Michael Cheng, Psychiatrist

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Stress, Anxiety and Depression
Presentation for Youthnet, Cottage Boardroom,
Nov 16, 2005

• Michael Cheng, Psychiatrist
• http//www.drcheng.ca

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• This presentation is protected under a Creative
  Commons Deed (http//creativecommons.org/licenses/
  by-nc-sa/2.0/
• You are free to copy, distribute, display and
  perform this work, as long as this work is not
  used for commercial purposes

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Goals

• An overview about stress, anxiety and depression
  in youth
• What is it
• What causes it
• What can you do about it
• Where to get help (in Ottawa)

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Top Questions from Youthnet Facilitators

• What is the meaning of life?
• What is bipolar?
• Common causes of teenage depression?
• What to do when having an anxiety attack?
• Where to refer someone with mood/anxiety problems
  (in Ottawa)?

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Its All About Balance
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Q. What do normal people need in life?
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Everyone needs a healthy body, mind, spirit
Body

• Body (Physical, Biological Self)
• Mind (Psychological, Emotional Self)
• Spirit (Spiritual Self)
• Note Overlap, e.g. psychological interventions
  can cause biological changes, and vice versa

Mind
Spirit
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The Triple A
Agency / Autonomy / Achievement
Activity (as opposed to passivity)
Affiliation (Relationships)
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The Triple C
Control
Chipper (or being active)
Connections with Others
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Three Ps
Power
Proactive
People
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Point A
Point B (Goals)
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Obstacles such as stress (at home, school, work),
depression, anxiety
Point A
Point B (Goals)
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Life is full of things that cause imbalance (in
mind, body, spirit)
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Typical stresses in our modern society

• Body
• Medical / physical illness
• Lack of sunlight / Drug Use
• Mind / Social
• School / Work
• Classmates / co-workers
• Family
• Friends
• Boyfriends/girlfriends
• Spirit

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Life is a balance between coping and stress
Demands / Expectations / Stresses
Coping Ability
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Problems if demands, expectations or stresses
outweigh coping
Coping Ability
Demands / Expectations / Stresses
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There are two solutions to restore the balance...
? Coping Ability
? Demands / Expectations / Stresses
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Stress can lead to

• Physical problems
• Emotional or mood problems such as
• Depression
• Anxiety
• Eating Disorders
• OCD
• Any problems with mood/coping...

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Prevalence of Mental Disorders in Children and
Adolescents in Canada (Stats Can, 2002, age 0-19)
Anxiety Disorder 6.5
ADHD 3.3
Depressive Disorder 2.1
Substance Abuse 0.8
Schizophrenia 0.1
Bipolar Disorder 0.1
Eating Disorder 0.1
Etc... Etc...
ANY DISORDER 15
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Mood Disorders What is It?

• Everyone gets sad from time to time
• Just enough sadness is good because it alerts
  people to do something to change their situation
• Mood disorders are when peoples moods are so
  extreme that it gets in the way of life
• It is not normal, and is not something that
  someone can easily snap out of

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Mood Disorders To Diagnosis or Not to Diagnosis?

• Classified according to the DSM-IV
• For formal DSM-IV criteria for disorders, visit
  www.mentalhealth.com
• Although imperfect, the DSM-IV nonetheless
  reflects an improvement from the past, when there
  was no common language in talking about what was,
  or was not a mental condition
• Each version of the DSM gives us a greater
  understanding of mental conditions

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Mood Disorders To Diagnosis or Not to Diagnosis?

• Pros
• Gives us a common language
• Allows people to learn and get support about
  their condition or problems
• Cons
• Being labelled may carry a stigma (perhaps
  stigma is the true problem?)
• The fact that people may misuse a diagnosis to
  avoid responsibility for a problem
• Being put into a box

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My personal bias...

• Appropriate use of a diagnosis in the right
  situation can be helpful

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Example of How To Use a Diagnosis

• Youve told me that before having these problems
  with your mood, you were always a happy, high
  achieving, outgoing person.
• Youve mentioned having problems with your mood,
  sleep, appetite, concentration and energy, and
  that youve been feeling hopeless.
• It sounds like you may have a medical condition
  called depression. The good news is that this
  condition is very treatable and we can help you
  feel better again.

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Example of How To Use a Diagnosis (Contd)

• You are not responsible for causing this
  condition.
• However, it is mainly up to you to get better.
• But the good news is that you are not alone we
  will support you in overcoming the depression.

