Lepage Associates Newsletter
Mental Health Matters
October 2009
Lepage Associates
Call: (919) 572-0000
In This Issue
Educational Testing
Bipolar Disorder
Let's Talk about Sex
Please click on each group for a flier with complete information to include description,
Dealing with Depression
Depression is often called the "common cold" of mental health disorders, in that most people experience depression at some point in their life. In fact, Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44. And, the number of out-patient medical visits for depression per year are 21.0 million. While major depressive disorder can develop at any age, the median age at onset is 32. Major depressive disorder is more prevalent in women than in men.
What is Depression?
To meet diagnostic criteria for clinical depression, symptoms must persist steadily for at least two weeks. Thus while most people experience depression in their lives, a smaller number are clinically depressed.
Depression can be characterized by either a depressed mood or the loss of interest or pleasure in nearly all activities.
Depression goes beyond occasional feelings of sadness and interrupts a person's daily life and functioning. Individuals with depression also commonly experience:
Changes in appetite or weight
Changes in sleep
Psychomotor agitation or retardation
Decreased energy
Feelings of worthlessness or guilt 
Difficulty thinking, concentration, and making decisions
One may also experience recurrent thoughts of death or suicide as well as make suicidal plans or attempts
A person experiencing depression may self-describe as depressed, sad, hopeless, or discouraged. Individuals may also complain about having no feelings or feeling "blah." Others exhibit bodily aches and pains rather than feelings of sadness. Family members often notice social withdrawal.
What Causes Depression?
There is no known single cause for depression. Research indicates that it is the result of genetic, environmental, biochemical, and psychological factors. Depression is a highly treatable disorder; like most disorders, the earlier the treatment the more effective it can be. Seeking treatment early when signs of depression are first evident can greatly reduce the likelihood the depression will worsen or persist.
How is Depression Treated?
A combination of talk therapy and drugs worked best for treatment of depression and anxiety. For those whose treatment consisted of only talk therapy, they did almost as well if they had 13 or more visits with the therapist.
    Treatment from primary care doctors (MDs) was effective for people with mild problems, but less so for people with more severe ones, who did better with psychologists.
    Treatment by psychologists yielded significantly better results for people who started out in poor shape.
    How Can I Help Myself?
    Turn to trusted friends and family members.
    Try to keep up with social activities even if you don't feel like it.
    Join a support group for depression.
    In order to overcome depression, you have to nurture yourself.
    While you can't force yourself to have fun or experience pleasure, you can choose to do things that you used to enjoy.
    When you're depressed, exercising may be the last thing you feel like doing, but depression requires you to act the opposite of what you're feeling!
    There is no shame is seeing someone for therapy. If you or someone you love has experienced these symptoms for more than two weeks, take it seriously. Visit our website for more information on depression, therapy, and ways to help yourself. 
  • www.lepageassociates.com 
    Educational Testing
    For Your Child
    The next school year is underway, and you may have some concerns about your child's academic performance.
    Now is the best time to consider getting a jump start on understanding how to help your child succeed in this school year.

    Attention Deficit Hyperactivity Disorder (AD/HD) and Learning Disabilities (LD) can greatly interfere with your child's ability to do well in school.  Not only does this mean that their grades could suffer but it may also leave them feeling uninterested in school and create problems with their teachers. In some cases, your child may be labeled as lazy or unintelligent, and the problem is left unresolved. 
    Despite public knowledge about AD/HD and LD, many parents are often unaware that their child has a disorder which is easily remedied with the accommodations at school and psychological treatment.  Psychological testing for AD/HD and LD is an effective way to learn more about the problems a child faces when it comes to interacting and engaging in their learning environment. 
    Symptoms of AD/HD include:  failure to sustain attention within certain areas of functioning such as school or work; difficulty following instructions; trouble maintaining attention during play or other activities; being forgetful or disorganized; and a general reluctance to engage in activities involving mental effort.  In order for someone to be diagnosed with AD/HD these characteristics need to be apparent in more than one setting such as when doing homework, in the classroom, or while participating in afterschool activities.
    Characteristics of Learning Disorders are separated into four categories:  Reading Disorders, Math Disorders, Disorders in Written Expression, and Learning Disorder Not Otherwise Specified (LDNOS).  Each scale is measured by comparing the individual's proficiency in the specific area to the average of children within their chronological age, intelligence, and age-appropriate education.  A diagnosis of LDNOS indicates a difficulty in all three areas of schooling, each may be to a different degree of significance. 
