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Bipolar Disorder
Cyclothmia
Depression & Families: It’s a Family Matter
Depression & Medical Illness
Depression in Later Years
Depression with Other Disorders
Dysthymia
Child & Teen Depression
Depression
Depression & Diabetes
Depression During Pregnancy
Depression in Older Adults
Dual Diagnosis
Post-Partum Depression


Bipolar Disorder

Bipolar disorder is also known as manic-depressive illness. It is a brain disorder and causes extreme shifts in a person’s mood. It also causes shifts in a person’s energy and ability to do things. Bipolar disorder is different from the normal ups and downs we all have. The symptoms are severe. They can result in the following:

Bipolar disorder can be treated, and people with this illness can lead full and productive lives.

More than two million American adults have bipolar disorder. About one percent of people 18 and older have this illness. It usually develops in early adulthood. Some people can have their first symptoms when they are a child. Others develop symptoms late in life. Bipolar disorder is a long-term illness, and it must be managed with care for a person’s entire life.

What are the symptoms?

Bipolar disorder causes extreme mood swings. People with bipolar disorder can be very high and/or irritable. Then they can be very sad and hopeless before they swing back again to high. There are often periods of normal mood in the middle. They also have severe changes in energy and behavior. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

A manic episode is diagnosed if elevated mood occurs. It must be with three or more of the above symptoms. These symptoms have to occur most of the day, nearly every day. They also must occur for one week or longer. If the elevated mood is irritable, four more symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

A depressive episode is diagnosed if five or more of these symptoms are found. They need to last most of the day and need to happen nearly every day, for two weeks or longer.

A mild to moderate level of mania is called hypomania. The person may feel good in this state. They may feel they are doing well and are extra productive. Family and friends may learn to notice the mood swings as possibly being bipolar disorder. The person may deny that anything is wrong. This can become severe mania in some people if not treated. I can also switch into depression.

Sometimes severe episodes of highs or lows include symptoms of psychosis. Common symptoms are hearing, seeing or feeling things not really there. Other symptoms include delusions – false, strongly held beliefs without logical thought. These symptoms are usually in the extreme mood state. For example, a person may believe he or she is the president or have special powers. He or she may feel extreme guilt or worthlessness during depression. People with these symptoms are sometimes not diagnosed correctly.

It may be helpful to think of the various mood states in bipolar disorder as a continuous range:

Some people may have symptoms of mania and depression that occur at the same time. This is called a mixed bipolar state. Symptoms of a mixed state often include the following:

A person may have a very sad, hopeless mood, but at the same time they may be feeling very energized.

What is the course of bipolar disorder?

People usually have high and low events all their life. Most people have no symptoms between the highs and lows. Usually about one-third of people have some symptoms that continue. Others continue to have symptoms that never go away even when treated.

People can lead healthy and productive lives when treated. With no treatment they will get worse. Over time, a person may suffer more and more severe episodes. In most cases, good treatment can help reduce the amount and severity of episodes. Treatment will help people keep a good quality of life.

Can children and young adults have bipolar disorder?

Yes, both children and young adults can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Adults tend to have symptoms that are more clearly defined. Younger people often have very fast mood swings. These mood swings also happens many times a day. Children with mania are more likely to be irritable. They are prone to bad tantrums more than being overly happy. Mixed symptoms also are common in children. Young adults who develop the illness may have more adult-type episodes and symptoms.

What causes bipolar disorder?

Scientists are still learning about the causes of bipolar disorder. Most scientists agree that there is no single cause and think there are many factors acting together. Because this illness tends to run in families, they have been searching for specific genes. Scientists are also looking at cells that influence how the body and mind work and grow. They think they are passed down through generations and that they may increase a person’s chance of getting the illness.

How is bipolar disorder treated?

Most people are helped with good treatment. However, bipolar disorder never goes away, which makes long-term treatment very important. It is best to combine medication and multiple forms of treatment for the mind and body to manage this illness over time.

Usually bipolar disorder is controlled better if treatment goes on continuously. It is not good to start and stop, but even when there are no breaks in treatment, mood changes can occur. Report any changes to the doctor right away. The doctor may be able to prevent a full-blown episode. He or she will make adjustments to the treatment plan.

Medications

Medicine is prescribed by special doctors. These are medical doctors with expertise in mental disorders, called psychiatrists. Regular doctors who do not specialize in mental disorders may also prescribe these medicines. However, it is recommended that people with bipolar disorder see a special doctor.

Treatment of bipolar depression

Research has shown that people with bipolar disorder are at risk of having symptoms if they take medicine for depression. Therefore, “mood-stabilizing” medicine generally is required, alone or in combination with medicine for depression, to protect people with bipolar disorder from the side effects of medicines for depression.

Psychosocial treatments

As well as medicine, certain forms of “talk” therapy are helpful. It helps support, educate and guide people. It also helps their families. Studies have shown that this therapy can lead to better mood stability and can lead to fewer visits to the hospital. A special doctor is usually seen or a social worker or counselor can also be seen. They often work together to monitor progress. The number and type of sessions should be based on the needs of each person.

A long-term illness that can be effectively treated

Bipolar disorder is a long-term illness. There currently is no cure. Staying on treatment at all times is important as it can help keep the disorder under control. It can also help stop the episodes from getting worse and happening more often.


Cyclothmia

Basics

People who have cyclothymia (sigh-clo-thigh-mee-uh), have huge mood swings. They have very high highs and very low lows. There may be calm times in between. People can have these ups and downs on an ongoing basis. They usually don’t go for more than two months without a mood swing.

Until 1980, people with were thought of as having an uneven temper. We now know it’s a milder form of bipolar disorder. The mood swings are not as wide.

