It feels cliché to say it - but times have changed for families over the past few decades. Today there is no foregone conclusion when it comes to the work/family balance as there once was.

Of course it used to be assumed that women would stay home with their children and take care of the bulk of household responsibilities. Men typically occupied the workplace where they earned the money to keep the family running.

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Today there are countless other scenarios as people have rightly learned to share responsibilities, challenge role assumptions and pursue whatever career or family goals work best for them.

Very often both parents juggle between work and family commitments or men stay home with their children while mom is the primary income earner.

Regardless of the work/home schedule and the roles and responsibility of each family member, a few tips can help make finding balance a little easier for any working parent.

First, recognize that pursuing a career and caring for dependent loved ones are both demanding roles. If you are balancing between the two, something will have to give. Although it is possible for us to do a bit of everything in our lives, it is not possible to be all things to all people all the time. That’s just reality.

Giving in to feelings of guilt for your inability to be in two places at once will not help anyone. In fact, it’s harmful to your own health and likely to your ability to successfully balance your responsibilities.

When you come up against conflicting priorities – perhaps an important work meeting takes place at the same time as a special event in your child’s life – you will have to choose one or the other. If you later regret your decision, try to choose differently next time.

If you choose to pursue a career even part time, invest in it when you can. Continue to develop your skills, improve your knowledge and network where possible. This way you will be prepared if and when you decide to work full time.

If you have a partner – negotiate roles and responsibilities to do with family and household. Generally, it works well to divide tasks based on what each person is best at or prefers and then divide or take turns on the things neither of you particularly enjoy. It is OK to enlist the help of your children – it is healthy for them to assist with jobs around the house according to their age and ability level.

If you’re feeling swamped and you can afford to get paid help - get it. There isn’t any virtue in trying to be a super human. Ask yourself what things you really need to do for yourself and what areas you could use some help with.

On a similar note, try to set realistic standards for yourself. Perfectionism should not be your goal in all areas – an uninvolved or exhausted parent is worse for a child than a messy house, the occasional fast food meal or store bought baking. Be as organized as possible, do what you can, and don’t waste time obsessing about the rest.

Above all – do what you love whether it’s working, raising children or continuing your education. Your surest route to happiness is to put your time and energy toward things you find rewarding and fulfilling.

By now, this shouldn’t come as news - depression is the leading cause of disability around the world.

The World Health Organization and many other health agencies have presented data about this and I have talked about it in several past columns.

A study of more than 250,000 people in 60 countries found depression was a greater detriment to people’s overall health than other chronic illnesses including angina, arthritis, asthma or diabetes.

Also, these and other chronic illnesses often trigger depression and the presence of depression in combination with any of these other diseases increases the level of disability.

Still, many are surprised to learn of the incredible impact of depression.

So what makes one disease more disabling than another? What puts a particular disease in the running for the title of leading cause of disability?

According to the criteria used in these international studies, the burden of disability for a given disease could increase if the causes are overwhelming (as in the case of an epidemic); prevention is ineffective; it is difficult to detect or diagnose; it is a disease which remits and recurs; treatment is ineffective, too expensive, unavailable or unacceptable; individuals do not seek treatment; or effective care is not provided.

In the case of depression, experts believe only the last two in this list are sufficient to account for the burden of disability.

This is encouraging because these issues are not completely beyond our control. At the same time, it is disheartening to see the effect these relatively simple obstacles are causing in terms of the disability experienced by depressed people around the world.

Once again, reducing stigma and raising awareness could go a long way toward solving these problems.

Large scale studies show only about half of those who met the criteria for major depression sought treatment during the study year. Of those who did not seek treatment, only one in six thought medication or cognitive behaviour therapy would be appropriate.

Since these are effective treatments for depression, education and awareness is an important issue. As more people are aware of the existence of effective treatments, more will likely seek them out and thus reduce the long term negative effects of depression.

A demand-driven model of care such as ours – where patients seek help only when they consider it necessary – can never be appropriate for dealing with an episodic but lifelong condition. This is particularly the case for depression since it is an illness that affects hope and volition, reduces treatment compliance and increases the risk of suicide.

Often when depressed patients relapse they feel they have failed their doctors and families and decide as a result to suffer in silence – which of course doesn’t help them or their loved ones.

A better treatment model would establish case registers and proactively organize consultations with patients including outreach to non-attenders.

Education would be another cornerstone to ensure all concerned understand the nature of depression, its treatment and the early warning signs of relapse.

In addition, treatment protocol for diagnosis and management of complex cases would involve criteria for specialist consultation and ensure good communication between specialists, nurses, family doctors and psychologists involved in an individual’s care.

In an ideal situation we would also make full use of our technological age with computer programs to record treatment and outcomes of all patients and flag when progress is not as expected.

In my opinion, there is no need for depression to remain at such a high rate of disability worldwide. We need to make changes to the way mental illness is perceived and treated so that people seek the effective treatments that exist and healthcare providers work together to give the best care available.

Antisocial behaviour ranging from lying, stealing and manipulating to physical violence, torture or killing is an aspect of mental health I am frequently asked about.

