In the midst of the pandemic, we have seen a rise in depression, anxiety and suicide in adolescents, particularly females.
One recent meta-analysis concluded that after the first year of the pandemic, “1 in 4 youth globally were experiencing clinically elevated depressive symptoms, while 1 in 5 youth were experiencing clinically elevated anxiety symptoms.” These were double pre-pandemic estimates. Another report from the CDC reported a 30% increase in hospital visits for suicide attempts for persons age 12-25 in the last year and half.
This is also what I see consistently in my practice. Even when I was a clinician in a community mental health facility 20 years ago, depression, anxiety and attentional challenges were the most common reasons children came to our clinic. Now it is more prevalent than ever and I wish I knew then what I know now about how to support the brain, the body and the heart of young people. What I do know is that there’s not a one-size -fits-all treatment.
With this rise, there is also an increased need for quality care that encompasses the whole person including therapy, appropriate medication support, nutritional support and social infrastructure. A holistic approach, with a root-cause focus, can be personalized and comprehensive. But most importantly, families need care and guidance to understand how to support their teens. Here is a guide to help get started, regardless of what stage of the journey you’re in.
ASSESSMENT
How do you know if your child is actually clinically depressed or anxious? We all feel sad and worried at times… but there are thresholds that impact our ability to carry out daily functions, and this is where we need to pay attention. Depression and anxiety can look slightly different in teens than adults, and they may not understand what is happening if this is new.
There are many root causes for anxiety and depression:
- Genetic: Your family has a history of depression and anxiety and these patterns were passed on in your DNA.
- Brain Chemistry: This can go hand in hand with genetics, but stressors, including normal brain changes in adolescence, may trigger alterations in the function of our neurotransmitters that impact mood and nervous system function.
- Diet and Nutrition: When certain nutrients are depleted in our bodies, it has a domino effect in our gut, cells, and in turn, the brain and nervous system function. Gut health equals brain health and what we put in (or don’t put in) can impact our thinking, our mood and coping mechanisms.
- Early Childhood Trauma: Adverse Childhood Experiences, or ACEs, including violence, abuse, divorce, and other stressful events have been found to increase the likelihood of depression and anxiety as well as asthma, obesity and cancer.
- Learned Behavior: We learn coping skills from our family and community. Those thoughts impact emotions, which affects behavior. If we are modeled negative self-talk, rigid thinking or blame and shame from those around us, we may use those strategies for ourselves.
Why focus on depression and anxiety together?
Because they are so connected with 50% of people who have one, have both. Depression can lead to thinking that focuses on the past: what went wrong, what is broken and can’t be fixed, often accompanied by a hopelessness to change. Anxiety tends to fixate on the future, anticipating what could go wrong with a need to control variables to ensure the desired outcome. We all fluctuate through experiences of sadness, frustration and worry, but clinical depression and anxiety mean these experiences are embedded so deep and wide they begin to impact daily functioning and relationships.
SUPPORT
Depression and anxiety can induce a spectrum of responses to internal and external beliefs and stressors. A holistic approach must take into account not only the root causes, but the inputs and outputs that keep the person stuck in an unhealthy pattern . So let’s break it down by four key areas:
Body:
The biochemistry of the depressed or anxious brain can be equated to a car engine. If the spark plugs are misaligned or misfiring, the car will not run smoothly. It may also be out of gas or have a flat tire. Oftentimes medication is introduced, which can act like the gas or the air in the tire, but if you put in too high of an octane or the tire still has a puncture, you aren’t really dealing with the root cause of the problem.
Antidepressants and anxiolytics are wonderful tools for lifting the fog and gain focus. The downside is that most medications deplete nutrients even further. And data shows that nutrient deficiency is a major cause and perpetuator of depressive and anxious symptoms and cognitive decline. Regardless of whether you take medication, here are some nutrient levels that should be tested regularly to determine how much to supplement.
- Vitamin D: 70-80% of the population is considered vitamin D deficient. We know vitamin D impacts immune, brain and HPA axis functioning. Multiple studies have shown positive effects on mood and brain functioning with sufficient vitamin D levels. This fat soluble vitamin can be detrimental in doses too high or too low. Get tested regularly to ensure appropriate and adequate supplementation.
- B12 and Folate: Two essential nutrients responsible for methylation that supports brain and nervous system function along with optimal energy.
- B6: An essential nutrient responsible for building neurotransmitters including serotonin, GABA and dopamine. These are all related to mood, sleep and nervous system function.
- B2 (Riboflavin): B2 is required to make B6, and is necessary for energy metabolism. Deficiency can lead to sluggish thyroid, low energy and skin issues.
- CoQ10: Found in every cell of the body, this antioxidant helps clear free radicals and produces energy in the body. Without it, we see increases in brain fog, reduced concentration and depression.
- Magnesium: This is an essential mineral responsible for more than 300 functions in the body, including the firing of neurotransmitters, hormones and enzymatic functions. Most people are deficient in magnesium, resulting in muscle weakness and cramping, headaches, nausea, insomnia and even suicidal thoughts.
- Zinc: Necessary for immune and metabolic function. Zinc has been found to improve depression and anxiety with sufficient levels.
