With the recent release of season two of the Netflix original “13 Reasons Why,” along with the recent tragic shootings I have had more and more parents and patients asking about depression and suicide, especially among children and adolescents. One of the most common questions parents ask me is how or why his/her child (relative, kid’s friend, etc.) is depressed and/or anxious, feeling the child is “too young” to be experiencing this and it is “just a phase they must be going through.” It’s a confusing and difficult experience for both the child suffering and for all other family members to go through. I want to start with the reassurance that depression, anxiety, bipolar disorder, psychosis, or most other mental health disorders are completely possible for children to experience.
So, why? Why are our kids depressed, anxious, and committing suicide, and what can we do to address these issues, prevent, or treat them?
- It is very rarely (if ever) that one single issue is the root cause. Many parents feel extreme guilt if their child experiences any of these conditions feeling that they “passed it down” or there is something they could have “done better.” It is more likely a combination of genetic, “chemical” (biologic/physiologic), and environmental factors. Frequently I describe this to my patients or their parents as a bridge relying on supports. One support being disrupted (i.e. genetic factors) will likely not cause the entire bridge to collapse, however the more supports you start taking out (environmental, biological, etc.) the less stable that bridge becomes, and the risk of collapse arises.
- Social Media. There is an amazing phenomenon that happens when we get engrossed in social media: We get depressed. More and more research is demonstrating that there is a correlation between the use of social media and depression. When we use social media we see a carefully edited, curated, photoshopped version of a life people want to show us. It is not reality, but it’s difficult for us, especially kids, to register this. We start to compare our lives to what we are seeing on Instagram, Snapchat, or Facebook, which makes our lives seem pretty lame. We wonder why we can’t look like that, or have those awesome clothes/gadgets, why we aren’t on vacation in some amazing location. When we start to compare ourselves to others it is very easy for a mood disorder to creep in or worsen. However what we see is not real life. I don’t know many people who post photos of themselves washing the dishes, or taking the garbage out. I always recommend limiting screen time. Yes, your kid will be mad and probably yell and cry and scream what an awful parent you are for doing this, let me assure you, you are not. It is ok for your kid to be mad at you! Let me reiterate that: IT IS OK FOR YOUR KID TO BE MAD AT YOU. The initial battle may not be pretty, but I see it countless times that both parents and the child/adolescent report almost an instant improvement in depression or anxiety if his/her cell phone or social media use is restricted.
- Bullying: This goes right along with the social media factor. When we are online/via text we do and say things that we never in a hundred years would say to someone’s face…so why do we feel comfortable doing it online? There’s another interesting issue we develop with more screen time, I’ve heard it called “Internet Autism.” Meaning when we cannot hear or see a person we are unable to pick up on the social/human cues, and we stop thinking of the person we are speaking to as a genuine, living, breathing human being and more as an object.
- Diet: This is a hard one particularly for teens who may be stubborn, but it is crucial. Think about it, when any of us live off a diet of Chili Cheese Fritos, Snickers Ice Cream Bars, and Dr. Pepper (which I will admit was my standard throughout junior high and high school) and stay up all night binge watching the latest Netflix show we do not feel like we are at our prime. We deplete ourselves of crucial vitamins and minerals that directly effect mood (Vitamin D, B Vitamins, Omega-3’s are huge).
- Exercise: Exercise really does help stimulate all of those “feel good neurotransmitters” that regulate our mood, so even if it’s for 20 or 30 minutes getting some exercise WILL help. Again, another thing that we see related to increase use of social media/screen time, increased sedentary lifestyles.
- Sleep Deprivation: Most of our kids are on some kind of device until they go to sleep, if not falling asleep next to them or with them on. The light these devices omit suppresses our body’s ability to produce/release melatonin, which is crucial to regulate our circadian rhythm. Also, when we’re tired our body wants us to have energy and looks for the easiest source of this. This is why when we’re dead tired we tend to find ourselves eating more, and eating foods high in carbohydrates or processed foods that are easily broken down for our bodies to use as energy. Then we get into a horrible on-going cycle with reason four.
Obviously this is a very difficult and complex subject and there are many more factors in kids developing mental health disorders, which we’ll leave for Side B.
So what are some warning signs of depression or risk of suicide?
- Anger: Depression/anxiety often presents as anger in children and adolescents, so if it seems that your kid hates everything from their teacher to the spaghetti that’s on the table, or seems to argue about any and everything this may be something to explore.
- Withdrawal: One symptom of depression is something called anhedonia, which is the inability to enjoy things that we typically would. A kid who refuses to come out of there room or is uninterested in seeing his friends may be struggling.
- Dark thoughts: Recurrent thoughts about death or harming themselves is a fairly obvious red flag, but pay attention to the music he’s listening to, what they’re writing about, jokes he’s telling, what kind of movies he is watching.
- A sudden drastic change in friends or appearance. A drastic change in appearance may be a way for someone to express he is not happy with who he is or is trying to send a silent cry for help in an attempt to get more attention. A sudden change in friends may also signal anger (frustration/arguments with current friends or disinterest in them).
- Suddenly developing a really good mood or become overly generous. This may seem counter-intuitive but if a person is contemplating suicide and make the decision to follow through with this, in some ways it may be a source of relief. Giving away possessions may be seen as generosity, but may be part of a person’s preparation for suicide.
What do we do? There are clearly no easy answers, limiting screen time, good nutrition and sleep are fairly intuitive (albeit not always easy interventions to implement) but perhaps the most important piece of advice I can give is: talk to your kids, if something seems wrong, ask. There has been a kind of myth or fear that asking someone about suicidal thoughts will give them the idea or motivation to do so, which has been proven many times to just not be true. One of the biggest concerns my kids/adolescents report when they come to see me is that they feel misunderstood, invalidated, or unheard, whether it be by peers, their previous mental health provider, or their family.
“I wouldn’t say a single word to them. I would have listened to what they had to say, because that’s what no one did.” –Marilyn Manson