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Whatever the scale of the disorder, not only can the disorder be managed using a variety of methods, it is also possible to regain normal functioning and good mental health. To learn more, please refer to the tabs on the right side of the page or contact us.
MAJOR DEPRESSION Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre
What is depression?
It is very important to distinguish between being “down”, which is really just a normal depressive response to certain life events, and “depression”, which is a real illness that requires special attention and appropriate treatment.
Feeling down is a reaction to social and psychological factors (e.g.: the death of a loved one, separation, divorce, job loss, bankruptcy, etc.) that cause normal feelings of depression. They don’t last for a long time, and the person can usually still react to certain pleasures and other stimuli.
In the case of major depression, there are physiological and genetic factors at work. A true depressive episode usually lasts a long time, up to a year or two if it is not treated properly. In addition, people who suffer from depression do not respond to stimuli, and find little or no pleasure in any activities.
Some facts concerning depression
- 15% of people will suffer from depression at some time in their life;
- Every year, 5% of people suffer from depression;
- Depression is more common in women during the childbearing years, that is, from puberty until menopause;
- Depression is more common among men after the age of 40;
- Many adolescents and elderly people suffer from depression;
- Anyone can suffer from depression, regardless of race or religion;
- The rate of depression is higher among people who have a family history of depression problems and alcoholism, or have lost a parent before the age of 13.
Illustration of the interaction between biological and psychosocial factors in depression
- Social stress
- Psychological defence (feeling down or physical reaction)
- Physiological sensitivity (major depression or physical illness)
The environmental, psychological, and physiological factors described below can contribute to the onset of episodes of depression to varying degrees from one person to another.
Depression can be caused by a variety of environmental factors:
- Drug use;
- Unhealthy work environment;
- Single parent family.
Certain psychological factors are observed during a depressive episode:
- Feelings of rejection and loss in connection with loved ones, even if they are still close by;
- Being very self-critical, subjecting oneself to rigid moral judgments, and wanting to punish oneself for past misdeeds;
- Negative thoughts, believing that one is a bad person, that everything around one is bad, and that everything will always be bad;
- Feeling that life is worthless and hopeless, and that there is no help possible. Physiological factors People who suffer from major depression undergo changes in their neurotransmitters:
- Decreased serotonin, which leads to depressive feelings, anxiety, and obsessive thoughts as well as sleep and appetite loss;
- Decreased norepinephrine, which causes a loss of energy and motivation, and negative thoughts;
- And decreased dopamine, which leads to reduced feelings of pleasure and concentration problems. We also see hormonal changes in people with depression:
- In women, hormonal fluctuations in the fertility cycle, during pregnancy and after childbirth, and in men, a progressive drop in androgens after age 40;
- Thyroid gland dysfunction;
- Increased release of stress-related cortisol;
- Immune function is also weakened.
The diagnosis of major depression is based primarily on the following symptoms:
- A depressed mood most of the day and most days for a period of at least two weeks;
- Sleep problems (insomnia or hypersomnia);
- Appetite problems with weight loss or gain;
- Lack of energy and fatigue;
- Loss of interest and pleasure; Psychomotor agitation or slowing;
- Decreased ability to concentrate, think, or make decisions;
- Feelings of guilt;
- Recurring thoughts of death (60% of cases) and recurring suicidal thoughts (15% of cases).
A person must exhibit at least five of these nine symptoms in order to be diagnosed with depression.
- Social withdrawal.
- The goal of psychological, pharmacological, and community-based treatment for depression is to improve the person’s general condition in light of the various physiological and psychosocial factors involved.
Early in treatment, psychotherapists can help patients by:
- providing them with support and education;
- meeting with their families in order to provide information;
- getting them involved in the process of restoring their physical and mental health.
During a crisis, someone who is suffering from a major depressive episode can get specific individual help through:
- cognitive-behavioural therapy;
- interpersonal therapy.
Once the crisis has passed, the therapist can begin:
- more in-depth therapy with the person;
- therapy involving the family.
