Dr. Deborah Serani

@dr-deb | contributor
Dr. Deborah Serani is a psychologist, professor, TEDX speaker, go-to media expert and an award-winning author.
Dr. Deborah Serani

7 Myths About Depression in Children We Need to Tear Down

Research shows children, even babies, can experience depression. The clinical term is pediatric depression, and rates are higher now than ever before. According to the Centers for Disease Control and Protection (CDC), 13 to 20 percent of children will face mental health challenges in a given year. Helping children learn to identify the kinds of feelings, symptoms and approaches early in life can help derail this trajectory. For little ones, bibliotherapy, otherwise known as reading books to learn and heal, has long been known to help parents and children communicate. What Adults Need to Know About Pediatric Sadness As a practicing clinician — and someone who has lived with depression since childhood — I’ve spent my life educating others about the textures and uniqueness of depressive disorders. My latest book, “Sometimes When I’m Sad” is completely grounded in research. It is a children’s picture book where each page explores how little ones experience sadness, and ways to help them express and heal such emotions. It also offers parents, teachers and other adults ways to detect sadness and depression in children. For when we learn about the different ways sadness and depression affect children, we can avoid believing the following myths. 1. Sadness looks the same in children as it does in adults. False. Children often don’t have the verbal language or cognitive savvy to express the textures of sadness. Instead, body symptoms like aches and pains, fatigue and slowness present, as can tearfulness, unrealistic feelings of guilt, isolation and irritability. 2. “Good” parents can always detect if their child is depressed. False. Most children who struggle with depression keep their thoughts and feelings masked. Little ones may not even understand the depths of their own sadness. The only way for parents to understand chronic sadness and depression is to be aware of age-specific behaviors and symptoms. 3. Chronic sadness will go away on its own. False. Chronic sadness will likely lead to pediatric depression and cannot be willed away or brushed aside. Ignoring the problem doesn’t help either. Depression is a serious, but treatable illness. 4. Talking about sadness with children can make things worse. False. I think talking about sadness with your child actually helps to reduce symptoms. Support and encouragement lets children know they’re not alone, are loved and cared for. 5. The risk of suicide for children is greatly exaggerated. False. Suicide is the third leading cause of death in adolescents ages 15 to 24, and one of the leading causes of death in children. Suicide is significantly linked to depression, so early diagnosis and treatment of chronic sadness is vital. 6. There are no proven treatments to treat pediatric depression . False. Studies show talk therapy treatments offer significant improvements for children who experience chronic sadness and depression. 7. Depressed children cannot lead productive lives. False: Many children with depression can grow up to live full, productive lives. In fact, many high-profile people, including President Abraham Lincoln, writer J.K. Rowlings, artist Michelangelo, actor Harrison Ford, choreographer Alvin Ailey, actress Courteney Cox, entrepreneur Richard Branson, Prime Minister Winston Churchill, rocker Bruce Springsteen and baseball player Ken Griffey, Jr. have been very successful in their chosen professions — despite struggling with depression in their young lives.

