Science AMA Series: I’m Kevin Coffey, an assistant professor in the department of Psychiatry at the University of Rochester Medical Center in Rochester, New York. I have 27 years of experience helping adults, teens and children dealing with anxiety and depression. AMA!

Abstract

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Can depression be "contagious" in younger people? I've noticed that teens tend to talk about it more openly and sometimes throw the term around flippantly. I wonder if it is possible for a seed to be planted that can cause an otherwise healthy teen to mistake having a bad day/week for depression and then label themselves as depressed and start to focus on that label and their negative thoughts so much that they can self-talk themselves into actual depression?

I've seen it first hand with someone close to me (Teen A) that they started hanging around with a friend (Teen B) who talked very openly about her mental illness and then after a while Teen A started talking about how depressed they were. It is possible that Teen A already had unrecognized depression and talking about it allowed her to start putting the pieces together. It also seems possible that Teen A was experiencing the normal ups and downs of human existence and hearing Teen B describe her depression repeatedly caused Teen A to attach that label and start thinking of herself as suffering from depression which I feel could mimic or even turn into true depression.

I guess what I'm asking is: Should parents err toward allowing their healthy child to be empathetic and actively supportive for their depressed friends or should parents be wary of their healthy child interacting heavily with someone with serious depression?

blue_garlic

There is often a contagion factor with young people. We see this with suicidal behavior as well as self-harming behavior.


Hi Kevin, thanks for doing an AMA. I teach students between the ages of 8-12. They all have a diagnosis of Autism Spectrum Disorder and if they meet the Program criteria, an additional diagnosis of MID (mild intellectual disability).

Many of my students over the years have also presented with clinical levels of anxiety, depression, and severe emotional disregulation.

When I seek professional intervention for their mental health I'm often told, "It's the Autism." and that there is nothing more that doctors can do.

I struggle with this because I have students who are mentally healthy and have Autism, so why shouldn't we be treating those who seem to have mental illnesses on top of their ASD diagnoses?

Do you have any thoughts or experience with ASD, anxiety and depression?

mintberrycrrrunch246

Individuals with autism respond differently to psychotherapy than individual who do not have it, but nonetheless they can be taught skills to manage their emotions more effectively.


Hi there!

Most people commenting on reddit state without doubts that anxiety and depression are "chemical imbalances". Yet, Wikipedia clearly states that "causes are unknown" and goes on to state that it's probably and interplay of many factors including social ones.

As a nuclear medicine researcher I've tried to take a look at the literature for receptors imaging in depression but the results seem totally inconclusive, further indicating that the chemical imbalance theory is not so solid.

So, what's your take on this? Is it a chemical imbalance or what?

When you start a treatment, whether based on drugs or not, how does this knowledge of the pathology helps you in choosing the appropriate treatment (or doesn't)?

lucaxx85

There are no exact causes for depression and anxiety. It is usually multi factorial including brain chemistry. Our knowledge of the brain and receptors is still rudimentary.


Hello and thanks for doing this AMA.

I've read that children born to parents with anxiety have much higher chances of developing that too. Are there ways to mitigate or prevent that, in daily life? Something the parents can do in their everyday life or in how they interact with their children, to minimize that effect on their children?

obscuredreference

Children who are born to anxious parents get their anxious biology and also get to learn from them how to deal with the world in an anxious manner. Teaching children to understand the thoughts and behaviors that increase anxiety will have them effectively manage anxiety.


Hi Kevin, and thank you for doing this AMA.

I am a moderator on several communities here at reddit, and something that has come to concern me is that I will occasionally see comments from users indicating that they are contemplating suicide - and sometimes the intent seems quite real and imminent.

What to do about these comments is something that I've struggled with. While these comments can be (and are) reported to the Reddit administrators, I have a sense that not much comes from many of these reports - in general reddit seems to lag behind other popular social media sites on reporting and handling suicidal ideation.

