Your Teenager: Just Moody… or Something More?

By Ken Duckworth from NAMI Blog

“Is my teen normal?”

As a child and adolescent psychiatrist and father of 3 teenagers myself,  I get asked this question by people in my community all the time—at the grocery store, at the community pool and at cookouts. It’s pretty clear to me this is an important public health concern for the people I know.

First, anxiety is normal and often healthy. It relates back to our human wiring—the evolutionary protection for being prepared for threats, like an incoming mastodon. In the modern day, we still have the same kind of alarm system even though the stresses are different.

For instance, it is natural to get anxious before the SAT exam because of the weight our society places on it. It’s perfectly acceptable to get anxious before your first week at sleep-away camp or trying out for a school play. Anxiety can be motivating to a point, but anxiety can also be overwhelming and disabling.

One way to answer the question is to look at your teen’s level of functioning. Does the anxiety reduce his ability to perform at school or engage with friends? Are the symptoms of anxiety stopping her from pursuing what she wants?

[vimeo http://vimeo.com/111773267]

When It Could Be a Mental Health Condition

Anxiety disorders often co-occur with other conditions, such as depression. Major depression in teens is an important public health concern and, like anxiety, often responds to treatment. Depression is characterized by more than 2 weeks of persistent sadness (or irritability, hostility) coupled with most of the following warning signs: sleep troubles, appetite changes, physical complaints, negative or hopeless thinking, concentration problems, loss of interest in activities and, most concerning, suicidal thoughts.

Family history of mood and anxiety conditions can increase the risk for some teens. People with trauma histories may be quicker to experience threat and anxiety based on the past. Teens who are stressed by divorce, are being bullied—on social media or at school—or who have problems “fitting in” in social circles are also at risk.

A full clinical assessment from a health care provider is a worthy investment of time and resources to determine a diagnosis if you’re seeing any of the signs I mentioned in your teen. There are a few medical concerns that can mimic anxiety and depression, so it’s a good idea to look for those—examples are thyroid disorders and substance use disorders.

Once a comprehensive assessment is made, the next step is forming a treatment plan that your teen can buy into. It is challenging yet essential to get your child’s acceptance and collaboration into any plan to approach these issues. While some kids will quickly acknowledge their vulnerabilities, others will be more resistant. This spectrum is natural and expected—not everyone will want support.

Communicating with Your Child

How do you talk with a teen you are worried about? Listening to them is the best first rule. Speak from your own experience. I don’t encourage parents to lead with a diagnosis—I begin with a supportive focus on the functional problems they are having, like with friends for example. This can often be something both the parent and teen can connect on. Loving a teen into care can be difficult, but keeping lines of communication open is key. You don’t need to get to yes on everything, but you may need to get to a professional. I tell parents that their job is to get their teen to my office, but it’s mine to get them back for a follow-up visit.

At the end of the day, I may not be able to give a well-rounded answer at the soccer field, but I hope that what I’ve shared will help if you are concerned about your child’s mental health.

– See more at: http://www.nami.org/Blogs/NAMI-Blog/February-2015/Your-Teenager-Just-Moody-or-Something-More#sthash.X8CfxZfh.dpuf

High Numbers of Students Entering College Report Poor Emotional Health in Previous Year

FROM Psychiatric News Alert: ?????????????????Record numbers of students entering college are self-reporting poor emotional health, according to a report on a national survey titled “The American Freshman: National Norms Fall 2014.”

Students were asked to rate their emotional health in relation to other people their age, in addition to the frequency with which they felt depressed. Additionally, the proportion of students who “frequently” felt depressed rose to 9.5 percent, 3.4 percentage points higher than in 2009.

The survey, conducted by the Cooperative UCLA University Higher Education Research Institute for almost 50 years, assesses hundreds of matters ranging from political views to exercise habits.

The report also noted that students with different types of disabilities say they are feeling depressed more frequently. Of those students who indicated being on the autism spectrum, 22.4 percent reported being “frequently” depressed. Over 17 percent of students who reported having a chronic illness or ADHD were “frequently” depressed.

