeared in Macaroni Kid on October 28th, 2019 by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine

Question: How do you tell the difference between teenage moodiness and depression? My son has been very tired, withdrawn, and sulky since school started. I ask him about school and he says everything is fine. He has friends and is in sports. His grades are fine. When I ask if he is feeling down, he says no and that he’s just tired. It seems like more than being tired or teenage moodiness though. How do I tell the difference?

Answer: You are doing a good job, mom, at paying attention! That is the key to finding an answer to your first question. There seems to be a lot going on here. Some of what is happening may be quite normal and age appropriate, while some may indicate some intervention is needed.  

Many parents are alarmed when their sweet-natured, family-oriented young teen turns, seemingly overnight, into a dark, moody stranger who wants nothing to do with the family. This is also the time when many things parents say are met with rolling eyes and disbelief. The good news; they usually grow out of this. This can be is part of a teen’s developmental task, which is moving toward becoming an adult and separating from parents. The teen years, with the help of hormones, can be full of testing, pulling away, moodiness and pushing boundaries, as they struggle to be different from their parents. It can be a baffling time for parents and really baffling for the teens. The emotions and uncertainty may cause them to experiment with risky behaviors, and affect their feelings about themselves, their world view, and sense of belonging. Sometimes they are overwhelmed by it all and can become moody and depressed, often isolating themselves from family activities and friends. 

Most of the difficulties with teen behavior are episodic, meaning they may have periods of moodiness but also are able to move on from that. So consider how long the moodiness has been going on. If he is able to pull himself out of it and have some periods of a lighter mood it is less serious than if it is prolonged.

The concerning part of your description of your son is about his tiredness. I recommend he have a health check-up to make sure there is nothing physically going on. Many things can cause fatigue. He may be staying up late studying, being online or playing video games. Is he tired from the sports workouts and staying up late to finish homework? If so, there will need to be some monitoring to ensure he is getting more regular sleep. Signs that there may be a problem are if he is spending an unusual amount of time sleeping or he is taking frequent naps. This could indicate depression or another health issue.

Here are some other important questions to consider. How you answer these questions may help you know what you need to do.  

  • Is he spending time with his friends? Are they old friends or new friends?  
  • Is there a special relationship starting or stopping? 
  • Is he feeling bullied or otherwise intimidated at school?  
  • Is his behavior different outside home?  
  • Is he engaged in activities that you have not previously seen him engage in? 
  • Is he pushing you away with his mood, so you won’t recognize that he may be using substances like alcohol, marijuana and other drugs?  
  • Does the school report that he attends regularly?  
  • Has anyone else noticed any change in his behavior?
  • Is he complaining of physical symptoms like stomachaches and headaches? 

Your teen may not choose to talk to you about any of this. If you suspect there is more behind his tiredness, if his symptoms are prolonged, or if he is losing interest in school, friends, sports, etc., then have him screened for depression. Your PCP is the first place to start. Lastly, many teens benefit from seeing a counselor who can be help them navigate the transition into adulthood. There are many counselors who work with youth, both male and female. It is difficult when a parent knows that something is making their teen struggle. I wish the best for you, and him.  

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine, a mental health and substance abuse treatment agency serving adults, adolescents, children and families. For more information or if you or someone you know needs help, call us at 877-888-4304 or visit our website www.healthaffiliatesmaine.com and click on “Referrals.”

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Depression has been called having “the blues”, “feeling down”, “sad” or “in the dumps” but that doesn’t begin to cover what depression is and does. Depression affects the body, mind and spirit.  It can be devastating and life changing. It affects not only the person’s life, but can impact significant others, family members, employment and even the community as well.  It can last for weeks, months or years without treatment and it can end in death by suicide.

Depression is a serious illness.

What causes depression?

Depression has its roots in chemical changes in the brain. There are many factors that can combine to cause depression.  The person’s temperament and personality, early grief and losses, trauma, stressful life events, the change in seasons or any time the body’s internal clock is out-of-sync. Medical problems such as a thyroid imbalance heart attack survivors, immune diseases, cancer, and nutritional deficiencies can also play a part. The presence of persistent pain, women associated with having their premenstrual cycles and some medications and their side effects are all contributing factors. Substance abuse issues and associated withdrawal symptoms can also result in depression.