This problem happens to small number of people (about one percent). For these people, life can be hard. It disrupts moods, sleep, work and your health. It makes it hard to deal with others. The high can feel great, but the gloom that follows is a heavy price to pay.

It’s almost like the way a toddler acts. Happy, then mad then happy again. But dealing with a grown up toddler can be stressful. The roller coaster of moods can make life hard for everyone.

If you think you or a loved one has cyclothymia, seek help.

Symptoms

Cyclothymia strikes men and women. It can begin the teens or early 20s. Many can end up with manic-depression (bipolar disorder).

The up feelings can be great. But it takes its toll. The things the person does during this time can bring trouble for loved ones and co-workers. The person may go on careless spending sprees. They may act inappropriately with the opposite sex. Soon though their mood swings to feeling low.

Be ready to spot the signs of a mood upswing:

A mood down swing soon follows for those with cyclothymia. The low isn’t bad enough to go to the hospital, but it can cause serious problems. The depressed person is tired, on edge, and very down.

Treatment

People with cyclothymia have problems with their brain chemistry. They need medicine. However, people with cyclothymia may also have other problems. So, don’t assume medicine alone will be the only care they need. It may be best include talk therapy. This can teach them problem solving and self-control.

Lithium carbonate is the most common medicine for cyclothymia. Over half of those who take it have reduced symptoms and less frequent mood swings.

Some people taking lithium have side effects like trembling hands, nausea and weight gain. The side effects will decrease as the body gets used to the medicine. And the good effects keep increasing.

Low doses of the anti-convulsants valproate (Depakote) and carbamazepine (Tegretol, Carbatrol) help, too. People are at a higher risk to get depressed with these medicines. But the side effects are usually mild.

Some people may need more than medicine. They may also need help in dealing with others when a mood swing is coming. Such as, if the person is becoming really talkative, he can find something quiet to do. He can take the phone off the hook to keep from calling friends late at night.

It’s important for families to be a part of the person’s care. Counselors can show family members, partners and friends how to give support. The person with cyclothymia needs to think of others. He may have pushed them to their limits with his actions. Everyone must know that it’s important for the person to keep getting care.

FAQs

I found out I have cyclothymia. My wife was fed up with the way I was acting and said she’d leave me if I don’t get help. But I’m worried about the medicines. Do they have serious side effects?

You may not like the possible side effects. But leaving your condition untreated can do far more damage in the long run.

With the help of a counselor and your wife’s support, you can find the right medicine and care. But don’t stop taking the medicine just because you feel better. Even counseling alone may help keep your marriage from being damaged beyond repair. While you may think your highs are fine, your wife doesn’t.

My wife has had cyclothymia since she was 18. She has taken medicine for many years. We are planning our first child. Should she stop her medicine?

Many providers think it may be risky for women to be on certain medicines when they are expecting. But there could be a risk if she stops taking her medicine. This risk can include suicide. There is no simple answer. You need to talk with your wife’s doctor.

Women with cyclothymia have a higher risk for mood swings in the first three months after the baby is born. Taking medicine at the time of delivery will reduce this risk. Use caution though when taking medicines while pregnant. There’s a much higher rate of birth defects found in babies whose mothers took certain medicines for cyclothymia while pregnant.

You and your wife should talk with her providers to determine the best plan. They may find a way to help her build coping skills. This may include reducing her activities. She may be able to ward off trouble without using medication.

Since starting college several months ago, my daughter has been acting odd. She goes from being full of energy, to being tired and grouchy. Some of the things she says sound strange, too. She says she’s not on drugs. But I’m worried. What’s wrong with her? What should we do?

Your daughter may be showing the early signs of cyclothymia. Or maybe it could be a more serious bipolar disorder. Stress such as starting college has been known to bring on mood problems. This is even more the case if she has shown signs of mood problems in the past or if there is a family history.

She may need to see a doctor. If she doesn’t want to go, keep trying. Give her time. Help her to accept that she has a problem and not to be embarrassed.

My friend just got out of the hospital. He tried to commit suicide. He says he has cyclothymia. He says it’s not serious. Is he right?

No. He is either mistaken or trying to mislead you. A suicide attempt indicates a serious illness. The person needs long-term care including medicine.

Resources

Books

Mondimore, Francis Mark, Bipolar Disorder: A Guide for Patients and Families. Johns Hopkins Press Health Book, 1999.

Whybrow, Peter C., M.D., A Mood Apart: the Thinker’s Guide to Emotion and its Disorders. HarperCollins, 1998.

Jamison, Kay Redfield, An Unquiet Mind: A Memoir of Moods and Madness. Random House, 1997.

Agencies

National Mental Health Association
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
(703) 684-7722
(800) 969-NMHA (6642) (automated information line)
www.nmha.org

Depression and Bipolar Support Alliance
730 N. Franklin St., Suite 501
Chicago, IL 60610-3526
(800) 826-3632
www.ndmda.org

Web Site

The National Institute of Mental Health offers a useful primer with information about diagnosis, symptoms and treatment of specific disorders at: http://www.nimh.nih.gov/publicat/index.cfm


Depression & Families: It’s a Family Matter

What Is Depression?

It’s normal to feel sad from time to time. But depression is more than feeling sad. It is a serious medical condition that can change your mood. It can change how you think. It can change how you feel about yourself, your family and friends. It can get in the way of your daily routine. For some people, depression can even lead to suicide.

Signs of Depression

Common signs of depression include:

Are the Signs of Depression Always the Same?

No. A depressed person may have some or all of the signs of depression. The signs also may be different in different age groups.

Children can show depression through:

Depressed adults usually complain of:

Causes of Depression

Doctors do not know what causes depression. It is thought that it could run in families. Major losses or setbacks could make it worse.

