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Recognizing the Signs of Depression

One of the more common conditions we see in Family Medicine is depression. Depression is the most common mental health condition experienced in the general population. About 15% of the adult population will experience depression at some point in their lifetime. 

Symptoms of depression can include feeling low, down, sad, or blue. However, there are many mental as well as physical complaints that can be signs of depression. Other common symptoms may include apathy, disinterest, inability to feel anything, problems with sleep, appetite, concentration, motivation, and social withdrawal. 

Most people feel low and sad at times. These feelings are normal reactions to life and are experienced when going through different life stressors such as losing a loved one, getting fired from a job, divorce, and other difficult situations. However, prolonged feelings of sadness, hopelessness, and despair that persist can signify depression.

I often find depression, and symptoms of depression are much more subtle and difficult to spot in oneself and those close to us; thus, symptoms may be missed and treatment not started. Currently, the American Academy of Pediatrics now recommends regular depression screening for all adolescents 12 and over, given that adults often overlook the symptoms of depression. Similar screening recommendations exist for adults. 

A tool called PHQ-2 can be an easy and quick screening for depression. This tool consists of two simple questions that one can ask themselves or a loved one. The questions are:

  • Have you often been bothered by feeling down, depressed, or hopeless during the past two weeks?
  • Have you often been bothered by having little interest or pleasure in doing things during the past two weeks?

A single “yes” answer of more than half or every day indicates possible significant depression, and one should seek further evaluation and care. Thoughts of death necessitate medical attention, and a plan to self-harm requires emergent care.

The good news is there are many effective treatments if you or a loved one is struggling. Effective treatments for depression may include medications, working closely with mental health professionals, and learning different coping mechanisms. Working closely with one’s healthcare provider is a great starting place to help determine the best course of treatments.

Keeping Control of Your Life During the COVID-19 Pandemic

Most of us have been on a roller coaster before and remember the dread, anticipation, and fear of going up the first massive hill on the coaster. It seems like the uphill climb takes forever, and we usually can’t see when we are going to crest the hill and start falling. The whole coronavirus situation feels a lot like this. It seems like we keep going up and up and don’t know when we are going to reach the end of or the worst of it, and the situation will start to resolve. COVID-19 is an entirely different situation, however. There is no thrill, no fun, no excitement, and zero desire to repeat this ride. Since our country and the entire world are already on this journey and the coaster isn’t going to stop midstream, one positive perspective will be to recognize we are all in this together, and if we can unite, we have the potential to learn something from this.

Professionally and personally, we have all been affected by the coronavirus. It is human nature to be fearful of things we don’t understand or can’t control. Rather than living in fear, choose to have faith, and live with hope. As scientists, medical teams, and experts in all fields of life tirelessly research, plan, care for affected individuals, and lead us through this coronavirus challenge, we are confident we will have better tools to treat and fight this illness. In the meantime, use this opportunity to look at your health habits and beliefs. Here are a few pointers to get you started as you recognize, remember, and reset your goals in life.

1. Physical

What are your hygiene habits?

Do you wash your hands appropriately? Before you eat, after using the restroom (and maybe before), after being outside or out in public?

Do you frequently touch your face? If so, do you avoid the mucous membranes of the mouth, nose, and eyes? Doing so significantly decreases the spread of many illnesses. Not touching the face may take more effort for those who wear contacts, have allergies, or are “pickers.”

What are your attitudes towards health?

Do you get your preventive screenings and examinations routinely?

Do your health habits support your immune system?

Do you get regular physical activity?

Is the most significant portion of your diet a wide variety of vegetables and fruits? If you avoid or can’t tolerate entire food groups, do you take a multivitamin or supplement to get the nutrients that are missing from your diet?

Do you limit processed and calorie-laden foods?

Do you “double-dip”? (for example french fries into fry sauce or veggies in ranch dressing)

Do you share cups, straws, drinks, meals, or utensils with multiple people?

Do you recognize the value of sleep?

Do you prioritize your goals and minimize idle time and distractions so you can get adequate rest? (i.e., social media, gaming, internet searches, and shows)

Do you smoke or vape? Since COVID-19 attacks the respiratory system, eliminating this habit may save your life. Smoking cessation is very challenging for many people but is one of the single best things you can do to improve your health. 

2. Environment

Do you regularly launder kitchen towels and sponges?  Bathroom and hand towels?

Do you routinely leave food out on the countertop or dirty dishes in the sink, where microbes have the opportunity to grow?

Do you have a cleaning schedule?

Do you regularly sanitize items that are frequently touched? (i.e., door handles and cabinets, light switches, phones, remotes, computer equipment, etc.)

Do you regularly wash pillowcases, socks, clothing, and blankets?

Do you pick up food, papers, and wrappers, particularly in dark or moist places where bacteria can thrive?

Do you practice CLEAN cooking principles? https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-14/

These are things that children and all family members should be taught and expected to take responsibility for in their living environment.

