Mental health and well-being have become a rising concern in our adolescent population. The last couple of years specifically have impacted children's mental health to a great extent. During COVID-19, the rates of childhood depression doubled globally compared to pre-pandemic numbers. A study of 80,879 kids found that 20.5% of them were experiencing depression. Additional numbers show that 15% of American teenagers (ages 12-17) suffered from at least one major depressive episode in the past year. With these stark statistics, it is essential that we utilize both conventional and integrative medicine to address this mental health crisis.
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What is Depression?
Depression is a mental health mood disorder in which the person will feel persistent unpleasant feelings such as sadness, irritability, or hopelessness. These feelings tend to disrupt an individual's ability to function in activities of daily living. Children can experience depression similarly to adults, but the manifestation of their symptoms may not come out in the same way. Adolescent depression is immediately concerning, but the long-term repercussions also raise a red flag. About 60% of childhood depression re-emerges in adulthood, often with more severe consequences such as suicide.
Signs of Depression in Teens
The most common indicator of depression in teenagers is sadness for no apparent reason. Each adolescent may present differently. In sadness, you could see any or many of these signs of depression in Teens (13-18 years old):
- Diminished interest in preferred activities
- Physical complaints- headaches, stomachaches, low back pain
- Fatigue
- Substance use-alcohol and drugs
- Excessive or unjustifiable guilt
- Irresponsible behavior- being late, skipping school, forgetting obligations
- Low appetite or overeating
- Rapid weight loss or weight gain
- Memory loss
- Increased thoughts on death-related topics
- Increased rebellious behaviors
- Unexplained crying or feelings of hopelessness
- Anxiety
- Daytime sleeping and staying up too late
- A decline in school grades
- Excess sensitivity to failure or rejection
- Social withdrawal and isolation
Possible Causes Of Depression in Teens
Each individual responds differently to bodily changes and life events. In the case of depression, there are five key areas that cause teens to experience depression.
Genetic Implication
Inheritance of depression is higher in those with a family history of mental health conditions. Major depressive disorder is said to have a heritability range of 30% to 50%, making it fairly capable of being passed on to offspring. While there is no single gene that is responsible for this occurrence, it's been postulated that a compounded effect of several genes in contributing to the genetic risk factor. A handful of genes are being studied independently to determine if they influence depression outcomes.
Brain Chemistry
The firing component in the brain are signals called neurotransmitters. These chemical messengers signal other brain and body parts to facilitate neuron activation. An imbalance can negatively impact the nervous system and areas of the brain that need these neuronal connections to function. Monoamines such as serotonin, dopamine, and noradrenaline have been the main focus regarding neurotransmitter imbalance and depression. Depletion of monoamines leads to negative effects in areas of the brain, like the frontal cortex and amygdala, which assist in decision-making and emotional regulation. Within the last decade, further investigations have discovered that the excitatory and inhibitory neurotransmitters, Glutamate and GABA, impact mental health when these molecules are diminished or out of balance with one another.
Hormone Fluctuations
Teens experience many hormone changes as they enter puberty. Sex hormones play a dynamic role in brain health. Since they fluctuate during adolescence, they can impact mental health. One aspect to consider is compounded stress, its effects during puberty, and how that can increase the risk of developing depression. Chronic stress can alter estrogen receptors in the brain, changing how the brain responds to hormones and ultimately causing cognitive and emotional disruption. Thyroid dysfunction, both hypothyroid and hyperthyroid conditions, can impact one's well-being. Thyroid hormone is regulated by the hypothalamus-pituitary-thalamic (HPT) axis. When this pathway is not operating at all levels, it can disrupt thyroid hormones- Triiodothyronine (T3) and Thyroxine (T4) from reaching parts of the brain that impact behavior.
Traumatic Experiences in Early Childhood
Events in childhood that cause mental, emotional, or physical trauma can impact their psychological health. A meta-analysis revealed that maltreatment (physical or sexual abuse, neglect, violence, or family conflict) in childhood increases the risk of developing depression at any point in life. Trauma of this nature can also increase inflammation in the body and be a predisposing factor for illness. Knowing this can help you and practitioners address depression risk factors in a preventative manner.
