Depression and anxiety in kids and adolescents certainly isn’t something that’s new, but is it getting worse? We’re definitely seeing a rise in mental health conditions across the board, but it’s difficult to determine if this is because we’re simply getting better at recognizing it and more willing to treat it. Even though we are making great strides in identifying these issues in kids, we’re still learning, and new factors and issues effecting our mental health continue to emerge. So this is a continuation of my last post exploring a few more of the issues contributing to mood disorders.
7. Pressure: You know the way you might feel that your boss keeps wanting you to do more and more with fewer resources? Our kids frequently feel the same way about school. I regularly have kids who are not even in high school come into my office in tears because they didn’t do well on an assignment/test and are now convinced they will never get into a good college, will never get a good job, and will be a miserable loser for the rest of their lives feeding feelings of self-doubt and hopelessness. This kind of distorted thinking is common even for adults with anxiety, it’s called catastrophizing (going to the absolute worst case scenario) which is particularly problematic with kids because the parts of our brain that allow us to think more abstractly, control impulsivity, and realistically weigh consequences of events or actions are still under development. The pressure is not only academic, in many senses our kids are truly becoming mini-adults at younger and younger ages. I look at so many of the young girls that come into my office with perfectly coordinated outfits, contoured makeup, acrylic nails, and listen to them sadly talk about how they think they’re not pretty enough, thin enough, good enough. They need to hear they are good enough, and they need to hear it until they believe it.
8. Our brains are getting wired to be depressed and anxious. Dopamine is a neurotransmitter that plays a huge role in our mood, it’s also a key player in things like addiction and reward processing. There’s a reason we get so sucked in to wanting to get more and more ‘likes’ or followers. Dopamine. Every time we get a ‘like’ we get a little boost of dopamine. This basically makes our brain tell us “Hey this is awesome, we gotta get some more of that!” We subconsciously train ourselves to self-medicate with these dopamine boosts. This means that when we’re not getting that insta-dopamine we notice we don’t feel as happy, we get more depressed and may even get cravings for that dopamine boost.
9. Substance use: This really can be a chicken or the egg situation. Many people start self-medicating with substances as a way to try to escape from negative emotions. Momentarily it may work, however when the effects wear off we’re more likely in a worse place than we were before we used. This is physiologically for a number of reasons, a big part is activation of that reward cycle in Reason 8. This basically turns into a horrible self-perpetuating loop where we continue using to mask and escape from negative emotions, our brains continue to tell us “Yes this is helping, sweet!” then we crash, and repeat.
10. Everyone is stressed and we feed off each other. I think it’s a pretty fair assertion that right now pretty much everyone has some major stress right now, whether it’s worrying about making rent, the health of a loved one, the political climate, meeting a work deadline, etc. we live in a stressful time. We also tend to be pretty awful at self care, meaning we frequently don’t really manage our stresses effectively. We pick up on each other’s stress and oftentimes internalize it. I don’t think I’ll ever forget a kiddo of mine coming into my office absolutely distraught because the family was going through a lot of financial and marital stressors. She thought if she gave her dog away it would solve the family’s problems. Or the kid who thought she was causing the stress and problems leading to a parent’s substance abuse. Parents are often so wrapped up in the well-being of their children, work, school, or whatever it is they often ignore or de-prioritize their own mental health. One thing that I find myself frequently reminding parents is that it is not selfish to take care of yourself, the happier and healthier you are, the happier and healthier your kids will be.
11. We’re more and more reliant on external validation to determine our self worth. The feelings of love and belonging are some of the most basic human needs. Humans by nature are social creatures, and even from an evolutionary standpoint we have a need to be accepted by others and be part of a group. This becomes problematic when our self esteem becomes reliant on the approval of others. How many people liked our post? How many parties did we get invited to? How many texts do we have? When we let these external sources of validation dictate our self worth we aren’t really able to see ourselves through a clear lens. Another distorted way of thinking we can get into the habit of is polarized or black and white thinking, or minimizing the positives while magnifying negatives “I didn’t get invited to that party so that means no one likes me, and I’m a loser who doesn’t have any friends.” This can make it difficult to accurately evaluate ourselves or the situations we’re in and crush our self esteem. Relying on this form of validation can also lead us to behave in ways that we might not feel comfortable with in order to fit in, or avoid conflict, however when this happens we often develop huge feelings of guilt afterwards, feeding into the cycle all over again.