Throughout this process, it can be very helpful to refer people who are suffering from depression and their families to community organizations such as Revivre.
2. Pharmacological treatment
Depression is treated with medications called antidepressants, while at the same time dealing with the person’s psychological and environmental factors.
This type of medication stabilizes neurotransmitters, and helps to restore the following fairly quickly (usually within a few weeks):
- Energy level;
- Positive thinking;
- Concentration level;
- Lower anxiety levels.
If the first choice of antidepressant doesn't work, the individual’s mood can be improved using a combination of antidepressants, or by adding other treatments, including the following:
- Hormones (estrogen, testosterone, and thyroid gland extracts);
- Mood stabilizers (lithium, anticonvulsants);
- Atypical antipsychotics;
In order to reduce the risk of relapse, antidepressants should be prescribed for at least six months after symptoms have ceased. However, the treatment might be prolonged if the depression persists. Antidepressants aren’t addictive, but they should be stopped gradually at the end of treatment.
Antidepressants are effective in 75% of people with depression. It is important to note that the goal should be a complete elimination of symptoms.
Where to go for help
If you think that you or someone you love might have depression, you should consult your family doctor. He can either treat the depression himself or refer you to a mental health professional for treatment.
Leanna J. Zozula, Ph.D., Psychologist
What is postpartum depression?
Becoming a new mom causes a great deal of change, and it’s perfectly normal to be filled with joy at some moments and sad and irritable at others. Most women (approximately 80%) experience what is referred to as the “baby blues” soon after their baby is born. This condition causes changes in mood and temporary bouts of sadness that can start a few days after childbirth, and last anywhere from several days to two weeks. The "baby blues" are transitory and go away on their own.
Postpartum depression is a much more serious disorder that appears approximately three weeks after delivery. The symptoms can last from a few weeks to a few months, or even longer. Postpartum depression can appear as many as 12 months after giving birth, though in most cases, it starts sooner. It manifests as anxiety, insomnia, and depression.
Postpartum depression affects approximately 8% to 15% of new mothers, along with 5% of new fathers, who also have to adjust to major life changes.
Postpartum psychosis is a much less common condition that affects 0.1% of new mothers. Symptoms appear within hours or days after childbirth, and include but are not limited to delusions, hallucinations, and losing contact with reality, which can increase the chances of a new mother killing herself or someone else – especially the newborn.
It takes time to adjust to being a new parent. It is completely normal to feel more exhausted and irritable during the first few days. It only becomes worrisome if these symptoms last more than two weeks and cause serious distress or have a significant impact on daily life.
The warning signs for postpartum depression can be very hard to detect, because in the beginning, they are hard to distinguish from the “baby blues”. The key factors are the severity and duration of the symptoms. For example, severe irritability that lasts several days and that is not interrupted by calmer moments or a woman feeling so unhappy that she thinks about killing herself are signs that should cause concern.
Certain factors can put a woman at greater risk of suffering from postpartum depression. Here are the most significant factors:
- Having experienced depression in the past;
- A family history of mood disorders (the risk is even higher if there is a history of postpartum depression);
- Having experienced depression or anxiety during the pregnancy.
The risk of postpartum depression is also increased by stressful situations or events during pregnancy or after childbirth, including the following:
- Lack of social support;
- A difficult marriage or relationship;
- Being the victim of abuse or violence;
- A particularly difficult delivery;
- Feeling too much pressure to be a perfect parent;
- Unrealistic expectations with respect to the birth.
A new mother may feel sad and feel like crying a lot. She may also have digestive problems and appetite changes, problems sleeping that show up as insomnia, or trouble concentrating and carrying out daily activities. She may be listless and have no interest in activities that normally give her pleasure, or on the contrary, she may be very agitated. She may also feel very anxious, which can sometimes lead to panic attacks.
