1. School-Based Interventions

2. What is Depression?  episode of sadness or apathy that lasts at least two consecutive weeks  interrupts daily activities

3. Symptoms  Emotional Symptoms  Sad mood  Loss of interest in daily activities  Hopelessness  Sulking  Withdrawal  Inability to concentrate  Impulsiveness  Feeling lonely  Nervousness  Extreme mood swings  Recurring thoughts of death or suicide.  Physical Symptoms  Pain :  Headaches  Back pain  Tender muscles  Fatigue  Dizziness  Sleeping too much/little  Appetite:  Unusual cravings  Loss of appetite  Persistent nausea  Diarrhea or constipation

4. Red Flag Expressions  “Nobody cares about me”  “I’m bored and just want to sleep”  “I don’t care anymore”  suggestions that they want to end their life

5. Suicide Ideation  People who are depressed are more likely to attempt suicide.  Warning signs  talking about death or suicide  threatening to hurt people  engaging in aggressive or risky behavior Anyone who appears suicidal should be taken very seriously.

6. Diagnosis DSM-IV (APA, 2000) Major Depressive Disorder  exhibit at least 5 of 9 symptoms:  one must include  depressed mood or irritability  anhedonia  others : daily insomnia, extreme weight, and reoccurring thoughts of death or suicide  Duration > two weeks Dysthymia (chronic)  exhibit 2 or more of these symptoms :  poor appetite or overeating  insomnia or hypersomnia  low energy or fatigue  low self-esteem  poor concentration or difficulty making decisions  feelings of hopelessness.  Duration > two years

7. Emergence & Prevalence  2% preteens and 5% adolescents (Battle, 2002)  Childhood rates: boys = girls  Puberty rates: girls 2x boys (Bayridge Anxiety / Depression Treatment Center, 2007)  In Saskatchewan:  9.8 % rate for urban, Caucasian youth  25% rate for First Nations youth on reserves (Lemstra, A9).

8. Concurrent Disorders  90% with one additional psychiatric disorders  50% experience two or more disorders  Anxiety (31-47%)  Various Phobias (2.2-8.7%)  Panic Disorder (2.2-2.6%)  Obsessive Compulsive Disorder (2.2-7%)  Posttraumatic Stress Disorder (11-19%)  Various Substance Misuse Disorders (4.3-19%),  Somatoform Disorders (14-28%) (Essau, 2008, p. 39).

9. Two Perspectives  Medications for Depression  Antidepressants (SSRIs) change the levels of feel-good brain chemicals, serotonin.  Prozac (fluoxetine)  Zoloft (sertraline)  Ludiomil (fluvoxamine)  Paxil (paroxetine)  Anafranil* (clomipramine) selective serotonin reuptake inhibitors (SSRIs) preferred over *tricyclic antidepressants (TCA)  Talk therapy (CBT)  better cope with the challenges of depression and life in general  help youth set realistic and positive personal goals  encourage participation in pleasant activities  learn to solve social problems  discourage negative thinking  foster assertiveness

10. Two Perspectives Treatment for Adolescent with Depression Study (NIMH, 2007)  Group 1 received medication only (Prozac)  improvement : 60% (12 wks); 69% (18 wks)  Group 2 received medication combined with CBT (Prozac + CBT)  improvement : 71% (12 wks); 85% (18 wks)  Group 3 received CBT only  improvement : 44% (12 wks); 65% (18 wks)  Suicidal thinking decreased in all active groups Available at : https://trialweb.dcri.duke.edu/tads/tad/manuals/TADS_PT_Manual.pdf andhttps://trialweb.dcri.duke.edu/tads/tad/manuals/TADS_PT_Manual.pdf http://www.nimh.nih.gov/trials/practical/tads/questions-and-answers-about-the-nimh-treatment- for-adolescents-with-depression-study-tads.shtml

11. Alternative Strength-Based Perspective Jonah Lehrer(2010), in Depression’s Upside “capacity for intense focus” “reduced the possibility of becoming distracted from the pressing problem” improve problem-solving “more aware and attentive” enhances “creative production” ie. Charles Darwin

12. Screening Measurements Children's Depression Inventory (CDI) ages 7 to 17 ; 20-item self-report inventory Beck Depression Inventory (BDI) adolescents;21 m/c self-report inventory Center for Epidemiologic Studies Depression (CES-DC) Scale www.brightfutures.org/mentalhealth/pdf/professionals/bridges/ces_dc.pdf www.brightfutures.org/mentalhealth/pdf/professionals/bridges/ces_dc.pdf children & adolescents; 20-item self-report inventory (National Institute of Mental Health, n.d; Counselling Resource, 2002-11).National Institute of Mental Health

13. School-Based Interventions #1  Talk Therapy  1. Cognitive-Behavioral Therapy  focus on the ‘here and now’  focus on problem-solving strategies; goals  Change maladaptive thinking patterns  2. Reality Therapy  conversation-like ; open ended questions  problem-solve and self-evaluate

14. School-Based Interventions #2  Group Counselling  teaching social skills in social and less threatening environment  openness  food and drink availability  relaxed, non-clinical environments  part of the group

15. School-Based Interventions #3  Physical Activity  Walking, Running  Yoga  Kickboxing

16. More School-Based Interventions  Mindfulness  Meditation  Breathing Exercises  Gratitude Journal  Light Therapy

17. Questions Concerns Worries Beliefs