Teen Depression in the Pandemic

This week’s guest columnist is Dr. Stephanie Barrow, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

A 16 year-old girl saw me in clinic after she’d told mom she was feeling down. Prior to the Pandemic, she’d been a spirited teenager, involved in student council, the Welcoming Committee, and intramural sports. After school closed last spring, she went from being busy every day to having nothing to do for months. She started isolating in her room, sleeping more, eating less, and becoming irritable with family.

Since the beginning of COVID, we’ve seen an uptick of patients with depression. Some  are having symptoms for the first time in their lives. Scariest of all, in the past month we’ve had an epidemic of adolescent overdoses. Every day at least one teen’s come to the Emergency Department having taken whole bottles of their medication, or someone else’s. One girl took fistfuls of several of her grandmother’s medications, any one of which could have been lethal.

My 16 year-old patient had a more common presentation of depression. Her world was turned upside down, like everyone’s this past year. Stuck at home with only social media and family, she felt trapped in four walls, and trapped in her own mind. She went from wanting to be with everyone and involved in everything, to closing herself in her room and even minimizing social media interactions with friends.

When we see kids like this in clinic or the ER, one first thing we do is check for metabolic causes for depression, like thyroid disease or drug use. We also ask questions to assess the symptoms and severity. His he feeling like a failure?  Has he lost interest in favorite activities? Trouble concentrating or sleeping? Appetite changes?  Moving more slowly? Even more worrisome: has he had suicidal thoughts or worse, attempted suicide in the past and not told anyone?

We set my patient up with a counselor and started an anti-depressant. She slowly improved with video counseling and the medicine, and mom saw a positive change. She began to feel like she had her daughter back.

Once my 16 year-old patient was doing better, mom brought in her 13 year-old brother. He was always an introvert, keeping to himself and never having many friends. However, recently he began sleeping poorly and barely eating. In clinic, he stated that he felt like nothing he could do was good enough. During my interview, he was slow to answer questions, mumbled, and wouldn’t make eye contact.

We knew his sister had depression, and counseling and medication had worked for her, so we tried that with him. Just one month later when he returned for a check-up, I could tell he was a new boy the moment he walked in. He looked all around and asked a million questions, and when he sat down he didn’t slump like a sack of potatoes; he sat straight up, looked me in the eye, and smiled! His sister was excited too, because earlier that week he spontaneously hugged her, which he hadn’t done for over a year.

Both my patients are so far having happy endings to their depression. Unfortunately, not all kids have that. As we mentioned above, we’ve seen a spate of suicide attempts by overdose recently. While some of those teens have had life-long depression and even admissions to psychiatric facilities, we’re seeing more and more with no previous histories.

It’s sometimes difficult to know what’s on a child’s mind. Knowing was less of an issue when they were going to school five days per week, interacting with teachers and schoolmates, and busy with school work and extracurriculars. And early in the Pandemic children could coast along with electronic interactions. As things linger though, they’re getting just as fed up with it as adults are. Many are also dealing with illness and death in loved ones and friends.

If you’re suspecting a child’s depressed, seek help immediately. Your kid’s doctor, your priest or pastor, the school, or counseling centers have resources to help. At home, restrict access to medications, lock away guns or keep them out of the house, monitor your kid’s on-line activities, and just talk to them about depression. Depression, and the Pandemic, aren’t quite going away just yet.

School Blues

On my first day of medical school, the dean gave a little speech about how it’s stressful, and that the school had a counseling center for students when their anxiety got overwhelming. Though the course work is intense, the dean said, most visits to the center “are about a girl.”  Everybody laughed- relationship trouble worse than medical school?  I laughed too, until 2 years later, when I found out my girlfriend at the time was seeing someone else; two weeks before a major exam that if you didn’t pass, you got held back a whole year.  Turns out the counseling center was pretty cool.

We see lots of anxiety, and anxiety-related symptoms, in the Pediatric Emergency Department.  Sometimes the kids come right out and say, “I’ve got anxiety,” and describe their depression, negative thoughts they can’t control, their feelings of impending doom.  Often though, they come in with symptoms that freak everyone out: trembling, shortness of breath, complaints of chest and throat tightness, even seizure-like activity.  Everyone is concerned that the teen is having an asthma attack or severe allergic reaction, when these symptoms are actually how he’s experiencing a panic attack.

We usually see these kids coming from school.  The child starts having these worrisome symptoms, a school nurse isn’t available to calm everyone down, and the ambulance is called.  By the time the stretcher wheels through our door, the kid’s back to normal, and it’s time for us to determine if this was a real allergic or asthmatic episode, or was it anxiety-related behavior.

Schools are a stressful place for children.  For most of their day, kids are immersed in multiple, continuing, unrelenting social interactions.  Often those interactions are good: laughing with friends, learning cool things with a favorite teacher, horsing around at PE or recess.  Sometimes they’re not so good.  Bullying is still mostly a school phenomenon, when a strong-willed kid and her group gang up on someone vulnerable.  Maybe the child’s having trouble with academic achievement, maybe add an unpleasant teacher, or a break-up..  All kids struggle with their sense of self-worth; put them in this pressure-cooker environment, and sometimes bad things happen in their heads.  It’s a wonder ambulances don’t get called more often.

My son’s college transcript showed that he failed Business Law, a bad start for a kid thinking of going into…business law.  After emailing his professor, he stumbled through the day in a haze of misery.  When he found himself enjoying something- a joke or nice weather, the happiness was quickly extinguished by the thought, “I’ve failed.”

