Lepage Associates Newsletter
Mental Health Matters
December 2008
Lepage Associates
Call: (919) 572-0000
In This Issue
Child & Adolescent Depression
Understanding Depression
Seasonal Affective Disorder
Please click on each group for a flier with complete information to include description,
Behavioral problems or something more: A look at child and adolescent depression
Depression represents a significant mental health concern for children and adolescents. It is often associated with significant impairment in other areas of their lives as well including disruption in academic achievement, peer relationships, family functioning, and sense of self.
There are multiple contributing factors to adolescent depression that include, but are not limited to, genetic contributors, family discord, deficits in problem solving, social and coping skills, difficulty with emotional regulation, and environmental stressors.
Child and adolescent depression are frequently unrecognized because they accompany difficulties in other areas. More often, adults attend to poor grades, skipping school, increased arguments with parents, oppositional behavior, and anxiety that frequently accompany depression.  
What to look for in your child or adolescent:

There are some differences in the presentation of depression in children, adolescents, and adults. In children and adolescents, irritability is more common than sad mood. As adolescents approach adulthood, the presence of a sad mood becomes more evident. When looking at children and adolescents, adolescents are more likely to show excessive sleep, hopelessness, lack of enjoyment in activities, sluggishness, and fewer physical complaints (i.e., stomachaches, headaches, etc.) than are children. Suicidal ideation is also rare in childhood and increases markedly during adolescence.
When you notice these traits in your child, it is important to seek professional help.
In the area of depression, prevention goes a long way. In taking preventative steps, you prepare your child with the tools to more effectively connect with others and regulate their own mood and environment. With treatment recovery rates are high.

Treatment often includes individual therapy to address skill building (social skills, coping skills, emotional regulation skills, and conflict resolution), family therapy to improve communication and parent-child relationship, and group therapy to enhance feelings of connectedness and self-esteem. 
To learn more about our child and adolescent services visit our website and read the bios of our treatment team.


