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What you need to know about

Anxietymost days for a period of at least six months, with associated physical symptoms such as irritability andWhat is it?

Anxiety is a natural response to a stressful or dangerous situation. The body reacts to a situation with a racing heart, sweaty palms and shortness of breath. For those with an anxiety disorder, this reaction is more intense, occurs frequently and can last hours, even days.

sleep disturbance.Post Traumatic Stress Disorder (PTSD)This is characterized by flashbacks, re-experiencing, persistent avoidance of people and places that remind one of the event, and increased arousal, such as difficulty concentrating, anger and jumpiness in response to the terrifying experience in which physical harm occurred or was threatened in.

Individuals with anxiety disorders tend to avoid anxiety-provoking situations, and relationships, school and activities and recreation.

oftenwork

have difficulty with Social Phobia

Individuals experience excessive fear in social situations where they believe they are going to be judged negatively or make a fool of themselves, and which interferes with relationships, work and school performance.

performance,

social

How prevalent is it?Anxiety disorders affect 12% of the population, making it the most common mental illness in Canada. For a variety of reasons, some individuals may not seek treatment for their anxiety, even though it can be effectively treated through many different options.

Panic DisorderIndividuals have repeated panic attacks (with physical symptoms such as palpitations, sweating and trembling) along with avoidance of places and situations that caused the anxiety.

Specific PhobiaIndividuals may experience only a specific phobia, such as a fear of flying, a fear of spiders, a fear of escalators, and so on, without the anxiety translating into other facets of their lives.

Who is at risk?If you have a family member with an anxiety disorder, you have a higher chance of developing one.

Obsessive Compulsive DisorderObsessions are uninvited, intrusive thoughts, such as concerns or doubting, that are time-consuming and cause distress. Compulsions are behaviours or rituals that are followed to try to reduce obsessive thoughts, e.g. handwashing or checking.

What are the risk factors/triggers?Anxiety disorders can be the result of

a number offactors, including genetics (children of adults with

an anxiety disorder have a higher risk of developing one), psychological (individual has a tendency to overestimate danger) and experiences (e.g. an embarrassing moment or a traumatic event).

What do I need to tell my doctor?

Anxiety may coexist with depression or bipolar disorder and make coping more difficult. It is important that symptoms of anxiety and a mood disorder be treated.

• Write down symptoms you’ve had and in which situationsWrite down key personal informationMake a list of all medications you are taking Write down questions to ask your doctor Take a family member or friend along

••••What are

the symptoms?Generalized Anxiety Disorder (GAD):GAD is characterized by excessive and

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Your doctor can suggest or provide appropriate therapy. Based on your symptoms, discuss all of the

available treatments and medications and their benefits and side effects before making any decisions.

• Learn about anxiety disorders. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what triggers your anxiety. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs. Get exercise. Physical activity may help reduce anxiety. Consider walking, jogging, swimming, gardening, or any other physical activity.Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well.Avoid alcohol and illicit drugs. It may seem like they lessen your worries, but in the long run, they generally may make it worse and make your condition harder to treat.

•

What are the treatment options?The most common forms of treatment for anxiety disorders include medication, Cognitive Behavioural Therapy (CBT) or a combination of the two, along with exposure therapy. Individuals can almost always be treated without being admitted to a hospital.

•

•

•CBT is a problem-focused treatment that allows the individual to change unproductive thought patterns and gain control over unwanted behaviours. It may also be worth exploring relaxation techniques to reduce stress. Additional treatments, such as massage, mindfulness meditation, shiatsu, therapeutic touch, aromatherapy, tai chi, Pilates and yoga, can also help to improve wellness.

•

Where can I learn more?

Anxiety and Depression Association of America

www.adaa.org

Exposure therapy, also known as desensitization treatment, is a systematic process wherein an individual with a fear or phobia is taught relaxation techniques and is then gradually exposed to the object of fear until it can be tolerated. Over time, the fear response is extinguished.Medications may also be given, and typically include antidepressants such as SSRIs (selective serotonin- reuptake inhibitors) and benzodiazepines. Don’t give up if one drug treatment fails; another may prove to be effective, even a drug of a similar type. Drug combinations may be tried if a single drug does not provide relief. Because some anxiety disorders are chronic, drug therapy may be needed for prolonged periods, even

American Psychiatric Associationwww.psychiatry.org/patients-families/anxiety-

disordersSocial Phobia/Social Anxiety

Associationwww.socialphobia.orgThe Panic Centerwww.paniccenter.n

etComplementary therapy, such as peer support groups and other support programs may also be helpful.

What are the things I need to do to get well?

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.

Brought to you by theMood Disorders Association of

Ontario 1-866-363-MOOD (6663)www.mooddisorders.ca


Bipolar Disorder

What are the symptoms?

What is it?Bipolar disorder is in a class of mood disorders that is marked by dramatic changes in mood, energy and behaviour. The key characteristic of people with bipolar disorder is alternating between episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months. The mood disturbances are severe enough to affect the person’s ability to function. The experience of mania can be very frightening and lead to impulsive behaviour that has serious consequences for the person and the family. A depressive episode makes it difficult or impossible for a person to function in his or her daily life

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Sad mood Preoccupation with failures or inadequaciesLoss of self-esteem Slowed thinking, forgetfulness Difficulties in concentrating and in making decisions Loss of interest in work, hobbies,

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Social isolation Lethargy or agitation Changes in appetite— eating too little or too much Oversleepingor insomnia Decreased sexual drive

•• •

• •

••

Bipolar disorder is a medical condition that treated.

can

beSymptoms of mania include:

• Elevated, expansive moodExtreme irritability Rapid, unpredictable emotional changes Racing thoughts, flights of ideas Overreaction to stimuli Misinterpretationof events

• Increased interest in activities OverspendingSense of grandiosity, inflated self-esteem Excessive energy Decreased needfor sleepIncreased sexual

How prevalent is it?Bipolar disorder affects approximately 3 to 5% of the

••

••

adult population and is equally males and females.

distributed

between

• ••

•• •Who is at risk?