Learned Negative Thought Patterns
A child's train of thought can impact mental health. One study looked at repetitive negative thinking (RNT) in adolescents. RNT in depression is typically associated with rumination, which is a fixation of thoughts around negative symptoms they're experiencing or past events. Cognitive distortion is also correlated to depression. This entails thoughts that result in an individual perceiving an inaccurate reality. This can affect how one processes incoming information, impacting behavior, mood, and interpersonal functioning. Studies on cognitive distortion are the basis on which cognitive behavioral therapy is applied as an intervention for depression.
Functional Medicine Labs to Test for Root Cause of Depression in Teens
Investigating the root cause of teenage depression could be challenging. More than likely, it is multifactorial and complex. Ruling out known causes by doing functional lab testing is a helpful way to get to solutions in the quickest amount of time.
Sex Hormone Testing
If a hormonal imbalance in teens is a suspected culprit to their depression, the Sex Hormones Profile, by Doctor's Data, could lend the way to therapeutic interventions. This will provide a snapshot of thirteen sex hormones and related biomarkers. Any imbalances present provide context for areas of support in your care plan.
Thyroid Panel
A full Thyroid Panel will determine if your symptoms are connected to thyroid hormones or autoimmune markers related to the thyroid gland. It's important to rule this out as a negative contributor to brain function. Thyroid conditions can be concurrent with depression, in which you'll want to address both areas.
Metabolic Assessment
Metabolic processes that take place in the gut can be evaluated by metabolite excretion in the urine. The gut-brain connection is an emerging area of science that reveals our microbiome's impact on brain function and vice versa. Alterations in the makeup of the gut microbiome can negatively impact neurotransmitter, hormone, and vitamin synthesis. An excellent test that will assess these areas is the Organic Acids Test (OAT) by Mosaic Diagnostics (formerly Great Plains Laboratory).
Neurotransmitter Testing
While an Organic Acid Test will provide insight into neurotransmitter metabolites, some practitioners may opt to do a neurotransmitter test independently or concurrently for a deeper assessment. Doctor's Data offers a Comprehensive Neurotransmitter Profile urine test that evaluates the secretion and the metabolization of 21 biomarkers, including serotonin, dopamine, norepinephrine, GABA, and glutamate.
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Conventional Treatment for Depression in Teens
Addressing depression in teens is crucial for immediate and long-term mental health. Depending on which level of depression they are experiencing- mild or moderate, different recommendations would be made. For mild depression, most conventional doctors will recommend increasing support at home. If symptoms progress or are persistent, the primary interventions are psychotherapy in the form of Cognitive Behavioral Therapy (CBT) or pharmacotherapy. Evidence shows that the best outcomes occur when there is a combined therapy of CBT and medications.
Cognitive Behavioral Therapy
CBT is a category of talk therapy that can address depressive symptoms. This is the recommendation for the first line of therapy for depression. This therapy aims to improve negative thought patterns by helping the child manage negative thoughts and be intentional about positive thoughts.
Pharmacotherapy
Antidepressant medication is considered based on the teenager's clinical presentation and patient/family preference. SSRIs (short for Selective Serotonin Reuptake Inhibitors) are the most widely used medication for adolescents. The two that are FDA approved are fluoxetine and escitalopram. This drug aims to increase serotonin in the brain, which will help increase positive feelings. SSRIs should be reserved for major depressive disorders as they come with a black box warning and can have negative side effects.
Integrative and Functional Medicine Treatment for Depression in Teens
Research has begun to explore new avenues to support teenagers living with depression. No two cases of depression will look the same, and each child should be treated individually while addressing their unique needs. Through clinical observation and functional laboratory testing, your doctor will be able to pinpoint areas that need support and supplementation.
Exercise and Sleep
Movement and adequate rest can both assist in mental health well-being. Data shows that kids living more sedentary lives are more prone to depression. Fatigue and inadequate sleep can also contribute to depressive symptoms. Incorporating regular exercise and sleep hygiene routines can set teenagers up for health-promoting lifestyle habits and adequate sleep. Yoga, specifically, has been shown to have positive outcomes in depression ratings and is a great way to move and relax the body.
