Treating Depressed and Suicidal Adolescents: A Clinician’s Guide

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About David A. But clinical depression is much worse than simple fluctuations in mood. Clinical depression varies from mild to severe. For example, some people complain of a few symptoms which occur some of the time. Other people, suffering from a severe depression, may complain of a large number of symptoms, which are frequent, long-lasting and quite disturbing.

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Because there are various degrees of depression, the severely depressed patient may wish to consider a number of treatments in combination. Who Gets Depressed? Depression is not something that happens to people who are "unusual" or "crazy. Along with anxiety which occurs more frequently than depression , it is the common cold of emotional problems. During any given year a large number of people will suffer from a major depression.


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The chances of reoccurrence of another episode after the initial episode are high. The reason for the sex difference in prevalence of depression is not entirely clear.

Treating Depressed and Suicidal Adolescents

Possible reasons may be that women are more willing to acknowledge feelings of sadness and self-criticism, females are undermined from an early age by being taught to be helpless and dependent, women control fewer sources of rewards than men do, and their achievement is often discounted. Another factor may be that men "mask" or hide their depression behind other problems, such as alcohol and drug abuse. Depression can affect all areas of your life. One study found that people with major depression lost 5. Depression often occurs with other problems that add to the difficulty of overcoming the depression.

Depressed individuals are five times more likely to abuse drugs. Women with marital conflicts are 25 times more likely to be depressed than women without conflicts. The cost of depression in terms of lost productivity or increased utilization of medical services is estimated to be over 82 billion dollars. There is no "one" cause of depression. We view depression as "multi-determined" - that is, it has biochemical, behavioral and cognitive components.

We will examine each one. Loss of Rewards. Have you experienced significant losses in your life recently - for example, loss of work, friendships, intimacy? The behavioral model of depression emphasizes the importance of reinforcement in the onset and maintenance of depression. There is considerable research evidence that people who suffer significant life stresses are more likely to become depressed - especially, if they lack or do not use appropriate coping skills.

Decrease of Rewarding Behavior. Are you engaged in fewer activities which were rewarding in the past? Depression is characterized by inactivity and withdrawal. For example, depressed people report spending a lot of time in passive and unrewarding behavior - such as watching television, lying in bed, brooding over problems and complaining to friends. They spend less time engaged in challenging and rewarding behavior, such as positive social interactions, exercise, recreation, learning, and productive work.

Skill Deficits. Are there social skills or problem - solving skills which you lack? Depressed people may have difficulty asserting themselves, maintaining friendships, or solving problems with their spouses, friends, or work colleagues. Because they either lack these skills or do not use the skills they have, they have greater interpersonal conflict and fewer opportunities to make rewarding things happen for them. New Demands. Moving to a new city, starting a new job, becoming a parent, or ending a relationship and trying to find new friends can be sources of significant stress for many people.

Lack of self-reward. Many depressed people fail to reinforce themselves for positive behavior.

For example, they seldom praise themselves or they are hesitant to spend money on themselves. Many times depressed people think that they are so unworthy that they should never praise themselves. Some depressed people think that if they praise themselves that they will become lazy and settle for less. Exposure to helplessness. The individual may feel sad, tired, loss of interest, and hopeless because he believes that no matter what he does he cannot make things better. Examples of helplessness are unrewarding jobs or dead-end relationships. Exposure to continual punishment.

This is a special kind of helplessness - not only are you unable to get rewards, but you find yourself criticized by others and rejected. For example, many depressed people may spend time with people who criticize them or hurt them in various ways. How Does Thinking Affect Depression? There are other causes of depression that have to do with the way you think your "cognitions".

Some of these causes of depression are described below: Unrealistic expectations. Many depressed people have unrealistically high standards for themselves and for other people. They believe that they or others shouldn't make mistakes, their job should be free of conflict or should be fun all the time, or that their marriage should be completely happy.

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Another group of depressed people have unrealistically low standards - they continually accept less than they could probably get elsewhere. Automatic thoughts. These are thoughts that come spontaneously, seem plausible, and are associated with negative feelings like sadness, anxiety, anger and hopelessness.

Examples of these distortions in thinking are the following: Mind reading "He thinks I'm a loser" Labeling "I'm a failure. He's a jerk.

Depression | Mental Health & Development | Caring for Kids New to Canada

I'll make a fool of myself. I can't stand being anxious. I don't enjoy anything. Nothing works out for me. These are the rules or philosophies of depressed people. They include ideas about what you think you should be doing or your theories about life: "I should get the approval of everyone. People who are depressed often focus on their short-comings, exaggerate them, and minimize any positive qualities they may have.

They may see themselves as unlovable, ugly, stupid, weak, or even evil.

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Are there styles of thinking that make you more depressed? Depressed people are more likely to ruminate about negative things—that is, they go over unpleasant thoughts and experiences over and over. Moreover, while you are ruminating you are not actively solving problems and not experiencing rewarding things in the real world.

Negative explanatory style. For example, if something bad happens you are more likely to blame yourself, think that your negative qualities will never change and then generalize it to other things in your life. Non-depressed people are more likely to think that not doing well might be due to not putting in as much effort or that this particular task was too hardbut that they can do well on other things.

Vague and overgeneral memory. Emotion focus rather than problem focus. Depressed people focus more on how they feel rather than what they can do to solve a problem. Although feelings are very important in therapy, learning how to evaluate situations accurately and engage in active problem solving can help empower you to overcome difficulties. Interpersonal Issues Losses in relationships.

Sometimes depression follows a breakup or loss of a relationship.


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Divorce or separation, losses of friendships, and even moving to a new place where you no longer have contact with people can make you more vulnerable. Coping with loss, loneliness, regrets, resentments and other problems following loss can help you overcome your depression. Conflicts in relationships.