Transcription:
Youth Depression and Anxiety

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Andrea Temkin-Yu. She's an assistant attending psychologist and instructor of psychology and psychiatry in the psychiatry department at Weill Cornell Medicine, and she's here to discuss depression, symptoms and therapy for our kids and teens.

Dr. Temkin-Yu, it's a pleasure to have you join us today. So, we're really kind of seeing a mental health epidemic in the country today, especially with our kids and teens. Have you seen an increase in depression and anxiety-related disorders in our kids lately?

Dr Andrea Temkin-Yu: Yeah, absolutely. And I'm glad to be here today to talk about it because there's definitely an increase among our youth and our young adults in depression, anxiety, and related disorders like attention deficit hyperactivity disorder. There have been so many stressors in the past few years that have created really difficult situations for kids and their families, and really seem to be increasing those symptoms of low mood, of worry and all the related difficulties that come with it.

I think it's also important to note that a lot of the events in the last two years have exacerbated symptoms for individuals who already had depression or anxiety. So if you're a child who already has low mood or predisposition to worry, and now we have increased isolation, we have real worries about health and safety, it's just compounding all the difficulties that already existed.

Melanie Cole (Host): It certainly is. So I just want you, before we get into the types of therapy and red flags for parents, to kind of set for us the different types of depression, because there's really this spectrum, right? And how do depression, worry, anxiety, how do those things all differ? Because we all have some degree of worry, anxiety. But when it becomes depression, clinical depression, that's a whole different ballgame, yes?

Dr Andrea Temkin-Yu: Yeah. Great question. And you're right, we all do have different periods where we feel low or we feel worried. And what we're really paying attention to is when does that sort of getting in the way. There are a few different situations in which depression can present, though importantly, the core symptoms don't necessarily change. So, for example, some individuals have depression linked to winter months when there's less light or more isolation. Some people might have depressive episodes in relation to their menstrual cycle across the lifespan. We know that people are more at risk for depression when they're pregnant or postpartum. So, there are different situations or events that can increase the chance of having depression.

What we're really looking for is, is there persistent low mood or irritability, loss of interest in activities? The one distinction beyond the sort of different events that might cause depression is we do have something called persistent depressive disorder, which is a little bit different from major depressive disorder. And the main difference is that in major depressive disorder, we see these sort of really acute symptoms that might be lasting for a period of time but are pretty intense. With persistent depressive disorder, we see a really long-standing pattern of low mood and irritability, that's maybe not quite as intense or quite as acute, but is lasting for months and months on end, sometimes years without letting up, but it might not be reaching the same level of intensity. So, those I think are helpful for parents to know. We have a sort of major depressive episode with these acute symptoms versus persistent depressive disorder, where we see long-standing patterns of low mood or irritability, but maybe not quite as intense.

In terms of the worry and anxiety, we do see lots of people have worry or anxiety, but what we're looking for is if it's reaching what we call an anxiety disorder. So similar to depression, is that level of anxiety really persistent, really long-standing and starting to get in the way of our kids' lives?

Melanie Cole (Host): So expand on that a little bit, Dr. Temkin-Yu. When you say affect their lives, I mean, teenagers especially have such mood swings, I mean, on any given day, right? They could be happy, sad, whatever. But the red flags, something that tells us that really something's off, something is different, whether it's school avoidance or changes in habits, eating habits, all those sorts of things. Give us those red flags. What should parents be looking for and for how long do we want to notice these things before we call the doctor in?

Dr Andrea Temkin-Yu: Yeah, that's just the right question because just like you said, a lot of the symptoms we see in depression are actually somewhat typical of just being a teenager when they happen in short periods. So, what I mean by that is we're looking at low mood or irritability. We're looking at loss of interest and activities, changes in eating or sleeping. We're looking for when kids are starting to say they feel hopeless or they feel really guilty, when they might have thoughts of death or dying or thinking they might not want to be alive anymore.

So, for those first two symptoms I mentioned like low mood, irritability, changes in sleep and eating, what we're really looking to see is, are they happening most of the day, almost every day for at least two weeks? So if your kid had a bad test, they got in a fight with a friend, you grounded them and they're grumpy for a day or even two days, or even three days, I'm not worried about it necessarily. That's pretty normal. But if those things are really starting to linger, they're happening over time, they're lasting for more than two weeks, and they're starting to get in the way of your child's life, meaning they're having a hard time getting to school, their grades are being affected. They are losing friendships because they're having a hard time responding to text messages or they can't get themselves out of bed to go see their friends, that's when I'm really starting to pay attention, and I want to make sure I'm tracking that quite closely.