Family Therapy
While the primary form of psychotherapy for adolescents suffering from depression is CBT, whole-family therapy as an intervention for symptoms of suicidal ideation with depression has shown to have beneficial outcomes. Family therapy focuses on modifying interactions among family members to improve functionality and engagement within the family unit. This can help address and resolve family conflict and attachment issues that may be impacting an adolescent's symptoms. If your child has suicidal ideation as part of their depression picture, incorporating family therapy may be beneficial.
Nutrition or Dietary Considerations for Teenagers with Depression
Data has found that poor eating habits negatively impact mental health. When a child's diet is of poor nutritional value, they are void of nutrients and vitamins that the brain and body need for optimal functioning. This can harm overall cognitive functioning, gut health, and, ultimately, neurotransmitter production. Recent analyses have connected the dots between the inflammatory standard American diet and the benefits of a Mediterranean diet for adolescents. This way of eating incorporates plenty of fruits, vegetables, healthy fats, adequate protein, and whole-grain food options.
Supplements and Herbs for Teens with Depression
Below are evidence-based supplements and herbs that teens can use for depression:
Omega-3 Fatty Acids
Multiple studies have provided promising results on omega-3 fatty acids. Data indicates that fatty acids can be protective against depression while also being supportive of neurotransmitter metabolism. One study looking at Omega-3 supplementation in children showed greater than a 50% reduction on the depression rating scale in 7 out of 10 kids taking the omega-3. In contrast, none of the placebo groups showed more than a 50% reduction in their depression. This study utilized 1000 mg capustules that contained 400mg of EPA and 200mg DHA. This dosage is commercially available and a great consideration for therapeutic use. Indirectly speaking, omega 3s have been shown to help treat thyroid conditions and balance hormone levels. Therefore, omega-3s could be a great addition if thyroid or hormonal imbalances are contributing to depression.
St. John's Wort
Hypericum perforatum, commonly known as St. John's Wort, is a commonly used botanical as a natural therapeutic option in treating depression. It can improve depression by acting on the nervous system, which will inhibit the reuptake of dopamine, serotonin, and norepinephrine in the brain. This is similar to how SSRIs work. Three studies on the use of Hypericum perforatum in adolescents found it to be effective in improving depression ratings. One study even found St. John's Wort to be 100% effective after 6-weeks of treatment by taking the botanical. The average dosing for the plant medicine is 300 mg three times a day, but it should be monitored and individualized to your needs by your practitioner. St. John's Wort should not be taken alongside SSRI medications.
Probiotics
Supporting gut health is an ideal avenue for therapies due to the gut-brain connection. Studies have looked at the benefits of probiotics and improving depressive symptoms. A meta-analysis on the topic revealed a significant improvement in those taking probiotics compared to placebo groups. The evidence goes on to state that when multiple strains of probiotics are taken, the treatment is more effective for combating depression. Working with your holistic practitioner to determine which strains are appropriate for you is the best way to address this.
Combining holistic healthcare with conventional medicine can provide teens experiencing depression with multiple layers of intervention and support. Listed are some evidence-based modalities that can address depression in adolescents.
Homeopathy for Depression
This traditional style of medicine has been used for centuries as a method to address underlying root causes of symptoms manifestations. Homeopathy is the utilization of specific remedies which are repertorized to match an individual's unique symptoms and personality picture. One study treated and evaluated 91 patients with either an individualized homeopathic medicine or the antidepressant medication, fluoxetine. Study outcomes revealed that those taking their unique homeopathic had just as effective outcomes, with fewer side effects, as those taking fluoxetine. While homeopathy is very safe, it is a specific method of medicine that should be utilized by a practitioner that is knowledgeable and fluent in case-taking and prescribing.
Acupuncture for Depression
This Traditional Chinese Medicine modality can profoundly affect individuals' vitality. Acupuncture has been shown to decrease the severity of symptoms of depression compared to conventional means of treating depression. It's also proven to be an effective adjunct therapy for those taking antidepressant medications.
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Summary
Mental health in our adolescents is of rising concern. While depression can look different in children compared to adults, the outcomes and therapeutics are similar. As a society or as holistic healthcare practitioners, we can play a vital role in helping our teens with depression. From conventional medicine intervention to preventative lifestyle implementations and integrative medicine modalities, we can help our young people overcome, manage, and reduce their risk for depression or the severity of symptoms.
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