Exercice is really good. There are a number of studies that show that exercise is good for the mood. I exercise quite a bit. At the end of the day, I sometimes find myself mentally exhausted. Or, if I haven’t slept, I’m mentally tired, but I’m never physically tired. I could probably dance all night if I had to. What happens is that you have more energy. In fact, as simple as it might sound, if a person isn’t straining to walk up a flight of stairs, everything is easier. If you are in bad shape, normal tasks become a burden. So you can certainly lessen the burden by exercising regularly. Plus, of course, it has all kinds of chemical changes, such as the release of endorphins.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

I think it obviously depends on his ability to function. Is this someone who was depressed all his life or just recently started getting depressed? Generally, the more functional you are, the better it is. If someone cooks for you every day, then, at some point, you’re not going to be able to feed yourself. If someone pays your bills for you, you’re not going to be able to pay your bills, etc. So, ideally, you want to function at the highest level possible. Having said that, when a person is really depressed sometimes they can’t function and they need assistance. So you’re always trying to walk that fine line between doing it for someone and encouraging them to do it themselves. You don’t want to overprotect them, but, at the same time, you don’t want to overburden them. But, sometimes, it becomes just an easy excuse because a person might just not feel confident and they’re looking to relieve themselves of responsibility. But, in so doing, they might actually just keep further chipping away at their self-confidence. I would encourage them to be independent as much as possible if I could.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

It has to do with the environment. People are getting displaced more significantly than they were in the past and, in addition, they are getting displaced to places where they don’t have friends or family near them.

According to scientist Michael Meaney, the reason why we think our life is more stressful than our parents’ and grandparents’ lives is the lack of extended families.

Also the issues surrounding recent geopolitical turmoil could contribute to a higher rate of depression over the next ten years.

-Joseph Rochford, PhD, Mini-Psych School 2009

Statistically there is always a greater chance because you may have a biological predisposition, and, if that’s the case, it’s still part of you. More often than not, if your temperament is such that you’re very hard on yourself, and have high expectations, you will be more prone to it. If you understand the factors that contributed to it, some of them can be changed and you can prevent another episode. But, without any changes, if you’ve been depressed, you’re always going to be more likely to become depressed.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

When a person sleeps a lot, it can be an indication of depression. But of course, it can also be an indication of anemia or some other physical problem, so it’s not always psychological – that’s why I think you need to be properly assessed. A proper assessment includes a psychological and a physical assessment as well. As a psychologist, I’m not going to do a blood test on people; I don’t know anything about medicine. But I do know that, if I ask someone if they saw their doctor lately and they said: “Yes, I saw him last month and had a blood test, and everything was normal,” then I know that the problem is most probably not physical.

So, what you want to know, first and foremost, is whether it is unusual. Some people just sleep a lot. Some people sleep ten hours a night, and that’s what they need to function; they’ve been doing it all their lives, it’s not an issue. If a person normally functions well with seven or eight hours and they find themselves constantly tired and needing more sleep, then there is some change. Then the question is: is that change physical or psychological? Obviously, if they told me that they lost their job and, since then they haven’t been able to get out of bed, chances are it’s more psychological. But still, we need to do a proper assessment to understand really what the source is.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009
 

Antidepressants can be very useful. Sometimes they're necessary. Sometimes they're not. It would be irresponsible to say that a person should or should not take the medication without knowing the background history. Some people taking antidepressants report feeling less bothered by things, therefore they're less depressed and anxious. However, some people report a sense of numbness. They feel as if the antidepressants take a little bit of spice away from them. Only a small percentage of people tend to feel that way. Like all medications, you have to balance between what it brings to you and what it costs you.

Take, for example, a patient who was a very successful and creative musician. He suffered from bipolar depression and needed a mood stabilizer. When he stopped taking his medication, he had a manic episode and ended up in rural Quebec, naked in the streets, and was picked up by the police. In such a case, not taking his medication was not an option. He needed it to function normally. The medication did affect his creative side, but that certainly was a small price to pay for what it brought him. So the answer to your question is: it depends on how much it helps you and how necessary it is. Sometimes, a different medication can bring the same benefits and have fewer side effects. (Mimi Israël, MD) The question as to whether your creative side gets you into trouble should be answered by you. However, it's important to share your hypothesis with the professionals that treat you because they may have interesting answers as well.