If you have a family member with bipolar disorder, you may be slightly more likely to develop it yourself.

•

What do I need to tell my doctor?What are the

risk factors/triggers?Bipolar disorder has no single proven cause, but research suggests that the condition is due to abnormalities in the way some nerve cells in the brain function or communicate. The disorder makes people more vulnerable to emotional and physical stress. As a result, stresses, such as upsetting experiences, substance use or lack of

•••••

Write down any symptoms you’ve had Write down key personal informationMake a list of all medications you are taking Write down questions to ask your doctor Take a family member or friend

Describe to the doctor what people think your “normal” personality is like. Describe how things are different now. Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things

done). Your doctor can suggest or provide appropriate therapy based on your symptoms. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

Pay attention to the warning signs. Find out what triggers episodes. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.What are the

treatment options?The most common forms of treatment for bipolar depression and mania are medication (mainly mood stabilizers such as Lithium or Epival) and psychotherapy, used alone or in combination with other treatments. The use of atypical antipsychotic medication such as Zyprexa, Risperidal or Seroquel has become more common, as they demonstrate fewer side effects than the older drugs, and serve to stabilize mood as well.

Get exercise. Physical activity reduces symptoms of depression. Consider walking, jogging, swimming, gardening, or any other physical activity.Avoid alcohol and illicit drugs. It may seem like they lessen symptoms, but in the long run, the symptoms generally get worse and may make your condition harder to treat.

Get plenty of sleep. This is especially important. If you’re having trouble sleeping, talk to your doctor about what you can do.

Some of the factors that determine the type of treatment are the nature of the symptoms, the severity and duration of the condition, possible precipitating causes and previous response to treatment. Approximately one in three people with bipolar disorder will remain completely symptom free by taking mood stabilizers.


Depression and Bipolar Support Alliance

www.dbsalliance.orgComplementary treatments, such as peer group support and other support programs, may also be helpful. Bipolar Disorder: A Guide for Patients and

Familieswww.psychguides.com/bp_patient

Additional treatments, such as massage, mindfulness meditation, shiatsu, therapeutic touch, aromatherapy, tai chi, Pilates and yoga, can also help improve wellness.

American Psychiatric Association

www.psychiatry.org/patients- families/bipolar-disordersWhat are the things I

need to do to get well?There are a number of medications available to effectively treat bipolar disorder. Often, the most effective treatment is a combination of medication and psychotherapy. There are also certain lifestyle choices that can supplement treatments:

Bipolar Burble (blog)

www.natashatracy.co

Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.

Learn about bipolar disorder. Empower yourself by learning about your condition.




Depression• Biological factors unique to the individual, as

well as hormonal changes due to physical conditionsWhat is it?

Depression is more than being sad or feeling grief after a loss. Depression is a medical condition, just like diabetes or heart disease. Day after day, depression affects your thoughts, feelings, physical health and behaviours. It affects normal day-to-day activities. For diagnostic purposes, a depressive episode must be experienced at a certain level of severity for a minimum duration of two weeks.

• Early childhood trauma

What are the symptoms?•

•••

Sad moodPreoccupation with past failures or inadequacies Loss of self-esteemFeelings of uselessness, hopelessness, excessive guiltSlowed thinking, forgetfulness, difficulty concentrating, difficulty in making decisions Loss of interest in work, hobbies, people Lethargy and fatigueAgitation or restlessnessChanges in weight and appetite — eating too little or too much Oversleeping or insomnia Decreased sexual drive

How prevalent is it?Almost 3 million Canadians have serious depression. It accounts for 30% of all disability recorded at three of Canada’s best known companies. Depression affects 10 to 15% of men and 15 to 25% of women.

••••••••

Who is at risk?These factors can increase the risk triggering depression:

of developing

or


••••

Having relatives with depression Being a womanHaving traumatic experiences as a child Having family members whohave committed suicide Experiencing stressful life eventsHaving few friends or other personal relationships Recently having given birth (postpartum depression) Having a serious illnessAbusing alcohol or drugs

•••••


•••••• Discuss all of your symptoms with your

doctorand

describe how they are affecting your life (e.g. inability to get out of bed and get to work/school). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

What are the risk factors/triggers?It’s unknown exactly what causes depression. There What are the

treatment options?The most common forms of treatment for depression are antidepressant medication and psychotherapy. The most effective treatment is generally a combination of both.

• Family history and genetics — inherited traits, including psychological vulnerability, and relatives with depression

• Life events, such as a loss of a loved one, financial


Anxiety and Depression Association of America

www.adaa.org

Some individuals suffering from depression may need a hospital stay or an outpatient treatment program until symptoms improve.

There are several types of antidepressant medication available, and they are categorized by how they work on the naturally occurring chemicals in your brain that affect your mood. Finding the right medication or medications will likely take trial and error. Patience is required, as some medications need eight weeks or more to take full effect, but don’t give up if you don’t find the right medication right away.

American Psychiatric Associationwww.psychiatry.org/patients-families/

depressionHope for Depression

www.hopefordepression.orgComplementary treatment, such as peer support

groups or other support programs, may be helpful. Mayo Clinic — Major Depressionwww.mayoclinic.com/health/depression/

DS00175Finally, additional treatments such as massage, mindfulness meditation, shiatsu, therapeutic touch, aromatherapy, tai chi, Pilates and yoga can also help to improve wellness.


• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed. Learn about depression. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what triggers your depression. Makea plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce the symptoms of depression. Consider walking, jogging, swimming, gardening, or any other physical activity. Maintain an adequate diet. The CanadaFood Guide is a useful reference in helping you choose how to eat well.Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen

•

•

•

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Early PsychosisWhat is it?The word “psychosis” is used to describe conditions that affect the mind, in which there has been some loss of contact with reality. The terms “early psychosis” or “first episode psychosis” mean that an individual is experiencing psychosis for the first time. Hallucinations, delusions (false beliefs), paranoia and disorganized thoughts and speech are symptoms of psychosis. Psychotic episodes are periods of time when symptoms of psychosis are strong and interfere with regular life. Although the lengths of these episodes vary from person to person and may only last a few days, psychosis is most likely to continue for weeks, months or even years unless the person is

Disorganized Speech or Behaviour. People with psychosis often have difficulty organizing their thoughts, actions and speech. One may move quickly from one topic to the next, or be difficult to understand. The person may have difficulty performing activities of daily living (e.g., cooking, self-care) or display inappropriate behaviours or responses (e.g., laughing while describing a personal tragedy).Some examples of negative symptoms include:

• Little display of emotionsNot speaking very much

• Difficulties in thinking or coming up with ideas Lowered levels of motivation or drive

• •

What are the symptoms?Early Signs

What are the risk factors/triggers?Approximately 3% of people will experience a psychotic episode at some stage in their life, although a first episode usually occurs in adolescence or early adult life. Psychosis occurs across all cultures and

••

Social withdrawal Reduced concentration, attention Depression/anxiety

•••

Sleep disturbance Suspiciousness Skipping school or work•

These symptoms could be signs of many things, including adolescent behaviour. Early intervention increases the chance of a successful recovery and so it is important to address changes in one’s thoughts, behaviours, moods and perceptions.

Psychosis can occur as a result of an illness, medical condition, drug use and stress. Some conditions in which psychosis may be present include:

•••

Schizophrenia Bipolar Disorder Depression

• Brain Injury/ Brain Tumor

Symptoms During a Psychotic EpisodeSymptoms are frequently separated into “positive” and “negative” categories. It is important to realize that this does not mean that the symptoms are either “good” or “bad”. Positive refers to symptoms that someone would not typically experience and therefore they are something that has been added to the person’s experience. Negative symptoms are things that are typical of human functioning but that are absent.

•

Unfortunately, at this time there are many theories about what causes psychosis, but no definite answers. Because psychosis occurs in a variety of mental and physical disorders it likely has multiple causes. Biology, stress and drug use are widely supported as being contributors to the development of psychosis.

BiologySome of the positive symptoms include:Delusions (Fixed false beliefs) such as the belief that one is:

• Neurotransmitters. There is strong evidence that psychosis involves a dysfunction in neurotransmitters, the “chemical messengers” in the brain, particularly dopamine.Genetics. Those with a family history of psychosis seem to be at an increased risk of developing it themselves. For example, the risk of developing psychosis associated with schizophrenia is approximately1%. This risk increases to 13% if you have a parent with schizophrenia and 9% if you have a sibling.

• Being followed or monitored

• Being plotted

• Having special abilities or “powers”

•

Hallucinations involve seeing,

hearing, feeling, smellingor tasting something that is not actually there. The

most common type of hallucination involves hearing things - such as voices or particular sounds. These hallucinations can seem very real to the person experiencing them.

•

changes in the brain. Possible causes of the changes include: genetics, abnormal neurodevelopmentdue to pregnancy or birth complications.

medications available to treat psychosis. These medications are called antipsychotics (or sometimes neuroleptics).Stress management and coping skills - Stress can worsen a person’s symptoms and ability to function. It is important to learn your warning signs and triggers of stress and find ways to manage it, such as exercise, relaxation techniques and finding artistic hobbies.

StressStress or stressful events, such as divorce, loss of a loved one, giving birth, or a traumatic event, can contribute to the development of psychosis. The amount of stress that may trigger psychosis differs for each person and likely contributes greater to those that are already vulnerable to developing psychosis.

Support groups - Groups provide a safe environment to meet with others who have been through similar experiences and can offer education and support about psychosis and the recovery process.

DrugsPsychosis can be induced by drugs or can be drug assisted. For example, it appears that amphetamines can cause a psychotic episode, while other drugs, including marijuana, can increase a person’s natural vulnerability to psychosis resulting in a psychotic episode.

Counselling/Psychotherapy– There are many types of “talk therapy” and it is important to find a counsellor with whom you feel comfortable to speak openly. Cognitive Behavioural Therapy is one type of therapy that has been found to help people understand and manage their thoughts, feelings and behaviours. Be sure to ask your potential counsellor what their focus and style of counselling is to determine if it will suit your goals.


What are the things I need to do to get well?The recovery process will vary from person to person in terms of duration and degree of functional improvement. Some people will recover from the psychosis very quickly and be ready to return to their life and responsibilities soon after. Other individuals will need time to respond to treatment and may need to return to their responsibilities more gradually.

•••••

Write down any symptoms you’ve had Write down key personal informationMake a list of all medications and drugs you are taking Write down questions to ask your doctorTake a family member or friend along

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Make sure to discuss all of the available treatments and their benefits and side effects before making any decisions.

What are the treatment options?Treating psychosis involves education, medication, close monitoring of symptoms, stress management and creating a strong, supportive environment.

All of the treatments listed above are important in helping a person recover. Some more strategies for staying well include:

• Setting achievable goals, including specific strategies for coping with change, staying social and having a trusted support network Maintaining regular medical check-ups Participating in positive social,recreational and work activitiesMaintaining a healthy lifestyle – diet, exercise, sleep

••Education - Becoming educated about psychosis is

important for the person and the family to help understand psychosis and how to recover. •Medication - Medication can relieve symptoms of psychosisand is critical in preventing relapse. There are many




Menopause and Depression

anxiety. Other symptoms are related to the “thinning” (atrophy)What is menopause?

Menopause is the point at which a woman permanently stops menstruating. Natural menopause usually occurs between the ages of 41 and 55.

of the walls of the urinary tract and vagina and include urinary incontinence, increased urinary frequency, and painful intercourse (mainly because of vaginal dryness).

Howprevalentis depression duringmenopause?The lifetime prevalence of depression in women is anywhere from 15 to 25%. Some studies have found an increased risk of the recurrence of major depression in women during perimenopause and menopause (women

Premature menopause is the term used when women go through menopause before age 40. Early onset of menopause may be the result of an autoimmune disorder or a thyroid problem.Perimenopause is the transitional phase, before menopause, when the menstrual periods may become irregular and symptoms such as hot flashes may begin. Symptoms noticed during this time are the result of declining estrogen production by the ovaries and may last anywhere from a few months (surgical reason) to a few years. Who is at risk?

