Robin Williams’ final gift to the world was to create a higher awareness of depression and mental health.
Depression is very real among adolescents and young adults. The World Health Organization’s “Health for the World’s Adolescents” 2014 report reveals that depression is the predominant cause of illness and disability for both boys and girls aged 10 to 19.
The Top 3 causes of adolescent deaths globally are road traffic injuries, HIV/Aids, and suicide, which collectively killed 1.3 million adolescents in 2012.
Globally, depression is the No. 1 cause of illness and disability in this age group, and suicide ranks No. 3 among causes of death.
Some studies show that half of all people who develop mental disorders have their first symptoms by age 14. If adolescents with mental health problems get the care they need, deaths and suffering can be prevented.
In light of this week’s tragic news, I conducted an e-mail interview with Dr. Edwin R.S. de Leon, a child and adolescent psychiatrist, and diplomate of the American Board of Psychiatry and Neurology, who practices at the Mind Health Institute in Newport Beach, California (www.mhi-nb.com).
What is the “simplest” way to describe/define depression, as opposed to sadness?
It is difficult to have an exact definition of depression, as different persons experience varying degrees (of it). However, depression is distinct from sadness in that it impairs the individual’s capacity to function efficiently. With depression, they are unable to carry out their activities of daily living.
People may feel sad due to challenges, setbacks and loss; however, they have the capacity to use personal coping skills to overcome these emotions. It is when they are unable to overcome this low mood, and when it affects their ability to interact with society, that we consider the possibility of an ongoing depression.
Is it correct to describe depression as a “profound sadness,” as we have heard so often?
I believe that “profound sadness” captures only a portion of the severity of depression. The book of Shawn Christopher Shea, “The Practical Art of Suicide Assessment,” describes depression as a deep psychological pain. People who eventually take their lives go through a complex and stressful weighing of the pros and cons. The pain is so severe that the thought of suicide may present to some an alternative that offers relief.
As a parent, what would help me spot depression in my child (adolescent and young adult)?
These are some of the warning signs from the American Academy of Child and Adolescent Psychiatry:
Persistent boredom, low energy, low motivation, a change from their previous level of functioning
Decreased interest in activities they previously enjoyed
Increased irritability, defiance and hostility
Frequent low mood, sadness and tearfulness
Feelings of hopelessness and helplessness
Low self-esteem, feelings of guilt
Social isolation and poor communication
Extreme sensitivity to rejection and failure
Difficulty with maintaining relationships
Frequent complaints of body ailments, e.g. headaches or stomach aches
Decline in academic performance, frequent absences or truancy
Inability to focus and concentrate
Change in sleeping habits and eating patterns
Attempts to leave or run away from home
Labile and destructive behavior toward others, property or self, e.g. cutting
Thoughts or expressions or suicidal ideation
What I have recommended to the parents of my patients is that they spend time with their children and be attuned to who they are as persons, and not what we hope or aspire them to become.
Assuming that my child is depressed, what can I do to best support him or her?
Seek the help of a mental health professional, a psychologist or a psychiatrist.
As a parent, be present for your child. It may seem like a simple suggestion, but in reality, parents who are working and busy in their careers “schedule time” with their children. Being present, means being attuned—listening, sensing, understanding from the child and adolescent’s perspective; do not be hasty to judge their decisions.
I had remarkable feedback from parents and their kids when I suggested they spend a day at the beach. Make a commitment not to bring any electronic devices.
Validate what they are saying and never dismiss their concerns, e.g. “OK lang yan, “Tibayan mo loob mo,” or other diminishing statements.
Does depression have a genetic component? How prevalent is it in the cases that you have seen?
Yes, there is genetic loading, and there are twin studies to support that it runs in families. Among the patient’s that I see, about 80-90 percent of the adolescents have parents with some form of behavioral or mental health issues—maybe not be depression per se, but other psycho-pathologies such as anxiety, mania, psychosis, bipolar mood disorder, chemical dependency and addiction.
What can I do as a parent to help my child become more resilient? Or to help my child gain a sense of hope?
The key is truly being present and attuned to your child when they want you to be, not when it becomes convenient or fits your schedule. Have an open mind and hear them out. Take a genuine interest in what they are passionate about.
If I suspect that my friend has depression and he or she refuses to seek help, how can I help him or her?
I always recommend being proactive, but at the same time be sensitive and discreet. A person with depression is also experiencing mixed emotions. On one end, they would like to cry out for help; on the other hand, they may not want to disclose their true feelings for fear of being labeled mentally unstable.
Can someone get out of a depression without medication?
Yes, for mild to moderate depression, the first treatment option is psychotherapy and teaching the child/adolescent coping skills. There are several forms of therapy, supportive therapy, interpersonal therapy, cognitive behavioral therapy, and dialectical behavioral therapy to name a few.
However, if with adequate therapy sessions, depression persists or is severe from the onset, medication management is the recommended option.
If I am a teenager and I fall into depression, is this something that I will have to struggle with throughout my life?
A lot of factors come into play—genetics/family history, presence or resolution of stressors at home or at school, compliance with treatment.
Each person responds to life events differently; each individual has his own temperaments, personality traits and life experiences to draw on. So the trajectory of one may differ from another.
From a treatment perspective, if the depression is a first-time episode and the patient responds well to therapy with medications, the patient may be weaned off the medications after six months of stable mood. However, should there be a recurrence of the depressive symptoms, the patient may require maintenance medication to help regulate mood and behavior.