Just pure happiness is not a disease. But, if you’re overly optimistic, you may not necessarily protect yourself when you’re really facing a threat. Having said that, there is mania, which is very different. I don’t know what you’re referring to but, when we talk about bipolar disorder, some people have strong mood swings: a person can have a depressive episode that tends to be unrelated to circumstances -- it’s more a biologically-based illness -- or they can have a rise that is not just feeling good but actually a state of mania or hypomania. In this state, you have an incredible amount of energy; you may sleep one hour at night, and find that you’re well-rested. There are authors who’ve written entire books on a weekend in a manic high, or people who have started businesses and so on. And when it gets more extreme, a psychotic process can take place. At very high levels, a person can have what are called delusions of grandeur – they might think that they are God and are all-powerful. One person said to me once: “I drove home at three o’clock in the morning, and went through all the red lights because I knew I could control the traffic.” The guy thought that he was God and he was testing his powers by driving through all the red lights just to test it. Fortunately it was three o’clock in the morning, but he could certainly have killed himself. I made sure his family got a court order and brought him in because this was a serious condition.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

I like to say no for that one even though depression not a single episode like when you have a virus and it’s gone. If it’s your personality, or if it’s the way you see things, if you’re really hard on yourself, then you tend to have that with you. Circumstances may change, and from time to time, they get difficult; so, if you really understand why you get down on yourself and make some fundamental changes, then you’re protected against it. If, on the other hand, you ride it out but nothing really changes, then you’re more vulnerable. So, researchers tend to show that it does become more likely, but I think it’s because our experiences keep affecting our confidence, and, if your confidence gets destroyed every time you have a conflict, then you’re more likely to react badly in the future.

Having said that, I do fundamentally believe that, if you really take the time to understand what is going on, then you can make changes. Cognitive behavioural therapy (CBT) involves having the patients question their attitudes and perceptions, become aware of their prejudices, and how they affect their own experiences. Having said that, for people who tend to keep getting depressed over and over again, there are what we call “acceptance” or “mindfulness” treatments. The old adage says: “change what you can and accept what you can’t change”. Obviously, the goal of therapy normally is to change the way we see things and thus change our circumstances, but we also sometimes need to just accept who we are and our circumstances. People with recurrent symptoms really need to learn to let go; if you can let go, then you tend to be more protected from depression.

-Camillo Zacchia, Ph.D., Mini-Psych School 2009
 

All I can really say is that most people who swear they’re hypoglycaemic are not. It’s one of those things that is easy to say whenever you start falling asleep: “Well, it’s because I just ate a big meal, I’m hypoglycaemic.” When people are actually tested with this glucose tolerance test, very few people are in fact hypoglycaemic. But, having said that, if we presume you are, then it will have an effect on your energy level and your energy level will have an effect on your mood, but it’s going to be more fluctuating rather than you being constantly depressed. If you eat small meals throughout the day, you should not see a fluctuation in your energy level if you are hypoglycaemic.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

Absolutely. You can apply the principles behind cognitive therapy to help yourself. The first thing to understand is that there are different kinds of depression. Some are chronic and some, like seasonal affective disorder, are episodic. Many recent therapies for all types of depressive disorders involve “assisted self help”. This can involve reading books, using the Internet, and having a coach to answer your questions. The effectiveness of this approach may depend on the severity of the depression. When depression is severe, medication may become more necessary.

- Camillo Zacchia, Mini-Psych School 2007

The effectiveness of self-treatment depends on the severity of the depression. Some over-the-counter products are available, such as St. John’s Wort, although there aren’t many studies on this substance. St. John’s Wort may also cause some people to become hypomanic. Omega-3 supplements and a healthy diet along with light therapy may also be good for mild forms and for people with a seasonal disorder, but again, there is not a lot of research in this area.
-Johanne Renaud, MD, Mini-Psych School 2012

Sleep apnea occurs when a person stops breathing during the night. This can increase blood pressure. More importantly, it keeps the person from sleeping properly. He/she doesn't have normal dream sequences or a restful sleep. Although sleep apnea may not cause depression directly, it does cause exhaustion, which can lower a person's resistance to anxiety and depression. It also lessens a person's ability to concentrate—a common complaint in depression. Although distinguishing between depression and sleep apnea can be difficult, it is necessary to do so, since the two problems are treated differently. Of course some individuals can suffer from both sleep apnea and depression.