The other symptom I mentioned is thoughts of hopelessness or death or dying. Those, I want to be paying attention to really early. So even if it's just one time where your child says, "I don't think I want to be alive anymore," even if that's not lasting for two weeks, I want to be paying attention pretty quickly. It doesn't mean it's a crisis situation. Sometimes kids say those things because they're upset and distressed and they don't know how else to express it. But regardless of that, I want to pay attention and take it seriously. Ask them a little more, see how they're feeling. Maybe schedule an appointment with a pediatrician or a psychologist or counselor, if that's available to you. But those main red flags we're looking for are these symptoms occurring over time and are they starting to affect my child's life at home, at school with friends and hobbies?

Melanie Cole (Host): Well, that's a good point that you made, that we really have to take those kinds of statements seriously. And while it may not be an emergent crisis right then, but that is an important point that you make. We have to really pay attention when our kids are saying things. I'd like you to step back for just a second and tell us as we're sorting these out, seasonal affective disorder, because that's something that can come and go and we see it in adults and in kids and people that really have this affect them every season. Can you tell us a little bit about how that differs? And while you're telling us that, what can we do to help with that?

Dr Andrea Temkin-Yu: So, the core symptoms of seasonal affective disorder don't really look any different than major depressive disorder. We're still looking for low mood. We're still looking at loss of interest in activities. We're still looking at changes in sleep or eating or energy levels. The main difference really seems to be this pattern of depressive episodes that are linked to changes in the season. So when we have less light, when there's more isolation, when people are indoors more, for some people, that seems to be a real trigger for these symptoms occurring every single year. So, it might look similar to other people's depressive episodes, but there's a more reliable pattern that we see for individuals who have seasonal affective disorder.

In terms of what we can do to help, we want to pay attention, we want to take it seriously. We don't want to accidentally overlook it because it's tempting to say, "Oh, you know, get over it. It's just a little dark. Just go play with your friends. Just do something fun." We still want to take it seriously, even if we think it's linked to seasons, not something else. But then we're going to look into all of our regular treatment options for depression, and I know we'll talk about that a little bit more, but things like therapy, possibly considering medication, those are all things we can look into for seasonal affective disorder.

Melanie Cole (Host): Well, then let's talk about that. If we notice any of these red flags that you've brought up for any of these conditions, this spectrum of anxiety and depression disorders. What's the first thing we do? Where do we go? Who do we turn to? Tell us a little bit about the steps that parents should take to get the child the help that they need.

Dr Andrea Temkin-Yu: So, you have a couple of different options. If you're not quite sure what's happening, you're not quite sure how big of a deal it is or what's really going on, a great first option is your pediatrician. Lots of individuals access mental health treatments through their pediatrician because it's someone that you know and you trust and you have access to, so that's great. That's certainly an option. If you're pretty confident that this is a mental health concern, that your child is feeling depressed or is feeling anxious, you don't have to start with your pediatrician. You could talk to a school guidance counselor. You could try to find a therapist, either a social worker or a psychologist. Some people want to try to find a psychiatrist right away. All those are absolutely wonderful options. It can be difficult to find those professionals. Often they don't take insurance, though some do. Many people have long wait lists. So, I just say that to note for families that you have lots of different options of where you can turn to get help for your children. And depending on your particular situation, insurance, finances, where you live, you might have more or less access to a mental health professional specifically versus talking with your pediatrician, but any of those are good options for places to start.

Melanie Cole (Host): And now, what treatments have been shown to be most effective for kids dealing with depression? Can you speak a little bit about some of those treatment options that you're doing today? Because your field has advanced so much recently and, with the advent of even telemedicine during COVID, that's really shown great advancements as well. So, can you speak about some of these treatments?