    Timing is crucial when planning an intervention to assure your child's success. Having your child tested and/or treated early in the school year can prevent him or her from falling behind.  As appropriate, medication and counseling services are readily available for your child. Family involvement is also crucial for success because the better you understand your child's disorder, the better you can advocate for, support and encourage them in their efforts at school and when doing homework.
    Treatment for AD/HD and LD not only improves one's academic career, but it can also prevent future behavioral and/or social problems.
    Children with AD/HD and LD often have difficulties in daily interactions with peers due to frustration, low self-esteem, and feeling misunderstood or "stupid."
    A psychologist can work on helping them improve their social skills, organizational skills, develop more confidence, and learn how to seek out attention and help from adults in a positive manner. Our child psychologists can help you understand your child's needs and how to best help them be successful in school.

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    October is an important month for awareness!
    October is the designated month to talk to your children about sexuality. We have included an article with tips regarding how to make this awkward conversation easier. 
    With school in full swing, if you have any concerns about academic performance, check out our article on what educational testing can tell you about your child's learning. 
    October 5-11 is Mental Illness Awareness Week, October 9th is Bipolar Awareness Day, and October 10th is World Mental Health Day and National Depression Screening Day. We have therefore included articles on recognizing and treating depression and bipolar disorder.
    Self-awareness is an important part of all life transitions. Learn more about how women can take care of themselves during a divorce from a workshop co-hosted by a family law attorney, financial advisor, and Dr. Lepage.
    Also check out our In The News article about the Freshman 15.
    Colloquially known as manic-depression, how does bipolar disorder affect your life or the life of someone you love? Learn about how treatment can help.
    Jonathan (not his real name) is a 35-year-old attorney who moved from Colorado to North Carolina. He started seeing a psychiatrist to continue his medication treatment with a mood stabilizer. He had been successful in work and relationships since he was diagnosed with bipolar disorder and treated in college. Moving to North Carolina was difficult because he worked all the time and had not made many new friends. About six months after he moved, he noticed a change in his mood. For about a month, he felt increasingly energetic although he was not sleeping more than three hours at night. Co-workers noticed he was talking very quickly, and he seemed to have so many thoughts going through his head that he could not get them all out. He started working longer and longer hours, but did not really get anything completed, and jumped from project to project. He also went out to bars after work each night and drank until they closed.
    What was going on with Jonathan?
    Jonathan was having a Manic Episode, which includes a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (Jonathan's mood would be described as elevated). Three or more of the following symptoms generally persist (four if the mood is only irritable) and are present to a significant degree.
    1. Inflated self-esteem or grandiosity - This did not appear to happen with Jonathan.
    2. Decreased need for sleep - Jonathan felt rested after only three hours of sleep.
    3. More talkative than usual or pressure to keep talking - This was noted by Jonathan's co-workers.
    4. Flight of ideas or subjective experience that thoughts are racing - Jonathan felt he had so many thoughts going through his head that he could not get them all out.
    5. Distractibility - This was evident in Jonathan's inability to finish projects at work.
    6. Increase in goal-directed behavior - This was demonstrated by his longer and longer hours spent at work.
    7. Excessive involvement in pleasurable activities that have a high potential for painful consequences such as unrestrained shopping sprees, sexual indiscretions, or foolish business investments. - Jonathan drank until the bars closed each night after work.
    Bipolar disorder often occurs with other disorders such as alcohol or drug abuse or dependence, anxiety disorders, eating disorders, and personality disorders.  These other illnesses are also primary illnesses and will need concurrent treatment.
    So, what can be done to help Jonathan?
    Bipolar disorder is the result of genetic and biological vulnerability that leads to mood disorder symptoms and dysregulation. This, combined with life and family stressors, triggers episodes. Studies show that the best treatment for bipolar disorder involves therapy, education and medication.  Leave out any one component of this treatment and the likelihood of a reoccurrence of mania or depression is greatly increased.  Bipolar disorder is a high risk disease.  Failure to obtain the full spectrum of treatment allows a patient to risk serious life consequences.
    The most common forms of medication treatments are mood stabilizers (for example, Lithium & Depakote). These medications, unlike antibiotics, do not treat the cause of the illness but only the symptoms. Many patients hope medication treatment is all that is needed, but alone it often leads to failures to properly remain stabilized and on medication. Because people often go through phases when they do not take their medication, (and even when they do, they have 'breakthrough episodes' - similar to what happened to Jonathan; breakthrough episodes develop when there is a reoccurrence of symptoms despite medication compliance.) People with bipolar disorder require therapy.