In addition, she may feel irritable around the infant, not enjoy contact with the baby, and have trouble taking care of him. She may have disturbing thoughts about the baby and be afraid of hurting him. All of this can lead to strong feelings of guilt and inadequacy. A mother who is experiencing postpartum depression often feels exhausted, desperate, and overwhelmed by the situation. In more severe cases, she may obsess about death, suicide, and hurting or even killing the baby. Although these are irrational thoughts that do not actually lead to such behaviours in the vast majority of cases, they still cause a lot of stress.
If left untreated, postpartum depression can have a significant impact on the psychological development of the baby, who is very sensitive to the quality of the interaction with his mother early in life. In addition, if postpartum depression is treated early, it will have less of an effect on the life of the new mother, and she will be able to recover more quickly.
Treatment options for postpartum depression include medication, psychotherapy, and social support.
In terms of medication, a doctor may prescribe antidepressants, which can often result in better sleep, increased appetite, more energy, more positive thoughts, less anxiety, and improved concentration. However, many new mothers are reluctant to take antidepressants, because doing so may mean that they cannot breastfeed if they so desire, among other things. In such cases, there are other options.
Psychotherapy is a good option. It can provide a mother with invaluable support and tools for adjusting to her new life. It can help her to work on the thoughts, emotions, and behaviours associated with her depression. The bond of trust with the psychotherapist is the most important factor. There are a variety of approaches that can help, but research supports the value of the cognitive-behavioural approach in particular. By working on the negative thought processes that feed the depression, it replaces them with a more accurate view of reality. This can help a woman to increase her self-esteem, restore her confidence in her ability to be a good mother, and find hope again. Cognitivebehavioural therapy also introduces behaviours that can be adopted gradually in order to make things easier.
Social support can also be a major factor in getting through postpartum depression. Getting help with the housework, having someone else look after the baby from time to time in order to take a break, calling a help line, visiting organizations for new mothers, and taking part in online discussion forums and self-help groups are some other ways to break the isolation and lighten the load that new mothers feel.
Where to go for help
If you think you have postpartum depression and you want to know more about the available treatments, the first step may be to talk to your regular doctor or nurse. For psychological help, you can consult a psychotherapist who is recognized by a professional association, such as a psychologist or a social worker.
Hani Iskandar, M.D., Medical Chief, Intensive Care Unit, Emergency, Brief Intervention Unit, Electroconvulsive Therapy Unit, Douglas Institute
What is seasonal depression?
With the coming of the fall season, many people experience changes in their appetite, weight, sleep pattern, mood, and energy level. This is a normal, short-lived occurrence, and is no cause for concern. Seasonal depression, which is also known as “seasonal affective disorder”, is a more serious problem that requires specific attention. It is a form of recurring depression that appears at the same time each year.
It usually starts in the fall, often around the end of October, worsens in January or February, and generally ends in late April or May, as the days get longer. It is directly linked to a decrease in the number of hours of sunlight, and occurs most often in northern countries.
Seasonal depression affects approximately 2% to 3% of Canadians, and 70% to 80% of those who suffer from it are women. It occurs primarily among adults (a large proportion being in their 30s), but cases have also been seen among children and adolescents. In fact, 10% to 15% of people who suffer from recurring mood disorders (depression or bipolar disorder) are affected on a seasonal basis.
Some of the warning signs include changes in interpersonal relationships, increased irritability, a desire to be alone more often, a lack of energy for daily activities, a feeling of being less productive at work or in our other activities because of the lack of the energy, and reduced levels of concentration and motivation. If these symptoms return every fall or winter for at least two years and prevent a person from functioning at the usual pace, cause serious distress, and last until spring, it could be seasonal depression.
The symptoms of seasonal depression are as follows:
- A depressed mood most of the day and most days;
- A loss of interest and pleasure in activities that we usually enjoy;
- Increased appetite (often an irresistible craving for sweets and carbohydrates);
- Sleeping longer, difficulty getting out of bed in the morning, and lower energy levels;
- Decreased ability to concentrate, think, or make decisions;
- Feeling slow, or on the contrary, feeling agitated;
- Feeling guilty or worthless, or even thinking about death or suicide in certain cases.