-Camillo Zacchia, Mini-Psych School 2006

The causes of depression include the biological background, meaning other family members with the same type of difficulties. This genetic component makes people more vulnerable to developing depression, although this outcome is not inevitable. Usually these people have a vulnerability to certain life events (usually early life events). So depending on your family history and temperament, you may at some point develop depression.
- Johanne Renaud, MD, Mini-Psych School 2010

Brain chemistry can, in my opinion, also change with psychotherapy. But the patient must undergo psychotherapy on a regular and intense basis, and it must lead to the anticipated outcome. In the case of obsessive-compulsive disorder, data clearly show the effects on the brain before and after cognitive behavioural therapy. Certain people are more sensitive to psychotherapy, while others need medication. Maybe in 20 years we will discover who is more likely to respond to a given treatment and therapies will be personalized. For the moment, I believe that if the condition is serious, a combination of the two is the best solution.
- Johanne Renaud, MD, Mini-Psych School 2010

During the teenage years, you do not progress at the same rate all the time. Some months you are more active and other months you are not very active. You can be sad or go through difficult periods, but this does not necessarily constitute depression. The condition needs to be examined very carefully to see if it is transitional or more sustained.
- Johanne Renaud, MD, Mini-Psych School 2010

The general recommendation when a person is depressed, if they are mildly to moderately depressed, is to get some sort of cognitive therapy, which is a therapy that looks at the way we perceive things and the cause we attribute to them. It helps us to understand our biases, how we see ourselves, and our successes and failures. A depressed person has a tendency to always blame themselves when something goes wrong, regardless of the circumstances. They will distort the facts to fit their belief that they are not very good. They will have a tendency to blame or to attribute to the outside world any successes that they have. So the general recommendation for mild to moderate depression is that kind of treatment.

If a person doesn’t respond, you really need to consider adding an antidepressant or some other pharmacological intervention. For moderate to severe depression, the usual recommendation is a combination of both. What is considered mild to moderate? What about moderate to severe? Again it depends on the person. If you’re not able to work, are not able to function, and are suffering a lot, you need to consider a combination treatment.

So, who is the best person to consult really depends on how bad it is. I think, first and foremost you need to find someone you can trust and you have to be prepared to maybe walk away from that person if they’re not helping you and try someone else. For the most part, there are very effective treatments both psychologically and medically, and a person can do one or either or both. But, sometimes people’s attitudes interfere with the help they can get. They might be against medication, they might be against therapy, or might be so pessimistic that they don’t think it’s going to help.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009
 

 Depression can be hormonal, and that is one of those instances where it would fit into axis III. It’s not a true clinical depression like an axis I but it can be exactly the same. For example, postpartum depression is clearly a hormonal-related depression.

-Joseph Rochford, PhD, 2009, Mini-Psych School 2009

Studies have demonstrated that children and adolescents who take drugs before the age of 16 have an increased risk of psychosis. To my knowledge, no study has evaluated the impact of drugs on depression. However, I see a large number of young people at the clinic who present both problems. The biggest problem among 12 to 25 year olds is the coexistence of major depression and addiction. I have also seen cases involving young people who were thought to be bipolar, but this diagnosis was actually the effect of drugs on the person's brain. If you visit the Web site of the National Institute on Drug Abuse (NIDA), you will see brain scans of young people who have taken drugs: even after 7 years, the brain tissue still contains small holes. These are images that young people understand.
- Johanne Renaud, MD, Mini-Psych School 2010

Yes. Even without treatment you can get better with time, but people can have relapses. It also depends on the number of traumas you have experienced, because a lot of people will go through different difficult life events. We can’t prevent people from going through them, but we try to support them and help them cope better with different stressors, because that’s life. And life can also be very fun, which is a message I also try and give my patients.
- Johanne Renaud, MD, Mini-Psych School 2010