Genetics plays a part. If someone on either side of the family was depressed there is a better chance that this would be passed on to the next generation.  Depression also affects the brain and is negatively affected by stress.  The more stress and longer the stress occurs, the more the brain and the body is affected.

Are there different types of depression? If so, what are they? 

There are a number of different types of depression. The most common is Major Depressive Disorder which can be mild, moderate, or severe, in partial or full remission.  Other types can include 

  • Persistent Depressive Disorder, known as Dsythymia which occurs for at least two years.
  • Disruptive Mood Dsyregulation Disorder includes temper outbursts with irritability or anger that occur daily and is seen in children between 6-18 years old.
  • Premenstrual Dsyphoric Disorder is associated with the menstrual cycle, starting a week before and ending in the week afterwards. This brings mood swings, crying, irritability and anger, depressive symptoms, tension and anxiety.
  • Substance or Medication Induced Depression associated with taking a substance or medication.
  • Depressive Disorder due to another medical condition. 
  • Specified Depressive Disorder, which is when full criteria cannot be met but most symptoms are present.
  • Unspecified Depressive Disorder. This diagnosis may be made when there is not sufficient information or time to make a specific diagnosis.

In addition, depression can be a symptom of other diagnoses such as Bipolar Disorder, anxiety disorders with depression, Attention Deficit Hyperactivity Disorder and sadness, which is not a diagnosis, but a natural part of our existence.

Can depression be prevented? 

Depression is complex. It can’t be prevented for everyone yet, but it can be treated. That is why one pill won’t work the same way for everyone, and why medication usually takes weeks before a change in symptoms is noticed.  For some people taking their medication as prescribed, being proactive when participating in therapy and actively making changes in their lifestyles can greatly reduce symptoms over long periods of time. Cognitive Behavioral Therapy has proven to be effective in changing thoughts and feelings that are associated with depression and in helping to identify, and make lifestyle changes that reduce depressive symptoms.

How can we help someone who may be struggling?

The first part is to become aware that there has been a change.  The change includes having a depressed mood, a loss of interest or pleasure and feelings of hopelessness or despair.  Remember, depression can be sneaky.  It can start by a person feeling “off”, more sad than usual, or having low energy, and may be perceived as the onset of a flu or cold when no other flu or cold symptoms appear.

Be aware of changes in routine, difficulty with starting tasks, staying in bed longer, or increased feelings of not caring about anyone or anything.  Family members or friends who notice these symptoms should talk to the person about it and suggest that they get help. 

Above all, don’t ignore the symptoms.  Be patient, encouraging, understanding and support the person who is depressed. Talk to them and, more importantly, listen to them. Encourage them to be more active, don’t push too hard, but continue trying.

Are there resources to seek help?

If there are ever any suicidal thoughts or feelings, the person should immediately call their therapist, doctor, or the crisis hotline 1-888-568-1112.  Above all, if the person is a danger to themselves or others, hospitalization may be necessary.

If the person is not suicidal, a doctor’s appointment can help to determine if there is any physical cause for the depression. Depending on the severity, a psychiatrist or doctor may prescribe antidepressants. This can help reduce depressive symptoms and may be given in combination or alone. If there are any side effects noted, encourage the person to call their doctor and go to their appointments. 

Seeing a therapist or clinician, whether on medications or not, has been proven to be effective in helping reduce symptoms of depression. There are a number of psychotherapies treatments that can help.

Research has shown that getting treatment sooner can relieve symptoms quicker and reduce the length of time of treatment. In other words, try to encourage the person to seek therapy.  For the person that cannot get out of the home there are also telehealth services, so getting therapy is easier than ever. The best thing to do to treat symptoms of depression is to get help as soon as possible.

 

Author: Cynthia Booker-Bingler, LCSW, Health Affiliates Maine

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