We had an opportunity to talk with Snow Tha Product, a California-raised bilingual rapper, proud Latina, and an advocate for social change. She’s as real as they come, and she’s encouraging a generation of young hip-hop fans to open up about their own personal battles. We asked her about mental health, advocacy, heritage, and the ways she sees it all intersecting in the dialogue she keeps with her fans.
Question: So we heard, before your music career took off, you’d considered working in the mental health field. Fast forward to today and you’re successful hip-hop artist instead, but you’re still finding ways to help young people through your music and advocacy. Can you share with us what drew you in that direction in the first place?
Snow: I was depressed as a kid while my parents went through a divorce. I ended up needing help and through my mom being low income, I was able to get access to the help I needed. I always wanted to be able to provide that same opportunity to others that might feel the same way.
How has that draw to help young people continued to inform your music career?
It has made me create songs and blog posts to talk to fans about certain issues that they haven't maybe heard from other artists. I’ve met a lot of fans that I wouldn't have otherwise met and they have been able to use music as a positive influence instead of as a crutch otherwise.
In your willingness to share your personal battles, you’ve encouraged your fans to open up about their own struggles. What’s that been like for you—to be such a catalyst for open conversation? And how do you hope that conversation progresses from here?
It's been a blessing but also a struggle to have that much responsibility. I do have a passion in making a difference in this and I am busy, but even if I can try to guide fans to the right place, I feel like I've made a positive impact.
What would you say to young people who are still afraid to talk about their stress, anxiety, depression, or whatever mental health issues they may be facing?
Don't be afraid to talk about it. Suppressing it makes you live in your head, and it makes you feel like you're alone. Talking to someone about your issues helps you understand that you're not the only one.
You’ve been outspoken about how important it is to celebrate your Latin American heritage. What would you say to any young Latin Americans that might feel like shying away from that celebration?
A lot of times we're the butt of the joke. There's a lot of self-hate among Latin Americans as well, along with colorism. You can act "Too Mexican," and our own people even use the word "Mexican" as a derogatory term, which is why it's so important to emphasize that "being so Mexican" is actually amazing. Because I am, and I am pretty cool haha.
Would you talk to us about how social media has helped you connect with your listeners? What does that relationship mean to you?
I get to show my followers my life. My crew is a family. They get to see us through it all, and see that we're regular people that have highs and lows like everybody else. That relationship and that connection means everything. It’s why I do this. It’s more than the music.
Are there effects of social media on mental health that you worry about? Everything children have to contend with today online, what they see on TV, hear in music—do you worry about the impact it can have on self-esteem and mental wellness?
I feel like there is a lot of music that leans on drug-use and depression. It is kind of terrifying for pre-teens and teens to listen to because the artists are promoting it. A lot of the artists don't even feel that way, so it's almost encouraging.
How do you deal with all the scrutiny that comes with being such a public figure—all the expectations and assumptions you must encounter? And what advice do you have for young people who feel like there’s so many voices telling them who and how they’re supposed to be?
I deal with it like any other human would. I try my best to be a good example for anyone going through something similar. I also look at other people who have gone through something worse. At the end of the day I'm still the same 15 year old that is depressed. Speaking to children that tell me that I've inspired them or that I have gotten them through something worse helps me get through things.
Next we chatted with Dr. Clayton Chau, MD, PhD, Regional Executive Medical Director for mental health and wellness for Providence St. Joseph Health. Here is what he had to say on the specific topic of depression for all ages and stages of life.
What is depression?
- Depression is a common but very serious mood disorder. For some people, it can result in severe impairments that interfere with or limit one’s ability to carry out major life activities such as school or work.
- It is the leading cause of disability in the U.S. for ages 15-44.
- More youth are becoming depressed.
- The World Health Organization has forecast that depression will rival heart disease as the health disorder with the highest disease burden in the world by 2020.
- Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few—but distressing—symptoms may also benefit from treatment. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
- Men and women sometimes show depression differently. Specifically, men are more likely to experience irritability, sleep problems, fatigue, and loss of interest in activities they liked previously as a result of depression, whereas women tend to have overt sadness and feelings of worthlessness and guilt when depressed.