Students who felt depressed more frequently reported behaviors reflecting disengagement—they were about twice as likely to “frequently” come late to class and “frequently” fall asleep in class. Further, they were less likely to “frequently” engage with their classmates by studying with other students or working with other students on group projects, according to the report.

The report concluded, “With counseling centers on campus reporting a record number of visits and increased wait times, it is clear that campuses have more work to do to assist students experiencing emotional health issues.”

The APA Caucus on College Mental Health will meet during at the 2015 annual meeting in Toronto on Monday, May 18, from 2 p.m. to 5 p.m. in the Toronto Room, Convention Floor, Fairmont Royal York. APA members interested in college mental health are encouraged to attend.

For more on the subject of college mental health, see the Psychiatric News article “College Students Explain Decisions About Getting MH Care.”

Drug Targeting NMDA Receptor Rapidly Improves Depression Symptoms in Phase II Study

Biological and science test tubesFROM Psychiatric News Alert: In a phase II clinical trial, a new compound that targets the NMDA receptor was found to quickly and substantially reduce depression symptoms, with no severe side effects. At the highest dose tested, 72 percent of study participants displayed a clinically meaningful response to this compound, known as NRX-1074, within 24 hours, compared with 39 percent who responded to a placebo.

The findings are extremely encouraging, as current medications for depression can take up to six weeks to show effects, but there are still many hurdles to overcome in the development of this drug.

For one, this current clinical study employed an intravenous administration of NRX-1074, which would not be broadly applicable. However, with the dosage guidance gained from these results, Naurex, the makers of NRX-1074, are proceeding to a second phase II trial using an oral pill. The new study will also evaluate whether repeated daily doses provide a sustained effect, which is also critical if this compound can be a front-line treatment.

The concept of targeting NMDA receptors arose from studies showing that ketamine can rapidly improve depression symptoms, albeit with many risks. Several pharmaceutical companies have been working on compounds that can mimic the mood improvement without the negative side effects.

To learn more about research into ketamine and NMDA receptors for depression, see the recent Psychiatric News article “Researcher/Clinician Working to Unlock Ketamine’s Mysteries.

Better Screening and Treatment Access Needed for Teens With Major Depression

Severe MDD was more common among older adolescents, and girls had two to three times the risk of MDD and four times the risk of severe depression than boys. image credit: zea_lenanet | DPC

Severe MDD was more common among older adolescents and girls. image credit: zea_lenanet | DPC

From Psychiatric News Alert: About 60% of teenagers with DSM-IV major depressive disorder (MDD) receive treatment, but only 35% were treated by a mental health professional, according to a nationally representative survey of 10,123 adolescents.

Lifetime prevalence of MDD was 11% among that sample, and 12-month prevalence was 7.5%, said Shelli Avenevoli, Ph.D., of the Division of Translational Research at the National Institute of Mental Health and colleagues in the January Journal of the American Academy of Child and Adolescent Psychiatry. Age and gender influenced prevalence, they said.

“The majority of depressed adolescents did not receive treatment specifically for their depression or from the mental health sector for any emotional or behavioral problem. These findings underscore the ubiquitous nature of this disorder in youth, suggest that a significant portion of depressive disorders have their first onset in adolescence, and support the notion of routine and universal screening during adolescence.”

To read more about treatment of adolescent depression, see:

Family-Based Interpersonal Therapy Found Effective for Child Depression

Treating Child Depression--photo credit: artmim | DPC

Treating Child Depression photo credit: artmim | DPC

From Psychiatric News Alert: Family-based interpersonal psychotherapy appears to be an effective treatment for preadolescent depression and proved superior to child-centered therapy, according to a report published online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers from the University of Pittsburgh School of Medicine and Columbia University College of Physicians and Surgeons/New York State Psychiatric Institute (NYSPI) randomly assigned 42 preadolescents with depression family-based interpersonal psychotherapy (FB-IPT) or to child-centered therapy (CCT). Depressive symptoms in children were measured by the Children’s Depression Rating Scale, Revised, and the Mood Feeling Questionnaire, Child and Parent Versions. Preadolescents receiving FB-IPT had higher rates of remission, a greater decrease in depressive symptoms from pre- to post-treatment, and lower depressive symptoms at post-treatment than did preadolescents with depression receiving CCT.