Dr. Deborah Serani

'The Anniversary Effect' or 'Reaction:' What It Is and How to Deal

There are so many dates that mark occasions throughout the year that bring us happiness. The first time we met. The last day of school. The moment you got engaged. The day you enlisted. Birthdays. Thanksgiving. Christmas. Wedding anniversaries. Valentine’s Day. But there are days in the calendar year that are hard to take. The day a loved one died. The birthday of a someone special who’s no longer alive. The date of a serious accident you endured. These dates press on your mind, body and soul in distressing ways. When they arrive on the calendar, you feel sad, lost and in pain. The clinical term for this experience is called “The Anniversary Effect.” Sometimes called an “Anniversary Reaction,” this psychological experience is defined as a unique set of unsettling feelings, thoughts, memories and physical strain that occur on the specific date of a significant trauma. For some, the Anniversary Effect causes a re-experiencing of the loss; for others it heightens the stressful aftermath of the event. Certainly for all, the anniversary of the day is marked with enormous emotional and physical pain. Sometimes you can trace the reason why you’re feeling sad, irritable or anxious. One look at the calendar and you connect the dots from your current emotional state to the traumatic event. For example, you readily recognize the date of a natural disaster, or when your father died, the date of your cancer diagnosis or a miscarriage, just to name a few. But there are dates that aren’t recognized or readily made conscious to us in the calendar year. They are subtly stored in our memory in less time-specific ways. The Anniversary Effect may come in sensorial or seasonal ways. For example, Autumn reminds you of when your child left for college, or a hot humid day recalls you time you foreclosed on your house. An icy storm summons the moment of a life-changing car wreck, or fireworks on the Fourth of July stirs memories of fighting in Iraq. Anniversary Effects are like a post-traumatic stress response, but in calendar form. Depression and The Anniversary Effect When you live with depression, you may live with two calendars — o ne that keeps track of time, while the other stores emotional experiences. And when it comes to Anniversary Effects, you need to be mindful of the dates of trauma in your life. Another thing to be conscious of is in the first year of a traumatic experience, painful feelings, despair and anxiety may occur at the third month, sixth month, and ninth month intervals of the anniversary date. After the first year, most people then tend to experience “The Anniversary Effect” on the year-marker date. When depression is a chronic issue in your life, managing your illness becomes a necessity. One of the ways to keep a healthy structure is to note the negative events that uniquely touch your life. By doing so, you can become more conscious of the power of these events. You can double down on self-care to prepare yourself for an Anniversary Reaction. Being mindful of these annual moments also can minimize the helplessness you can feel as the date approaches – or the element of surprise as the date suddenly appears on your radar. Every year, I note the happy dates on my calendar, as well as the painful ones. I’ve learned in my own therapy while recovering from depression how seeing these dates several weeks ahead prepares me for an Anniversary Effect. Being aware helps me keep my depressive symptoms from worsening. I make sure several weeks before these difficult dates arrive to eat and sleep well, not overdo too much and to delegate as much as possible so I can navigate the painful loss as it approaches. In my work as a clinician working with others who struggle with mood disorders, I also encourage my patients to do the same. In addition to learning the wonderful moments in a person’s life, the session work outlines days in the year that are tough. Together, my patients and I work to use the structure of the calendar to help manage the symptoms of depression that ebb and flow at such trying times. What You Can Do? Here are some more tips to help you deal with Anniversary Effects. 1. Look. Make sure you take time to glance at a calendar each month and explore dates and memories attached to such dates. Whether it’s an old-school paper calendar or a digital one, this kind of habit can keep you aware of traumatic dates – and prepare you for the possibility of an Anniversary Effect. For instance, I circle difficult dates in red on the  calendar that’s clipped to my refrigerator in my home. Seeing the color in relation to the present date helps me ready myself. 2. Remember. The anniversary date is not the only day you might feel out of sorts. Remind yourself that days or weeks leading up to an anniversary date – and even ones after, may be tough ones for you. For example, a patient of mine whose mother died around Thanksgiving has an equally difficult time when Mother’s Day rolls around in May. As the pumpkins from Halloween fade and the Christmas decorations begin dotting the landscape, she becomes mindful of her loss. But she also readies herself again when the commercials for Mother’s Day flowers or gifts stream across the television. 3. Let others in. Sharing the date with others can enable you to feel less isolated when the anniversary of a difficult day approaches. Resist the urge to shut down or withdraw as it can worsen depression. If the Anniversary Effect touches the life of your child, make sure you reach out to teachers or other important adults to alert them to the dates. 4. Limit media. Anniversaries of public traumas like 9/11, disasters, somber holidays like Memorial Day or Veterans Day receive significant media coverage. Often, media outlets revisit distressing imagery. So, a good idea is to limit watching of TV, surfing the internet or reading newspapers around those dates. 5. Get it out. Expressing your thoughts and feelings when an Anniversary Effect happens can help you move through it. You can do this by talking with a family member, a cherished friend, journaling, scrapbooking, blogging and other creative ways to express your inner experiences. 6. Take good care. Nourish yourself with things that bring you comfort, ease and peace during these times. Self-care, like eating healthy, keeping a steady sleep schedule, pampering yourself, and delegating as much as possible will help ground you as you move through your anniversary date. 7. Ask for help. If you find you’re struggling with your trauma, remember you’re not alone. Loss affects each of us differently, so don’t put a time limit on your grief. But, if you feel exceedingly overwhelmed or can’t readily cope with your Anniversary Reaction, consider calling a mental healthcare professional who specializes in depression and trauma. We want to hear your story. Become a Mighty contributor here . Thinkstock photo by serggn