- Though children can experience depression, teens are much more vulnerable to major depression. Hormone and sleep cycles, which change dramatically during adolescence, have an effect on mood and may partly explain why teens, especially girls, are particularly prone to depression. Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including the following:
- Poor school performance
- Persistent boredom
- Frequent complaints of physical symptoms, such as headaches and stomachaches
- Some of the classic adult symptoms of depression may also be more obvious in children, such as changes in eating or sleeping patterns (Has the child lost or gained weight in recent weeks or months? Does he or she seem more tired than usual?)
- Symptoms and signs of depression in teens may include more risk-taking behaviors and/or showing less concern for their own safety. Examples of risk-taking behaviors include driving recklessly/at excessive speed, becoming intoxicated with alcohol or other drugs, especially in situations in which they are driving, being in the presence of others who engage in risky behaviors, and engaging in promiscuous or unprotected sex.
- Parents of children with depression report noticing the following behavior changes. If you notice any of these, discuss this with your pediatrician;
- The child cries more often or more easily.
- The child's eating habits, sleeping habits or weight change significantly.
- The child has unexplained physical complaints (for example, headaches or abdominal pain).
- The child spends more time alone, away from friends and family.
- The child actually becomes more "clingy" and may become more dependent on certain relationships, but this is less common than social withdrawal.
- The child seems to be overly pessimistic or exhibits excessive guilt or feelings of worthlessness.
- The child expresses thoughts about hurting him or herself or exhibits reckless or other harmful behavior.
- Elderly - While any of the classic symptoms and signs of depression may occur in elderly men and women, other symptoms also may be noted:
- Diminished ability to think or concentrate
- Unexplained physical complaints (for example, abdominal pain, changes in bowel habits, or muscle aches)
- Memory impairment (occurs in about 10 percent of those with severe depression); sometimes can be mistaken for dementia
- Since elderly individuals tend to show more physical symptoms of depression compared to younger individuals, this puts these individuals at risk for having their depressive symptoms erroneously attributed to medical problems.
- Psychotherapies - Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. There is a wide number of effective therapeutic approaches utilized for the treatment of depression today. These range from cognitive behavioral therapy, to behavioral therapy, to interpersonal therapy, to rational emotive therapy, to family and psychodynamic approaches. Both individual and group modalities are commonly used, depending upon the severity of the depressive episode and the local resources within an individual’s community. Psychotherapy can help you:
- Adjust to a crisis or other current difficulty
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Explore relationships and experiences, and develop positive interactions with others
- Find better ways to cope and solve problems
- Identify issues that contribute to your depression and change behaviors that make it worse
- Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
- Learn to set realistic goals for your life
- Develop the ability to tolerate and accept distress using healthier behaviors
- For some people, other procedures, sometimes called brain stimulation therapies, may be suggested:
- Electroconvulsive therapy (ECT) - In ECT, electrical currents are passed through the brain to impact the function and effect of neurotransmitters in your brain to relieve depression. ECT is usually used for people who don't get better with medications, can't take antidepressants for health reasons or are at high risk of suicide.
- Transcranial magnetic stimulation (TMS) - TMS may be an option for those who haven't responded to antidepressants. During TMS, a treatment coil placed against your scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.
- Here are other tips that may help you or a loved one during treatment for depression:
- Try to be active and exercise
- Set realistic goals for yourself
- Try to spend time with other people and confide in a trusted friend or relative
- Try not to isolate yourself, and let others help you
- Expect your mood to improve gradually, not immediately
- Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation
- Continue to educate yourself about depression.
The national 24/7 suicide prevention lifeline is 800-273-8255.
What are the signs and symptoms?
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious or “empty” mood
- Feelings of hopelessness, or pessimism
- Irritability or agitation
- Crying spells
- Feelings of guilt, worthlessness or helplessness
- Loss of interest or pleasure in hobbies and activities
- Loss of energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering or making decisions
- Difficulty sleeping, early-morning awakening or oversleeping
- Significant appetite and/or weight changes
- Tendency to isolate from friends and family
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
What causes depression?
