Monday, November 3, 2014

Meet My Black Dog....His Name is Depression

Monday, November 3, 2014




The student was on a collision course for destruction.  She was skipping class, yelling at her teachers, hanging out with a group of girls who loved to fight, and refused to give her contact information to the administration when she got in trouble.  After several weeks, the student was referred to me for a consultation.  Not really familiar with the student, I took to the time to get to know about her and I got the suspicion that she was extremely sad or depressed; however, I needed to talk to the parents about her behaviors at home to make sure I was on the right track.  Finally, the parents came to see me and it was evident from all our observations that the student was experiencing extreme sadness and she was acting out to forget about her depression.  At the end of our meeting, the parents decided to make a mental health appointment to get the student the help she needed.

Many times during the year, I consult with parents about the importance of taking their student to a mental health clinician when there is a possibility they have depression.  Although school counselors do not diagnose depression, we have the opportunity and responsibility to connect students with mental health services when they exhibit changes in behaviors like long periods of sadness, loss of interest in once liked activities, weight changes, sleep problems, or extreme agitation.

According to psychologist, Dr. Nancy Rappaport, the onset for depression in teens is age 14. Dr. David Cantor states that it is the most underdiagnosed disorder in adolescents and he believes that if it is identified early, students have a greater the possibility of recovery.  The tragic message for school counselors is that 80% of students do not receive any help which can lead to issues like substance abuse, bullying, eating disorders, and even suicide. In addition, LGBTQ teens are at a higher risk for depression than their heterosexual classmates.  The reason for depression can result from the lack of family support, violence from peers, and internalized homophobia. The school counselor can be instrumental in helping LGBTQ find a supportive counselor. This positive connection is important as LGBTQ students tend to end their counseling after one session due to the feelings of being unsupported (School Counselor Competency and Lesbian, Gay, Bisexual, Transgender, and Questioning Youth ).

GBLTQ Depression

What is Depression?

As a school counselor, it is important to know what depression is, how to identify its symptoms and recognize its signs.  Dr. Nancy Rappaport states that depression is a medical condition that lasts longer than a two week period and interferes with student functioning.  According to the Suicide and Depression Voices of Education website, teens with depression do not think like healthy teens.  Why you ask?  Well, it is all about the brain and how it processes information. The brain passes messages through a chemical called neurotransmitters. When there are not enough of these chemicals, the
depressed v not depressed
messages are not sent correctly and the result is depressive thoughts.  Many people who suffer from depressive thoughts experience extreme sadness and even physical pain.  To end these feelings, many teens will resort to suicide to stop experiencing sadness.


Types of Depression

There are several types of depression that teens can experience according to SAVE:

Atypical Depression

With atypical depression a teen can still have fun and experience pleasure if an opportunity presents itself, such as a party or good news, but the feeling is short-lived. Heaviness, fatigue, and lack of motivation recur until the next pleasurable occasion. Moodiness, and at least two of the following symptoms characterize atypical depression: oversleeping, overeating, extreme fatigue and rejection sensitivity.

Cyclothymia

A form of bipolar illness, this is a mood rollercoaster. A person may feel up one day and down the next, or up one week and down the next in seemingly unpredictable patterns. Periods of normal mood may be few and far between.

Dysthymia

This is chronic mild level of depression. A teen usually continues to function, but doesn't experience pleasure like a healthy teen does.

Major Depression

A teen suffering from major depression no longer feels normal, but rather is overwhelmed with feeling depressed, slowed-down, or in a fog. Ability to function normally may be significantly impaired. A person may experience a single episode, or may continue to have episodes throughout their lifetime.

Premenstrual Syndrome

A variety of physical and emotional symptoms presented prior to a teen girl's menstrual period. Symptoms include irritability, nervousness, sadness, low energy, and physical symptoms like body aches and bloating. PMS seems to be related to depression in some teens.