Dr. Deborah Serani

The Lies Depression Tells You

Depression is a beast. It’s an illness so insidious sometimes you don’t realize the scope of its life-threatening power until you’re drowning under its wave. It attacks your mind, body and soul by seizing your neurochemistry, weakening your neural pathways, distorting your thoughts, exhausting your body and leaving you emotionally vulnerable. As depression rails against you, it challenges everything you know, trust and believe. It deceives and mangles in ways that makes it one of the most lethal of mental illnesses. I know this beast. I lived with it as a child and as a teenager. Its corrosive effects pitched me into a devastating depression and suicidal state I barely escaped. I was lucky though. I got treatment and emerged from my depression with a keen awareness of what damage it can do, what lies it tells. Here are but a few of the big, stupid, destructive lies depression tells you. 1. “You’re not trying hard enough.” Depression will tell you that you are weak and lazy. It will con you into believing you’re not medically ill. It will make you believe if you’d just only work harder at things, then you’d feel better. Truth : Depression is a real illness that affects emotional, social, behavioral and physical health. You cannot will it away or readily snap out of it. 2. “You’re broken and unfixable.” Depression has a way of making you feel useless, worthless and utterly unlovable. When you’re depressed, you’ll believe no one wants to hear about your sadness or troubles. You’ll be convinced you‘re undeserving of love, tenderness and attention from others. Depression will decimate your confidence and invalidate your sense of worth. Truth: Research shows negative thinking is responsible for low self-esteem. So, learning how to use positive self-talk is vital to combat depression. Psychotherapy is a great way to retrain your mindset. Treatments will help you ground yourself with realistic truths about who you are, the strengths and talents you possess, as well as owning your flaws and weaknesses. You can learn to love yourself, as well as allowing others to love you, not in spite of your depression, but with acceptance of it. 3. “Nothing matters.” Depression will coax you into believing people and things no longer hold value to you. Dread and apathy reign supreme where happiness and meaningfulness once ruled. You become less and less connected to things in your life. Depression crushes your world until it becomes a space of infinite emptiness. You don’t care anymore. You don’t try anymore. It’s all futile. Truth: Depression creates this helplessness by overriding your ability to control aspects of your life. Without direction and a sense of purpose, you slowly become powerless. Again, talk therapy offers ways to offset these self-defeating thoughts. It’ll take practice and patience, but when you change your thoughts, you change your world. 4.“Being alone is better.” Depression isolates. It wants you to believe being alone is safer and it’s more comfortable to dwell in a solitary place than be connected and supported with others. Truth: Studies show depression worsens when we isolate ourselves from others. You will likely have to push yourself to be with others or allow others to pull you out of the black hole of depression. It will be worth it. Social attachment, interpersonal connections, even hugs and affectionate touch raise levels of oxytocin, a natural pain reliever and feel-good hormone. The truth is being with others who support you and believe in your recovery exponentially reduces depressive symptoms. 5. “There’s no hope.” Depression doesn’t want you to feel hope or believe any real kind of change can take place. It will shrug off any motivating beliefs you have, squash suggestions from others and debunk treatment as a way to get better. Truth: Like helplessness, hopelessness is grounded in pessimistic thinking. The negative thoughts that exaggerate hopelessness often lead depressed individuals toward self-destructive thoughts. This is why seeking psychotherapy or medical attention is so important. While you may not want to go to therapy (because you’ve lost all hope), you may find others “forcing” you to get help. In the short run, you may be angry when others intervene, but in the long run, you may thank them for caring so deeply for you. 6. “You’ll never amount to anything.” Depression convinces you even if you can feel better, you’ll never be or have anything of value. Depression will deform your positive beliefs and strike down your dreams. It’ll leave you empty and vacant. Depression decays any optimism for greater things. Truth : Many who have struggled with depression can live full, productive lives. In fact, many high profile people, including President Abraham Lincoln, writer J.K. Rowling, artist Michelangelo, actor Harrison Ford, choreographer Alvin Ailey, actress Courteney Cox, entrepreneur Richard Branson, prime minister Winston Churchill, rocker Bruce Springsteen and baseball player Ken Griffey, Jr. have been successful in their chosen professions. 7. “ Suicide is the way out.” Depression, at its worst, corrodes your ability to think and reason. It keeps your focus rigid, narrow and dangerously limited to the belief that dying by suicide can relieve you from your emotional and physical pain. Truth: Getting immediate intervention will diminish depression’s lethal hold on you. With psychotherapy and/or medication, your symptoms of depression may lessen. As you recover, you will likely be surprised you ever thought of dying by suicide because possibility, promise and hope have emerged in your life again. Depression is a serious but treatable illness. Don’t let the lies depression tells you make you think it isn’t. There is always help. There is always hope. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