Depression is a very complex disease. No one knows exactly what causes it, but it can occur for a variety of reasons. Some people experience depression during a serious medical illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason.
Of the precipitating factors that cause depression, chemical imbalances in the brain is a big problem. Genes that produce mood-enhancing neurotransmitters are switched off by epigenes that are chemical tags serving as an intermediary between genes and the environment. Epigenes have the ability to turn on or turn off gene segments in ways that promote health or facilitate disease. Because of faulty chemical signaling in the brain, neural circuits go awry and lead to depression and anxiety. Which is why many antidepressant and antianxiety medications target certain neurotransmitters (brain chemical messengers).
There are a number of factors that may increase the chance of depression, including the following:
- Abuse - Past physical, sexual, or emotional abuse can increase the vulnerability to clinical depression later in life.
- Certain medications - Some medications, such as high blood pressure medication, the antiviral drug interferon-alpha, and corticosteroids, can increase your risk of depression.
- Conflict - Depression in someone who has the biological vulnerability to develop depression may result from personal conflicts or disputes with family members or friends.
- Death or a loss - Sadness or grief from the death or loss of a loved one, though natural, may increase the risk of depression.
- Major events - Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced or retiring. However, the syndrome of clinical depression is never just a "normal" response to stressful life events.
- Other personal problems - Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can contribute to the risk of developing clinical depression.
- Serious physical illnesses - Sometimes depression co-exists with a major illness or may be triggered by another medical condition, such as hypothyroidism, diabetes, cancer, heart disease, etc.
- Substance abuse - Nearly 30 percent of people with substance abuse problems also have major or clinical depression. And, substance abuse is common among people who are battling a depressive disorder. Because alcohol and many illicit drugs are central nervous system depressant, the use of these drugs tend to trigger depression symptoms like lethargy, sadness and hopelessness. However, many depressed individuals reach for drugs or alcohol as a way to lift their spirits or to numb painful thoughts. As a result, depression and substance abuse feed into each other, and one condition will often make the other worse.
How common is it?
- In 2015, an estimated 3 million adolescents aged 12 to 17 and 16.1 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year. These numbers represented 12.5 percent and 6.7 percent of all people living in the U.S. within those age range respectively.
- In the same year, of those with depression, an estimated 2.1 million adolescents aged 12 to 17 and 10.3 million adults aged 18 or older had at least one major depressive episode in the past year with severe impairments. These numbers represented 8.8 percent and 4.3 percent of all people living in the U.S. within those age range respectively.
- Rate of youth depression increased to 12.5 percent in 2015 from 8.5 percent in 2011.
Is it genetic?
Research has shown that people with parents or siblings who have depression are up to three times more likely to have the condition. This can be due to heredity or environmental factors that have a strong influence.
A family history of depression may increase the risk. It's thought that depression is a complex trait, meaning that there are probably many different genes that each exert small effects, rather than a single gene that contributes to disease risk. The genetics of depression, like most psychiatric disorders, are not as simple or straightforward as in purely genetic diseases such as sickle cell’s or cystic fibrosis.
Studies of families with depression have indicated that the disorder has a genetic link and scientists think around 40 percent of the risk of developing it is contributed by genes, with the rest down to environmental and other external factors.
Perhaps, many genes are involved in depression.
How is it diagnosed?
A comprehensive evaluation is necessary. A complete psychological and physical evaluation along with a detail interview to determine whether a person has depression. Because the side effects of some medications and medical conditions can include some of the symptoms of depression, all three components are necessary to avoid false diagnosis.
Therefore, a mental health clinician should work closely with the primary care provider to ensure proper diagnosis.
The current recommendation is that doctors routinely screen all individuals, at least age 12 and above for depression. This screening might occur during a visit for a chronic illness, at an annual wellness visit, or during a pregnancy or postpartum visit.
When does it typically present?
Major depressive disorder can develop at any age but the median age at onset is 32. It is more prevalent in women than in men.
What are the treatments?
- Nationally, 57 percent of adults with mental illness receive no treatment, and in some states (Nevada and Hawaii) that number increases to 70 percent.