3. Meaning

When illness or death strikes a loved one, our mortality may seem threatened. This threat can provide increased motivation to look for purpose in your life. What truly is important to you? Do your words, thoughts, actions, and behaviors reflect this?

Can you use this interruption of lockdown and distancing as a tool to help simplify your life? Even if you miss the sporting events, numerous extracurricular activities, lessons, and business of life try to allow this jolt to reshape how you budget your time in the future. 

How are your relationships?

We all have the same amount of time in 24 hours. How do you spend your time? 

How often do you think about others?

Research has shown that people who serve others live longer and find more meaning in their life. Do you give your time or resources to help and serve others?

Are you grateful? (for example: for teachers, toilet paper, and water)

Are you continually learning?

Are you continually growing?

During this time of social distancing, be creative in finding ways to connect with those who are important to you. Some types of personal visits may be appropriate. Use technology to FaceTime or Skype loved ones and grandparents, rebuild relationships with old friends, use your phone to actually talk to someone, etc.

4. Preparation

The Federal Emergency Management Agency (FEMA) is associated with the Department of Homeland Security and is responsible for coordinating the federal government’s response to natural and human-made disasters. FEMA safety experts recommend storing 72 hours of survival supplies (up to 96 hours). Are you prepared? https://www.ready.gov/kit

Do you have basic food, cleaning supplies, and toiletries?

Do you have adequate clothing, a plan for temporary sanitation, and an idea of how to heat your living environment?

Do you have methods for water purification and possibilities to cook if the power is out for an extended period?

Do you have finances reserved for an emergency?

Do you have a method to communicate, along with a specified contact person for your family and key information written down? (i.e., phone number and address)

Money and storage space needs consideration, and I’m not talking hoarding supplies. As a general rule, anything in excess is probably not a good thing. Emergency preparedness can be an overwhelming project and currently, resources are limited and many states are on lockdown. Our current situation is not the time for shopping and potential exposure. Now is a great time to evaluate the needs of your family (which is different than wants and what you’ve become accustomed to) and what supplies or preparation your family needs for future emergencies.

5. Emotions

How do you handle stress?

Have you rehearsed coping techniques so that they can benefit you in a stressful situation? (For example, guided imagery or deep breathing exercises. You have to practice methods of relaxation when you don’t feel stressed in order to manage well in an acutely stressful situation.)

Who is your support system? (family, neighborhoods, church groups, friends, community resources, support groups, etc.)

Look for opportunities to express gratitude, find ways to laugh (which creates endorphins that make us feel happy), and alternate routes to connect with loved ones.

You can’t control all the circumstances and situations around you, but you can control how you respond to them. You get to write your own story and create the person you want to become.  Take this challenge to become a better person. Recognize what you are doing well and what you can do better. Remember the things you were taught about hygiene and sanitation but also about connecting, supporting others, and being able to see things from a different perspective. Find something every day to be thankful for and take this opportunity to reset and replace bad habits and unhealthy thought processes with better ones. COVID-19 has the rush of a roller coaster ride but in a whole different and potentially life-threatening/life-altering way. We will get through this together. 

Here is another great article from a colleague, Tracy Frandsen, MD, Canyon View Family Medicine. Dr. Frandsen’s article talks about how we can all find peace in unsettling times like those we now see

Finding Peace In Unsettling Times

Life as we knew it has changed. Life as we know it is fleeting. Life in the future is unknown.

Social distancing, including no school, no church, no movies, no NBA basketball, no March Madness, is changing our lives. March Madness has taken on a new meaning. How do we preserve our mental health during this time of uncertainty?

While there are many things we can’t do during this time of the coronavirus pandemic, there are many things we should do to maintain our physical and emotional health. And, they are things we can continue to do, no matter the circumstances, which will stabilize our mind and give us the resilience we need to succeed. 

Exercise –

Exercise is the great medicine of all ages and for all ages. You don’t need a gym to exercise. You don’t need a Technogym, a Diskus Dumbbell set, a Lova Kettlebell Rack or any other expensive piece of equipment to get the benefit of exercise. You just need to move. Social distancing doesn’t mean you can’t walk on the sidewalk. It doesn’t mean you can’t run at the park. It doesn’t mean you can’t ride a bike. You can and should do this. Not only will the exercise strengthen your physical self, but it will also release chemicals in the brain that will calm your emotional self. Don’t let a day go by without exercising. A rule of thumb for adults: Get your heart rate up to 180, minus your age. You will feel better. 

Sunshine –

Sunshine, particularly the spring and summer sunshine, will also allow your brain to produce chemicals that will give you a positive outlook on life. Take the time to go outside. If you are laid off; if you are home from school; if you are working from home and need a break, or if you are still on the job, go outside for ten to fifteen-minute breaks. Soak in the sunshine.