I was wondering if this is something you have come across in your own experience? If you see a comment indicating a strong intention to imminently commit suicide in a social media setting, what should be done? Do you think moderators have different responsibilities than regular users?

SirT6

Suicidal statements should always be taken seriously. I would recommend these incidents be reported to law authorities. In this day and age, we have numerous ways to locate people. Suicidal behavior is a significant risk factor and needs to always be taken seriously.


Kevin thank you for this AMA. I am currently Federal Agent with the Army's Criminal Investigation Command. We are unique to any other law enforcement because we investigate ALL felonies to include: murders, suicides, rapes, child rapes and child abuse among other things. Also unlike other law enforcement, we do not have any professional outlets (aside from behavioral health which goes on your record and typically ends your career) to regularly talk with after working these daily investigations. I see far too frequent and experienced myself, my peers and subordinates become overwhelmingly depressed, numb to everything, developed disassociation for the victims, but then it transfers over to daily lives. I myself have been extremely depressed. I have developed a coping mechanism where I just pretend. Literally fake everythink. It is like I do not feel love or anything, but pain. Not for my kids, my wife, my extended family, my friends it is just like they are people and if they die, oh well. I know I should love them, and I pretend to love them, but I also know they realize something is wrong. Sorry to go on such a long rant, feels good to throw that out there. I guess my question is what are some positive methods for first responders to overcome this self-imposed disassociation from reality spawning from trying to prevent emotional connections from all the death and destruction in our daily lives? Edit:words. Edit: thank you for the encouraging messages.

Throw_phone

Your's is a very difficult situation. You see and know about what others do not want to know about. What you describe is very common. It is a self-protective mechanism. I recommend good self- care as well a place where you can be real and get your feelings behind the numbness.


Hey Kevin. Thanks for doing this. I was diagnosed with PTSD and Anxiety 4 years ago after the sudden death of our first child and I just want to know... will I ever go back to feeling normal? I went from being 25 and never had a panic attack to weekly/sometimes daily ones. I have long since worked through my grief and come to terms that life is just life and you cant control things. I have had many sessions with therapists and counselors. I just am so tired of having panic attacks and my anxiety is holding me back from feeling normal anymore.

Depthcharge87

Your loss was significant. Exploring behaviors and thoughts that lead to your anxiety may help. Exposure can be another avenue for treatment.


Hi, thanks for doing this. I'm interested in the recent studies portraying psychedelic substances such as LSD or psilocybin as a powerful remedy against depression and anxiety. What's your opinion on this? Are enthusiasts exaggerating? Also, ketamine. Heard good things about it as well, almost asked my dog's vet if he could get me some.

Thanks again.

JohnConnor7

There are trials of these treatments happening. It does seem odd but it will be important to see the evidence that the trials produce.


On a positive note, are there things people with anxiety are better at than the general population? How can it be used as an advantage instead of an impediment?

FCCCaffeineQueen

You are correct individuals with anxiety and OCD can be better at certain tasks and even occupations. Helping individuals know their strengths is an important part of treatment. All behavior was a one time functional.


Thank you so much for doing this!

Up until even 8 years ago I did not hear often of children with anxiety and now it seems to come up so often it feels like an epidemic. I'm a teacher and I can't count how many kids I teach struggle with keeping it together. Are we just relabelling the 'nervousness', 'lack of confidence ' of previous years? Why is this such an issue now?

idipafhtp

As families have change including both parents working, more single parent families, less involvement with extended family make it harder for youth to get their needs met. This has lead to an increase in depression and anxiety in children and adolescents.


Hello Prof. Coffey. I was wondering if it is possible for depression to "mutate" or change based on environmental factors to a more serious mental health issue and if cutting down on triggering environmental factors would help to restore the original, more mild form of depression?

Ex: I currently have dysthymic disorder, but with enough stress and trauma, could it change into bipolar disorder or cause more severe mental health disorders?

JPCate

Depression and anxiety often start with social and environmental factors. These issues can lead to sleep problems which bring in the biological factors.