Monthly Reader
Each month we will recommend a book that someone at our practice has found useful. This month's books are:
Feeling Good
by David Burns 
Authentic Happiness
by Martin Seligman
For other reading suggestions check out our
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With the winter ahead of us, we often experience sad or stressful feelings, and rates of depression increase in the winter. In this issue we focus on depression, often times referred to as the "common cold" of mental health since so many people experience it at some point in their lives. Here are some ideas to help you cope with this time of year.
We are excited to have added PSYCHIATRY
 at Lepage Associates.
Understanding Depression
and Effective Treatments
How do I distinguish between depression and normal variations in mood?
Everyone has felt fed up, miserable, or sad at times. These feelings can come and go and don't interfere too much with all of life's activities and responsibilities. There may or may not be a clear reason for the feelings, but regardless, people usually figure out a way to manage them. In depression, however, these feelings don't readily improve. They can last for weeks or months, and start to interfere with daily responsibilities. People with depression can struggle with persistently low mood, low energy, loss of enjoyment in activities, difficulty sleeping and eating, feelings of guilt, poor concentration, irritability, and even thoughts of suicide. Some may experience other symptoms, such as agitation, anxiety, and physical problems like headaches and stomach aches. Children also can have depression, but it tends to be more characterized by irritability and loss of interest in previously enjoyed activities.
What causes depression?
There are several factors that can cause or contribute to depression. Stressful circumstances, physical illness, genetics, prior negative life experiences, and alcohol and drug use can all play a role in causing or perpetuating depression.
What can I do to help myself?
Depending on your individual circumstances, finding someone to talk with about your problems can be helpful. Finding ways to reduce stress, such as by reducing your obligations and responsibilities can also be an option. Other strategies for helping your mood might include exercising regularly, practicing relaxation strategies such as meditation or prayer, eating well, avoiding alcohol and drugs, and getting enough sleep. Other forms of self-help include reading books or leaflets and looking for self-help computer/internet programs.
When should I seek help?
You should consider seeking help if you notice your feelings seem worse than usual or don't seem to be getting any better. Also, you should seek help if your feelings and symptoms interfere with your work, interests, and relationships. Finally, you should seek help if you are struggling with thoughts life isn't worth living or thinking of suicide.
What kind of help is available?
Besides self-help strategies, two forms of professional treatment are therapy and antidepressant medications. There are several empirically-validated forms of therapy for treating depression to include cognitive-behavioral therapy (CBT), problem-solving therapy, and interpersonal psychotherapy. These forms of depression therapy can be provided in different settings such as individual therapy, couple's therapy, family therapy, and group therapy. For mild to moderate depression, any of these therapies are good options. Antidepressant medication can also be a good option, particularly in moderate to severe depression. In these cases, a person may be more able to benefit from therapy when taking medication, as antidepressant medication can lift some of the fog and sadness of depression that can sometimes interfere with successful therapy. Studies have shown in general, people with depression have the best chance of getting better by using a combination of both therapy and medication. Relapse rates have been found to be higher when antidepressant medication is used alone without therapy, likely because in therapy you also learn and improve coping skills and strategies. Many people choose to take an antidepressant because of ease of use and cost, depending on the medication.
(Click here to read the full article, which includes what you can expect from antidepressant medication. You can also read more about our new
Is what I'm experiencing normal or
do I have Seasonal Affective Disorder?
You may have noticed that you would like to sleep a bit more lately or that your eating habits have changed slightly now that the days are shorter and the weather is cooler. Does this mean you have Seasonal Affective Disorder? Chances are, probably not. Researchers in Boston (Harmatz et al, 1999) conducted a study with over 300 people who rated feelings of depression each season over the course of a year. The results showed that feelings of depression were highest in the winter and lowest in the summer (this was also found with feelings of hostility, anger, irritability, and anxiety!). What causes these changes? The researchers in this study suggest that diet, activity, and light exposure all show seasonal variation and might, either singly or in combination, contribute to the seasonal differences of these feelings.
Although these differences in mood seem to be common, our society, unfortunately, does not encourage being less productive or less active during the winter months. This may lead some people who are naturally feeling less active or more moody to feel guilty and more depressed because they are not as happy as they "should" be by society's standards. (It is these feelings of inadequacy that may lead to a more serious form of depression.)

While some variation in mood and activity level is normal, some people do experience differences that are a form of a depressive disorder. A seasonal pattern to depression (or mania) is called Seasonal Affective Disorder (SAD). The winter version of SAD affects up to half a million people each year in the United States. Symptoms of SAD include feeling down for most of the day, feelings of hopelessness or worthlessness, loss of energy, withdrawing from friends, oversleeping, losing interest in activities you previously enjoyed, significant weight gain, feelings of inappropriate guilt, and difficulty concentrating. A major marker for determining whether the winter blues you're experiencing is normal or more serious is to look at how impairing these feelings are for you. Are you feeling so down that you're missing days of work or school? Have your relationships suffered? Have you found it much more difficult to do daily tasks like cooking or other tasks of caring for yourself or your children? If the answer to any of these questions is "yes," you may find talking to a mental health professional very helpful. In addition, anyone experiencing a form of winter blues may find the following tips helpful in improving your mood:
1. Let there be light.
Make your home sunnier and brighter. Open blinds, add skylights, and trim tree branches that block sunlight.
2. Get out. Get outdoors on sunny days, even during winter. Take a long walk, eat lunch at a nearby park, or simply sit peacefully on a bench and soak up the sun.

3. Exercise regularly. Physical exercise helps relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.

5. Take care of yourself. Get enough rest, eat a balanced diet, and take time to relax! Don't turn to alcohol or unprescribed drugs for relief. If your body is asking for a couple extra hours of sleep, give yourself permission to take that time.

6. Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.

7. Socialize. Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.

8. Take a trip. If possible, take a winter vacation in a sunny, warm location.
Happy Holidays!

We generated over $800.00 in donations

from our silent auction at the
Health and Happiness Fair.
We will be making donations to
NAMI and The Durham Food Bank,
just in time for the holidays!
Thank you
for your support!
Happy Holidays