- 64 percent of youth with depression do not receive any treatment. Even among those with severe depression, 63 percent do not receive any outpatient services. Only 20 percent of youth with severe depression receive any kind of consistent outpatient treatment (7-25+ visits in a year).
- Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
- Medications - Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
- Antidepressants take time—usually 2-to-4 weeks—to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness.
- If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
What is the connection between depression and suicide?
- Major depression is the psychiatric diagnosis most commonly associated with suicide. About ⅔ of people who complete suicide are depressed at the time of their deaths.
- One out of every 16 people who are diagnosed with depression eventually go on to end their lives through suicide. The risk of suicide in people with major depression is about 20 times that of the general population.
- People who have had multiple episodes of depression are at greater risk for suicide than those who have had one episode.
- People who have a dependence on alcohol or drugs in addition to being depressed are at greater risk for suicide.
It is not hard to see why serious depression and suicide are connected. Depression distorts a person’s viewpoint, allowing one to focus only on the failures and disappointments and to exaggerate these negative things.
Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the strictest warning for prescriptions. In some cases, children, teenagers and young adults underage 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.
- Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when starting a new medication or with a change in dosage. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact a doctor or get emergency help.
- Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Are there different types of depression?
- Persistent depressive disorder, also known as dysthymia, is depression that lasts for at least two years in adults and one year in children. A person with dysthymia may have episodes of major depression with periods of less severe symptoms, but the symptoms must last for two years to be considered dysthymia.
- Disruptive mood dysregulation disorder is chronic and severe persistent irritability manifested by frequent temper outbursts and persistent irritable or angry mood that is present between the severe temper outbursts. It is most common among children and the rates are expected to be higher in males and school-age children than in females and adolescents.
- Perinatal depression is much more serious than the ‘baby blues’ that many women experience during pregnancy or after giving birth (postpartum depression).
- Psychotic depression occurs when a person has severe depression and some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing things that others don’t (hallucinations).
- Seasonal affective disorder is depression usually occur during the winter months when there is less natural light. It generally lifts during spring and summer and predictably returns every year.
- Premenstrual dysphoric disorder (PMDD) is a particularly severe form of the premenstrual syndrome (PMS). Both PMS and PMDD cause disturbing symptoms during the second half, known as the luteal phase, of a woman's menstrual cycle. The symptoms tend to worsen over the week before the onset of the menstrual period and then improve within a few days after the period starts. PMDD can cause a number of different symptoms, but fatigue, tiredness, mood changes and bloating are common. A low percentage of menstruating women are estimated to suffer from PMDD. In contrast to PMS, the symptoms of PMDD are severe enough to have a significant impact upon the woman's daily activities and functioning.
- Situational depression is a short-term form of depression that can occur in the aftermath of various traumatic changes in your normal life, including divorce, retirement, loss of a job and the death of a relative or close friend. It is referred to as adjustment disorder. Most people with situational depression develop symptoms within 90 days following the event that triggers the condition. Depending on the individual, these symptoms can be similar to those of a major depression. In many circumstances, mild cases of situational depression will disappear on their own if you take certain steps to limit their effects. In more serious cases, they may require treatment.
What is the connection between music and depression?
Music therapy has been used in different ways to treat depression. Music therapy can address people’s physical, emotional, cognitive and social needs by either creating, singing, moving to or listening to music.
Approaches can be active or receptive.
- Active techniques might be used to help people, especially youngsters with emotional, developmental and behavioral problems, who cannot articulate their difficult feelings. The certified music therapist uses clinical techniques to connect with the patients by improvising, recreating, or composing music using instruments or the voice, which can then act as a springboard to emotional awareness.
- Receptive techniques involve the use of music for relaxation, reflection, guided imagery or meditation. This process allows the patients to improve their mood and develop coping and relaxation skills. The certified therapist selects instruments and music based on each patient’s individual preferences and needs.
The duration and frequency of music therapy sessions vary, but they typically last 20 minutes to one hour. Patients may undergo sessions daily, weekly or monthly. Sessions can take place in a group or individually in a hospital, therapist's office or patient's home.