First of all, thanks so much for doing this AMA!

I've heard quite a bit (anecdotally) about using CBD oil for anxiety management for people with anxiety disorders (both acute episodes and generalized).

Is there any solid research to support the idea behind its use, either controlled via prescription or over the counter? Should it be taken more seriously as an alternative to drugs like xanax, benzos, etc? If so; is it something that should be considered viable for common use as? If not; why not?

Thanks again for dropping by!

joshuarion

I am not aware of solid research, but self-soothing activity can help manage depressive and anxiety symptoms. My friends into essential oils have one for multiple ailments. If it works, for someone, they should keep doing it.


Is it safe to take lexapro for decades?

sketchdailyuser1

Prozac is a cousin of Lexapro has been around since 1986. These drugs have been shown to be safe with long term use.


Hello!

Thank you for doing this AMA! I have the following questions:

1) Depersonalisation and feelings of unreality (DPAFU) can sometimes present with anxiety, depression and other mental disorders. What exactly is DPAFU and why does it occur?

2) What is the best way to combat depersonalisation and derealization?

3) My next few questions are regarding the trans* population. In recent years, have you noticed an increase in the number of transgender individuals seeking support for transition?

4) In regards to mental health, do the transgender population have specific health concerns? For example, transgender-related social anxiety and distress.

5) As a follow-up to the previous question, how are such concerns are being dealt with?

flowersformiceandmen

Mindfulness skills can help with denationalization and derealization which are common with depression and anxiety Trans individuals face numerous obstacles that contribute to increase anxiety and depression including distress about their bodies that do fit with their gender.


The only days that I don't feel anxious or depressed is when I eat two bananas in the morning. Is there any correlation between an electrolyte imbalance and anxiety?

LandoVonDoom

Any biological imbalance including electrolytes will magnify depression and anxiety


Thanks for doing this AMA, and thank you for the work you do.

While there is a lot more awareness of mental health issues lately, access to mental health professionals such as yourself is still severely limited (by factors like high cost and limited number of doctors). As such, I still find it almost impossible to get help.

My question is: what resources would you recommend (books, websites, etc), for people looking to do some self-reflection and develop healthy coping mechanisms for their anxiety/depression?

Thanks!

MyloByron

DBT Work Bookbook can be helpful.


What are some good ways to deal with intrusive thoughts?

SakuraFett

Mindfulness strategies can be helpful with intrusive thoughts.


Where do you think future progress will be made in treating mental illness? Drugs or Therapy? Which is most promising?

heavenlydigestion

Currently, the combination is the most effective. I believe that will remain the same in the future.


Are depression and anxiety really as much of a widespread pandemic among teens and young adults as it seems or is it more of a case of rampant self-diagnosis?

NoeGarcia5

There are numerous factors that have lead to increased depression and anxiety in younger people including changes in family relationships, technology, and difficulties in society.


Do you think you can heal a person completely from suicidal thoughts, or will he/she/it always have those also after called sane again?

italianjunky

Most people's suicidal thoughts and behaviors stem form a crisis. Typically as the crisis clears or is remedied, the majority of individuals stop having these thoughts and behvior.


How effective is exercise?

Jajo5

The best antidepressent!


Hi Dr. Coffey,

I'm curious about your thoughts regarding the usage of MDMA and ketamine to treat symptoms of depression, anxiety and PTSD. Is this hippie science gone rogue, or are we just resistant (as a society) to exploring potentially useful alternatives, such as those described?

Thanks!

kroberry

These drugs being trialed raises a lot of concerns for me, but we need to wait to understated the results of the trials. Treatment and change are hard work and our society always wants an easy answer.


Hi Dr. Coffey,

I'm curious about your thoughts regarding the usage of MDMA and ketamine to treat symptoms of depression, anxiety and PTSD. Is this hippie science gone rogue, or are we just resistant (as a society) to exploring potentially useful alternatives, such as those described?