Dr Andrea Temkin-Yu: Yeah, absolutely. So gold standard of treatment, meaning sort of the thing we try to recommend most is often a combination of therapy and/or medication. So, there's research out there showing that individuals with depression can do really well on medication alone, can do really well on therapy alone or some people really do best with a mix. We unfortunately are at a place where we don't know exactly who's going to do best with what yet. So usually, it takes a little bit of trial and error for individuals to figure out what's the best treatment mix for them. If you're interested in taking a medication or you just want more information, talking to your pediatrician or finding a psychiatrist is a great place to start. I can certainly speak more to the therapy piece. So, we know that something called cognitive behavioral therapy or CBT is a really effective treatment for depression, and the way that I think of CBT is that we all have patterns of thinking, of feeling, of behaving, and sometimes those patterns are really helpful, and sometimes they get us stuck.

So for an individual with depression, for example, they might feel really low, have low energy, they might have thoughts like nothing's going to get any better or I just can't do the things I'm supposed to do. And then, their behavior is to pull back and withdraw and avoid, because it all just seems really overwhelming. So, what CBT does is help individuals build skills to manage those intense emotions, to catch and come up with more helpful thinking patterns and then behave in ways that help them engage with problems effectively.

One subset of CBT is something called behavioral activation, and I say that because I think it's a good thing for families to ask about when they're looking for treatment. And behavioral activation is really about helping kids and adolescents engage in meaningful activities that help them feel productive, that boost their mood, that help them build a sense of meaning or mastery in their lives. Some people who do CBT will focus on behavioral activation, others not, but either of those are really good options to ask about, so CBT or behavioral activation.

You also mentioned teletherapy. So, there's actually been a pretty good standing history of research showing that teletherapy is as effective as in-person therapy. But like you noticed, the pandemic really sort of forced everyone to focus on teletherapy more. So, it's great that we have some evidence already existing that is a good option. I love teletherapy because I think it makes it really accessible for families and especially when we're thinking about kids and adolescents who are feeling low, who are having a hard time getting out of bed. It's a lot easier to sign into your therapy appointment than it is necessarily to get yourself to an office after school when you're hungry and you're already tired and you're feeling low. So, it's really made it accessible for a lot of people, and it's a wonderful option in terms of getting all the good skills and benefits of CBT or behavior activation from your home.

Melanie Cole (Host): I agree completely. I've seen it work with my kids and even myself and it's just like you say, it's more convenient and you don't have to go places and park and do all that stuff, so it is a very nice option now. As we wrap up, please give parents listening your best advice if they've got children that are on the spectrum of depression and anxiety disorders, what would you like them to know? And while you're saying that, give us some tips for parents for self-care to teach their children about exercise, eating healthy, getting some sunlight on them, anything that you would like to tell parents that they can try with their kids at home, that can at least help with some of this.

Dr Andrea Temkin-Yu: Yeah, great. A lot of good questions in that. So in terms of what I would like parents to know, there are great treatment options available for your kids. And it can be really scary to watch your child suffering and not know what to do, but there are really excellent treatments out there. I'll also say, as we've already noted, there's a huge increase in the need for mental health services. So, please don't be discouraged when the first person or two that you called doesn't have room. It doesn't mean you'll never find a spot for your child to get help, it's just going to take a little extra patience these days.

In terms of tips, I think all the things that you mentioned are great. Good sleep, making sure we're trying to get our kids enough sleep, you know, eight to nine and a half hours depending on their age, trying to get outside, trying to exercise, trying to engage in activities that you find meaningful or interesting. So if your child really loves dance, let's see if we can make that happen. If your child really loves hanging out with their friends on the weekend, let's see if we can make that happen. So, we really wanna try to help them find activities that feel good and powerful for them. I also think it's really crucial that parents are taking care of themselves. All the effects of the last two years are obviously not only impacting our children, they're impacting parents as well. And then, having a child who's having mental health difficulties can really exacerbate those symptoms for parents. So making sure that as much as you are trying to get your kids to sleep and exercise and do things that are meaningful, you're trying to do those things for yourself too, and reaching out for your own support if you need it or you think it would be helpful. I think that's so crucial, both in making sure that parents really have enough reserve, emotional reserve, to help their kids, and it's great modeling for your kids that we all go through periods that are difficult and there are things that we can be doing to help feel better.

Melanie Cole (Host): Great advice. So informative. And thank you, Dr. Temkin-Yu, for joining us today. This is really an issue that so many parents are dealing with, and you gave us great information to work with today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, please visit weillcornell.org and search podcast. So many great ones there. And don't forget to check out our Back to Health. I'm Melanie Cole.

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