Later that afternoon his professor replied- it was a mistake. My son’s final exam grade hadn’t been entered into the system, triggering the fail.  It would be fixed, and he breathed an enormous sigh of relief.  But it still took some time to shake that dread that had haunted him.  Anxiety can be sticky.

We’re born with a need to be anxious.  It’s an ancient motivator from evolution, keeping us from getting eaten.  Worried about that sabre-toothed tiger eyeing you? Good, run away!  Even animals as primitive as lizards have anxiety.  Just approach one, watch it twitch and scuttle about, before tearing off.

Anxiety has been rising in past decades. Most families worry about money. Despite corporate economic gains, people’s buying power has declined, as their wages remain stagnant against rising costs.  There’s also growing distrust in institutions meant to protect us, like law, medicine, and government.  Finally, there’s the 24/7 news cycle, the channels and websites finding more bad news (crime, war, injustice, political bickering) to keep us glued to them and their advertisers.

Children get anxiety too.  Not only do they get it at school, as we described above, but it’s fed by their parents’ anxieties too.  When parents hear that the world is spiraling to destruction, kids hear that too.  Sometimes they get symptoms like we discussed above- palpitations, trembling, tight chests- and come to the Emergency Department.

When kids’ anxieties interfere with their lives, counseling and sometimes medication  help.  However, prevention is always better.  The world’s actually a safe for you and your kids. I’ve visited countries that, in news stories, are constantly violent.  Yet I see people instead living in peace. New York City used to be portrayed that way, but really wasn’t more dangerous than Disneyworld.  And institutions like government, medicine, and law, still work quite well.  Teach your kids that the world’s okay.  And maybe turn off the cable news.

High Anxiety

My son’s transcript showed he had failed Business Law, a bad start for a kid considering applying to law school for…business law.  After emailing his professor to ask the particulars, he stumbled through the day in a haze of misery.  When he found himself enjoying something- a joke or nice weather, the happiness was quickly extinguished by the thought, “I’ve failed.”  One big worry: how was he going to explain this in a law school interview?

Later that afternoon his professor replied- it was just a mistake. My son’s final exam grade had not been entered into the system yet, which triggered the fail mark.  It would be fixed, and my son breathed an enormous sigh of relief.  But it took some time to shake that feeling of dread that haunted him for half the day.  Anxiety can be sticky.

Many teens, and elementary school kids too, are plagued by anxiety.  There’s school- worry about grades, fear of bullying, tense relations with teachers.  Home can make a kid anxious too- divorce, yelling, sometimes abuse. Many kids have concerns about their neighborhood- they have to live with the threat of crime, violence, and drug dealers on the corner.  Finally, kids see the news too, and worry about the world.  They hear stories about environmental collapse, threat of deadly epidemics, and the possibility of nuclear armageddon.

We are born with the tendency to be anxious.  Anxiety is a motivator cultivated by evolution, keeping us from getting eaten.  Worried about that sabre-toothed tiger eyeing you?  Good, run away!  Even animals as primitive as lizards have anxiety.  Just approach one, watch it twitch and scuttle about, before tearing off.

Some kids and adults are better at handling anxiety than others.  And many kids have manifestations of anxiety that look like illness.  That’s when we see them in the Emergency Department.  Sometimes the signs in kids are subtle- headaches, stomach aches, fatigue.  Sometimes they have more concerning symptoms, like chest pain or fainting. And occasionally we see true panic attacks.

When I was in high school, worried about getting grades good enough to be a doctor, I failed a french test.  The big red “F” on the paper burned into my brain at first period. But it wasn’t until fifth period that I became shaky, broke out in sweat, and was led sobbing to the nurse.  She called my parents to admonish them about putting too much pressure on me.  My mom replied, “It’s not us!  The stupid doctor thing is all his idea!”

Anxiety can make kids short of breath, and thus parents bring them to the Emergency Department. Some are just hyperventilating, but kids with asthma can have true attacks triggered by anxiety.  In fact, in the mid-twentieth century, when medicine was full of freudian theory, many thought asthma was a psychological disorder.  Even in the face of real wheezing, the noise was attributed to patients’ “suppressed cries for help”- wheezing was those cries fighting to get out. Fortunately, asthma is now recognized as true disease.

Sometimes it’s hard to tell the difference between a panic attack and medical emergencies like asthma.  Both kids have trouble breathing.  Both complain about chest pain and tightness.  And whether their shortness of breath is due to airway narrowing or panic, either kid looks anxious!  Occasionally it can be tough for even doctors to tell panic attacks and asthma apart, despite stethoscopes and oxygen monitoring.

How do we manage anxiety?  Kids handle anxiety differently.  Some aren’t bothered by stress, those proverbial ducks letting worries roll off their backs like water.  But some need help.  Counseling can help kids tell the difference between true medical problems like headaches and stomachaches, and those symptoms being triggered by worry. Many don’t recognize when they’re having anxiety, and knowing if you’re anxious, and why, is a big step in coping with it.

Counselors can also help kids identify management strategies.  For some, exercise helps “burn off” anxiety.  For others it’s prayer, meditation, yoga or other relaxation techniques.  A few kids need medication, to temporarily get them through rough patches as they learn to cope.

If you think your child is anxious, talk to them about their feelings, and maybe see their doctor to explore it more.  You want to do that before worry becomes panic attacks, and needing to come see me.