It’s not easy
American teens are stressed and depressed. As a pediatrician, I see the suicide attempts, the overdoses, and all the new methods that teens are finding to intentionally hurt themselves — to somehow dull the pain.
It’s getting worse. According to recent results from the Stress in America Study, teens are now more stressed out than adults:
• 40% feel irritable or angry
• 36% feel nervous or anxious
• 31% felt overwhelmed due to stress in the past month
•36% feel fatigued or tired, and
•Almost 30% feel depressed or sad
I’m not surprised. Here’s what teen stress and depression look like in my ER, and what parents can do to help:
Prescription drug seeking
Here’s the classic story—teen comes in with perfect story for kidney stones. He’s rolling on the waiting room floor in pain. We put in an IV and give morphine. He feels better. After thousands of dollars of tests and the radiation of a CAT scan, we find no evidence of a stone or any other illness. We were duped. Then he has the nerve to ask for a prescription for Percocet “in case the pain comes back after the morphine wears off.” I tell him the morphine wore off about 2 hours ago. Oops.
I also see kids whose parents are using them as drug seekers. One child sat through about six hours of blood tests and imaging, but we couldn’t find anything wrong with him. He continually rated his pain as “8 or 9” on a scale from 1-10. No matter how much pain medicine we gave him, he didn’t feel better. Then the charge nurse figured out his mother was on our list of patients with a history of drug seeking behavior…
ADHD drug abuse
Nearly 1 in 10 U.S. children have been diagnosed with ADHD. Although it is counter-intuitive to give a hyperactive child a stimulant, stimulants are one of the most effective and most heavily researched treatments for ADHD. Accordingly, more than 4 million Americans take prescription amphetamines, and US amphetamine production more than quadrupled over the past decade. It’s no surprise that so many teens turn to amphetamine abuse to manage stress and depression.
ADHD meds are a quick fix to help you stay up late to finish school work, concentrate during an exam, or get a quick high when you’re feeling down. And it’s not hard to get ADHD for them: Most kids can find some in their own medicine cabinet, usually prescribed for a sibling. No one notices until that child ends up short for a few months in a row. Any teen on ADHD meds knows they can sell their meds whenever they need extra cash. I see these patients when they come to the ER with a racing heartbeat, or when they overdose on all the meds they can find.
Suicide attempts—with a gun
A few times a year I see teens brought to the ER after they were caught holding a gun to their head. I never see the ones who pulled the trigger. Teens who attempt suicide with a gun are the most likely to be successful. I’m a moderate on gun control, but wherever you stand on this issue please get rid of the guns in your home if you have a teen with depression or other mental illness. Every parent whose child attempts suicide tells me a story about why they thought the gun and/or bullets were secure.
Salt and ice burns
It’s a trend on YouTube. “Salt and ice” burns occur when you put salt on ice then hold the ice on your skin for as long as you can stand it. The problem is that the burns keep getting worse, even after the salt and ice are removed. They come in screaming, trying not to cry. The pain is horrific. Sometimes it starts as a dare, but I’ve also seen salt and ice burns as a form of masochism in depressed patients. At first the area is just very red and painful, often requiring narcotics for pain control. Later the burns can blister, and, if not treated appropriately, become infected.
Fad diets taken to the extreme
The Stress in America study also showed that teens aren’t managing their stress well—they aren’t eating well, exercising and getting enough sleep. And our children are getting fatter. According to the National Health and Nutrition Examination Survey (NHANES):
• 31.9% of children and adolescents were overweight (BMI at or above the 85th percentile)
• 16.3% were obese (BMI at or above 95th percentile).
What do overweight stressed out teens do? They try a fad diet. At St. Louis Children’s Hospital we’ve had multiple inquiries from parents regarding the safety of “Plexus Slim” also known as “The Pink Drink.” This diet can be safe (although expensive) when used appropriately, but the recommended “accelerator” contains multiple stimulants and can be abused. Teens that are using fad diets or diet pills often have eating disorders.
Heroin
My heroin patients are middle-class, suburban teens that have good high-school attendance records. Heroin, stress and depression are a toxic mix. Heroin has permeated the midwest in the past few years, and it’s very hard to find any treatment program that will accept these high risk minors.
Marijuana
My patients openly admit they smoke marijuana to treat their depression and anxiety, right in front of their parents. Marijuana isn’t taboo anymore, and my patients see it as an acceptable medical treatment for their psychiatric illness. Except, their marijuana is not prescribed, is poorly regulated (if at all), and they’re not trying counseling or other well-studied treatments that have been shown to be effective.
Psychedelic mushrooms—in peanut butter and jelly sandwiches
In 2006 the U.S. government actually funded a study at Johns Hopkins University regarding the effects of psilocybin, a chemical found in psychedelic mushrooms. Two months after the study, symptoms of anxiety and depression were improved or totally gone. Seventy-nine percent of the participants also reported increased well-being or satisfaction. It’s no wonder that so many teens with depression and anxiety are trying psychedelic mushrooms.
The problem with mushroom patients is that I have no idea what they really took. Real psychedelic mushrooms are expensive and hard to get, so lots of “shrooms” are just regular grocery store mushrooms that have been laced or injected with other substances. Since not every teen loves to eat raw mushrooms, they are often consumed in peanut butter and jelly sandwiches, ice cream, brownies, or other choice foods. Mushroom patients often consumed other street drugs, too. So when they show up in the ER with an irregular heart beat or anxiety, I usually have to admit them for cardiac monitoring.
