Depression: Should I Tell the Boss?

By Gina Newsome Duncan, MD

Depression is the leading cause of disability among people ages 15-44, affecting nearly 7 percent of the adult population in a given year. That means that close to one in ten American adults is suffering from depression at any given point in time. A recent CNN Health article highlighted the dilemma one woman with depression faced when considering whether to tell her employer.

It may not be talked about much, but depression is most certainly present in the workplace. What are the effects? People suffering from depression can experience a decrease in concentration, difficulty making decisions, feelings of isolation, feeling slowed down in their thinking and mental processing, and poor sleep, which can lead to daytime fatigue. All of these factors can result in poor job performance. In fact,a decline in job performance is often the wake-up call that someone is experiencing depression and needs to do something.

If you feel that you may be suffering from major depressive disorder and are concerned about the effect on your work, what should you do?

1. A good first step is to talk with a psychiatrist or your primary care physician about your symptoms and explore possible treatment options. Psychiatrists and primary care physicians are familiar with employment issues and should be able to get you started on a plan to address your concerns.
2. Find out about your company’s Employee Assistance Program (EAP). It is in your company’s best interest for you to function at your optimal level, and most large companies offer some type of EAP. In most cases, confidentiality and privacy requirements apply to EAP services, and the employer does not usually know who is or is not using them, except in cases where the employer referred the worker to the EAP. Employee Assistance Programs offer a broad range of services, including psychological assessment, counseling, support and referrals.

Other things to keep in mind:

Depression is real, but it is not as visible as something like a broken leg. Depression can be difficult for others to accept as a true illness or valid reason for being excused from work. As a society, we can be stoic when it comes to issues of emotional distress; “Just suck it up and keep going,” we tell ourselves and others. It can be hard for others to understand or appreciate the effects of a major depressive episode or another mental illness unless they or a loved one have experienced it. Employers are beginning to understand that attending to their employees’ mental health is not just a nice thing to do, it makes good business sense.

Federal laws protect the rights of workers who become medically ill or disabled. This includes workers who are unable to work due to a mental illness such as major depression. However, employer sensitivity toward such employees can vary, particularly if the employee has not taken official medical leave but is frequently calling out sick or requesting time off for regular psychiatrist or therapist appointments during work hours.

Whether or not to disclose your illness to your boss and/or your coworkers is an individual decision that depends on your company’s culture and your own preference. But here are a couple of thoughts to keep in mind: If your symptoms are not affecting your job performance in a visible way and if, with the help of your doctor, you have started a treatment plan that you are finding helpful, then disclosing your illness to your employer may not be necessary. If, on the other hand, your symptoms are severe, causing frequent missed days of work or other job performance issues that threaten your employment, and if you have not yet started treatment, then being proactive and addressing the issue with someone you trust, like a doctor, Employee Assistance Program or a boss, can be an important step.

Have you experienced firsthand the effects of depression in the workplace? If so, how was it addressed? How can we reduce the culture of stigma that surrounds mental illness in the workplace?
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Family-Based Treatment May Benefit Teens with Anorexia

By Molly McVoy, MD

A recent Wall Street Journal article reported on a study regarding teens with anorexia. The results of the study, published in the Archives of General Psychiatry, indicate that having parents actively involved in the treatment of adolescents with eating disorders is more effective than the traditional one-on-one treatment with a therapist.

The study looked at 120 teenagers using the Maudsley model versus traditional one-on-one therapy. The Maudsley model encourages parents to take charge of the eating habits of their children with eating disorders, such as anorexia. At one year, the study found that about 50 percent of patients treated with this family based therapy were in remission versus 23 percent in the more traditional individual therapy.

Anorexia nervosa is a serious, often life-threatening illness in which patients fear gaining weight to such a degree they restrict their diet and maintain a body weight below the 85 percent of a healthy weight. Successful treatment is intensive, involving medical monitoring, dietary interventions, therapy and, at times, medication.

This study adds to accumulating evidence that family involvement is critical in successful treatment of adolescents with eating disorders. As more studies are published with similar data, treatment centers for eating disorders and increasingly involving families in the intensive treatment programs.

The HealthyMinds.org has more information on eating disorders. 

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ADHD: Can My Kid Just Outgrow It?

By R. Scott Benson, MD


Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.

But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”

So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.

Let us know of other successful behavior training programs in your community, and we will post those links here.

Supporting Gay Youth as a Way to Prevent Suicide

By Tristan Gorrindo, MD

Coming out of the closet is one of the hardest things that a gay, lesbian, or bisexual person will do.

“Coming out,” is the process of revealing to friends, parents, family members, and acquaintances that he or she is gay. It is more that just a simple act or decision to announce that a person is gay, but rather a process that unfolds overtime, usually in small steps. For many people, it involves telling one person, then a group of friends or family members, then classmates or co-workers, and finally the world at large. But for each person, the journey is different and often filled with emotional ups and downs.