Doctors know that depression is not a sign of weakness. People with depression cannot just snap out of it. Depression is no one’s fault.

Help Is Available

The most common treatments for depression are:

Recently, parents have noticed “black box” warnings on some medicines. They worry that these medicines might cause thoughts of suicide. The American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry want you to know that these medicines are important. They can help people with depression. They can also save lives. It’s a good idea to know the side effects and warning signs for any medicine. And watch for warning signs when doses are changed. Talk about any worries with your provider.

There are also other kinds of care. Ask your provider about them.

Does Depression Run In Families?

Studies show that depression can run in families. Children can become depressed if a parent is depressed. The risk is highest if the parent was depressed as a child. Or if he or she has been depressed more than once.

Misconception about depression is common. Depressed parents may think they are weak. Or, they think that the way they feel is their fault. Children may not know why a parent is depressed. They may think they did something wrong. This adds to the stress of dealing with this serious condition.

There is good news. Depression can be handled when families work together. Early screening is a good way to tell if someone is depressed. A good care plan can bring results in a few weeks. And good care is the key to stopping depression from coming back.

If a Family Member Is Depressed

Follow these steps:

  1. Share your concern. Talk with your family member about any signs of depression. Offer to help get him or her to a provider. Remember that children may not be able to tell you how they feel.
  2. Make a list. Write down your child’s signs of depression. Be sure to include your questions about depression and treatment. An adult family member with signs of depression may want to do this on their own. Or, they might want your help.
  3. Talk with your provider. Share the list you have written. Ask questions about depression. Talk about any medicines your family member is taking.
  4. Choose the right care. Ask your provider to tell you about the risks and benefits of all types of care. Also ask about the type of care that is most likely to help your family member.
  5. Learn more. Call your provider or local mental health group. They can also tell you about local support groups. You can also get information from the National Mental Health Association at 1-800-969-NMHA (6642) or www.nmha.org.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.


Depression & Medical Illness

A Common Combination

What Is Depression?

Feeling sad from time to time is normal. And the sadness goes away by itself. But depression is more than feeling sad. It is a serious medical condition that can change your mood and thinking. It can also change how you feel about yourself, your family and friends. It can get in the way of your daily routine. For some people, depression can even lead to suicide.

Signs of Depression

Common signs of depression include:

Am I Depressed?

Ask yourself the following questions:

Did you answer “yes” to either of the questions? You may be depressed. Contact your health care provider for a check-up.

Did You Know

Treatment Is Available

The most common treatments for depression are:

There are also other kinds of care. Ask your provider about them.

Is There a Link Between Depression and Medical Illness?

Depression is common. It can be a part of a medical problem. Five to 10% of people seeing their doctor have depression. The rate is 10 to 14% for people in the hospital.³

People who don’t feel well become depressed because of what’s going on with their body. They may feel depressed because they are in pain. Or because they can’t do things. Depression and medical problems may not be related, but they can happen at the same time.

Is there a link? It isn’t known. But medical illness and depression are harder to treat when they happen together. Patients with depression are more worried. They do not function as well in their lives. It is hard for them to follow advice from their doctors. The first step to getting better is to understand that you have depression. The next step is to get help. Treatment is available and can help.

What Should I Do If I Think I’m Depressed?

Follow these steps:

  1. Make a list. Write down any signs of depression you have. Write down your questions about depression and its treatment.
  2. Talk with a health care provider. Plan a visit with your health care provider or a mental health professional. Share your list of signs and questions about depression. Tell them about any medicines you are taking.
  3. Choose the right treatment. Ask your health care provider to tell you about the risks and benefits of treatment. Also ask about the type of treatment that is most likely to help you.
  4. Learn more. Your provider or local mental health association can tell you where to find more information. You can also get information from:
    • National Mental Health Association, 1-800-969-NMHA (6642) or www.nmha.org
    • National Institute of Mental Health, 1-800-421-4211 or www.nimh.nih.gov
    • Depression and Bipolar Support Alliance, www.dbsalliance.org
  5. Tell your provider how you are doing. Once you are in treatment, make sure your provider knows if you are feeling better or worse. Ask questions about how you are doing. Do not stop taking any medicine when you start to feel better. Never stop taking medicine without talking with your doctor first.

Depression can be helped. It should be given the same care as other medical problems. Take care of yourself by quickly dealing with both your medical illness and depression.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.

¹ New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.

² Ibid.

³ Ibid.


Depression in Later Years

YOU DON’T HAVE TO FACE IT ALONE

Older Adults and Depression

How do people view getting older? Is it spending more time in the garden, on the golf course, or with family and friends? There are many changes come with getting older. Older adults often have to deal with the death or illness of a spouse, other family members and friends. They may think they do not have a sense of purpose or have enough to do. They also may have health problems. Or, they might not be able to do things they used to do.

Dealing change can be hard. Many older adults get depressed. This makes it difficult to enjoy life. Some illnesses make it more likely that a person will get depressed. This is not a normal part of aging. Help is available. You do not have to face your problems alone.

Facts about Depression

Am I Depressed?

Ask yourself the following questions:

  1. In the past month, have I often felt down, depressed or hopeless?
  2. In the past month, have I often had little interest or happiness in doing things?

Did you answer “yes” to either of the questions? You may be depressed. Contact your health care provider for a check-up.

Signs of Depression

Common signs of depression include:

Treatment Is Available

The most common treatments for depression are:

There are also other kinds of care. Ask your provider about them.

What Should I Do If I Think I’m Depressed?