In addition, because the signs of seasonal depression can easily be confused with the signs of major depression, it is important to know the actual triggers. The onset of depression or a relapse may occur during the fall without being considered a seasonal depression. The determining factor is the recurrence of the symptoms at the same time of the year.
This disorder is caused by a reduction in daylight hours, and therefore, light therapy is one of the main treatments. The individual is exposed to light from a special lamp that simulates natural daylight and that has a filter for harmful UV rays. In order to be effective, the lamp must produce at least 10,000 lux (equivalent to a sunny spring morning). The treatment should be administered in the morning, if possible, because doing in later in the day can make it harder to fall asleep.
The individual is exposed to this light for approximately 30 to 45 minutes every day, and can do other things at the same time (eat breakfast, read, etc.). If the depression is truly related to a lack of light, the person will usually notice a change within a week. Certain restrictions apply, primarily related to the health of the individual and any medications that he or she may be taking. Therefore, it is important to consult a doctor before
starting any treatment.
On the other hand, psychotherapy can help you work on the thoughts, emotions, and behaviours that feed the depression. It can provide the support and the tools that you need in order to get back into action. There are a number of different approaches that may be appropriate, depending on the needs of the individual, research supports the value of the cognitive-behavioural approach in particular. The bond of trust with the therapist and the feeling that he or she understands what you are going through are the most important factors in the success of the therapy.
In terms of medication, a doctor may prescribe antidepressants, which can help to restore energy and a more positive mood. These medications often lead to good results, but they must be taken for several weeks, or even moths, in order to reach their full effect.
This type of depression is directly related to a lack of light, and therefore, taking a walk every day, especially in the morning, can help you to get through it. This also allows you be physically active, which is another factor that helps to overcome depression.
Where to go for help
If you think you have seasonal depression and you want to know more about the available treatments, the first step may be to talk to your doctor. For psychological help, you can consult a psychotherapist who is recognized by a professional association, such as a psychologist or a social worker. Finally, you can call Revivre’s support, information and referral line, at 1-866-REVIVRE (1-866-738-4873) to find out how to rent or buy a light therapy lamp. You can also check with your pharmacy’s prescription counter, because many pharmacies carry these products.
Jean Leblanc, M.D., Psychiatrist
What is dysthymia?
Dysthymia is a chronic form of depression that lasts for at least two years (one year for children), but often lasts for many years. Although the symptoms that are associated with this type of depression are fewer and less severe than those that are associated with major depression, they can still seriously reduce the quality of life for anyone who suffers from it. Over the long term, these symptoms can negatively impact normal functioning as much as major depression.
The disorder often begins early in life, either in childhood, adolescence, or early adulthood. 6% of the population will suffer from it at some point in their lives. Adult women are 2 to 3 times more likely to develop dysthymia than men. In the case of children, the disorder occurs just as often among boys as among girls.
Studies tend to suggest that there is a genetic vulnerability to the disorder. However, a person can have the vulnerability without ever developing the disorder. There are many interactive factors that cause dysthymia, including biological, psychological, and social factors.
From a biological perspective, certain neurotransmitters (e.g.: serotonin) may be involved. In terms of the environment, a number of situations (e.g.: financial and relationship problems and high stress levels) can take their toll on a person’s morale over the long term, and can lead to the development of dysthymic disorder.
It's normal to feel more depressed some days or when going through hard times, or to be sad occasionally, or to feel inadequate. This only becomes a problem when the feeling doesn’t go away over time, and when the symptoms cause serious distress or interfere with general functioning, whether at work, in relationships, or in other important aspects of the person’s life.
In addition to a depressed mood for most of the day and most days for at least two years, people who suffer from dysthymia exhibit at least two of the following symptoms:
- Low energy levels or fatigue;
- Low self-esteem;
- Trouble concentrating or making decisions;
- Feelings of hopelessness;
- Appetite problems (poor appetite or overeating);
- Sleep problems (insomnia or hypersomnia).
However, the psychomotor symptoms, sleep problems, and appetite problems are less frequent than in the case of major depression.
