World Mental Health Day: Part 3, Tweens

Once in awhile I get a chance to think a lot about what my patients come to see me about. And let me tell you, there are a few themes I want to discuss here.

Do you have teens in your life, those energetic, tech savvy, millennials whom I can barely keep up with, travelling around the world and asserting fierce independence? I am so impressed by their energy, their vision. For many kids, the transition through the teenage years plays out like your first time on a wooden roller coaster.

Pay attention to new symptoms like headaches and abdominal pain. Sometimes these can be symptoms of mood changes- your body’s reaction to stress and mood changes. Symptoms of depression and anxiety are not obvious, increased irritability, missing school and work, avoiding activities that used to be fun and enjoyable. Excess or missing sleep, changes in appetite, poor concentration are all possible symptoms of depression.

Are you noticing these changes and wondering what to do next? First of all, there is no “normal” way to make it through the teenage years. Your frontal lobe (in charge of planning, impulse control, rational thinking and filtering your responses) is just in development and it can be very confusing. Teens are living in the moment, pressured by peers and social media. Symptoms can come and go, great days and bad days. But symptoms of depression or anxiety will stick around more days than not, over more than just a few weeks. And there may not be any good “reason” for these to come up in an otherwise healthy teen. I cannot stress enough, there is no right or wrong way to live your teenage years. You don’t do anything that brings on depression and anxiety. This is a clinical diagnosis, like diabetes or high blood pressure, that needs a medical visit and a proper diagnosis and you cannot just “snap out of it”. We cannot bring more shame onto these symptoms. I promise you these kids are feeling pretty darn bad about not feeling normal- they are too confused and feeling bad enough as it is for us adults to bring more shame upon them. I get all fired up about this because shame is such a powerful tool. You do not make yourself depressed, you can make some changes to help your symptoms, which I will let you know about later, but again, this is a MEDICAL DIAGNOSIS. Just like we don’t blame our patients with high cholesterol, restless legs, or migraines- we cannot blame people for being depressed or anxious. I promise they feel bad enough all on their own. So let’s pay attention to what symptoms we see, mood changes, changes and withdrawing from activities, and let us start supporting our friends and family. Start an open conversation, draw from what you see— “I notice you haven’t been going out as much, is there anything going on that you want to talk about?”. Try, try, try not to put labels on it – state what you see. Normalize this with your own experiences if you can. Most of us have felt similar symptoms at some point in our lives, I know I have.

So now what? We feel like there are enough symptoms and things don’t seem quite right. You need to talk to a medical doctor or nurse practitioner.

Let’s prepare for that visit.

Bring with you a list (or bottles) of all prescription medication, over the counter herbal supplements, vitamins, anything your teen is taking on a regular or as needed basis. Prepare for a 15-30 minute visit in most cases. There is evidence that we will interrupt you after less than 30 seconds, so be ready to get that information out right away. If your teen is willing, come into the visit with them so you can express your concerns about their mood and physical symptoms. Your doctor will want to know when the symptoms began, what symptoms are present, what brings them on, how much they are interfering with everyday activities like school and work and relationships. We will ask a bunch of questions to rule out alternate diagnoses, like thyroid dysfunction, anemia, etc. We will ask about your eating, mood, concentration, weight changes, bowels, sleep, medications, substances, school functioning, previous diagnoses and symptoms. Knowing your family history is also important as mood disorders do have a genetic tendency. Other diagnoses like learning disability, bipolar disorder, substance abuse, are also going to be considered. Don’t be surprised when your primary care provider asks you to leave so we can talk to the patient alone. In Ontario, there is no age of majority, and we really need to give our patients a change to confidentially talk about their symptoms and share what’s going on. That part of the visit stays confidential unless the patient is at risk of harming others or feeling suicidal. Then in Ontario, we have an obligation to disclose that information to keep our patients safe.

So what’s next?

In the case your doctor is also concerned about a possible diagnosis of mood disorder, likely some blood tests to rule out other medical diagnoses (remember that mention of thyroid and anemia?). The mainstay of treatment of depression and anxiety circles around cognitive behavioural therapy () and medication. I’m not going to talk about medication today, as its a huge discussion. But it has a role, its generally safe, effective, and used in kids and teenagers under the care of a medical practitioner.

Sometimes the most helpful thing is just checking in and being present. You may or may not understand what your teen is feeling, but you can be there to support them when they are ready to talk. You may not have experienced specific depression or anxiety, but I’m sure you know a feeling of not being enough, of uncertainty, shame, embarrassment, loneliness, sadness, guilt, confusion, frustration and anger. Can you share those? Because although I’m seeing lots of teenagers presenting in my office with mood changes, abdominal pain and headaches related to their moods, I’m seeing JUST AS MANY, if not more adults with the same symptoms. Seriously it is THE most common reason I see people in my office. There is truly an epidemic of mood changes and stress in our society.

Get outside. There is evidence that being out in nature and physical activity can reduce some of the symptoms of depression. Remember, motivation FOLLOWS action. Get a routine going, same time to bed, same time awake. Fill your body with healthy, whole foods and water. Avoid caffeine and substances.

Follow up.

Keep regular appointments with your health care provider, follow up, ask questions, keep a notebook of questions, symptoms, response to medication and therapy. Seek support for yourself- caregiver burnout is a real thing. It is exhausting being around someone who is in their own battle with a depressive or anxious disorder, but you need to take care of yourself so you can be there for them. Be open, there is no shame and there is nothing you have done to create these symptoms.

Do your own research. I’ll leave you with some tools, readings, information and support. You are not in this alone. But this will be work. Like training for a marathon or learning to change your tire, this will be work and you need to participate. There is no quick fix. The idea that most of us can just feel fine all the time without any work is just NOT reality.

Some final thoughts.

If you’re reading this, you are already getting involved about understanding mood changes and how our body can create physical symptoms as a result of symptoms of depression and anxiety. You are already wondering about your teen, or someone you know who may be experiencing symptoms of low mood, sadness, irritability, mood swings, sleep changes and who is withdrawing from activities. Thank you for being honest about these symptoms, for being thoughtful about the possibility of depression or anxiety, for putting a name to it. Take away it’s power. Take away the shame, the guilt. Let’s start the healing process. We have such a short time on this earth that we cannot waste it worrying about other people’s opinion of us or our family.

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