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Mood Disorders Types

• Major Depression (aka Clinical Depression, Major
  Depressive Episode)
• Dysthymic Disorder (aka low grade depression)
• Adjustment Disorder (mood problems following a
  stress, but not severe enough to be major
  depression
• Bipolar Disorder

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Major Depression

• Problems with mood (sad, angry, irritable), PLUS
• Physical problems with
• Sleep, Energy, Appetite, Concentration
• May also have problems with
• Thoughts
• Low self-esteem
• Hopelessness / Suicidal thoughts
• Behaviors
• Social withdrawal, loss of function

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Dysthymic Disorder

• Problems with mood (sad, angry, irritable), PLUS
• Some physical problems
• Some problems with
• Thoughts
• Behaviors
• BUT is not as severe as Major Depression

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Adjustment Disorder

• Problems with mood (which are not severe enough
  to meet for depression or dysthymic disorder)
  following a stress
• Does not involve significant changes

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Bipolar Disorder

• A condition with severe highs and lows where
  ones moods are like a roller coaster, to the
  point it causes problems
• During highs
• Mood high or irritable, excessive energy, less
  need for sleep, excess talking, excess activities
• During lows
• No energy, depressed mood, more need to sleep,
  i.e. essentially like being depressed

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Anxiety Disorders

• Everybody has worries and gets anxious from time
  to time
• Just enough anxiety is helpful because it keeps
  us cautious and safe
• Anxiety Disorders are when one has so many
  worries that they get in the way of life

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Types of Anxiety Disorders (or Conditions)

• Generalized Anxiety Disorder
• Constant worries with physical symptoms that
  cause problems
• Panic Disorder
• Out of the blue feelings of panic that cause
  problems
• Obsessive Compulsive Disorder
• Repetitive thoughts or behaviors that cause
  problems
• Social Anxiety Disorder
• Extreme shyness that causes problems

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Restoring the Balance
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A General Approach to Helping Others

• Figure out the persons goals
• What would you like to get from coming here to
  see me/us?
• Figure out what to do to get to that goal
• What do you think we need to do to get to your
  goal?

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A General Approach to Helping Others

• Figure out what stress is causing (or
  contributing to) the anxiety or depression
• Usual stresses include
• School
• Family
• Friends
• Problem-solve and find ways to deal with that
  stress

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Approach to Conflicts

• Conflict is when two parties want or expect
  different things
• Solution
• Figure out what each party wants or expects from
  the other
• Ensure it is reasonable
• For things that each party wants in common,
  great!
• For things that each party disagrees on,
  negotiate and compromise

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Everyone needs a healthy body, mind, spirit
Body

• Body (Physical, Biological Self)
• Mind (Psychological, Emotional Self)
• Spirit (Spiritual Self)
• Note Overlap, e.g. psychological interventions
  can cause biological changes, and vice versa

Mind
Spirit
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Body

• Ensure healthy amounts of
• Sleep
• Diet/nutrition
• Exercise
• Individual exercise
• Group / social exercise
• Yoga / Martial Arts
• Sunlight (in the case of winter depression)

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Body

• Medications may be a helpful body or physical
  intervention in certain circumstances
• For anxiety and depression, in general
• Non-medication strategies are tried first
• Medications are used if non-medication strategies
  are unsuccessful

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Body

• Common types of self-medication
• Sweets, carbohydrates, chocolates
• May possibly be a way of getting serotonin
• Exercise
• May be a way of getting adrenaline / dopamine
• Caffeine
• May be a way of getting adrenaline / dopamine
• Street drugs

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Mind

• Ensure good coping strategies and ways to deal
  with stress
• School / work
• Family
• Friends and
• Boyfriends/girlfriends

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Mind

• Psychotherapy such as cognitive behavior therapy
• Anxiety or depression is caused by cognitive
  distortions
• Fixing cognitive distortions will overcome the
  anxiety or depression

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Thoughts
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Spirit

• Figure out what gives meaning to the persons
  life
• Ensure those things are in the persons life

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Types of Help for Anxiety and Depression

• Speaking with friends
• Speaking with family
• Speaking with religious supports (e.g. chaplain,
  priest, rabbi, iman, etc.)

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Types of Professional Help for Anxiety and
Depression

• School personnel (teachers, guidance counselors,
  vice-principal, social workers, coach, etc.)
• Medical Doctors (family physicians,
  pediatricians, psychiatrist)
• Psychologists
• Counselors
• Social Workers

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Questions?