Thanks!

kroberry

These drugs being trialed raises a lot of concerns for me, but we need to wait to understated the results of the trials. Treatment and change are hard work and our society always wants an easy answer.


Hi Dr. Coffey,

I'm curious about your thoughts regarding the usage of MDMA and ketamine to treat symptoms of depression, anxiety and PTSD. Is this hippie science gone rogue, or are we just resistant (as a society) to exploring potentially useful alternatives, such as those described?

Thanks!

kroberry

These drugs being trialed raises a lot of concerns for me, but we need to wait to understated the results of the trials. Treatment and change are hard work and our society always wants an easy answer.


How seriously do you investigate dietary issues, vitamin deficiencies etc in regards to depression/anxiety? Thanks.

burthombre

These are important parts of a good assessment prior to initiating treatment.


Thank you for doing this AMA!

While progress is being made, mental health is still significantly stigmatized (at least where I am, in the United States), despite mounting evidence that it is grounded in physiology. What's society's biggest hurdle in the movement of perception from "mental health" to "brain disease" and how do you think we can get over that?

ralevin

People be more honest and truthful about these issues. These are issues that are part of living and need not be shied away from.


Hi Kevin! Thank you for doing his AMA. Could I hear some of your success stories? (Such as people finding a better life after your help) Thanks again!

evdawgy14

The best part of my work is witnessing individuals who get better. One young man who had no life since his father's death. He was able to give up substance abuse, got a job and a girl friend.


Hey Kevin!

I was wondering if you think I should seek therapy. I've lived a pretty monotonous life and am almost out of college. My biggest fear is that I'm too socially awkward to ever get a gf, it sounds silly but it's really affecting me.

Are there ways to deal with social anxiety? I'd like to almost just take notes on someone who isn't socially anxious and repeat what they say for introductions, conversation topics, or segways. What I'd give to be a fly on a wall..

piepei

Social anxiety can be easy to treat. I would advise getting to treatment. Often with anxiety we make things much worse than they are.


Do you believe everyone can recover from depression? Or are some people just depressed for their whole lives

gore_whore_

The majority of individuals can be treated and do get better. There is small percentage who do no respond to current treatments.


In your experience, what is the closest thing to a "cure" rather than a lifelong "treatment" for depression? What has the best rate of long term remission?

LudovicoSpecs

Balanced living, activity that give meaning, and a good support system is a recipe for a happy life.


Hi, thanks for doing this. What's your best advice/tip to start the day off wel or get a grip on your life?

I mean everyone has some days it's ok and you try but some days you're just empty and don't feel like doing anything.

Any advice for those bad days?

JustLeysen

Acceptance and not making it worse than it is.


What's the difference between the general anxiety that everyone has and anxiety that should be medically treated?

losewell

Anxiety cannot be escaped in life. In fact, it can protect us. When it starts to prevent someone from effectively living their life, is when it should be treated.


I suffered myself from depression and anxiety, I'm in a much better place now, but my wife is having a hard time dealing with her depression, and feelings of worthlessness, how can one be a supportive partner of someone with depression?

ikhos

Encourage them to engage in treatemtn and be a loving and supportive partner.


What do you attribute to the increase in children committing suicide now more often?

jimmyolsenblues

Youth had the lowest suicide rates in the 1950's. By 1990, these rates had quadrupled. I believe many changes in family structure and our society are driving this increase in youthful suicidal Behavior.


Hello just wanted to say that I'm grateful for the services Strong Memorial Hospital provides in their mental health department. Having been through some mental health issues and utilized the hospital and their outpatient program, I think it's only fair to say thank you.

The only questions I have is how do you feel about the use of psychedelic drugs that are currently illegal for psychotherapy?

Also, what are your opinions about Borderline Personality Disorder? To elaborate, do you believe the validity of the diagnosis?

Foserious

I have concerns about these experimental treatments. I think Borderline Personality is real diagnosis, that can be effectively treated.


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