Kevin Leehey M.D.
Child, Adolescent, and Adult Psychiatry
Community of Concern Workshop
Depression and Self Destructive Behaviors
What causes depression, anxiety, and self harm?
What is Depression ?
What is Anxiety ?
What is stress?
What is self destructive behavior ?
How do I help my teen ?
Life events, losses, environment, disappointments
“Stress” - personal, family, peers, societal pressures
Alcohol and other drugs
ADD, ADHD, Learning Disorders
“Nature vs Nurture” - genes or experiences
Types of Depression
Existential or adolescent angst
Personal and Family History PH, FH
Major Depression : for diagnosis 5 of below for at least 2 weeks
Sad, mad, down most of every day
Anhedonia - loss of interest, withdrawal
Fatigue, loss of energy
Sleep change - up or down
Appetite change - up or down
Feel worthless, hopeless, guilt, negative
Agitation or slowed movements and thoughts
Decreased concentration and ability to think, or decide
Recurrent thoughts of death or suicide
Especially common in depressed teens :
Irritable, cranky, negative
Change or avoid friends
Drop in school performance
Quit or fail to follow through with activities, jobs, etc.
Anxiety, worry about the future, hopeless, no longer trying, loss of motivation
Other Forms of Depression
PH and FH
Mania: while not one’s usual self for at least a week, a marked change
Elevated, expansive, irritable, temper
Inflated self esteem, grandiosity
Markedly decreased need for eating or sleeping
Flight of ideas
Loss of judgement, spend, sex, illegal, pleasure seek, substance abuse, gamble, unwise business ventures
Psychosis can occur
Excessive worry, fear, nervous
Generalized Anxiety Disorder, GAD
Panic, “anxiety attack”
Separation anxiety, school anxiety
Obsessive Compulsive Disorder, OCD
O/C style, perfectionism
PH and Family history
Forces from the outside (or inside) that impinge, affect, or impact us.
Mild to moderate stress can promote growth.
Severe, sudden, or chronic stress cause biologic damage resulting in physical and emotional damage, disease.
Trying to do too much too fast, pressure to grow up, achieve, excel
Co- and Extra-curricular Activities
studies show :
10-20 hours a week is best for most teens
Kids who do <10 hours and kids who do >20 hours do less well in school
Sports, clubs, music, job, youth groups, 4H, horses, volunteer, martial arts, etc.
learn a skill, develop a hobby, make new friends, build self esteem, manage time, get experience, build a resume, find a mentor, have positive fun
Self Destructive Behavior
Any behavior that hurts you
Piercings ? Tattoos?
The “choking game”
Self harm, self mutilation
Cut, scratch, burn, mutilate
Trendy, myspace, “community”, “emo”
Arms and more
Mild to severe
To release feelings physically; to convert emotional pain into physical
Usually not suicide intent
“accidental”, uncertain intent, ambivalent, passive, nihilism
Ideation, plan, intent, act
#2 to 3 cause of death age 15-24
Firearms 80% in boys; 50% girls
Overdoses, hanging, “accidents”
Arizona in worst 5
“survivors”, the suffering of those left
Suicide - cont’d
1) Depressed, angry, substances
2) “the last person you’d ever expect”
3) Eating Disorders especially Bulimia
4) Psychosis or severe mental illness
Connectedness, support system
Lethality of method and intent
Rate dropped 25 % in last decade
How do I help my Teen?
Model healthy living and coping
Be present, involved, and caring
Avoid over-control and intrusion
Focus on developing the life skills your teen will need for happy independence
Encourage but limit electronics
Use the Community of Concern
How do I help? - cont’d
Teach or provide “teacher” of healthy coping skills, stress mgmt, values, spirituality, self esteem, goals
The “relaxation response”
Motor vehicles, firearms, substances
Therapy and counseling
Therapy and Counseling
Individual therapy- Cognitive Behavioral (CBT), Behavior Management, Interpersonal, Psychodynamic, Psycho-education
Family therapy- Family system, Structural, Parenting, Psycho-education
Intensive Outpatient Programs
Safety - carefully prescribed and monitored the safety record is excellent
The more “biologic” signs that are present the more likely medicine will help and is needed
The more severe the anxiety or depression
The stronger the family and personal history
If therapy is not enough, not effective,
refused, or if medication is preferred
Medication - cont’d
25% best with therapy alone, 25% best with medicine alone, 50% best with combination for Major Depression or severe Anxiety
SRI’s, buproprion, SNRI’s, etc.
Bipolar disorder usually requires medicine
Omega 3 (and 6) FA’s, supplements, vitamins, diet, exercise, other
Good night and good luck!
Kevin Leehey M.D.
Return to www.leeheymd.com