Follow these steps:

  1. Make a list. Write down any signs of depression you have. Write down your questions about depression and its treatment.
  2. Talk with a health care provider. Plan a visit with your health care provider or a mental health professional. Share your list of signs and questions about depression. Tell them about any medicines you are taking.
  3. Choose the right treatment. Ask your health care provider to tell you about the risks and benefits of treatment. Also ask about the type of treatment that is most likely to help you.
  4. Learn more. Your provider or local mental health association can tell you where to find more information. You can also get information from:
    • National Mental Health Association, 1-800-969-NMHA (6642) or www.nmha.org
    • National Institute of Mental Health, 1-800-421-4211 or www.nimh.nih.gov
    • Depression and Bipolar Support Alliance, www.dbsalliance.org
  5. Tell your provider how you are doing. Once you are in treatment, make sure your provider knows if you are feeling better or worse. Ask questions about how you are doing. Do not stop taking any medicine when you start to feel better. Never stop taking medicine without talking with your doctor first.

For More Information

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.

¹National Institute of Mental Health.


Depression with Other Disorders

Depression is a serious illness. It can be treated. The chance of depression is sometimes bigger in people with a bad medical illness. The warning signs are a lot of times not seen. People think it is normal to feel depressed when they are sick. Signs of depression can be hidden by signs of another illness. This may cause treatment for the signs of the illness but not depression.

The Cause of Depression in Primary Care Settings

Why Depression and Medical Illnesses Often Happen at the Same Time

Depression with Other Medical Illnesses

Heart Disease and Depression

Stroke and Depression

Cancer and Depression

Diabetes and Depression

Eating Problems and Depression

Alcohol and Drugs with Depression

Signs of Depression and Other Medical Problems

Getting Help


Dysthymia

What is Dysthymia?

The word dysthymia means bad state of mind or ill humor. It is similar to depression, but with milder symptoms. It is longer lasting. It lasts at least two years. Most people who have it are usually able to go on working and do not need to be in the hospital.

How Common Is It?

About three percent of people will have it at some time. That’s lower than the rate of depression. It occurs more often in women than men. It is more common among poor and single people. The signs usually appear in young adults. Sometimes it doesn’t appear until middle age.

Warning Signs

The warning signs of dysthymia are:

Over half of people have some other mental or medical problem as well.

Current Care for Dysthymia:

The signs may be hard to see. Most people with this problem only see their family doctor. The doctor may think something else is wrong. Especially if a lot of the signs are physical. Many people do not like to think they are depressed. They are relieved to be told they have a physical illness.

Signs of a problem

Adults with this problem are in a low, sad mood for least two years. They are unhappy most of the day. They are sad more days than not. A child or teen is unhappy or irritable for at least a year.

People with this problem don’t enjoy life. They tend to put themselves down. Being down is common. Many people with this problem have poor personal relationships, because:

During periods of depressed mood, people have least two of these signs:

People with dysthymia may think they have are just gloomy people. They try to learn to live with always feeling down. They may not realize they have a treatable problem.

Some people may have an “I don’t care” attitude about living or dying. While not suicidal, they may say they wouldn’t mind if they just didn’t wake up one morning.

Kinds of Care

The first step is to talk to your doctor. Is the problem being caused by a medical problem? Or a medicine you’re taking? If physical causes are ruled out, a psychiatrist or psychologist can assist in finding out what’s wrong.

Therapy

Two types of therapy work well for dysthymia:

Interpersonal therapy. This short term therapy focuses on the person’s relationships. It may uncover clues about the source of depression. It may show how the problem is getting in the way of relationships. The person’s spouse and other family members sometimes are involved.

Cognitive behavior therapy. This focuses more on the person. This type of therapy looks at how the person thinks and acts. The therapy helps the person look at why they are so down. It helps the person gain confidence.

Medicines

Most people with dysthymia can be helped with medicine. It can take a few weeks for medicine to build up and take effect. It’s typical to continue taking medicine for up to six months after your mood improves. Let your doctor know if you’re feeling better or worse while taking medicine. The doctor may change the amount or try something else.

Self-help

In addition to speaking with your doctor and following the plan of care, you can take these steps to feel better:

FAQs

What’s the difference between dysthymia and major depression?

Major depression comes and goes. When the person is depressed the sadness is overwhelming. They may be so low they stop feeling anything. A person with dysthymia doesn’t experience deep depression. Their illness is always long term. It lasts for at least two years. It is considered a mild disorder when compared with major depression. But it is serious and should be treated.

I’m 25 years old and think I have dysthymia, but I’ve had symptoms for only one year.

To be dysthymia, you need to have it for at least two years. You may have depression. Or it could be the beginning of dysthymia. You’d need to wait a year to find that out. But you should see your doctor now.

How do I know that this not just a part of my personality? Maybe I’m just a gloomy person. There’s nothing that can change that, right?

Researchers think that some people may have a depressed personality, so you might be somewhat right. But if you want to change your life for the better, you can improve your mood, attitude and habits. It has been said we are works in progress. We can change for the better if we work at it and have the support of those close to us.

Do people with dysthymia have to go to the hospital?

Almost never. People with this problem live their lives fairly normally, without feeling happy. If the feelings are serious enough to go to the hospital, the person has probably developed major depression on top of dysthymia.

Resources

Associations

National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
(800) 950-NAMI (6264)
www.nami.org

Depression and Bipolar Support Alliance
730 N. Franklin St., Suite 501
Chicago, IL 60610
(800) 826-3632
www.ndmda.org

National Foundation for Depressive Illness
P.O. Box 2257
New York, NY 10016
(800) 239-1265
www.depression.org

The National Institute of Mental Health
NIMH Public Inquiries
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD 20892-9663
(301) 443-4513
(800) 647-2642 (toll-free information line)
www.nimh.nih.gov

National Mental Health Association
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
(703) 684-7722
(800) 969-NMHA (6642) (toll-free automated information line)
www.nmha.org

Books

Burns, David D., M.D., The Feeling Good Handbook. Plume Publishers, 1999.