Alcohol
I see more teens in the ER from alcohol than any other drug. Snow days and school holidays are the worst—days when teens are left home alone while their parents are at work. Mix some Red bull with vodka and you’ve got a quick fix for your stress, anxiety and boredom, until you break your arm and don’t notice it’s broken until your mother comes home from work. The stimulants in energy drinks can blunt the sedating effects of the alcohol, so that teens (and adults) don’t realize how intoxicated they are until it is too late.
Teens usually get their alcohol from their parents. If you have a teen that is showing signs of depression or anxiety, get the alcohol out of your house. Alcohol use increases risk of suicide—1 in 4 suicide victims is legally drunk. If you have a depressed child, leaving alcohol in your home is like handing them gun. Just get rid of it.
The Stress in America study found that about 40% of teens reported they aren’t doing enough to manage their stress. Our children can’t manage stress and depression without us. We need to teach them healthy living—what to do when you feel overwhelmed, tired, angry, depressed, or anxious. If your teen is stressed or depressed, here’s what you can do to help:
Seek professional help—depression is often a fatal illness. Fifteen percent of depressed people commit suicide. Start by seeing your primary care physician, or going to the ER. Your doctor can make sure depression is not related to medications your child is already taking, and run blood tests to be sure that thyroid or hormonal disorders aren’t contributing to the problem. Many primary care physicians will start depressed children and adolescents on anti-depressants so that they don’t have to wait until they can get a psychiatrist appointment.
Encourage exercise. Exercise has been shown to be as effective as antidepressants in some studies. Help your child find some form of exercise they really can do on a regular basis. Go for a daily walk with him/her. Encourage dance. Join an aerobics class together. Dust off our bikes. Take a tennis class.
Figure out your child’s love language, and recognize that it might not be yours. Children need love with words, actions, and physical touch. Everyone needs all three, but most people respond better to certain expressions of love. Does your child need to hear praise and “I love you” more? Is this hard for you to say? Or do they need more physical touch, a hand on the shoulder or a hug? It can be especially hard for some dads to show physical love to boys, but perhaps this is what your child needs. Perhaps your child needs more time with you, one-on-one activities, favorite dinners prepared, or other acts of service even when you don’t think they “deserve” it.
Get outside. A 2007 study by researchers at the University of Essex in England found that a daily outdoor walk could be as effective as taking antidepressant drugs for treating mild to moderate depression. And it wasn’t just the exercise: patients who walked in a shopping mall did not get the same antidepressant effect as those who walked through green spaces.
Expect that your depressed teen can be very irritable and moody. Remember, their bodies have been assaulted by changing hormones. If you’re experiencing menopause or andropause, as many parents of teens are, you might be able to empathize with this point. Weathering the storm of such moodiness can be hard. Take care of yourself. Know when you need to take a break from your teen rather than blow up at them.
Hold your tongue when you want to criticize. Depressed teens and kids and be overly sensitive to criticism. Try not to criticize when you are angry. Choose your words carefully and try to find the most effective way to deliver constructive criticism.
Don’t let them withdraw from you. Depressed teens often withdraw from parents, and they can push you away by being very unpleasant to be around. Your job as a parent is not to abandon them.
Help them contribute to your family. Give them manual labor jobs. Paint the house. Pull weeds. Play games with younger children or ask them to hold a baby (with your supervision).
Help them help other people. Do service projects. Serve food at a soup kitchen, volunteer for Habitat for Humanity, raise money for a charity. Try to find ways to help your child think less about themselves and more about others.
Limit time on Facebook and social media. In 2011 the American Academy of Pediatrics coined the term “Facebook Depression” and warned that too much time on social media could lead to adolescent depression. This claim has been disputed, but I think it’s still important to realize that social media can’t replace an in-person or even telephone relationships. One study of girls in stressful situations found that those who spoke with their moms on the phone had lower levels of stress hormones after the call than those who conversed with their moms via text messaging. People “market” themselves on Facebook, painting an idealized version of themselves that leaves out reality. Teach your child to market themselves when they need a job, not when they need a friend.
Encourage healthy eating. Yes, diet matters. There is no dietary cure for depression but what you eat can affect your mood. I had one depressed teen tell me all she had eaten that day was smiley face fries and Twizzlers. Limit caffeine and junk food. Don’t skip breakfast and watch school snacks and lunches. Eat a balanced diet and use common sense. There is growing evidence that omega-3 fatty acids and vitamin D may be effective in improving depression symptoms.
Address addiction. Drugs, alcohol, food, the internet, pornography, sex, and reckless behavior can all be addictive. I’ve even seen kids addicted to eating non-food products such as paper or hair. Watch for addictive behaviors and address them early.
Take care of yourself. Taking care of kids with depression is exhausting, even depressing. Many parents feel helpless, or have a desire to give up. Violent behavior and disrespect for household rules leads many parents to kick depressed teens out of the house, or let them run away. You can’t take care of a depressed kid unless you first take care of yourself.This was true when your child was a newborn, and it’s still true now. Like they say on the airplane, put your oxygen mask on first, then assist your child.
Someday your child’s depression may turn out to be a gift to them—a life experience that will make them stronger, more compassionate, and better prepared to live a healthy adult life outside of the home. Perhaps it’s a good thing that so many of our children struggle with mental illness while they still live under our roofs. This is our chance to help them learn to live with depression and cope with the stresses of life. They shouldn’t face these challenges alone.