- Melatonin: A hormone that impacts our circadian rhythm, including sleep/wake cycles. Deep restorative sleep is necessary for optimal brain and mood health. I do not recommend regular supplementation of melatonin, but it can be used periodically to help a person get back on track.
To see my recommended protocol for mood health head here. Additionally, dessicated liver supplements, like those from Ancestral Supplements, are key to getting whole food nutrients that are highly bioavailable like Vitamin A, B12, folate, B2, zinc and choline.
Focusing on nutrient sufficiency early and often can prevent or reduce the negative effects of using pharmaceutical medications. Ask your doctor to run labs for these nutrients or enlist a nutritional therapist like myself, who can run blood labs to identify if nutrient deficiency is a root cause for your child’s symptoms.
Mind:
One of the most important, yet highly stigmatized strategies for disordered moods, is therapy or counseling. It is a key component for diagnosis and building necessary skills. Here are a few to consider based on the type and severity of challenges one is facing in no particular order or preference:
- Eye Movement Desensitization and Reprogramming (EMDR): This is a highly researched, specific treatment modality therapists are trained in. It is used primarily for recovery after traumatic or distressing life situations leading to PTSD, depression, anxiety and panic attacks. It is not a talk therapy focused on thoughts, emotions and behavior, but rather uses lights and eye movement to help the brain and nervous system recover and heal. It typically only requires a few sessions.
- Cognitive Behavioral Therapy or CBT: This is a highly researched and widely used modality. It combines both cognitive and behavioral therapies that concentrates on negative thought patterns and behaviors associated with anxiety and depression. It focuses first on identifying negative response patterns, then teaches new or more positive responses to triggers.
- Dialectical Behavior Therapy or DBT: This is a newer treatment modality based on CBT, but incorporates more than just identifying the pattern. It includes acceptance and validation of negative emotions. There is a greater focus on relationships than CBT and includes more mindfulness practices as well.
- Somatic Experiencing or SE: It was developed by Peter Levine PhD. as a body-focused approach to healing from trauma and significant stressors. SE has become a highly effective holistic approach to depression and anxiety since trauma is a leading cause of both. Because we store trauma and stress in our bodies, SE is a gentle approach that focuses on the nervous system, releasing motor responses that are stuck in fight, flight or freeze responses from early stressors. When we learn to tolerate sensations in the body and suppressed emotions, we are better able to cope with everyday stressors.
One or more of these approaches can work in individual, family and group therapy to support the mind and body. When it comes to working with teens, I encourage a combination of all three to allow for the individual and collective support needed to cope with depression and anxiety.
Social:
This leads me to the social aspect of treatment for teens. No young person lives in a vacuum, and many of the challenges in depression, anxiety and potential suicide is the sense of shame and isolation.. Stories flourish in our minds and when not spoken aloud, are allowed to weave and take root, creating rigid thinking. Yet, when we bring the shame and pain to light, they lose their power. . We can only do that in the presence of another. Individual, and group therapy, with peers, is powerful,along with mentorship.
I am a big fan of mentorship, pairing a teen with an older teen or adult who has had similar experiences, someone who can be real, listen and direct them towards greater support when needed. Programs like Boys and Girls Club of America, Mentoring.org or Girls Rising are a great place to start.
Spirit:
Spiritual practice has been supportive of mental health. Studies have demonstrated that belief in a higher power, the importance of prayer, and finding meaning through challenges were effective antidotes to depression. Significant research has shown mindfulness, meditation, and other spiritual practices are supportive in the treatment of depression and anxiety. My estimation is that the sense that faith and trust in a greater plan can be comforting for many. It can be as simple as:
- Using an app like Headspace to develop a simple practice of meditation
- Keeping a gratitude or affirmation journal
- Attending religious or other spiritual services that are accepting, supportive and open to all genders, orientations, ages and backgrounds.
- Singing, dancing, chanting
These should not be used in lieu of therapy and other treatments, but as adjuncts to support their care.
In Conclusion:
Addressing the needs of a teen experiencing symptoms of depression and anxiety can be scary. Especially if those symptoms include self-harm or suicidal thoughts. Navigating the mental health and medical system can be confusing and overwhelming for most.. Many teens will not tell you they are struggling, but their behavior will. They must be taken seriously, but in a supportive and loving manner. Punishment or isolation for behaviors associated with depression and anxiety are counterproductive and may lead to actual self-harm by the teen.
For parents concerned with the mental health and well-being of their child, I encourage you to reach out for support immediately. You can speak to a doctor, school counselor or therapist if you need support. I am also available for consultation to help you determine the next best steps for your child’s care.
To book a free 20-minute discovery call, schedule here: https://calendly.com/amysaloner/20min
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Resources
https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181193/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874849/
https://www.sciencedirect.com/science/article/pii/S0028390811003054
https://link.springer.com/article/10.1007%2Fs00726-008-0195-6
https://www.psych.theclinics.com/article/S0193-953X(12)00100-1/fulltext
https://www.sciencedirect.com/science/article/abs/pii/S009130571300004X
https://pubmed.ncbi.nlm.nih.gov/23377209/
https://pubmed.ncbi.nlm.nih.gov/?term=vitamin+d+and+depression