Dr. Deborah Serani

Depression: A Doctor's Perspective

I have a mental illness. It’s taken hours of talk therapy, months of finding the right medication a nd years of work to learn how to live successfully with it. I’ve redefined how I think and feel — and learned what kinds of people and experiences to limit or allow in my life. Now at age 55, I’ve come to know the textures of my own mental illness and the wisdom that comes from living within its margins. But there was a time when I wasn’t so wise. A time when my mental illness overwhelmed me. A time, when at age 19, I was ready to end my life. As a young girl, I didn’t even know was depressed. I was always tired and tearful and just thought everyone felt those kinds of things. And no one — teachers, friends or family — took notice of my depression back then either. Partly because children weren’t thought to experience clinical depression. Partly because I was able to use a smile to hide my pain. But as I grew older, my depression worsened. The tiredness and tearfulness I felt as a child morphed into an unshakable fatigue and a looming despair. In college, I became withdrawn, had trouble keeping up in school and was socially splintered from others. I skipped classes and then stopped going to college altogether. I slept hours at a time in bed. Sometimes I didn’t know if it was morning or afternoon, or if it was a Tuesday or a Thursday. And the fatigue was just the tip of the iceberg. What bubbled below the surface were negative, menacing and dangerous thoughts. And feelings that completely overwhelmed me. Luckily, my suicide attempt was interrupted and I got immediate help. I began working with a psychologist who helped me understand mental illness — more specifically, mood disorders — and the one I was struggling with which was called unipolar depression. I learned how my own life story and my genetics created the perfect storm for my mental illness to hit. Psychotherapy not only saved my life, it changed my life. I decided to become and psychologist and treat others who had the very same mental illness I did. Now in full remission over 25 years, I use my personal experiences with depression to inform my professional work. This dual approach gives me a unique perspective because not only do I know what it’s like to diagnose and treat depression… I know what it’s like to live with it, too. I don’t just talk the talk, I walk the walk. Personally, I understand what it’s like to have mental illness. How you can feel betrayed by your own mind and body. I understand the shame that comes from needing medication. And the frustration from side effects. The weight gain. The loss of libido. The night sweats and the hand tremors, just to name a few. And I know how hard it is to take the skills learned in therapy and apply them to real life. I’ve also felt the cold hard stares and stigmatizing remarks from others when they discovered I have a mental illness. I remember a pharmacist once telling me when I called in for a refill, “Yes, you can’t forget to pick up your Prozac. There’s a full moon out tonight.” Now, a therapist doesn’t need to live through an event or have firsthand knowledge of illness to help someone heal. But my own depression informed me in ways that clinical training and education never could. So, what if you knew depression as a doctor and as a patient? Well, you’d know these six things. As a doctor I’d tell you: Stigma is still as bad today as it was decades ago. Instead of technology and science helping explain mental illness, the general public is still uneducated about what a person living with mental illness is really like. Fear and ignorance is also found in the healthcare community — with doctors and nurses stigmatizing people with mental illness. Research has shown that diagnostic overshadowing — which is defined as the tendency for health professionals to overlook symptoms of patients with mental illness because they stigmatize them — is a huge problem. As a result, children and adults with mental illness suffer higher rates of physical illnesses and undiagnosed disorders — and are more likely to die prematurely than members of the general population . The state of stigma is so bad,  the