Stress, Anxiety and

Depression
Presentation for Youthnet,
Cottage Boardroom,
Nov 16, 2005
Michael Cheng, Psychiatrist
http://www.drcheng.ca
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 Goals
 An overview about stress, anxiety and
depression in youth
 What is it

 What causes it

 What can you do about it

 Where to get help (in Ottawa)

 Top Questions from Youthnet
Facilitators
 What is the meaning of life?
 What is bipolar?

 Common causes of teenage depression?

 What to do when having an anxiety

attack?
 Where to refer someone with

mood/anxiety problems (in Ottawa)?

It’s All About
Balance
Q. What do normal people need in
life?
 Everyone needs a healthy body,
mind, spirit
Body
1. Body (Physical,
Biological Self)
2. Mind (Psychological,
Emotional Self)
3. Spirit (Spiritual Self)

Note: Overlap, e.g.

psychological
interventions can
cause biological
changes, and vice Mind
versa Spirit
 The Triple A
Agency / Autonomy / Achievement

Activity (as
opposed to
passivity)

Affiliation
(Relationships)
 The Triple C
Control

“Chipper” (or
being active)

Connections
with Others
 Three P’s
Power

Proactive

People
Point A Point B
(Goals)
 Obstacles such as stress
(at home, school, work),
depression, anxiety

Point A Point B
(Goals)
 Life is full of
things that cause
imbalance (in
mind, body, spirit)
 Typical stresses in our modern
society
 Body
– Medical / physical illness
– Lack of sunlight / Drug Use
 Mind / Social
– School / Work
– Classmates / co-workers
– Family
– Friends
– Boyfriends/girlfriends
 Spirit
 Life is a balance between coping
and stress

Demands /
Expectations /
Coping Ability Stresses
 Problems if demands,
expectations or stresses outweigh
coping

Coping Ability Demands /

Expectations /
Stresses
 There are two solutions to restore
the balance...

 Coping Ability  Demands /

Expectations /
Stresses
 Stress can lead to:
 Physical problems
 Emotional or mood problems such as

– Depression
– Anxiety
– Eating Disorders
– OCD
– Any problems with mood/coping...
 Prevalence of Mental Disorders in
Children and Adolescents in Canada
(Stats Can, 2002, age 0-19)
Anxiety Disorder 6.5%
ADHD 3.3%
Depressive Disorder 2.1%
Substance Abuse 0.8%
Schizophrenia 0.1%
Bipolar Disorder 0.1%
Eating Disorder 0.1%
Etc... Etc...
ANY DISORDER 15%
 Mood Disorders: What is It?
 Everyone gets sad from time to time
 Just enough sadness is good because it
alerts people to do something to
change their situation
 Mood disorders are when people’s
moods are so extreme that it gets in
the way of life
 It is not normal, and is not something
that someone can easily ‘snap out of’
 Mood Disorders: To Diagnosis or
Not to Diagnosis?
 Classified according to the DSM-IV
 For formal DSM-IV criteria for disorders, visit
www.mentalhealth.com
 Although imperfect, the DSM-IV nonetheless
reflects an improvement from the past,
when there was no common language in
talking about what was, or was not a mental
condition
 Each version of the DSM gives us a greater
understanding of mental conditions
 Mood Disorders: To Diagnosis or
Not to Diagnosis?
 Pros
– Gives us a common language
– Allows people to learn and get support about
their condition or problems
 Cons
– Being ‘labelled’ may carry a stigma (perhaps
stigma is the true problem?)
– The fact that people may misuse a diagnosis to
avoid responsibility for a problem
– Being put into a box
 My personal bias...
 Appropriate use of a ‘diagnosis’ in the
right situation can be helpful
 Example of How To Use a
Diagnosis
 “You’ve told me that before having these
problems with your mood, you were always a
happy, high achieving, outgoing person.”
 “You’ve mentioned having problems with
your mood, sleep, appetite, concentration
and energy, and that you’ve been feeling
hopeless.”
 It sounds like you may have a medical
condition called depression. The good news
is that this condition is very treatable and
we can help you feel better again.”
 Example of How To Use a
Diagnosis (Cont’d)
 “You are not responsible for causing
this condition.”
 “However, it is mainly up to you to get

better.”
 “But the good news is that you are not

alone – we will support you in

overcoming the depression.”
 Mood Disorders: Types
 Major Depression (aka Clinical
Depression, Major Depressive Episode)
 Dysthymic Disorder (aka low grade

depression)
 Adjustment Disorder (mood problems

following a stress, but not severe

enough to be major depression
 Bipolar Disorder
 Major Depression
 Problems with mood (sad, angry,
irritable), PLUS
 Physical problems with
– Sleep, Energy, Appetite, Concentration
 May also have problems with
– Thoughts
• Low self-esteem
• Hopelessness / Suicidal thoughts
– Behaviors
• Social withdrawal, loss of function
 Dysthymic Disorder
 Problems with mood (sad, angry,
irritable), PLUS
 Some physical problems