    In individual therapy, people learn the importance of medication adherence and stress management. They develop an understanding of their signs of depressive and manic episodes. They realize the importance of self-care such as balanced eating, exercise, regular sleep routines, and relaxation. They develop a plan with family and friends to recognize their symptoms and intervene when necessary. They also learn to challenge their depressive thinking and increase positive experiences to help manage their emotions.
    In family and marital therapy, individuals learn how to express emotions, communicate, and recognize when they are experiencing stress and other symptoms. Education about bipolar disorder is often completed with families to help them understand their loved one's vulnerability to future episodes and the need for medication. Families also need to be taught the difference between symptoms and personality, how to recognize and learn to cope with their own stressors, and the importance of reestablishing relationships after episodes.
    What happened to Jonathan?
    Jonathan was taken to the emergency room and a call was placed to his psychiatrist. The psychiatrist was able to work with him on an out-patient basis to adjust his medication, and Jonathan took a week off of work to reduce his stress level. The psychiatrist recommended Jonathan see a clinical psychologist trained to do therapy with people with bipolar disorder. Jonathan received this therapeutic help and began to readjust within a week and started to really feel better within about a month. For the past year, he has learned to only work 40-hours a week, get enough sleep, exercise, eat healthfully, take his medication, and spend time getting to know people and relaxing. He has also learned to recognize his symptoms in case he starts to feel depressed or manic.
    Bipolar disorder is not unmanageable, but its treatment is multifaceted involving a combination of therapy, education and medication. If you think you or someone you know suffers from bipolar disorder, now is the time to seek a consultation regarding prevention and treatment.
    Sexuality: Successful Communication
    Between Parents and Their Children
    Educating your children about sex can be one of the most challenging and awkward steps of parenting. However, research shows engaging children about these issues instead of putting them off may  help prevent premature sexual activity,  teen pregnancy, and  sexually transmitted diseases. As a parent, it may be difficult for you to decide on the right time to talk to your children about sex, and many parents wait until they are confronted by their son or daughter about these issues. As you may feel uncomfortable or unsure about what to say to your children,  here are some tips to help with your discussion.
    Before jumping to the pre-teen and teen years, let's start from the beginning, since even young children may ask about sex-related topics, such as body parts, pregnancy, etc. There are many sources of information which can influence your child's understanding of sex such as television, movies, music, and peers. For this reason, parents should provide their children with age appropriate answers to their questions starting at an early age; importantly, this helps distinguish you as someone they can turn to about these types of questions.
    • Young children have a tendency to be curious about their own bodies. Take this time, perhaps during bath time, to help them understand the different parts of their anatomy. Don't be afraid to say "penis" or "vagina" to prevent negative associations with their bodies. It is important that you express which parts of their bodies are private and which are okay to show in public.
    • A child's curiosity may lead to masturbatory behavior, even in a public setting. While this behavior is normal for children, parents should express to their child that this is not acceptable in public; the message and tone is not that the behavior is wrong but rather it is private.
    • Communicate to your children that their genitalia should not be exposed  to others, nor should anyone other than a physician,  nurse, or parent be allowed to touch their private areas. Talk to them about "good touch" and "bad touch," letting them know if they ever feel bad about touch they should tell their parent or a trusted adult. While the vast majority of interest in bodies is perfectly normal, parents should be aware that a child's overenthusiastic interest in [PC1] sexuality could be linked to sexual abuse. Consulting with a pediatrician or psychologist can be helpful if you have such concerns.
    • When preschool children see someone pregnant, it may prompt them to ask how pregnancy occurs. Like all questions at this age, the trick is answering honestly but in a way they can understand, and realizing they don't need full information yet and probably won't even notice you've left out the details. For example, one answer to this question would be: When a man and a woman are grownups there is a special grown up hug they can do that make babies.
    • Take a minute to listen to the content of questions, as some questions seemingly about sex may not be at all. In one family a preschool child made a group of adults quiet quickly when she asked upon meeting her aunt's new husband for the first time if they slept together. The aunt cautiously replied, "Yes," to which the child said happily, "Oh good!" When the aunt asked why that was good, the child explained, "Now I know who he is. Like mom and dad sleep together, grandma and grandpa sleep together..." The child knows nothing of sex, but a couple sleeping together tells her something about the relationship, that it is close and special.
