TEENAGERS AND DEPRESSION
It’s a critical issue, experts say
Last month, the American Academy of Pediatrics (AAP) created a flurry of excitement by releasing new guidelines for depression screening for teens. The AAP suggested that all teenagers be screened at least once a year for depression.
What triggered this response? Why does it have to be all teenagers? Could this be a “scheme” by doctors to over-diagnose depression and then over-prescribe medication, thus benefiting pharmaceutical companies? Why are teenagers these days so depressed? How were teens able to cope in the past?
These were some of the questions and concerns that followed the AAP’s release of guidelines when I scrolled through the comments sections of various major newspapers and social media sites.
The reality is that more and more physicians encounter depressed teens every day. In my own clinic, not a single day passes without encountering at least one or two teenagers with mental-health issues. When I first started my practice 31 years ago, it was not so.
The trend is described as “a huge problem” by Er. Rachel Zuckerbrot, associate professor and psychiatrist at Columbia University. Zuckerbrot helped write the AAP’s guidelines.
The report cites that only 50 per cent of adolescents are diagnosed, too many are diagnosed too late, and that two in three depressed teens fail to get the appropriate help.
Suicide is the second-leading cause of death for the age range of 10 years to the early 20s. It thus makes a lot of sense to identify early all those who are at risk. Failing to do so not only leads to suffering in families, but it has a ripple effect on communities.
Sadly, the medical system is falling short, in that most physicians admit they were not properly trained to deal with mental-health issues and there is a shortage of psychiatrists. Fven in an egalitarian society such as in Canada, there is a definite two-tier system because most families do not have the financial resources to afford psychologists.
Not many doctors are keen to embark on a career in developmental and behavioural pediatrics and one must wonder why.
In a report published in the March 2018 edition of Pediatrics, Er. Carolyn Bridgemohan and her colleagues lament the fact that “there is a limited pipeline” of new doctors entering the field of developmental-behavioural pediatrics (EBP). Reporting on her efforts to survey clinicians working in the field, she concluded that dark times lie ahead because more and more caregivers in this field are suffering burnout.
The doctors’ burnout is related to increased patient complexity, long wait times and plenty of additional time spent per visit in non-reimbursed clinical-care activities such as paperwork, calls and dealing with schools and other mental-health workers.
(It should be pointed out that the Alberta Medical Association has an arrangement with government to reimburse doctors for work that needs to be done apart from the actual clinical encounter, such as letters, telephone calls and co-management with psychiatrists. Not all jurisdictions in Canada allow that to happen.)
It is not unexpected that various experts would want to weigh in on the causes of an everincreasing number of depressed teenagers. Some claim that it simply is a case of parents failing to connect better with their children. Supposedly, if parents built strong relationships with children from a young age and maintained that, all will be well.
Hordon Neufeld, author of a popular book, Hold on to Your Kids — often recommended by psychologists and family therapists — bases much of his work on attachment parenting.
Personally, I saw a huge shift in mental-health concerns around 2007. It was the year smartphones saw the light. I call these devices the new cigarettes. When I am in a mischievous mood I tell my patients that these devices, although called smart, made us E.U.M.B. (distracted, unable-toexist-without, materialistic and boring).
Clearly, electronics are only part of the problem.
Ean Siegel, a psychiatrist, expert on the adolescent brain, and New York Times bestselling author, coined the term “mindsight.” In his book, Brainstorm, which I consider a must-read for parents, Siegel meticulously dissects the various ways a teenager’s brain functions, but he also gives seven very simple and practical ways to enhance mental health or, as he calls it, “create a healthy mindsight.”
Siegel describes seven mindsight practices: Time-In; Sleep Time; Focus Time; Eowntime; Playtime; Physical Time and Connecting Time.
The motive of the AAP in encouraging pediatricians to screen all teenagers is not a case of being politically correct, or to get more children on medication. For more information on this critical topic, see www.aap.org/en-us/ about-the-aap/aap-press-room/ pages/AAP-Publishes-TeenEepression- Huidelines.aspx.