The risk factors for developing depression during menopause include, but are not limited to:

Postmenopause is the time period after a woman has not experienced a period for 12 months. Postmenopausal women may experience problems caused by the long-term effect of estrogen loss, such as osteoporosis. In comparison to pre- menopausal women, postmenopausal women have a greater risk of developing heart disease. Due to these potential health problems, it is important that menopausal women take preventive measures (such as adopting a healthy diet) to avoid these illnesses. For further information, please consult your doctor.

•••••••

History of depressionHistory of Premenstrual Dysphoric Disorder (PMDD) History of postpartum depressionLengthy perimenopause (with physical symptoms) Caretaking responsibilities (parent, partner or child) Loss of significant otherChronic health problemsWhat is depression?

Depression is more than being sad or feeling grief after a loss. Depression is a medical illness, just like diabetes or heart disease. Day after day, depression affects your thoughts, feelings, physical health and behaviours. It affects normal day- to-day activities—it is more than a bout of the blues and you can’t simply “snap out” of it. A depressive episode must have a certain level of severity and a minimum duration of two weeks.

Surgical menopause happens when a woman goes through surgical removal of the ovaries or has ovarian failure before the natural menopause. Ovarian failure may occur following removal of the uterus or after cancer therapy (chemotherapy or radiation). The factors that seem to increase the risk of menopausal depression following removal of the uterus are:

••••••

History of depression Young ageLack of social supportDifficulties in relationship with partnerHistory of multiple surgeries

What are the symptoms of menopause?During perimenopause/menopause women may experience hot flashes (sensation of extreme heat that develops suddenly and lasts for 1 to 5 minutes), cold

For women who have had their ovaries removed, the drop in estrogen is sudden and they almost invariably will experience hot flashes which may cause great discomfort and even depressed mood.

Some preparations of the hormone estrogen seem to improve mood in perimenopausal and postmenopausal women, especially if symptoms are mild to moderate and particularly if the woman has never been depressed before. Although HRT with estrogen and progestin also has the benefit of improving the physical symptoms of perimenopause, HRT is not without risks. Please consult your doctor to make an informed decision about whether HRT is a good treatment for you.

What are the symptoms of depression?

••

Sad mood Preoccupation withfailures and inadequacies Loss of self-esteem Feelings of uselessness, hopelessness,excessive guilt Slowed thinking,forgetfulness,

• Loss of interest in hobbies, people Social isolation Lethargy and/or low energy AgitationChanges in appetite and weight — eating too much or too little Oversleeping

••

Antidepressant medication may be more effective for women with a history of depression and is usually the recommended first-line treatment when symptoms of depression are severe.

••

•• Psychotherapy is an important part of the treatment of

depression. Two types of psychotherapy are recommended:

•

• • Interpersonal Therapy: focuses on understanding human relationships.Cognitive Behaviour Therapy (CBT): teaches how to identify and change the negative thoughts and beliefs that

• •

What do I need to tell my doctor? What are the things I

need to do to get well?

•••••

Write down any symptoms you’ve had Write down key personal information Make a list of all medications you are taking Write down questions to ask your doctor Take a family member or friend along

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.Set realistic expectations. Be kind to yourself. Don’t pressure yourself to do everything.Ask for help when you need it.Learn about perimenopause/menopause and depression. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what may make your depression worse. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes.Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce symptoms. Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well.Avoid alcohol and illicit drugs. It

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. inability to care for yourself or your family). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

•

•

•

What are the treatment options?The treatment of depression that occurs in association with menopause depends on how severe the symptoms are and whether the woman has had a previous history of depression. The treatment may include:

••

•

•••

Hormone replacement therapy (HRT) Antidepressant medication Psychotherapy

•




Premenstrual Dysphoric Disorder and Premenstrual SyndromeWhat is Premenstrual Sydrome (PMS)?PMS is characterized by troublesome physical and/or emotional symptoms that are present in the last seven to 10 days of the menstrual cycle (before the menstrual flow).


•••••

Bloating Headaches Irritability Weight gain Food cravings

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Mood swings FatigueBreast tenderness What is Premenstrual

Dysphoric Disorder (PMDD)?PMDD is a condition associated with predominantly severe psychological symptoms which cause disruption of the daily lives of affected women. Dysphoria is derived from the Greek word dusphoros, which means hard to bear. The symptoms of PMDD are recurrent. They usually start seven to 10 days before menstruation and decrease within a few days of the onset of menstrual flow. Then, they disappear completely until the next premenstrual phase.

Each affected woman presents a different combination of some of these symptoms, which may also differ from month to month.

Unlike PMS, PMDD symptoms are very severe, completely disrupting the lives of women affected by it. Women diagnosed with PMDD usually present 5 or more of the following symptoms:

•••

Very depressed mood, feelings of hopelessness Marked anxiety, tension, feelings of being “on edge”Marked mood shifts (e.g., suddenly feeling tearful or extremely sensitive) Persistent or marked anger or irritability or increased interpersonal conflicts Decreased interest in usual activities (e.g., work, school, friends, hobbies) Difficulty concentratingFatigue, tiredness, loss of energy Marked change in appetite, overeating, food cravingsInsomnia (difficulty sleeping) or sleeping too muchFeeling out of control or

•

How prevalent are they?

••••PMS is present in about 30% of

womenin theirchildbearing years. Studies have found that up to

8% ofwomen with PMS meet the criteria for PMDD.

•••Who is at risk?

A few studies suggest that women with a personal or family history of postpartum depression, unipolar depression, and mood changes induced by oral contraceptives may be at greater risk of developing PMDD.

These symptoms do not necessarily occur every cycle, but they are present in the majority of the cycles. Some months may be worse than others. For an accurate


diagnosis of PMDD, it is important to keep a mood chart for at least two consecutive months.