World Health Organization called the conditions endured by many with mental illness “a hidden human rights emergency.” As a doctor, I’d tell you health professionals aren’t using enough of new technology to help patients with depression. Personalized medicine, particularly genetic metabolism testing, can help depressed patients shave months, even years of trying to find the right medication. Genetic testing also reduces the likelihood of side effects and adverse reactions — some of the big reasons why patients stop their meds. And can help find more genetically-suited medications. And can detect treatment resistant depression. Personalized medicine is a field that offers enormous hope. As a doctor, I’d tell you that the most important part of recovery for depression is consistency — or what is clinically called treatment adherence. Consistency doesn’t just mean going to psychotherapy. Or taking your medication. Consistency means making every psychotherapy appointment. Being on time for sessions, and making sure you don’t skip treatment because you want to go to the beach or just don’t feel like talking. Consistency means taking your medication every day at the same time, with the same dose. Consistency means making sure you get refills in time so there’s no break or gap in your medication regime. Treatment adherence means you aim to eat well, sleep well and exercise. The single biggest issue I see as doctor treating depression is how children and adults rarely adhere to their treatment plan. But thing is, once consistency is attained, recovery begins. And that’s where hope of feeling better becomes a reality. The mantra of real estate is location, location, location. For living with mental illness, your mantra needs to be consistency, consistency, consistency. As a patient I’d tell you: Please watch your words. Don’t tell me to snap out of it. Buck up or work harder. You’d never say that to someone who has another illness. You need to respect depression is an illness. One that involves serious neurobiology. Just like you wouldn’t expect one round of chemo to cure someone’s cancer, or one shot of insulin to regulate blood sugar, recovery from depression won’t happen with one dosage of medication or a therapy session. Depression is a chronic illnesses that requires acceptance. Living with depression means I need to know my triggers. So, please respect me when I say no to things that may be too much for me to do. Like, if I say I can’t have a drink on your birthday, or can’t stay out till two in the morning — or that I don’t want to go see the latest tear-jerker film. There’s a reason for my “No’s.” I can’t mix alcohol with my medication. I can’t stay out too late because lack of sleep is such a serious trigger for me. Or a super sad movie can be too emotionally overwhelming. So please honor my needs so I can keep my treatment plan strong. Self-care is a vital piece to my well-being. As a patient, I want you to know there’s a good chance my depression might overwhelm me again. Studies show that upwards of 70 percent of people who have experienced two episodes of depression can have a relapse – so I need you to know what to do, who to call and where to go if I fall into a serious depressive episode. This is called an emergency plan. My emergency plan contains the contact information of my healthcare team, my pharmacy, the nearest hospital and other important things. You may have to call 9-1-1 to get me to the ER if I won’t go willingly. And don’t worry if I get angry, become resistant or say mean things to you. Once I recover, I won’t care about being mad. I’ll be thankful that you cared enough about me to help when my illness was clouding my reasoning. I’ll be thankful to be alive. Depression is a serious but treatable disorder. As a doctor, I’m here to tell you there is hope. And as a patient, I’m here to tell you there is healing. If you or someone you know needs help, see our suicide prevention resources. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. The Mighty is asking the following: Create a list-style story of your choice in regards to disability, disease or mental illness. Check out our Submit a Story page for more about our submission guidelines.