Markowitz, John C., M.D., Interpersonal Psychotherapy for Dysthymic Disorder. American Psychiatric Press, 1998.

Whybrow, Peter C., M.D., A Mood Apart: The Thinker’s Guide to Emotion and Its Disorders. HarperCollins, 1998.

Greenberger, Dennis, and Christine A. Padesky, Mind Over Mood: Change How You Feel by Changing the Way You Think. Guilford Press, 1995.

Support Group

Mood Disorders Support Group of New York City offers help at: www.mdsg.org


Child & Teen Depression

Feeling sad instead of glad

Depression or “the blues”

Depression can start out as “the blues” or feeling sad. Everyone feels sad from time to time. Sadness can happen after stressful events. It lasts for a short time. A bad day or an argument can make you feel sad for a while.

If the sad feeling does not go away, you may have more than just “the blues.” If sadness gets in the way of your daily routine, you may have more than just “the blues.” Sadness or stress can lead to depression. Depression affects the way we eat, sleep and live our lives. Without help, signs of depression can last for weeks, months or years. Depression is a serious medical condition. Head and stomach aches can be a part of depression. Depression can be life threatening. Two-thirds of depressed young people do not get the help they need.

Causes of depression

Doctors do not know what causes depression. It is thought that it could run in families. Major losses or setbacks could make it worse.

Doctors know that depression is not a sign of weakness. Children and teens with depression cannot just snap out of it. Depression is no one’s fault.

Risk factors

Doctors do not know which children and teens will develop depression, but they do know that some have a higher risk. The risk is higher in children who have parents with depression. It is also higher in children who are in the hospital a lot.

Once a young person has had depression, he or she is more likely to have it again, often within the next five years.

Other factors that make children and teens more likely to have depression are:

Help is available

The most common treatments for depression are:

Recently, parents have noticed “black box” warnings on some medicines. They worry that these medicines might cause thoughts of suicide. The American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry want you to know that these medicines are important. They can help people with depression. They can also save lives. It’s a good idea to know the side effects and warning signs for any medicine and watch for warning signs when doses are changed. Talk about any worries with your doctor.

Depression checklist

Signs of child and teen depression may be different from those seen in adults. Early signs can be hard to notice. Signs of depression in children and teens can include:

Young people who are depressed have a higher risk of suicide. This is why it is important to get help if you think your child or teen is depressed.

Parents and adults can help

If you think a child or teen is depressed, you should:

GET HELP FOR THE CHILD OR TEEN RIGHT AWAY IF HE OR SHE IS THINKING OF HURTING HIM OR HERSELF OR OTHERS. CALL US AT (800) 631-1314. Please remember, always call 911 in the case of emergencies.


Depression

When it’s more than just the blues

Depression Is More Than Just the Blues

Depression can start out as the blues, or feeling sad. Everyone feels sad from time to time. Sadness can happen after stressful events. It lasts for a short time. A bad day or an argument can make you feel sad for a while.

If the sad feeling does not go away, you may have more than just the blues. If it gets in the way of your daily routine, you may have more than just the blues. Sadness or stress can lead to depression. Depression affects the way we eat, sleep and live our lives. Without help, signs of depression can last for weeks, months or years. Depression is a serious medical condition. Head and stomach aches can be a part of depression. Depression can be life threatening.

Every year, more than 19 million Americans get depression. Men, women and children from all walks of life can get it. But many don’t get the help they need. People miss the early warning signs or think they have a physical problem. Or they think they should be able to “just get over it” But this is not true. The good news is that most people who get help can get better.

Causes of Depression

Doctors do not know what causes depression. It is thought that it could run in families. Major losses or setbacks could make it worse.

Doctors know that depression is not a sign of weakness. People with depression cannot just snap out of it. Depression is no one’s fault.

Depression Checklist

Some common signs of depression are:

If you have any of these signs for more than two weeks, you may be depressed. Contact your health care provider for help or information.

Treatment Is Available

The most common treatments for depression are:

There are also other kinds of care. Ask your provider about them.

What Should I Do If I Think I’m Depressed?

Follow these steps:

  1. Make a list. Write down any signs of depression you have. Write down your questions about depression and its treatment.
  2. Talk with a health care provider. Plan a visit with your health care provider or a mental health professional. Share your list of signs and questions about depression. Tell them about any medicines you are taking.
  3. Choose the right treatment. Ask your health care provider to tell you about the risks and benefits of treatment. Also ask about the type of treatment that is most likely to help you.
  4. Learn more. Your provider or local mental health association can tell you where to find more information. You can also get information from:
    • National Mental Health Association, 1-800-969-NMHA (6642) or www.nmha.org
    • National Institute of Mental Health, 1-800-421-4211 or www.nimh.nih.gov
    • Depression and Bipolar Support Alliance, www.dbsalliance.org
  5. Tell your provider how you are doing. Once you are in treatment, make sure your provider knows if you are feeling better or worse. Ask questions about how you are doing. Do not stop taking any medicine when you start to feel better. Never stop taking medicine without talking with your doctor first.

Practice Guidelines

These guidelines suggest the best treatment for certain medical conditions.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.


Depression & Diabetes

Depression can happen to anyone. People with diabetes may be at greater risk. People with depression may be at greater risk for getting diabetes. Getting help for depression helps people deal with signs of both diseases.

Many studies show that diabetes doubles the danger of depression. The chances of becoming depressed become higher as diabetes gets worse. Research shows that depression leads to worse physical health. Treating depression with “talk” therapy can make a patient feel better. Pills can also help.