Also, it is important to have a complete medical evaluation and laboratory tests in order to rule out other possible medical problems.

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.Set realistic expectations. Be kind to yourself. Don’t pressure yourself to do everything. Ask for help when you need it. Learn about PMS and PMDD. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what may trigger your symptoms, or make them worse. Make a plan so that you know what to do if your symptoms get worse. Contact yourdoctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce symptoms.Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well.Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but

•What do I need to tell my doctor? •

•••••


•

Discuss all of your symptoms with your doctor

and •describe how they are affecting your life (e.g. depressed mood making it difficult for you to get to work or appointments in time). Your doctor can suggest or provide appropriate therapy. Based on your symptoms, discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

•

•

•

What are the treatment options?There are three main approaches that can be used to alleviate the symptoms of PMDD:


National Association for Premenstrual Dysphoric

Disorder napmdd.org/

••

PsychologicalStress reduction (e.g., rearranging schedule to decrease stress during the premenstrual week) Cognitive Behaviour Therapy (CBT)Relaxation techniques Healthy lifestyleDietary changes: reduce salt, alcohol, caffeineReduce or stop smoking ExerciseTake a daily dose of vitamin B6, calcium (speak with your health care provider about this and other dietary supplements) MedicationsAntidepressants

•••••••

PMDD and Menstruationwww.pmdd-and-

menstruation.comMedem – Medical Library

www.medem.com/ (keyword search: PMDD)

Facts for Health – PMDD

www.factsforhealth.org••••




Postpartum DepressionWhat are postpartum mood disorders and how prevalent are they?Postpartum mood disorders encompass a wide range of conditions which differ in scope, symptoms, duration, and severity ranging from the well-known “baby or maternity blues”, which affects an estimated 85% of women, to the most severe form, postpartum psychosis, which affects an estimated 0.1% to 0.2% of women.

seeing things that other people cannot), delusions (fixed, false beliefs), extreme confusion and suicidal thoughts. It is a serious condition that requires rapid treatment for the safety of the mother and her baby. This condition is more common in women with bipolar disorder.

What are the risk factors/triggers?Postpartum mood disorders can develop after the birth of any child. Women may be a greater risk of

••

They have a history of depression They have had postpartum depression following a previous pregnancyThey have experienced stressful events during the previous year They have a weak support systemWomen living with bipolar disorder are at

The “baby or maternity blues”They typically begin on the third or fourth day after delivery and may include such symptoms as tearfulness, anxiety, irritability, insomnia, poor concentration, fearfulness, and emotional instability. This condition is often transient and disappears by about one to two weeks. For a few women, however, the condition may last longer and become a more serious mood or anxiety disorder.

•••

What are the symptoms?Postpartum

Depression (major depressive disorder with postpartum onset)This condition is estimated to affect approximately 10 to 15% of women and often begins within two weeks to six months after delivery. In addition to some of the classic symptoms of depression or anxiety, women might also exhibit extreme irritability, panic attacks, obsessive- compulsive symptoms, and intrusive thoughts about harming the baby. This condition is more common in women who have previously experienced depression but

•••

Feeling restless or slowed down Feeling sad most of the dayLoss of interest or pleasure in all or most things, including the baby Extreme irritability, frustration, or anger Feelings of hopelessnessTrouble sleeping even when the baby is sleeping Loss of appetite or eating too muchDifficulty thinking, concentratingor making decisions Crying for no reasonOverwhelming feelings of guilt, worthlessness or inadequacyScary thoughts about harming your baby Anxiety or panic attacksNo desire to be with friends or family Excessive worrying about your baby’s healthSuicidal thoughts or frequent thoughts of death Postpartum Psychosis:Hallucinations and

•••••••••••••••••

The most serious of the postpartum disorders, this condition affects about 1 to 2 in 1,000 new mothers. Onset is rapid, sudden, and very dramatic, often within days to weeks of delivery. It can be characterized by psychotic depression, mania, hallucinations (hearing or

If you are experiencing some of these symptoms, and they have lasted for more than two weeks, you may be experiencing a postpartum mood disorder and should seek prompt professional help.

• Learn about postpartum mood disorders. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what may make your depression worse. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce symptoms.Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well.Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen symptoms and make the depression harder to treat. Get

•

What do I need to tell my doctor? •

• Write down any symptoms you’ve had, and for how longWrite down key personal informationMake a list of all medications you are taking, and any previous mood disorders you have had Write down questions to ask your doctorTake a family member or friend along

••• •••

•Discuss all of your symptoms with your doctor

anddescribe how they are affecting your life (e.g. inability to care for the baby). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions.


Postpartum Progresswww.postpartumprogress.co

m

What are the treatment options?There are a variety of very effective treatmentspostpartum mood disorders including:

for Postpartum Support International (information for moms, their partners and link to chat room) www.postpartum.net•

••

Psychotherapy (individual or family) Participation in postpartum support groups Antidepressant medications Online Postpartum Depression Support

Groupwww.ppdsupportpage.comThe most important step to take is to become

knowledgeable about PPD and seek help.more Pacific Postpartum Support

Societywww.postpartum.orgWhat are the things I

need to do to get well?• Stick to your treatment plan. Don’t skip

psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.

• Set realistic expectations. Be kind to yourself. Don’t pressure yourself to do everything. Ask for help when you

Postpartum Depressionwww.psycom.net/depression.central.post-

partum.html




Rapid Cycling Mood Disorder

••••••••

Difficulties in concentrating and in making decisionsLoss of interest in work, hobbies, people Social isolationLethargy or agitationChanges in appetite— eating too little or too much Oversleeping or insomniaDecreased sexual drive Suicidal

What is it?The essential feature of rapid cycling bipolar disorder is the occurrence of four or more mood episodes during the previous 12 months. These episodes can occur in any combination and order. However, the episodes of major depression, mania, mixed or hypomanic episodes must be separated by a period of full remission or by a switch to an episode of the opposite polarity.