 Some problems with

– Thoughts
– Behaviors
 BUT is not as severe as Major
Depression
 Adjustment Disorder
 Problems with mood (which are not
severe enough to meet for depression
or dysthymic disorder) following a
stress
 Does not involve significant changes
 Bipolar Disorder
 A condition with severe highs and lows where
one’s moods are like a roller coaster, to the
point it causes problems
 During highs
– Mood high or irritable, excessive energy, less
need for sleep, excess talking, excess activities
 During lows
– No energy, depressed mood, more need to sleep,
i.e. essentially like being depressed
 Anxiety Disorders
 Everybody has worries and gets anxious
from time to time
 Just enough anxiety is helpful because

it keeps us cautious and safe

 Anxiety Disorders are when one has so

many worries that they get in the way

of life
 Types of Anxiety Disorders (or
Conditions)
 Generalized Anxiety Disorder
– Constant worries with physical symptoms that
cause problems
 Panic Disorder
– Out of the blue feelings of panic that cause
problems
 Obsessive Compulsive Disorder
– Repetitive thoughts or behaviors that cause
problems
 Social Anxiety Disorder
– Extreme shyness that causes problems
Restoring the
Balance
 A General Approach to Helping
Others
 Figure out the person’s goals
– “What would you like to get from coming
here to see me/us?”
 Figure out what to do to get to that
goal
– “What do you think we need to do to get
to your goal?”
 A General Approach to Helping
Others
 Figure out what stress is causing (or
contributing to) the anxiety or
depression
– Usual stresses include
• School
• Family
• Friends
 Problem-solve and find ways to deal
with that stress
 Approach to Conflicts
 Conflict is when two parties want or
expect different things
 Solution

– Figure out what each party wants or

expects from the other
– Ensure it is reasonable
– For things that each party wants in
common, great!
– For things that each party disagrees on,
negotiate and compromise
 Everyone needs a healthy body,
mind, spirit
Body
1. Body (Physical,
Biological Self)
2. Mind (Psychological,
Emotional Self)
3. Spirit (Spiritual Self)

Note: Overlap, e.g.

psychological
interventions can
cause biological
changes, and vice Mind
versa Spirit
 Body
 Ensure healthy amounts of
– Sleep
– Diet/nutrition
– Exercise
• Individual exercise
• Group / social exercise
• Yoga / Martial Arts
– Sunlight (in the case of winter depression)
 Body
 Medications may be a helpful ‘body’ or
physical intervention in certain
circumstances
 For anxiety and depression, in general

– Non-medication strategies are tried first

– Medications are used if non-medication
strategies are unsuccessful
 Body
 Common types of ‘self-medication’
– Sweets, carbohydrates, chocolates
• May possibly be a way of getting serotonin
– Exercise
• May be a way of getting adrenaline /
dopamine
– Caffeine
• May be a way of getting adrenaline /
dopamine
– Street drugs
 Mind
 Ensure good coping strategies and ways
to deal with stress
– School / work
– Family
– Friends and
– Boyfriends/girlfriends
 Mind
 Psychotherapy such as cognitive
behavior therapy
– Anxiety or depression is caused by
cognitive distortions
– Fixing cognitive distortions will overcome
the anxiety or depression
Thoughts
 Spirit
 Figure out what gives meaning to the
person’s life
 Ensure those things are in the person’s

life
 Types of Help for Anxiety and
Depression
 Speaking with friends
 Speaking with family

 Speaking with religious supports (e.g.

chaplain, priest, rabbi, iman, etc.)

 Types of Professional Help for
Anxiety and Depression
 School personnel (teachers, guidance
counselors, vice-principal, social
workers, coach, etc.)
 Medical Doctors (family physicians,

pediatricians, psychiatrist)
 Psychologists

 Counselors

 Social Workers
Questions?