Causes of the link between depression and diabetes are not clear. Depression may start because of stress. It may also begin from the metabolic effects of diabetes on the brain. Studies show that depressed diabetics are more likely to have issues. People may pay a lot of money for primary care.

Depression sometimes goes without being treated. There have been a lot of studies on the brain in the past 20 years. People don’t always understand the signs of depression. Good doctors will recognize these signs. They will help with treatment.

Depression Facts

Depression is a serious medical problem. It affects everyday life. Depression can start at any age. NIMH-sponsored studies estimate that 6 percent of 9- to 17-year-olds in the U.S. have some type of depression. Almost 10 percent of American adults have some type of depression. Treatments make the signs of depression better in over 80 percent of those treated. Less than half of people with depression get the help they need.

Depression begins when the brain is not working well. The reasons why people get depressed are being studied. It could come from family health history. It could begin because of stress. Depression can limit the energy needed to keep focused on treatment for other health issues.

Diabetes Facts

Diabetes hurts the way the body uses food to grow and live. Most of the food we eat is broken down into a sugar called glucose. This gives the body energy. It passes into the bloodstream. Insulin helps this sugar get into cells. It changes into energy.

The immune system breaks up the beta cells of the pancreas that make insulin in type 1 diabetes. Children and young people usually have type 1. They take insulin shots for the rest of their lives. Insulin won’t make diabetes go away.

Five to 10 percent of diabetes cases in the United States are type 1. It happens in men and women. It is more common in white people. Some signs are being thirsty. A sign is going to the bathroom a lot. Another sign is being hungry a lot. People with diabetes may have weight issues. Things may look blurry. They may feel very tired. They could end up in a coma if they don’t go to a doctor for diabetes.

Ninety percent of cases of diabetes in the United States are type 2. It happens a lot to adults over age 40. This kind of diabetes happens a lot with people who are heavy. It happens a lot with people who are not active. It happens with people who have type 2 diabetes in their family. It is more common in African Americans. It also happens to a lot of people who are Hispanic. It happens a lot with people who are American Indian. It happens a lot with people who are Asian. It happened a lot to Pacific Islander Americans. Type 2 diabetes has been on the rise since a lot of people are heavy these days.

Type 2 diabetes is sometimes part of a metabolic problem. People with type 2 diabetes first have problems with insulin. Muscles do not use insulin the right way. Fat does not use insulin the right way. Liver cells do not use insulin the right way. The pancreas makes more insulin. Slowly it can’t secrete insulin. The timing of insulin secretion becomes strange. The amount of insulin only gets worse once diabetes starts.

Signs include being tired. They may feel sick to the stomach. They may be thirsty a lot. They use the bathroom a lot more. Things may be blurry. It may take a long time for a sore to get better. Some people have no signs at all. Researchers think that about one-third of people with type 2 diabetes don’t know they have it.

Many people with type 2 diabetes can control their blood glucose by eating right and exercising. Sometimes they need to take pills. If a person has type 2 diabetes for a long time they may need insulin shots.

Gestational diabetes starts when someone is pregnant. It happens to a lot of people who are Hispanic. It also happens a lot to people who are African American. It happens a lot to American Indians. It can also happen to people who have people in their family with diabetes. It usually goes away after the mother has the baby. The mother has a bigger chance of getting type 2 diabetes later in life.

Managing Diabetes

Research shows that tight glucose control is the best way to stop issues with diabetes. Glucose levels should stay as close to normal as possible. People with diabetes should eat well. They should exercise. Blood glucose levels must be checked a lot. Research has helped people with type 2 diabetes. Blood pressure pills help with heart and kidney disease.

People with diabetes try to keep blood glucose from going too high or falling too low. When blood glucose levels drop too low a person can become nervous. They can also become confused. This is called hypoglycemia. Judgment can be harmed. They can also faint.

High levels of blood glucose is called hyperglycemia. It can cause bad health problems. It can cause blindness. It can cause heart and blood vessel disease. A stoke could happen. Kidneys could go bad. Body parts may need to be taken off. Nerve damage could happen. Uncontrolled diabetes can hurt pregnancy.

Researchers are trying to find more information about diabetes. They are trying to find ways to stop it. They are testing new drugs. They are also trying to make fake beta cells that secrete insulin.

Get Treatment for Depression

There are a lot of ways to treat depression. The treatment must be picked by a professional. They should think about the person and family when making their choice. Pills help. They are safe for people with diabetes. Specific types of “talk” therapy can help depression. It takes time for a depressed person to feel better. Pills can take many weeks to work. They may need to go along with “talk” therapy. Not everyone handles treatment in the same way. Pills and the amount of pills taken may need to be fixed.

Scientists say that “talk” therapy and pills have good effects on both mood and glycemic control in people who have diabetes and depression. More studies will help us better understand the links between depression and diabetes.

Treatment for depressed diabetics should be managed by a mental health doctor. The mental health doctor should talk with the doctor giving care for diabetes. This is really important when pills are needed to stop harmful drug connections. There are doctors that are taught to care for those with depression and a physical sickness. Depressed diabetics should tell any doctor they see about their medication.

People with diabetes should talk to a doctor before taking any herbs. Scientists have found that St. John’s wort may cause problems with some other pills.

Other mental problems may happen in people with diabetes. They can be treated.

Depression is a disorder of the brain. It can be treated. It can also be treated along with a physical health problem. Don’t lose hope if you think you may be depressed. Get help for depression.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.


Depression During Pregnancy

Pregnancy is supposed to be one of the happiest times of a woman’s life. But many women feel confused, afraid, sad, and even depressed. Many women will have depression when they are with child. Many of these women will have it worse than others. This is an illness that includes 1 out of every 4 women at some time in their life. So, it should be no surprise that this illness would also affect women who are with child. But many times, people don’t get help for it. People think it is just another part of being with child. But, it can hurt the mother and the baby. This is an illness that can be helped. The first step of asking for help and support is the most important.