Of course, behaviours such as these can really range from mild to severe and cause varying levels of dysfunction or danger to both individuals and those they come in contact with.

Generally antisocial behaviours crop up in childhood or adolescence and can continue throughout life if they are not dealt with.

As with most things, there are both biological and environmental contributions to antisocial behaviours.

In severe cases, antisocial personality disorder could be involved, but this is not always the case. Some people simply behave badly but don’t have a specific psychiatric diagnosis.

In case you needed one more reason to quit smoking, maternal smoking during pregnancy has been implicated in some studies as a potential contributing factor for antisocial behaviour– and this connection remained even after controlling for other factors such as socioeconomic issues, education, marital state and antisocial behaviour in the mother.

Head injuries can also contribute to antisocial behaviour. In a study of 145 serial killers, approximately one quarter had experienced lengthy periods of unconsciousness from head injury during childhood or early adolescence.

Childhood abuse is the most common contributor to antisocial behaviour. Boys who have been abused are at risk for antisocial personality disorder and future violent offences. In the case of abuse, the earlier the abuse is experienced, the more likely the victim will develop problems with antisocial behaviour.

Serial killers often come from horrific backgrounds where they have been brutalized by one or both parents.

In the absence of abuse, good parenting and early life relationships likely have a protective effect. It isn’t surprising to learn that inconsistent discipline and lack of supervision during childhood has been associated with later development of maladaptive or antisocial behaviours.

Further, hanging out with the wrong crowd or witnessing violence firsthand or via the media can also contribute.

Children with no friends are also at higher risk for developing problems. A majority of serial killers are loners and unable to enter into normal relationships. In fact, the rate of schizoid personality disorder – characterized by a pervasive pattern of detachment from social relationships and emotions in interpersonal settings - is about 50 times higher among serial killers than in the general population.

Aside from these environmental influences, genetics can also play a role and it seems physical aggression is more often inherited than simple rule breaking behaviour.

So far a handful of genes have been implicated. Those identified are involved in the creation of various neurotransmitters and their receptors within the body.

One example is the gene for monoamine oxidase A (MAOA). In studies of mice, aggression increases when this gene is removed and it lessens when the gene is restored. Among humans, a study found five men in a single family who lacked this particular gene and all had engaged in antisocial behaviours including arson, exhibitionism and attempted rape.

Another study found two variants of this MAOA gene accounted for why some boys developed antisocial behaviour after childhood abuse while some did not.

Boys who had been abused and had a short version of this gene accounted for only 12 per cent of the study sample, but 44 per cent of the convictions for violent acts. Of those who had been severely abused and also had the short version of this gene, 85 per cent had engaged in some sort of antisocial behaviour.

Although genetic vulnerabilities exist, the best data to date still shows that much antisocial behaviour could be prevented. We need to ensure children are given the proper environment during their early years – free of abuse and neglect.

Everyone knows depression involves feelings of sadness and a low mood that last longer than a normal bout of the blues and persists regardless of life circumstances.

In addition to the low mood there are many other physical and psychological symptoms associated with depression, which I have highlighted in several past articles.

Negative thinking patterns are also associated with depression and this may be somewhat less obvious to people without a direct relationship with someone who is depressed.

When in the throes of an episode of depression, people tend to be pessimistic, overly sensitive and view everything very negatively. Further, a depressed individual distorts or misinterprets their environment – if there are two ways of viewing a situation, the depressed individual usually picks the most negative.

An example of a common pattern in depressive thinking follows like this: “If someone disagrees with me, they don’t like me. If a particular person doesn’t like me, no one likes me. If I am not liked, I am a bad or worthless person. If I am worthless, my family would be better off without me.”

Obviously, negative thought patterns like this are not helpful to the depressed state in general. Depressed thoughts and pessimism lead to the trademark feelings of hopelessness, helplessness and worthlessness.

Early life experiences such as parental loss in childhood can predispose an individual to this kind of thinking, which can be triggered by distressing events or loss in later life. With each event and subsequent depression, it takes progressively less severe stress or loss to set off a depression.

Genetic vulnerability also plays a role since we are not all equally affected by early life experiences. Studies have shown that individuals with a genetic predisposition to depression are also more readily affected by loss or stress and this leads to the kind of negative thinking discussed above.

Within the brain, the amygdala is associated with the evaluation and processing of emotionally charged events. Among individuals predisposed to depression, this region is hyper-reactive and this is the biological reason behind this depressive thinking. Abnormally high reaction in the amygdala leads in turn to the excessive secretion of the stress hormone cortisol.

In addition to increased activity in the amygdala, depressed individuals have decreased activity in the prefrontal cortex, which is the area of the brain involved in intellectual re-evaluation of emotional responses. Lower activity in this area reduces the depressed person’s ability to evaluate negative thoughts and come to a more rational conclusion.

For these reasons, it is easy to see how cognitive therapy and medication can work hand in hand to treat depression. Therapy is focused on strengthening the weakened ability to think rationally about negative thoughts while medication quietens the amygdala and activates the prefrontal cortex. Together, these can tackle the same problem in different ways to produce the best result – a return to adaptive thinking and remission of mood symptoms.