Symptoms of mania include:

•••••••••••••

Elevated, expansive mood Extreme irritabilityRapid, unpredictable emotional changes Racing thoughts, flights of ideas Overreaction to stimuli Misinterpretation of eventsIncreased interest in activities OverspendingSense of grandiosity, inflated self-esteemsExcessive energy Decreased need for sleep

How prevalent is it?Rapid cycling occurs in approximately 10 to

20% ofindividuals with bipolar disorder. Although the

gender ratio is equal for bipolar disorder, women make up 70 to 90% of individuals with a rapid cycling pattern. The mood episodes are not linked to any phase of the menstrualcycle and occur in both pre- and women.

post-menopausal

Who is at risk?If you have a family member with bipolar disorder, you may be slightly more likely to develop it yourself.


What are the risk factors/triggers?Rapid cycling may be associated with hypothyroidism, certain neurological conditions (eg. multiple sclerosis), developmental delay or head injury. Rapid cycling can occur at any time during

•••••



anddescribe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

What are the symptoms? What are the

treatment options?It can be challenging to find an effective treatment forrapid cycling. Lithium, often used to treat bipolar

••••

Sad moodPreoccupation with failures or inadequacies Loss of self-esteemSlowed thinking, forgetfulness

is effective in about 20 to 40% of people with rapid cycling. Anti-convulsant medication (such as Valproic Acid) has been effective in the treatment of lithium-resistant rapid cycling and mixed states. Certain atypical anti-psychotic medications can also be helpful in treating people with rapid cycling bipolar disorder. Talk to your doctor about your individual treatment plan.

• Tell yourself frequently when distressed that change is inevitable in rapid cycling. You got through episodes in the past and you will be able to do it again.Don’t pressure yourself with criticism and unrealistic expectations.Stay away from overstimulating situations. Keep your life simple and ask for assistance if you need it.

•

•

Antidepressant medications, particularly tricyclics, may provoke rapid cycling. Psychotropic medications should be tapered off gradually under the supervision of your doctor.

•


Depression and Bipolar Support Alliance

www.dbsalliance.org

Complementary treatments, such as peer support groups or other support programs, may be helpful.

What are the things I need to do to get well?Rapid cycling can often lead to turbulent behaviour and disturbed relationships. People experience rapid cycling in varying patterns. Individuals can observe themselves for signs that signal the approach of their episodes of depression or hypomania/mania. This is empowering and the knowledge gained decreases feelings of helplessness and hopelessness which often occur in depression. Prompt action taken to reduce stimuli and irritability may also decrease the severity of the

DualDiagnosis.org www.dualdiagnosis.org/bipolar-disorder-

and- addiction/rapid-cycling-bipolar-disorder

Sometimes, it is difficult to be completely objective about how you are doing. Input from those people who know you well can be helpful. Your friends and family can give support. Notify your physician when you are having difficulty.

• Prepare yourself for episodes of illness by learning about rapid cycling.Discuss difficulties and successes with peers in a support group. You are not alone.Sleep and rest are important. It is important to stabilize sleep, reduce or stop the use of caffeine, nicotine, alcohol and substances. Establish a bedtime routine. Rest when tired.

•

•

•




Seasonal Affective Disorder (S.A.D.)

What are theWhat is it?Many people experience seasonal changes in feelings of well being and in energy, sleep patterns and eating patterns, to a greater or lesser degree. The “winter blues” or “February blahs” are common. But some people experience powerful changes to the degree that it becomes a form of clinical depression, called Seasonal Affective Disorder (S.A.D.)

symptoms?• Oversleeping— sometimes an

increase of 2 to 4 or more hours per day Lethargy (low energy)Intense craving for carbohydrates Weight gainWithdrawal from social contactsDepressed mood occurring over at least two consecutive winters, alternating with non- depressed periods in the spring and summer

•••••

How prevalent is it?About 2 to 6% of Canadians will experience S.A.D. in their lifetime. Another 15% experience a milder form of S.A.D.


Who is at risk? •••••


Adults are at a higher risk of S.A.D.

than children orteenagers. After the age of 50, the risk of S.A.D.

starts todecline.Women are up to eight times as likely as men to reporthaving S.A.D.


anddescribe how they are affecting your life (e.g. sleeping several extra hours per day and missing work/school/ appointments). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

People in northern countries are more likely to experienceS.A.D. than those who live closer to the equator because the days get shorter the further north you S.A.D. tends to run in families — most individuals withS.A.D. have at least one close relative with a history of depression.

What are the treatment options?Light therapy has been found to have an anti-depressant effect in 70% of people with S.A.D. Most people find relief within two weeks of beginning light therapy.

What are the risk factors/triggers?A variety of psychological, social and biological

Light therapy involves exposure to bright light under specific conditions. The light can be delivered through special lights or through a light visor. Daily treatment sessions usually last from 15-30 minutes. Because homemade light fixtures have the potential to damage the eyes, it is best to purchase approved light therapy units.

••••

Inherent vulnerability Light deprivation StressBiological factors unique to the individual, as well as hormonal changes due to physical conditions Early childhood trauma•

A few mild side effects have been reported, including eyestrain, headaches, irritability and insomnia, the latter occurring if treatment is taken too late in the day.

What else can I read?Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder, edited by Raymond W. Lam and Anthony J. Levitt, Clinical and Academic Publishing (1999)

Avoid self-diagnosis and self-treatment. There may be existing medical conditions that can interfere with light treatment. Consult your doctor. Be aware of eye problems or medications taken with photosensitivity as a side effect.

Don’t be SAD, Your Guide to Conquering Seasonal Affective Disorder, Celeste A. Peters, Script Publishing Inc. (1994)

Other treatment options include psychotherapy and antidepressant medication. Your doctor will discuss this with you. Complementary treatment, such as peer support groups or other support programs, may also be helpful.

Winter Blues, Norman E. Rosenthal, The Guilford Press(1998)

Where else can I go to learn more?

The Society for Light Treatment and Biological

Rhythms sww.sltbr.org

Finally, additional treatments such as massage, mindfulness and meditation, shiatsu, therapeutic touch, aromatherapy, tai chi, Pilates and yoga can also help to improve wellness.