What is depression when you are expecting?

Being depressed when you are with child is an illness just like normal depression. It includes changes in the brain. During pregnancy the body goes through many changes that can affect the brain. These changes can lead to depression and nervousness. It can become worse with difficult life situations. This can lead to depression during pregnancy.

What are the signs of depression during pregnancy?

Women with depression usually have some of the following signs for two weeks or more:

What causes depression when a woman is with child?

Can it hurt my baby?

If you don’t help, it can hurt the mother and the baby. It can lead to poor eating, drinking alcohol, smoking, and thoughts of ending your life. This can then cause early birth, low birth weight and other problems as the baby develops. A woman who is depressed often does not have the energy or want to care for herself or baby. This is why problems arise.

What help is available?

If you feel you may be having a hard time with depression, the most important thing is to get help. Talk with your doctor about what you are feeling and having a hard time with. Your doctor wants the best choice for you and your baby. They can talk to you about the different types of help available. This can include:

If you are having a really hard time, your doctor may want to put you on medication right away. There are approved medications that are safe to use when you are expecting. Talk with your doctor what they feel is safest for your baby, but can still help you.

If you do not feel comfortable talking with your doctor about your feelings, find someone else to talk with. The most important thing is that someone knows what you are feeling and can try to help you. Never try to do it alone… your baby needs you to get help.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.


Depression in Older Adults

Depression in older adults causes worry. It also causes people to suffer. It leads to problems with the body, the mind, and the way a person acts with others. It is often not seen and not treated. Many older patients do not get help for their depression. Many do not get enough help. Part of the problem is that depression in older people is hard to find. This is because other conditions also affect older people.

Depression’s signs are different in older adults. Having a lot of signs together can be as serious as major depression. This is called minor depression.

Minor depression is also a big deal. It is common and has a big impact. Eight to 20 percent of older adults in the community show signs of it. Up to 37 percent in primary care settings show signs. Treatment does help. But it takes longer to help older adults.

Identifying Major and Minor Depression

Major depression includes:

Major depressive disorder is the most common type in adults. It can occur in people over and over again. It can include the following signs:

Major depressive disorder cannot be identified if the signs last for less than two months after a loss or other sad or painful experience.

Most older patients who show signs do not have major depression. Some are told they have minor depression. Minor depression is not yet seen as an official disorder.

Minor depression comes about more often. Minor depression can be:

Minor depression is more common. People with major and minor depression use more health care services and sometimes have a poor quality of life.

Late-Onset Depression

Depression identified after age 60 is called late-onset depression. This is not a diagnosis. This type of depression is similar to early-onset depression. But there are some differences:

The risk of depression coming back is very high in patients who are diagnosed after age 60.

Causes of this type of depression might include:

Problems in Identifying and Treating Depression

It is dangerous not to identify and treat depression. One study showed that only 11 percent of depressed patients got the right help. 34 percent had help that was not good enough. 55 percent got no help.

There are reasons why doctors might not see depression in older adults. People might think the signs are related to age. Older adults are also not as willing to tell doctors if they are not feeling well. They are not as willing to say they feel worthless. But these signs are important in finding depression.

Depression can make problems with the body worse. These problems can take attention away from the depression. Many older patients might not want to admit they have depression. Older men do this most often. They have the highest rates of killing themselves in later life.

Providers might not want to tell older patients that they have depression because they:

Many people believe that depression will always happen in older people when:

Thinking about death is also thought of as a normal part of old age. Some doctors even believe these things. These wrong beliefs can lead to:

Connections to Problems with the Body

Mental problems in older people can be related to problems with the body. 25 percent of older people with constant sicknesses have depression. This is the highest rate. These sicknesses can include:

Older people with one or more of these are more likely to have depression.

Not being able to sleep is another sign of depression in older patients. Problems with sleep are also related to:

Five to 10 percent of older adults have constant sleep problems. Doctors are not sure why sleep problems might cause depression in older adults.

Consequences of Depression

The worst result of depression in older adults is a higher risk of death. This can be from killing themselves. It can also be caused by problems with the body. This can happen if the treatment is not good. People over age 65 have the highest rate of killing themselves. This happens to people age 85 and older more than any other age group.

Older adults who kill themselves are most likely to have late-onset depression. That is more likely to be the only cause of this in older people. It is normal for older people to think about death. But older adults who think of killing themselves need help. This is not normal. It is also important to give older adults the right medicine for depression. It can help stop this from happening.

Depression can also lead to death from other diseases. These can include heart disease and cancer. Doctors are not sure why this happens.

Causes of Late-Onset Depression

Causes can include:

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.


Dual Diagnosis

What is Dual Diagnosis?

A person who is misusing alcohol or drugs and feelings of being upset, angry or not feeling like themselves is said to have Dual Diagnosis. To get better, the person needs help for both problems.

How Common Is It?

It is very common:

What Kinds of Problems are Common in People with it?

The following are common in people who use alcohol or drugs a lot and in the wrong way.

Which Comes First?

For some people the emotional problem usually come first. To feel happier, a person with an emotional problem might drink or use drugs. Doctors call this “self-medication”. It may lead a person to use alcohol or drugs in the wrong way. If it does, the person then suffers from not just one problem, but two.

In teens, drug or alcohol abuse may lead to problems later in life. This may lead to emotional problems. Other times, using alcohol or drugs in a wrong way is the main problem. When a person’s problem becomes worse, it may lead into an emotional illness. This may include depression, anger, strange thoughts, or they may try to kill themselves.

How Can a Doctor Tell What is the Biggest Problem?