Recent events in the national media have highlighted the issues surrounding coming out and youth suicide. By some estimates, as many as nine gay youth died by suicide since September 1, 2010. Government officials and celebrities have publicly referred to this as a national crisis.

Many population scientists have tried to understand why gay teens are at such high risk for suicide -- by some estimates 7 times the national average for their age. And although there are many possible contributors to what might make a gay teen suicidal, we must first remember that all teens, gay and straight alike, are struggling with basic questions about self-identity.

A friend of mine once described being a teenager is like, “being at a costume ball where the costumes and guests are constantly changing.” As part of normal teenage development, teens are “trying on” different roles, different groups of friends, and even different kinds of dress. It is a time when teens are first experimenting with the idea of romantic relationships and at the same time trying to separate from their parents. Gay teens have the added burden of sorting out the confusing, often negative messages from the culture about what it means to be gay. When these ingredients mix -- unsure sense of self-identify, novice experience with romance, trying to separate from one’s parents, and fear of what it means to be gay -- gay teens run the risk of feeling quite isolated and alone.

Regardless of one’s personal views of homosexuality, I think we can all agree on the importance of supporting our youth during difficult times. The American Psychiatric Association is committed to reducing the stigma around homosexuality and to promoting the psychological health of gay, straight, and bisexual individuals.

We owe it to our teens to make sure that they know that coming out is not a process that they have to go through alone. A wide variety of resources exist, from grass-roots YouTube videos which offer gay teens hope, as in The Make It Better Project, to 24-hour suicide hotline for gay teens offered through The Trevor Project. Additionally, The National Suicide Prevention Lifeline also is available 24/7 at 1-800-273-TALK (8255) to anyone struggling with suicidal thoughts. The Healthy Minds website is a source of clear factual information on sexual orientation. And let us not forget the parents that may also be struggling with how to help their gay child; for them there is support and advice offered through PFLAG.
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Anger: A Complicated Emotion

Anger is a normal emotion that can be useful in coping with the world. But anger expressed in excess or suppressed can cause problems. Healthy Minds blogger Molly McVoy, M.D., talks about anger, how to recognize inappropriate anger and what to do about it.

Athletes Suffer from Depression Too

By Claudia L. Reardon, M.D.

Athletes don’t get depressed, right? After all, they are so physically fit and healthy that they must be equally emotionally healthy. Unfortunately, this is not true. Just like the rest of us, athletes can be at risk for depression. This is the case all the way from the school-aged child playing on a recreational team, up to the professional athlete who makes a living playing his or her sport.

Whenever we see a news story about a famous athlete with depression or an athlete who has committed suicide, it tends to come as a big surprise since athletes tend to be glamorized and admired in our society. However, here are some things we know about the reality of depression in athletes:

1. Athletes seem to be at least as likely as the general population to suffer from depression.

2. Athletes who suffer multiple concussions are up to four times as likely as other athletes to suffer depression. Athletes in some sports, including football, hockey, and soccer, are especially likely to suffer concussions.

3. Overtraining syndrome can occur in athletes who are seriously training for an event and do so beyond the body’s ability to recover. Overtraining can look very similar to depression and can actually lead to full-blown depression. Like depression, overtraining can include fatigue, insomnia, appetite change, weight loss, difficulties with motivation, and poor concentration. Overtrained athletes usually notice that their sports performance worsens. They may develop more injuries; experience muscle and joint pain, and lose enthusiasm for their sport. If an athlete is overtrained, the treatment is usually to cut back on physical activity or do cross training at a lower intensity until the symptoms start to improve. If overtraining leads to full-blown depression, medication and/or talk therapy may also be helpful.

4. Besides concussions and overtraining, other common factors that can lead to depression in athletes include injuries, competitive failure, aging, retirement from sport, and the same daily stressors that can lead to depression in the general population.

5. In recent years, athletes across several sports have started to open up about their struggles with depression. Hopefully this will help athletes with depression to feel better about seeking help for this disorder.
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Working with Schools When your Child has Problems

By Gariane Gunter, M.D.

Well, we have made it through the first months of a new school year! However, for some students the start of a new year has been difficult. I have received many calls and heard numerous concerns from parents who are wondering how they can work with their child’s school to ensure a success. Below is a list of the Top Ten Tips for Working with Schools that was shared with me by a Lead School Psychologist in my area. I hope you have a great year!