Seasonal Affective Disorder or SAD

This is a depressive illness that has to do with a teen's reaction to the amount of light a person receives. Symptoms of depression such as low energy, fatigue, or overeating may appear when the days begin to get shorter and there is less sunlight. Teens who have SAD may produce an excess of the hormone melatonin, which is related to the body's sleep cycle and biological clock.

Source:  SAVE Glossary

Causes and Signs of Depression

Dr. Nancy Rappaport identified four broad reasons for adolescent depression.  These causes include:

Trauma
Bullying
Physical or Sexual Abuse
Genetics

Since this is not an exhaustive list, you may want to check out these sites for other signs and symptoms of depression in teens.

Mental Health America
Mayo Clinic



In addition, she identified some visible signs of depression in students that school counselors and parents can see.  


Some of the signs of depression in teens

Tools for Assessing Depression

There are several screeners school counselors can use to give parents information if you or other teachers notice signs of depression in a student.  Remember, all teens should be referred to a professional. 

Psych Central Depression Screening -Psych Central provides an 18 question online quiz for individuals.

Teen Depression Quiz

Depression Wellness Analyzer

Complications of Untreated Depression

Teens who go untreated for depression often are at risk for health, emotional, and behavioral issues.  Some of these issues include:

Substance abuse
Isolation from friends and family
Academic issues
Poor self image
Involvement with law enforcement
Self injury
Suicide

Source:  Mayo Clinic

It is important to identify students early and get them the help they need!!

The Good and Bad News About Depression

The good news is that depression, like heart disease and diabetes, is treatable!!  There is no single treatment for depression.  Treatments can include a combination of medication, psychotherapy, talk therapy, cognitive behavior therapy, psychodynamic therapy, problem solving therapy, exercise, a balanced diet, and avoiding excess caffeine. The earlier depression is identified in adolescence the greater the chance the teen will recover.

Now, the bad news.  Left untreated, depression can end tragically for teens. Many teens cannot cope with the depression and choose to die through suicide.  Suicide is the third leading cause of death in teens and school counselors are at the front line of suicide prevention and intervention.  The University of South Florida has created a Youth Suicide Prevention School Based Guide that includes: elements of a comprehensive suicide prevention program;  checklists and self-assessments; and guidance to school administrators of how to incorporate the comprehensive elements in their school.

There are three primary ways to identify suicidal students in schools:

1.  Incorporating a suicide awareness curriculum that utilizes a mental health approach.
2.  Gate Keeper Training-training school faculty and staff how to recognize when a student is at risk for committing suicide.
3.  Suicide Screening Instruments-most school districts have their own screening instruments that school counselors can use to identify suicidal youths. 

What Can Counselors Do To Help Depressed Students?

Darrell Sampson, school counselor and author of From the Counselor's Office blog, wrote a post in November, 2012 about how school counselors can help students with depression.  I thought his blog gave some great tips for school counselors and I wanted to share some of his suggestions with you.

1.  Build resiliency in students by helping them to get involved in clubs, extracurricular activities, and community service to build connectivity to school. One great resource to use is Sources of Strength for training students to help build their "sources of strength" in their school community.

Sources of Strength Toolkit
Strength Building Quick Cards

2.  Educate students and staff about the signs of depression and suicide.  Gatekeeper Training is a great training resource for identifying the signs of suicide.

3.  Contact parents of students who present signs of depression and give them contact information of mental health professionals.  It is great to create a resource list of mental health professionals in your area.

4.  Be supportive of students while they are at school by checking on them during the week and providing a safe space.

5. Another suggestion is to build a peer listening program where students can help their peers and make referrals.  Here is some information from SAMSHA on peer listening training below.

Crisis Response Training

Also, you can contact the National Association of Peer Program Professionals for a list of trainers in your area for peer listening.

National Association of Peer Program Professionals



Some Additional Resources:

Webinars:

Depression Webinars
Parent Webinar on Depression









School Kits:

Suicide Prevention Kit for High Schools
State Suicide Prevention Plans

Organizations to Join:

National Alliance on Mental Illness

Professionals to Follow:

Nancy Rappaport