Children experience depression in different ways. Some children are more shy and anxious, whereas others are extremely reactive and have a higher risk of suicide. We therefore treat these two types of depression in different ways. For more anxious children, we work on social anxiety and teach them to face their fears. Some will need medication to calm their anxiety and relieve their depressive symptoms. For children with stronger reactions, we are currently trying to develop a model called the dialectic behavioural approach, which teaches them how to withstand emotional upheavals as they happen. We show them how to think about something else or distract themselves in order to withstand difficulties instead of trying to hurt themselves or commit suicide.
- Johanne Renaud, MD, Mini-Psych School 2010

I think that young people in particular believe they always have to succeed. But this is impossible. In life, everyone goes through difficult situations and experiences failure at a certain point. I think you need to experience small failures and not succeed all the time. You need to have a plan B. In fact, this is what we ask patients in our clinic: "What are you going to do if things don't work out? Do you have other strategies?" We try to get them to adapt or find other ways to deal with problems. Then, if the result is still failure, they can use these strategies to get through the ordeal and come out even stronger.
- Johanne Renaud, MD, Mini-Psych School 2010

This protocol is based on relapse studies. If you stop too soon, the risk of a relapse is higher. Generally after one episode, we see the person for 6 to 12 months. Unfortunately, major depression can now be considered as a chronic illness, as a lot of adult patients need more than one trial of medication and psychotherapy. However, the same treatment is not necessarily appropriate for a teenager because they need to have some hope. I tell them that the condition needs to be taken very seriously and that they need to undergo psychotherapy to get different ways to cope with their stressors.
- Johanne Renaud, MD, Mini-Psych School 2010

Depression is indeed the main risk factor for suicide, but the opposite is not true: not everybody who is depressed is going to think about suicide. While we do not have a predictive evaluation, we do have certain risk factors that we can assess. However, suicide risk assessments are still very difficult.
- Johanne Renaud, MD, Mini-Psych School 2010

Studies seem to show that each depressive episode can change the brain, which increases the risk of future episodes. But generally there is a precipitating factor. People who are depressed should therefore undergo psychotherapy to learn adaptation techniques to better manage the events in their lives. Our hope is that these techniques will prevent the person from experiencing another episode of depression. I think that psychotherapy is very important for changing how we see the world. Learning "protective" strategies and adopting an optimistic attitude won't help you succeed at everything in life, but you will be in a position to better react to difficult situations.
- Johanne Renaud, MD, Mini-Psych School 2010

Absolutely. But this takes more time, and there will be an impact on how they socialize and function in the world. Certain youths are not at all suicidal, only depressed; they do not have a lot of energy, but they can still function. But these children risk not living up to their full potential. I have seen young people who have realized in retrospect that they had not really been well for two years, but they never thought they suffered from depression.
- Johanne Renaud, MD, Mini-Psych School 2010

Usually if a parent has depression, this person’s offspring has a 3 to 5 times higher risk of depression. The genetic component of depression is quite complicated and there is not only one type. This heterogeneity means that everybody is at risk in some way.
-Johanne Renaud, MD, Mini-Psych School 2012

We know that this population has been through a lot of different life stressors, so these children are at a high risk. The expression of symptoms may be different in different communities, and just being exposed to very severe traumatic experiences increases the risk if someone comes from this type of population. The expression of depressive symptoms can be different; for example, at one point in China, more women than men in the rural areas successfully carried out suicide. The method used can therefore change statistics, as this population had access to very dangerous and extremely lethal pesticides. So the number of attempts may be similar to what we see in North America, but the lethality of the means made the actual number of suicides higher. Now that these pesticides have been banned, there has been a decreased rate of suicide in the population. This means that statistics can sometimes be cultural but can also be related to access to different means.
-Johanne Renaud, MD, Mini-Psych School 2012