12. We’re disconnected. While technology is an amazing tool that gives us access to people and information, this can lead us to have less quality face to face time with each other. Think about it, look at almost any group of people, at anytime how many people are on their cell phones, or at least have them out? When our attention is split like this we limit the quality of the experience we’re having in real time. When we feel disconnected, we likely end up feeling lonely which goes back to Reason 11. The primary reason that group therapy is effective is the sense we are not the only one experiencing what we are, or that other people understand, and maybe the most important factor in psychiatric treatment is the therapeutic relationship, these things all give us that sense of love and belonging and lets us know that we are not alone.
13. It’s everywhere. Every time one of my kiddos come to me and describe these things or tell me they’ve attempted or have considered suicide it breaks my heart, and I try to think back to how old I would have been when I would have even been aware of what the concept of suicide was. It really does seem that it’s been everywhere TV, movies, news, music, you name it. Now coverage and discussion of these issues is something that is necessary and important. Risk comes when it is sensationalized or glamorized. Parents ask me all the time if they should let their child watch a show like “Thirteen Reasons Why” and my answer is usually that it depends on the purpose. I believe it can be a helpful tool in facilitating a conversation, but this should be done with guidance. Like I mentioned earlier there is still so much fine tuning and brain development that is going on during this time that kids are not able to process and analyze information like this in the same way as adults do. Kids just do not have the executive functioning to fully understand what suicide really means. Many times it may be viewed as a way to show someone how much pain they are experiencing or to prove a point. The finality of these actions is not something that they are able to process which is where the danger comes in. A good example of this is in the most recent season of Thirteen Reasons Why the protagonist who committed suicide in the first season is featured throughout the entirety of the program, seeming to still interact and communicate with at least one of the characters, continuing to tell her story and help guide others through the season. This is where the major disconnect comes in (for the purposes of this discussion let’s put aside religious beliefs about the afterlife, which would add a whole other layer to this). The finality of suicide is what is a difficult concept for kids/adolescents to understand, and the protagonist’s continued presence even though she is dead is often how kids conceptualize it.
So what do we do with all of this? The number one thing I can say is talk. Have the uncomfortable conversations. It may be the immediate reaction (and reasonably so) to hit the roof when you find an empty bottle of vodka in your kid’s room, or find inappropriate pictures on her phone, but I would ask for you to look at what else is going on. Is there something she is trying to escape? Is there some kind of validation or need that isn’t being met? I’m not saying this is an excuse, but rather may be an explanation of certain behaviors (which still need to be addressed and corrected). Encourage them not solely to succeed in school, athletics, or extracurriculars, but teach them how to handle disappointments and shortcomings and not let failures negate successes. One of the most beneficial things to do to improve overall mood is to foster an environment of gratitude. At some point in the day share things that you are grateful for and encourage your kids to do the same. When we’re able to express gratitude it helps counteract that negative all or nothing/black and white thinking and helps us bring the positive into focus. The last thing I advise would be to take care of yourself. Don’t feel selfish for taking time to go to a yoga class, have a date night with your significant other or go to a therapy session (whatever your self care is) we can’t help others effectively if we don’t help ourselves. Just remember, if you have any doubt or concern bring your kiddo in for an evaluation! Worst case scenario is you spend an hour of your time with your child discussing your concerns. Remember it is not our job as providers to make judgements on you, your child, your parenting, etc. while sometimes people may be hesitant because of past negative experiences or beliefs about psychiatry/therapy I truly believe that 99% of providers sincerely want to help and only want what is best for you and your child.
If you or someone you know is struggling with suicidal thoughts there is always someone there to help.
Call the National Suicide Prevention Lifeline available 24 hours every day 1-800-273-8255
“No matter how many reasons why, there are always more reasons why not.” –13 Reasons Why