People who suffer from dysthymia can also feel sad frequently, be self-critical and hard on themselves and everything around them, ruminate about things from the past, feel guilty, be irritable or angry, be less productive, and take little interest or pleasure in most activities. They can also isolate themselves from others and withdraw into themselves.
People who suffer from dysthymia sometimes ascribe their symptoms to their personality, because they may believe that they have always been like that, especially if the disorder began early in life.
Children who suffer from dysthymia may seem to be more irritable than depressed. Children often do worse at school, and have problems with social interactions, low selfesteem, and a pessimistic attitude.
Although people can occasionally feel happier and more energetic, in order for someone to be diagnosed with dysthymic disorder, the intervals of feeling better can’t last more for than two months within a two-year period.
Sometimes the symptoms can get worse, at which time the individual may experience major depression along with their dysthymia for a period of time. When this happens, it is referred to as double depression. However, an individual is not diagnosed with dysthymic disorder if an episode of major depression occurs within the first two-year period.
The two preferred forms of treatment are medication and psychotherapy.
In terms of medication, antidepressants that act on a number of the neurotransmitters involved in the symptoms of depression (e.g.: serotonin, norepinephrine, and dopamine) are usually prescribed. These medications take several weeks to reach their full effect, and in the case of dysthymia, it is recommended that they be taken over a long period. Once the person feels better, the doctor may suggest a maintenance dose for several years, and sometimes for life, in order to prevent relapses.
In terms of psychotherapy, an individual who suffers from dysthymia can work on the thoughts, emotions, and behaviours associated with depressed moods. The bond of trust with the psychotherapist is the one of the most important factors. There are a variety of approaches that can help, but research supports the value of cognitive behavioural therapy in particular. This type of therapy works on the negative thought processes that feed the depression, replacing them with a more accurate view of reality. This can help the individual to improve his self esteem, regain confidence in his abilities, and find hope for the future. The individual also works on behaviours that can be adopted gradually in order to get back into action despite the symptoms, and to return to an active and social life.
Interpersonal psychotherapy is another type of therapy that is effective in treating major depression, and it is also helpful in treating dysthymia.
Self-help groups and workshops – such as those at Revivre – can also be another effective form of support. They provide a place where people can talk about their feelings without being judged. This can help people to feel less alone in what they’re going through, and validate their experience of feeling depressed in the company of others who are going through similar situations. They can get ideas from other people's stories, and try new ways of getting through the tough times.
Where to go for help
If you think you have dysthymia and you want to learn more about available treatments, one of the first steps may be to talk to a doctor. For psychological help, you can consult a psychotherapist who is recognized by a professional association, such as a psychologist or a social worker.
Patricia Garel, M.D., Psychiatrist, and François Maranda, M.D., Psychiatrist, CHU Sainte-Justine
What is depression?
Major depression is not just an adult disease. It also affects 1% of the preadolescent population (ages 12-15 years) and 7% of teens before the end of adolescence (ages 15-18years). Numbers like these should prompt us to learn more about depression so that we can recognize the symptoms quickly in teens.
Major depression is considered to be a disease, but it is not really like other diseases, because it alters a person’s judgment. However, like other diseases, it must be explained, demystified, and treated quickly. The teenager and his family must understand the issues involved in both the illness and the treatment. There is no reason for needless suffering or isolation.
Feeling down vs. depression
Feeling down is different from depression. Feeling down is a normal response to the psychological and social pressures that we all face in our lives at one time or another. It is a temporary situation that doesn’t stop a person from experiencing pleasure from certain activities or at certain times, despite being down in the dumps. A teenager can feel down over grades, conflicts with family and friends, everyday problems, etc.
The disease that is known as depression, or major depression, is characterized by serious problems affecting normal functioning and a marked lack of interest in normal activities.
Teens may withdraw, or just the opposite, them may not be able to be alone. They may have trouble concentrating, be afraid of everything, or become irritable and aggressive. Some behaviour problems (e.g.: drug addiction, running away, etc.) may actually be depressive equivalents, and therefore, a depressive episode must be ruled out before a condition can be called a conduct disorder.