Although this hasn’t been proven, people who receive this acne treatment may have depressive symptoms. The medication is not necessarily the cause of the symptoms. It could be that someone with a very intense acne problem is at a higher risk of a depressive episode. This condition can be embarrassing, and you don’t feel very self-confident. I would still recommend the Acutane treatment, as the product is improving, but anyone who takes this medication needs to be followed and supported by a doctor.
-Johanne Renaud, MD, Mini-Psych School 2012

You have to be very careful because when somebody suddenly gets better and you haven’t seen a gradual improvement, this may be a sign that they have decided to kill themselves. Generally with depression, the person undergoes at least 6 to 12 months of treatment. At the end of the first year of treatment, the intensity is decreased to see if the person is stable or experiencing previous symptoms. Although sometimes expensive, other types of support, such as seeing a psychologist, are necessary and can be covered under insurance up to a certain number of times per year.
-Johanne Renaud, MD, Mini-Psych School 2012

We have a few options that we need to follow. At some point we may have more information, because now we have different Magnetic Resonance Imaging studies on the brains of teenagers with depression. If you look at MRIs of people with depression, there are certain types of abnormalities. Treating these people with psychotherapy or medication improves the way that the medication is used in their brains. In the future, we may conduct MRI or computed tomography  scans on a regular basis as a baseline intervention before treating the depression.
-Johanne Renaud, MD, Mini-Psych School 2012

This question comes up again and again. Psychotherapy is an option, although this may not be easy for teenagers if they have to pay for these sessions. In terms of medication, since you have to involve the pharmacist, it’s not that easy. We can always do something, but just giving medication is not ideal, because the teenager still needs supervision and support.

Children reach the age of consent for medical care starting at 14, so they can seek help on their own at this point, although it is still hard to do this when your parents don’t support your actions. Teenagers can also go see their school counsellors; although again, this is not always the ideal option.

In all cases, we need to sit down together to look at all options that are in the best interest of the child. Sometimes youth protection may need to be called. Teenagers may also not want their parents to know about their problem, but we usually need to ask the parents for more information about the young person’s biological background, and then all other information is kept confidential.
-Johanne Renaud, MD, Mini-Psych School 2012

This symptom is possible in the case of co-morbid disorders. It is hard to say if this behaviour is a tic or a compulsion, e.g., a symptom of ADHD (an impulsivity disorder), OCD (obsessive compulsive disorder), or depression. This behaviour is usually part of other problems, such as impulsivity disorders. We still need to consult with a neurologist to rule out any other condition, but this symptom could be part of depression.
-Johanne Renaud, MD, Mini-Psych School 2012

Teens can find it hard to get help, as they don’t know where to turn, and they may try to alleviate their suffering in other ways. I would tell someone with depression that if you look for resources, if you call the help lines, if you get a therapist and if you get help, it does get better. You have to be supportive of any teen who is depressed, because they really need support at this time in their lives.
- Johanne Renaud, MD, Mini-Psych School 2012

For teens with learning disorders, dyspraxia or other types of disorders, you need to make sure that they are in the best supportive environment. Because if they are not in the right setting or with the right people, over time they may become overwhelmed and can become more depressed. In all cases, if you can eliminate the stressors or difficulties, the person will improve.

In the case of mental disability, you can’t expect the best performance, but you can expect the best performance compared to peers with the same impairments, and the environment has to be adapted to the teenager’s capacities. It can also happen that young teenagers with autistic spectrum disorders get bullied a lot at school, which can lead to sadness and even self-harm.

Depression can occur even in someone with traits of pervasive developmental disorder, as the person may be in a difficult environment or have a family history of depression. In this case, treatment for depression is indeed indicated.
-Johanne Renaud, MD, Mini-Psych School 2012

After giving birth, you can have what is known as the “baby blues.” For some women, the blues can develop into something stronger that lasts more than a month or two. We need to screen very closely for anyone with difficulty adjusting, especially if this person has gone through depression before. Postpartum depression and psychosis, which is even more difficult, can have an effect not only on your mood but also on your relationship with your child. More than ever, OBG departments are very sensitive to these issues.
- Johanne Renaud, MD, Mini-Psych School 2010

I used to hate Septembers because I had to go back to school, which meant that summer was over! Certainly when days shorten and there is less light, there can be more depression. This can especially affect people in the Far North, who get only 2 or 3 hours of sunlight a day at certain times of year. Also, when the weather gets colder, we're often not as physically active, which can affect our mood. Depression can come and go. We're not always sure what causes it. Sometimes, it's just normal fatigue. Sometimes recurring events can make us feel a little more depressed, like deadlines, exam periods, annual reports―the kinds of things that tend to recur. Also, if someone special has passed away at a certain time of year, that season will remind us of that person. There are many possible explanations for seasonal depression.