Meditate –

(Mindfulness—not ruminate) Taking time to refocus and slow down the bodily processes will allow the stress hormones to dissipate at that moment and the effects will last over the next several hours. Most of these involve breathing techniques that are used to accomplish this. There are multiple apps that will guide you through this process. Calm, StressFree by the Cleveland Clinic, Aura, Stop, Breathe & Think, and Insight Timer are examples of these types of mindfulness apps. Yoga, religious worship, and reading are other such examples.

Regular Schedule – 

Keeping a routine or regular schedule allows our bodies to find a rhythm that can coincide with our diurnal cycles. Sleep schedule and its resultant adequate sleep are very important. Establish a regular bedtime and a regular get-out-of-bed time. Make sure you are getting at least seven hours of sleep. You will feel better. Not only do adults benefit from a regular schedule, but also children find normalcy through a regular schedule, particularly now that they are home, trying to navigate how to accomplish online school. Try to schedule breaks to get up and move around at least every 50 minutes. This is important for the whole family. 

Healthy Eating –

Fruits, vegetables, nuts, and grains. Get plenty of these foods. They also help regulate your bodily functions. Forget the soda. It may satisfy for the moment, but it will not give stamina like good foods. 

Life as we knew it has changed. But life has always been changing. And, it will continue to change. We can find stability during change with good physical and mental habits. We can build resilience. In addition, we remain available to assist our patients with questions about their health and their current medical situations. While we may keep our distance, we will not be distant. Together we can find sanity during this March madness. 

Every Day Strong – Combating Anxiety and Depression by Building Resilience

Every other year children in Utah schools are given a survey that asks: During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? In 2011, 13% of youth responded yes, but when the survey was repeated in 2017 that number had risen to 25%. (Utah County Student Health and Risk Protection (SHARP) survey data.)

While not all of these children who answered yes would meet the criteria needed to diagnose a Depression or an Anxiety Disorder, this trend illustrates the increasing challenge our children are facing. Frequently I’m asked if the causes of this increase are known. While there are many theories about contributing factors, such as the use of smartphones, living at elevation, changes in family structure, helicopter parenting, and social media, none of them fully capture what is going on, and more importantly, they do not provide any guidance on what parents should do for those kids who are suffering.

To address this, the United Way created a program called Everyday Strong, which focuses on building resilience in kids to help them combat anxiety and depression. This is achieved by focusing on our physical needs, our need for safety and our need for connection, which when met, allows us to feel confident and hopefully thrive in life.

Below is a brief discussion of these concepts, but for more details and ideas you can read through the EveryDay Strong Handbook, attend a live presentation, or watch a recorded presentation here.

At the most basic level, we all have physical needs that must be met. Examples include sleep, food, water and rest.  We all know that person who becomes “Hangry”, but once you give them a little food, they return to a more productive version of themselves. When I was on Active Duty in the Navy, I learned that when marines, soldiers, sailors or airmen had experienced combat stress, the most effective intervention is “3 Hots and a Cot”, or in other words three hot meals, a chance to get good sleep, with a plan to return to their unit as soon as possible.

Once our most basic needs are met, we need a place to feel both physically and emotionally safe. As parents, we can focus on creating an environment where it is safe to talk, safe to feel emotions, safe to explore, and safe to fail. Because even if a child is safe, they may not feel it. It’s better to listen more than you speak while withholding judgment about what they are feeling and discuss failure as a chance to grow. This is easy to say, but much harder to do.

As you strive to create a safe environment, this should lead to opportunities for you to connect with your child. One of the most common complaints of teens experiencing anxiety and depression is feeling alone even when they are surrounded by people. You can connect by playing together, laughing together, learning about their interests even if you think they are boring, and apologizing to your child when you’ve done something wrong. Sometimes this is easy when you and your child share similar interests, but other times it is a real stretch. For example, what if they love playing the video game Fortnite or enjoy being in theatre, (things that don’t necessarily appeal to you)? Taking time to learn the basics, even making a fool of yourself by participating can go a long way to making that connection. Every child is unique and taking time to find that uniqueness is what brings about connection.

Ultimately, it is impossible to make someone else feel confident, but there are things you can do to encourage your child to find confidence. Some examples include trusting your child’s ability to solve problems, role-playing solutions, and remember when they have been successful. One specific tool that can help when dealing with Anxiety and Depression is naming the problem the child is facing. If every time a child is about to go to school they get overwhelmed worrying about all the things that can go wrong, you can start a conversation that what they are feeling is Anxiety. At times, giving this feeling of anxiety a specific name such as the “Bossy Pants” or “Stinky Head” helps externalize what they are feeling and allows them to get back in charge.

As you meet a child’s basic needs, help them feel safe, create meaningful connections, and build confidence, your child will have an opportunity to thrive.

The information provided by the United Way is not meant to replace professional mental health care. If you feel like your child’s needs surpass the given advice, please make an appointment with one of the Pediatricians at Canyon View Pediatrics.

https://www.unitedwayuc.org/images/pdfs-doc/UnitedWay_ResilienceHandBook_Web.pdf

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