Top Ten Tips for Working with Schools

1. Let the school know up front if you have concerns
2. It helps to be visible in the school but do not intrude on the learning
3. Every school is a little different in its approach

4. There are lots of different ways of working with student problems in schools. Not just one of them is right. 
5. If you want to talk to a classroom teacher, ask to make an appointment with them. When teachers are with students, their first responsibility is to teach and supervise them.
6. School folks got into education for the joy of working with students.
7. School Psychologists and Special Teachers are there to study individual students. Help them by giving your specific observations. Your observations matter.
8. Lots of teachers and other school folks use e-mail, but remember that teachers check e-mail when they have planning or breaks.
9. If you have made a request and you haven’t received a response, don’t wait too long before asking about it. Sometimes requests do get lost.
10. Schools can be fun places to be; it is where all children gather to learn. Enjoy your time there too!

Reference: Shirley A. Vickery, PhD

A Parent’s Guide To Social Networking

By Adair Parr, M.D.

If you are like most parents, your teenager knows more about social networking than you do. According to a Pew Internet Project study, nearly three-quarters of teens online use social networking sites. What’s more, many teenagers now access social networking through cell phones, further increasing their online presence. The phenomenal rise of Facebook is documented in the movie, The Social Network, which was number one at the box office this past weekend.

Are your teenagers on Facebook? Are you wondering where to draw the line? Many parents feel overwhelmed by understanding media and technology and feel that they will never catch up to their kids. While you may not text as fast as they do, making an effort to learn about social networking is important. Teens are designed to experiment with risky behavior and social networking is one area in which they may try such behaviors. By educating yourself on the topic, you will be better prepared as a parent to help your child to use media and social networking responsibly.

What can you do to help ensure your teen’s responsible use of social networking?

1. Talk to your kids about the media in their life. Ask your teen how social networking changes lives.
2. Keep the lines of communication open with your teen. Know who they are communicating with online.
3. Remind your teenager to limit the amount of personal information online.
4. Remember that everything your teenager posts is public information. Once it is posted, it is online forever.
5. Educate your teenager about cyberbullying and what to do if he or she is a victim of cyberbullying.
6. Model responsible media use behavior for your teenager.

The Healthy Minds website has additional information about mental health for college-age students and children. Check out these resources to help parents navigate the murky waters of social media:

• Common Sense Media
• Be Net Savvy
• Net Lingo
• Facebook Safety
• Frontline, KidsOnline 

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It's Not Your Fault

Healthy Minds. Healthy Lives. blogger Gariane Phillips Gunter, MD, talks about how individuals with mental illnesses cannot be blamed for mental illness and how to get help for someone struggling with mental health issues.

Finding Meaning in Modern Life

By Roberto Blanco, M.D.

During recent travels, I visited the Yad Vashem Holocaust Museum in Jerusalem and came across Man’s Search for Meaning at the bookstore. It is written by Dr. Viktor Frankl, a Viennese professor and psychiatrist before World War II, who became a holocaust survivor. Dr. Frankl narrates his experiences and observations in different concentration camps and describes how, against all odds, he survived.

Dr. Frankl, however, did not intend the book to be solely a tale about survival. As he explained in his preface to the 1984 edition, he wrote the book so that others could see concretely that life, even in the most hopeless and miserable conditions, holds meaning. He wanted to show how having meaning in one’s life is the most important aspect to living fulfilling lives. In the book, Dr. Frankl proposed that he was able to survive because of luck and because his faith that his survival had some great meaning was unshakeable. During years spent in brutal conditions in concentration camps, Dr. Frankl was able to endure by finding some goodness to hold on to, even if sometimes this goodness could only be found in his head. He also observed how those who eventually lost motivation and hope usually did not survive much longer.

It is difficult not to be inspired by Dr. Frankl’s story, but it makes me think about how difficult it can be to feel fulfilled in our modern world. How can a man who had everything in his life taken away from him, find more meaning in his life than many who have all of the freedoms and material possessions they could want? I think that the answer lies in slowing down to appreciate the little things in life and to appreciate the meaning of it all. Every day should serve as a challenge to find a meaning, even if it is a small one.

The ways in which people find meaning depend on their age, current role in life, and developmental stage. Some people are motivated by special people in their lives; the relationships that provide meaning often change as people become independent of parents, find partners, and then have children of their own. Others develop a relationship with a higher power, which also can change as they grow and change themselves. And finally, having a mission, vocation, or cause often gives people meaning to their lives. These often change, as well, as people change careers, go back to school, or have other new experiences.

On a day-to-day basis, here are some things that you can do to answer the challenge of the day:

1. Be kind to another person.
2. Strike up a conversation with a friendly stranger.
3. Re-connect with an old friend.
4. Reminisce about that special memory that brings back positive feelings.
5. Further your cause or mission in some way.
6. Participate in a favorite hobby, sport, or special interest.
7. Pray.
8. Go for a walk.
9. Tell that special someone how you feel about them.

I’m interested to hear, what is it that brings meaning to your life?