It's difficult to determine what is normal and what is not because there are so many human reactions and a lot of factors that we are not aware of. However, one of the guidelines professionals use is: How does it affect you? Does it stop you from going to work? Does it stop you from going out? When it starts to affect your day-to-day functioning, then it starts to be less normal. This is one way of assessing whether things have gone a little too far.

-Camillo Zacchia, Mini-Psych School 2007

If someone is depressed for five months and isn’t able to function, would you say that they don’t need treatment until they have another month under their belts? It’s an arbitrary decision. We simply use a time period to distinguish between a very brief episode related to a circumstance, bad news, etc. If you lose your job, you’re going to be depressed, but they’re not going to give you treatment right away unless you remain depressed for a period of time. I think the longer it is, the more of a problem it obviously is. If you’re depressed because you lose a loved one, I wouldn’t expect you to feel better after two weeks. What is a normal period of mourning? Would it be six months? Would it be two years? Some people are functioning quite well after a month or two and some people need longer. Don’t get too lost in specific criteria; as far as you’re concerned, what matters is how you are doing. And if you’re not doing well, then you want to consider getting some sort of treatment.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

Women in this situation need a specialized program to make sure they have the right medication. Gynecologists and obstetricians are more informed than they used to be, and the CHU Saint-Justine has a specialized centre that provides information on medication for the best treatment plan. Of course, it is always best not to take any medication when pregnant. However, if a woman is going through a depressive episode, she will still need treatment. Although there are risks, some medications are indeed allowed during pregnancy, but these risks are very low compared to symptoms of depression and suicidal thoughts. Again, any woman in this situation has to be followed after pregnancy, as the post-partum period is also a high-risk period. It’s better to have support and to talk about your condition with your physician both during pregnancy and after the child is born.
-Johanne Renaud, MD, Mini-Psych School 2012

We do have one of the highest rates of suicide, but this is also true of Switzerland and France. A lot of northern countries seem to have a high suicide rate. However, some countries do not report the information in the same way, and even across Canada, the data is not always reported consistently. One of the hypotheses is that French Canadians tend to marry more within their own culture, so there could be a higher risk of mood disorders, and therefore a greater risk of suicide, that is genetically based.
-Johanne Renaud, MD, Mini-Psych School 2012

If ADHD is the major problem, the person needs to get the best treatment for that condition first. Practitioners have to be careful, as some teenagers with ADHD who receive treatment may become more depressed because of the side effects of the medication for their first problem. The response to treatment needs to be closely monitored to ensure that the depression is not a side effect. Some medication may increase anxiety or depressiveness or even cause rebound reactions (a lower concentration when the effect of the molecule decreases). Again, comprehensive work has to be done with the school staff and the treating team, as well as with the teenager and the parents, to determine the best treatment.
-Johanne Renaud, MD, Mini-Psych School 2012

When treating depression with an antidepressant, the patient starts at the lowest dosage to adjust to the side effects. The dosage is then optimized to initiate a response. It takes three weeks after the first week to see some improvement. If the person tolerates the medication, then approximately 6 to 12 months of treatment is required to make sure the person is feeling better. After this period, the antidepressant is decreased in the same increments as in the beginning. The person is then monitored to see if the previous symptoms return. If not, the medication is decreased and then ceased. Patients still have to be followed to ensure they don’t have another episode. Depression can be a chronic illness, but symptoms can be prevented with psychotherapy.
-Johanne Renaud, MD, Mini-Psych School 2012

Yes. Although it doesn’t happen very often, post-partum depression that is very severe can lead to psychosis.
- Ridha Joober, MD, PhD, Mini-Psych School 2012