What are the things I need to do to get well?Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.

Dr. Rosenthal on S.A.D.(an interview with Katie Couric)

www.normanrosenthal.com/video1.html

Learn about S.A.D. Empower yourself by learning about your condition.

Pay attention to the warning signs. Find out what triggers your S.A.D. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce the symptoms of S.A.D. Consider walking, jogging, swimming, gardening, or any other physical activity.

Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen symptoms and make S.A.D. harder to treat.Get adequate sleep. This is especially important. If you’re having trouble sleeping, talk to your doctor about what you can do.

Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose to eat well.




Seniors and Depression

••••

Health problems Medications FearsRecent

What is it?Depression is more than being sad or feeling grief after a loss. Depression is a medical condition, just like diabetes or heart disease. Day after day, depression affects your thoughts, feelings, physical health and behaviours. It affects normal day-to-day activities. An episode must have a certain level of severity and a minimum duration of two weeks to be diagnosed as depression.


Depression is not a natural part of aging any more than it is a natural part of any other life stage. At any stage of life, depression is a condition that requires attention.

••

Sad mood Preoccupation with failures and inadequaciesLoss of self-esteem Feelings of uselessness, hopelessness, excessive guilt Slowed thinking,forgetfulness, difficulty in concentrating and in

• Loss of interest in hobbies, people Social isolation Lethargy and/or low energy AgitationChanges in appetite and weight— eating too much or too little Oversleeping

••

••How prevalent is it?

Current national statistics show the rate of depression in men and woman over age 65, who live in the community, to be under 2%. The figure rises to 10-15% if seniors suffering from all depressive symptoms are included.

••

• •

•There are differences by gender in rates of depression and suicide. According to a study in Edmonton, Alberta, the percentage of women suffering from depression (14.1%) is almost double that of men (7.3%) (Newman et al, 1998) Men over the age of 65 are at the highest risk for suicide among all age and gender groups (Health Canada, 2002). It is estimated that 30 to 40% of seniors living in long term care facilities live with depression (National Advisory Council on Aging, 1999).

Most often, seniors with

depression will lose theirappetites and develop

insomnia.Suicide is five times more likely in individuals over 60 than in younger age groups. It is also more likely to occur in those living alone. Bereavement from the death of a spouse, other family member or friend is highly associated with suicide. Loss of mobility, functionality and independence are related to higher suicide rates. Suicidal talk should always be taken seriously and professional help sought immediately.

Who is at risk?••

Those with a family history of depression Those with a personal history of depression – a past episodeTaking certain medicationsThose with co-occurring health issues A recent loss or bereavement

What do I need to tell my doctor?•

••

•••••


What are the risk factors/triggers?It’s unknown exactly what causes depression. There

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. slowed thinking that causes you to lack focus or not get things done). Your doctor can suggest or provide appropriate therapy. Make sure to discuss all of the available

• Loneliness and isolation• Reduced sense of

purpose

treatments and medications and their benefits and side effects before making any decisions. If you are the adult child of a senior who you think might be depressed, be sure to tell your parent’s doctor about all the changes you have observed.


• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as directed. Learn about depression. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what triggers your depression. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapistif you notice any changes. Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce the symptoms of depression. Consider walking,swimming, gardening, or any other physical activity.Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen symptoms and make the depression harder to treat. Get adequate sleep. This is especially

What are the treatment options?Depression in older people is sometimes harder to recognize than in younger people because it often co- occurs with medical, other psychiatric and substance abuse disorders. It is important to recognize that a diagnosis of depression is treatable. Research indicates that the best long term outcomes for the treatment of depression in older adults is medication, therapy and social support. Whether depression is caused by physical, psychological or social factors, the plan for treatment should address them all.

•

•

•

•

If you think you may be experiencing the symptoms of depression, talk with your family and friends about how you’re feeling, call your local mental health centre, and see your family doctor. The most common forms of treatment for depression are antidepressant medication and therapy. The most effective treatment is generally a combination of both. Some individuals suffering from depression may need a hospital stay or an outpatient treatment program until symptoms improve.

•

•


Healthy Me — Seniors and Depression

www.ahealthyme.com/topic/srdep

There are several types of antidepressant medication available, and they are categorized by how they affect the naturally occurring chemicals in your brain that affect your mood. Finding the right medication or medications will likely take trial and error. Patience is required, as some medications need eight weeks or more to take full effect, but don’t give up if you don’t find the right medication right away. Hope for Depression

www.hopefordepression.org

Complementary treatment, such as peer support groups or other support programs, may also be helpful. Seniors and Depression

www.qualityhealth.com/depression- articles/seniors-depression

Additional treatments, such as massage, mindfulness meditation, shiatsu, therapeutic touch, aromatherapy, tai chi, Pilates and yoga, can also help to improve wellness.




SuicideIf you or someone you know is in immediate danger or imminent National Suicide Prevention

Lifeline24-hour, toll-free, confidentialcrisis of suicide,

call 911 1-800-273-TALK

What is it?Facts about suicide: bullying and sexual orientation issues. Warning

signs: eating disorders, deliberate self-harm, withdrawal from normal activities, exceptional and extreme mood swings, perfectionist behaviour or extreme self-critical behaviour

• Thoughts of suicide are a common symptom of mood disorders80% of suicides are carried out by individuals suffering from a depressive illness50 to 80% of seniors who commit suicide have a history of major depression Women suffering through a depressive episode most often attempt suicide in the latter stages of the episodeWomen are three to four times more likely to attempt suicide than men, but men are more likely to

•People who have recently had a major loss or life change are at higher risk, as grief can change to depression that may last several weeks or longer. Warning signs: major changes in attitude, changes in eating or sleeping habits, loss of energy or loss of interest in things that were once enjoyed.

•

•

•Especially vulnerable are people who are recovering from an episode of depression or who have a history of suicide attempts, or who have just been released from the hospital.

•

How prevalent is it?According to the World Health Organization, there were3,926 suicides in Canada in 2012.

What are the risk factors/triggers?