“These findings provide strong support for FB-IPT as an effective treatment for preadolescent depression with medium to larger effect sizes. There was a significant indirect effect for decreased social impairment mediating the association between the FB-IPT and preadolescents’ post-treatment depressive symptoms. This may suggest that reducing social impairment is one mechanism by which FB-IPT may decrease preadolescents’ depressive symptoms.”

For related news, see the Psychiatric News article “Family Intervention Benefits Children of Depressed Parents.”

Have You Been Screened for Depression Today?

Every year you probably visit a dentist to make sure you don’t have any cavities or a primary care doctor to get your blood pressure and cholesterol checked. But you may not think about getting screened fordepression. You might see the lack of desire to meet up with friends or increased feelings of tiredness as just passing feelings. But for nearly 7% of adult and more than 9% of children those feelings are more than just passing sensations. They can be signs of depression.

As part of Mental Illness Awareness Week, National Depression Screening Day will be held on Thursday, Oct. 9. Around the world there will be depression screening questionnaires offered free of charge to help anyone identify signals of depression. Visit Help Yourself Help Others to take a screening online or find a place near you that is holding a screening.

It’s not always easy to stand up and admit you need help—it’s more difficult than getting a cavity filled. But once you do get help, you can begin to get better. Here are some suggestions from real people about how to live well with depression.

  • Become an expert. Learn all you can about treatment options, attend local conferences and network with other people at meetings and support groups. Build a personal library of useful websites and helpful books.
  • Recognize early symptoms. Identify triggers, such as times of year or events that may aggravate your depression symptoms, so you can identify an emerging episode and get the help you need as soon as possible. Don’t be afraid to ask the people around you for help—they can help monitor your behavior.
  • Engage in your treatment. A positive relationship with your health care providers can help improve the effectiveness of treatment. You both must develop a trust and a strong line of communication. Speak honestly about your symptoms and experiences with treatments.
  • Develop a plan. Most communities have a crisis hotline or emergency walk-in centers, so know where they are and keep them handy. The National Suicide Prevention Lifeline can be called 24/7 at 1-800-273-8255.
  • Find emotional support from others living with depression. Share your thoughts, fears and questions with other people who have the same illness. Connect with others through peer-support groups like NAMI Peer-to-Peer. You can also sign up for afree NAMI.org account and connect with others on our online message boards.
  • Avoid alcohol and drugs. These substances can disturb emotional balance and interact with medications. You may think using drugs or alcohol will help you “perk up,” but using them can block your recovery.
  • Get healthy. Eat well and exercise. To relieve stress, try low-key activities like meditation, yoga or Tai Chi.

Crowd Funding Movie Project: Her

Her is about seventeen-year-old Kristen who loves her family, idealizes her best friend, Lexus, and has a secret crush on John. However normal her life sounds, Kristen is not like other kids her age. She feels frustrated, isolated, and confused and knows something is wrong with her. She is unable to please her abrasive mother and is scared to confront her abusive stepfather. Kristen’s imaginary friend, Mr. Sharp encourages her feelings of self-loathing and pushes her to cut herself. Soon, she can’t take much more, and a failed suicide attempt lands her in a mental hospital with a diagnosis of BPD. From there, Kristen begins her journey to survival. She struggles to understand her mental illness and fights to be a survivor against her own worst enemy: self-blame.

The crowd-funding page for this book-to-movie project is at THIS HATCHFUND LINK.

“I know, first-hand, that a diagnosis like this can be a turning point in a young person’s life. One out of every four people struggles with mental illness – stop and think and you’ll discover that you probably know someone who is going through that right NOW.  Yes, mental illness is the dark secret so many live with. Now you can help change this.

The Project’s Goal:

To change the perception of mental illness  To provide hope to those who seek help Help those suffering from mental illness, and their, families cope. We can make a difference by showing teens that they are not alone on this journey and that there is light at the end of the tunnel. I want to lend a helping hand out of suffering, so that suicide will never be a viable option again.