    Elementary School
    Elementary school brings about another series of questions which children may ask their parents concerning sex. Children may ask more about the connection between sex and having babies and sex and love. Around the pre-teen age, children's bodies begin to develop, which can be very confusing. Here are some tips to help you better communicate with your child.
    • There is quite a difference in this group when we look for example from first grade to fifth and sixth grade. With younger children, continue the advice from above in the preschool section, i.e., answer questions honestly but only with as much detail as the child seems to be pulling for.
    • You may find yourself answering questions earlier than you had imagined because an older child at school informs a group of younger children about the birds and the bees! Stay calm and listen at first; see how much your child has been told before you start your answer. Often the child's biggest concern is that an older child is making fun of them and perhaps trying to get them to believe something that isn't true, or similarly showing the child is a "baby" because he or she doesn't know the facts of life. Whatever your child has been told about sex that is true, confirm as true, and correct any misconceptions the child has been given.
    • An ounce of prevention is worth a pound of cure. In the pre-teen years (perhaps ages 11-12), if your child is asking questions about having sex, you may want to take this time[PC2]  to begin to discuss contraception and STDs. Express your concern for their well-being and need to protect and respect their bodies and others.
    • Some children may begin to experience puberty as pre-teens. Both males and females should be knowledgeable of menstruation, male and female genitalia responses, and breast development in order to[PC3]  better understand the changes occurring in their own bodies as well as others. Particularly with girls, as it can be scary if they begin menstruation not knowing it is going to occur, so most experts would say girls should know about this by age 11 or 12 at the latest.
    Junior High School/ High School

    Junior high school and high school children go through the most difficult sexual pressures. Now is the time when parents are able to bond with their child through open communication about sexual relationships. Being the one to answer all of those confusing and embarrassing questions is perhaps one of the most important roles parents can play during this phase of their child's life.
    • Parents should work together to educate their children. Children may be curious about the changes the other gender experiences. It can be helpful to get both a mother's and a father's perspective on sex and sexual development.
    • Assure them that the physiological changes they are going through are completely normal. All of his or her peers are experiencing the same insecurities, difficulties and curiosity they feel. There is no need to feel they are unusual or weird.
    • Teen pregnancy is becoming more common each year, but few children know how devastating this can be for their futures, particularly girls. Encourage your child to use contraception if they are going to engage in sexual activity but to also be aware that using them does not guarantee they will prevent getting pregnant. Alert them to which ones only protect against pregnancy and which prevent both pregnancy and STDs. Suggesting abstinence as an alternative to sex is also recommended. Let your child know sex has emotional aspects that can be complicated and are better handled as an adult. The overall message is that sex has practical and emotional consequences and for your child to delay sexual activity and particularly intercourse until older.
    • Keep the lines of communication open. As a parent, it can be difficult to remain calm when you find out your child has done something of which you do not  approve. Overreacting can sometimes cause more harm than good. If you yell at your child for one sexually related issue, they are less likely to come to you when they may have a more serious one. Address them with a cool-tempered, but genuinely concerned attitude to motivate change without turning them away.
    • Let your child know how you feel about sex. Knowing how a mature adult views sex can create a healthy role model for them to follow. They will then be better able to assimilate your beliefs and knowledge into their own personal views; however do not be surprised if they do not share your perspectives.
    • Parents should alert their children to stressful situations in which they may feel pressured to engage in sexual activity. It is crucial that parents prepare their child to say "no."[PC4]  Encourage them to develop an assertive language regarding saying "no" to intercourse and other sexual activity.
    • Parents should discuss with their child strategies for handling their feelings of sexual desire. If you are going to be encouraging them to say no to sex then it is helpful to discuss openly situations in which this will be difficult. Do not shame the child or make his or her sexual desire seem bad or wrong; conversely, let your child know desire is normal and that thinking in advance about how to choose not to engage in sex even in the face of desire helps one be prepared for the moment.
    • Let your children know that in a secure, mature relationship sex is a wonderful, bonding, and fun part of intimacy! If you make sex sound all bad, i.e., pregnancy, disease, a "bad" reputation, etc., they may tune you out completely. Instead, explain that when they are older sex will be a wonderful part of their relationships, and you just want to encourage them to wait and bring sex into their lives at the time when they are best prepared to handle all of the complicated aspects of it.


    Monthly Reader
    Each month we will recommend a book that someone at our practice has found useful. This month's book is:
    Taming Your Gremlin
    by Rick Carson