Factors that can contribute to an increased likelihood of a teenager developing depression:
- Having a family member who suffers from mental illness;
- Having been the victim of physical, emotional, or sexual abuse;
- Losing a parent as a young child, either through death, divorce, or abandonment;
- Having a chronic illness;
- Having a family member who has committed suicide.
The diagnosis of depression is not based on a single symptom, but on a variable set of symptoms that change over time within a given context. A teenager who suffers from depression can present with some of the symptoms associated with major depression.
Symptoms that appear during depression:
- Sustained difficulties in relationships with family and friends;
- Abnormal irritability and apathy toward everyday things;
- Poor personal hygiene and not keeping his room tidy;
- Delinquent behaviour: such as like skipping school, violent behaviour (verbal and physical), and alcohol and drug abuse;
- Appetite changes;
- Attention and concentration problems;
- Sleep problems: insomnia or hypersomnia (sleeping all the time);
- Mood changes: sadness, irritability, and aggressiveness;
- Suicidal behaviour or pervasive suicidal thoughts – wanting to die in order to end the suffering.
The treatment for depression in teens usually includes both a pharmacological and a psychological component.
1. Pharmacological treatment
The doctor will prescribe one or more medications that act on neurotransmitters (anti- depressants or other medications). Neurotransmitters are the chemicals that are used by neurons to communicate and carry out brain functions. This communication is altered during depression. The purpose of the medications is to properly restore this communication. You should know that these medications don’t start to work right away. Sometimes you have to wait a few weeks for them to reach their full effect. When effective, they help the teenager to gradually get his life back in balance in the following areas:
- Normal energy level;
- Normal concentration level (this sometimes takes longer);
- Enjoying activities again;
- Realistic plans;
- Interest in pursuing studies, etc.
2. Psychological treatment
Cognitive therapies aimed at correcting the misconceptions and false perceptions surrounding depression are effective, and they complement the pharmacological treatment. Other types of therapy (group therapy, analytically- oriented therapy, etc.) may also be indicated in certain cases.
It is important to consider a healthier lifestyle for any teenager who suffers from depression, particularly in terms of schedule, diet, sleep, exercise, and not taking drugs (especially marijuana).
Where to go for help
Roles of the various people involved in helping a teenager who suffers from depression
Parents are often the first ones to notice a problem with their child’s functioning. Although the parent-child bond can sometimes influence their perceptions, they are still in the best position to observe what is happening. Therefore, it is important for them to express their fears or doubts to a qualified person. Parents are always essential in the process of evaluation and care.
The family doctor is often the first person to be consulted for the various physical symptoms that go along with depression (fatigue, pain, etc.). He will carry out a medical workup in order to rule out any physical ailment that may explain the symptoms (thyroid problem, infection, anaemia, etc.), and will pursue the evaluation with the teenager and his parents. He can then request a consultation with a psychiatrist, or begin treatment after a reasonable amount of time.
A psychiatrist is a doctor who specializes in mental disorders, and is the best person to coordinate all aspects of the treatment.
School practitioners (nurse, psychologist, social worker) are often the first to be consulted by the teenager. They play a crucial role in welcoming, supporting, and caring for the teenager in distress. They will steer him to the appropriate specialists.
The teenager can also meet with and confide in a trusted teacher, who can advise and support him in getting help from a doctor or an organization.
The CSSS youth mental health teams are specialists in the problems that teens face. Don't hesitate to contact them.
Organizations like Revivre, Kids Help Phone and Tel-Jeunes provide information and support for clients and their families. They are available anytime for information concerning resources, referrals, help, and support at various levels.
Siblings and friends can help!
A teenager who is not feeling well will often confide in a friend, sister, brother, etc. who can help him through the bad time, and who will not allow him to be alone or isolated. They can put him in touch with an adult who can take the necessary steps.
If you recognize the signs and symptoms of depression in your teenager, consult a general practitioner or a child psychologist. Recognizing the illness and having it treated quickly by qualified professionals is the best thing you can do.