Who is at risk?Older adults are at higher risk due to life changes and transitions through loss, lifestyle changes due to physical disability, a move from independent living to assisted living and social isolation and abuse. Warning signs: appetite changes, lack of participation in social events, signs of abuse and neglect.

• Unbearable feelings: depression can cause extreme feelings of hopelessness, despair and self-doubt. The more acute the feelings, the higher the suicide risk Putting affairs in order: making final plans, preparing wills or life insurance, or arranging for the family’s welfareRehearsing suicide: seriously discussing one or more specific suicide methods, purchasing weapons or collecting large quantities of medication,

•

•

Young people are at higher risk due to family and school pressures, major life changes, hormone changes,

• Drug or alcohol abuse: intoxication may cause impulsive behaviour and make the person more likely to act on suicidal thoughts Isolation: cutting off friendshipsand social connectionsSudden sense of calm: someone with an active mood disorder who has just passed an episode’s lowest point on the way to recovery. Suddenly appears calm and settled in such a way that is not in keeping with their state of recovery.

•

•

What do I need to tell my doctor?If you are thinking of suicide, tell someone – a doctor, friend, family member, teacher

If you are planning to commit suicide, get help right away – call 911.


National Suicide Prevention Lifeline

www.suicidepreventionlifeline.orgAmerican Foundation for Suicide

Preventionafsp.org

Alliance of Hope for Suicide Loss Survivors

www.allianceofhope.org




Teen Depressionof the factors listed above may act as triggers to releaseWhat is it?

Everybody feels sad or blue now and then. But it may be depression if you’re sad most of the time and it’s giving you problems with your relationships, your grades or attendance at school, alcohol, drugs or sex, or controlling your behaviour in any other way. Depression can affect your thoughts, feelings, behaviour and overall health.

disturbances in brain chemical function.What are the symptoms?•

•You feel sad or cry a lot and it doesn’t go awayYou don’t feel like doing a lot of the things you used to like — music, sports, being with friends, going out — you want to be left alone most of the time You feel like you’re no good; you’ve lost confidence Life seems meaningless or like nothinggood is ever going to happen again. You have a negative attitude a lot of the time, or it seems like you have no feelingsIt’s hard to make up your mind. You forget lots of things and it is hard to concentrate You get irritated often. Little things make you lose your temper and you overreact Your sleep pattern changes: you sleep a lotmore or you have trouble falling asleep. Or you wake up really early and can’t go back to sleep You’ve lost your appetite or you eat a lot more You feel restless and tired

How prevalent is it?••Approximately 5% of adolescent males

and12%

ofadolescent females experience serious depression each year.

•Who is at risk?Sometimes people get seriously depressed after a divorce in the family, major financial problems, someone you love dying or breaking up with a boyfriend or girlfriend. Other times — like with other medical conditions — depression just happens. It’s important to get treatment for depression before it leads to other troubles.

•

•

•••

What are the risk factors/triggers?

Talk to a professional if you’ve had five or more of these symptoms for more than two weeks. If any of the symptoms cause such a big change that you can’t keep to your usual routines, see your doctor.There is no single cause of

depression.Stressful

anddiscouraging situations naturally overwhelm and have the potential to become serious. Experiences of failure commonly result in temporary feelings of worthlessness and self-blame, while personal loss causes feelings of sadness, disappointment and emptiness.

What you need to know about suicideMost people who are depressed don’t commit suicide. But depression increases the risk for suicide or suicide attempts. It is not true that people who talk about suicide do not attempt it. Suicidal thoughts, remarks or attempts are ALWAYS SERIOUS. If any of these happen to you or a friend, tell a responsible adult immediately. It’s better to be safe than sorry.

The onset of depression may be attributed to some of these factors:

• Genetic predisposition – a family member has depressionDeath or illness of friend/family memberFinancial difficultiesDifficulties with job or personal relationshipPoor self-esteemSeasonal or hormonal

••••••

Depression, alcohol and other drugsA lot of depressed people, especially teenagers, also have problems with alcohol and other drugs. Sometimes the

Researchers believe that a deficiency of certain chemicals in the brain and/or genetics may also affect how likely we are to develop an ongoing or serious depression. Any

depression comes first and people try drugs as a way to escape it. Other times, the alcohol or other drug use comes first and depression is triggered by the drug itself, withdrawal from it or the problems that substance abuse creates.


• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.Learn about depression. Empower yourself by learning about your condition.Pay attention to the warning signs. Find out what triggers your depression. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapistif you notice any changes. Ask friends or family to watch out for warning signs.Get exercise. Physical activity may help reduce the symptoms of depression. Consider walking, jogging, swimming, gardening, or any other physical activity.Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they

Sometimes you can’t tell which came first. The important point is that when you have both of these problems, the sooner you get treatment, the better. Either problem can make the other worse and lead to bigger trouble, like addiction or flunking school. You need to be honest about both problems — first with yourself and then with someone who can help get treatment. It’s the only way to really get better and stay better.

•

•

What do I need to tell my doctor?Having depression doesn’t mean that a person is weak or a failure or isn’t really trying. It means that they need treatment. Most people with depression can be helped by medication, counselling, or a combination of the two.

•

•

•

Talk to someone. If you are concerned about depression, talk to someone about it. There are people who can help get you treatment: Where can I

learn more?Kids Health

(both physical and mental health issues) www.kidshealth.org

•••••••

A professional at a mental health centre A trusted family memberYour family doctor Your clergyA school counsellor or nurse A social workerA responsible adult

Teenage Depression and Suicide Preventionwww.thekeltyfoundation.org/depression-

resources.htmWhat are the treatment options?Counselling means talking with a trained professional about thoughts, feelings, actions and relationships. You work together to find where problems exist and to learn how to makes changes in the relationships, thoughts and behaviours that contribute to depression.

Teen Lineteenlineonline.or

g

Medication effectively treats depression that is severe or disabling. Antidepressants are not “uppers” and are not addictive. Sometimes several types have to be tried before you and your doctor find the one that works best.



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