At first, it may be hard to tell what the biggest problem is. This is because alcohol or drug problems may look like other problems. The person must first get the alcohol or drugs out of their body. Then the doctor can tell if there’s an emotional problem also.

Which Problem Should They Get Help for First?

A person should get help for both problems at the same time. For any person using drugs or alcohol in the wrong way, they should first stop using the alcohol or drugs to get it out of their body. They should do this with a doctor and it can take a few days to a week or more.

Removing alcohol or drugs from the body can be very painful. Doctors can give them medicine to help make it less painful. When the alcohol or drugs are completely out of the body, it’s safer and easier.

What Is Next?

A person should now get help for both problems. Getting together with people who have the same problem can help a lot. Learning about the problem can also help a lot. Eating right, working out and getting into a 12-step program like Alcoholics Anonymous can also help a person get better. A person has to learn to be happy without alcohol or drugs.

A doctor can help a person find the right kind of help. Talking to other people who have the same problem and getting medicine from a doctor can help a lot. Joining a group with other people who have the same problem may also help. In these groups people can talk about their feelings and learn ways to keep them from drinking or using drugs.

Does a Person Have to Get Help in a Hospital?

Not all the time. It depends on how bad the illness is. It also depends on any problems they may have had before getting help. There are many kinds of help out there. These include going into the hospital or getting help from a different place where they only go in for just part of the time.

Can the Family Help?

A family’s help is very important. They can help the person get care from a doctor, learn about the problem and get help from groups who have the same problem. When a family learns and understands the problem, the person with the problem will get better sooner.

How Can Family and Friends Help?

Yes, family and friends can help. They can help by learning to stop letting the person use alcohol or drugs. Here’s an example -a woman whose husband drinks too much might call in sick for him when he is too drunk to go to work. That’s letting the person continue with their problem. Also, family or friends might give the person money to buy drugs because they feel sorry or are afraid of him or her. That’s also letting the person continue with their problem.

The best way to help someone is to get them help. At that point they learn how to stop letting the person continue with their problem. If they use what they have learned, the person is less likely to go back to drinking or taking drugs.

How Can Family and Friends Help with a Person With an Emotional Problem?

They should be calm and understanding, rather than frightened or hard on the person. They should be warm and open. Although it is fine to ask the person how they are doing with the help they are getting, also talk about other things, not just that.

How Can I Help When I think Someone Has These Problems?

Help the person to see that they may have a problem and that they need to get help. Talk to them about seeing a doctor. If the person doesn’t want to do it, look for a doctor, make the appointment and go with the person to see the doctor. A little support from you may be all it takes. If you talk to the doctor first, be honest about what you are seeing. This can help the doctor a lot.

There Is Hope

You can play a big part in helping a person get the help they need. By learning about it, you can help this person find and stay with a good program that will work for them. As with any illness, a person can get better once they get the right help. By looking for more information, you can learn to see the signs of it and help someone live a better life.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.


Post-Partum Depression

Having a baby means major changes in one’s life. No matter how prepared you feel, you may still feel physical, emotional and personal lifestyle changes.

It is not unusual to feel tired or irritable. More than 50% of new mothers have the so-called “postpartum blues.” This usually happens over the first ten days or so after giving birth.

Symptoms are short-lived and often include:

Talk to your doctor if you feel these signs. Let your friends and family know what is going on. Ask them to support you.

Postpartum blues can be normal. It usually goes away within a matter of a few days to two weeks. Postpartum depression is quite different. The symptoms make you feel like you aren’t able to care for a new baby. It is a serious condition. It will not go away on its own. It is more likely to get worse if it is not treated the right way.

Symptoms experienced with postpartum depression can include:

A woman with postpartum depression may spend a lot of time crying. They may feel guilty about the birth. They may feel bad about their skills as a mother. She may feel worthless. She may even fear that she will harm herself. She may worry about harming her baby. This type of depression happens in about 10 – 15% of mothers. It usually starts within the first week.

The Good News: There are safe and effective treatments for postpartum depression. You can get treatment even if you are breastfeeding.

GET HELP IMMEDIATELY IF YOU:

What Causes Postpartum Depression?

What causes this very real depression at a time when a woman is supposed to feel so happy? There are many unanswered questions about postpartum depression. What is known is that the causes are far more complex than changes in hormone levels. Factors can happen at any time during pregnancy, childbirth, or the postpartum period.

Examples include:

A common theme of new mothers with depression is how hard they try to hide it. They suffer in silence. They are afraid to admit that their feelings about new motherhood are less than perfect. Many times, they’ve been swayed by the over-glamorous portrayals of motherhood. Depression can happen when no sleep and total disruption of daily routines becomes a reality.

A woman’s need for both physical and emotional support is great after having a baby. It is important that she feels her needs are being met. She needs to feel loved.

What Can You Do?

Do not try to cover up the way you feel. Emotional support is very important. The “pull yourself together and snap out of it” attitude will not work this time.

Remember:

Everything does not have to be perfect. It may be helpful to:

Think about therapy or counseling to help you in your relationship. Therapy can improve your feelings about yourself. It can help you feel better about your skills as a mother. It can help your self-confidence. An antidepressant medication may be necessary. Talk with either your primary care physician or your obstetrician. They are there to help you through this.

There is much more we still do not understand about postpartum depression. Having a baby is a normal crisis for every mother. Call your doctor if your feelings of helplessness are keeping you from caring for your baby.

Again, get help immediately if you:

Books that might be of help include:

Postpartum Survival Guide, by A. Dunnerwald and D.G. Sanford

Other sources of help include your local mental health agency or your employee assistance program.

Remember, you do not need to suffer.

Get help right away if you are thinking of hurting yourself or others. Call us at (800) 631-1314.