Teenage Depression: Is a Cure Any Nearer?
The Curious PR team was delighted to be invited to this year’s excellent New Scientist Live expo at London ExCel to witness hundreds of stands designed to illuminate and education us on everything S.T.E.M. – from lunar rovers that had been up in space, down to ocean bed conservation, and everything in between.
THINGS FALL APART
Of particular interest to those of us involved in healthcare communications is the subject of adolescent mental health. The declining health of vulnerable young people is such that university campuses and schools are over-run by requests to see a therapist, and there are waiting lists of six months or more for NHS treatment. The Times newspaper reported today that ambulance call-outs for children suffering a mental health crisis are rising at a faster rate than for adults, with cases of attempted suicide, drug overdoses, self-harming and other psychiatric conditions rising by a third in the past five years.
Almost a quarter of patients with a mental health problem are waiting more than three months to see an NHS specialist, leading psychiatrists have warned following The Royal College of Psychiatrists’ poll of 500 mental health patients, which found 24% waiting more than three months to see an NHS specialist.
The system is struggling to cope, yet, surely, we owe it to the next generation of thinkers and leaders to be one step ahead of them, and to plan and communicate effectively. So, with pad in hand, we headed to a Q&A session with Dr Sarah-Jane Blakemore, Professor of Cognitive Neuroscience and author of Inventing Ourselves: The Secret Life of the Teenage Brain’. There, we got the chance to listen, and ask a couple of questions of our own.
TEENAGE KICKS – LEARNING THE HARD WAY
Prof Sarah kicked off by attempting to answer the age-old question of why teenagers take risks, confirming that this is the case in all cultures, and is evident in other mammals. Rats go through an adolescent period lasting around 10 days, and if they are kept from socialising during this key period of development, they fail to mature normally.
So many of our ‘seminal moments’ as teenagers involve experimentation whereby a lesson was well and truly learned, often, the hard way. When my uncle was a young teen, he jumped off the garage roof clutching an umbrella. Was he exploring Newton’s principles, the ability to transmogrify into Mary Poppins, or just testing the sanity of my poor grandmother? (Either way, he ended up with several stitches in his chin.)
Blakemore went on to explain that risk-taking in teenagers confers an evolutionary benefit because the pushing of boundaries enables learning to take place at this key time of life. Adolescence is, afterall, all about gaining independence. As Prof Sarah pointed out, this means that the consequences of taking risks need explaining carefully – ideally before any great escapade or display of bravado. Even as adults, however, we fail to learn our lesson, as evinced by the fact that four people a minute in the UK get a speeding ticket!
Yet, even with the best advice from our elders, adolescence can be an excruciatingly self-conscious time. During the BBC Radio 4 programme co-hosted by Prof Brian Cox and Robin Ince, The Infinite Monkey Cage: The Teenage Brain, Ince’s insight still echoes in my mind that adolescence involves a strange tension between wanting to be original and wanting to blend in.
BOYS DON’T CRY: WHAT’S THE CURE?
Sadly, in some cases, adolescents may wish to disappear altogether, and Prof Sarah reminded us of the tragic reality that suicide remains the biggest cause of death in males from adolescence up the age of 50. This, she explained, may be because men don’t express their emotions in the same way women and girls do, depending on the culture in which they grow up. So, should teenagers cry in public? This was a question posed by another parent in the audience: As Blakemore pointed out, the UK offers an extreme example of a culture where not showing one’s emotions is encouraged in men.
So, although Prof Sarah cited two major epidemiological studies showing a huge rise in depression in girls (with a quarter of girls self-reporting symptoms that were worse than mild depression), the jury is out on whether girls self-report symptoms differently to boys. In her words, “If a boy experienced low mood and anxiety, maybe he’d be less likely to put it down on paper.”
THE PASSION PIT
Besides risk-taking, similarly acute qualities during the teenage years involve passion and creativity. This is the time to test one’s peers, once elders, and the status quo. Dr Sarah confessed to finding her own teenage diaries in the attic recently, and initially thinking they’d be helpful to publish them. Upon reading them, she decided better! At the time of writing, she’d felt as if she was experiencing profoundly original ideas, but to her adult eyes, they were merely typical of the age group she has come to study! Personally, I’d conjecture that the teenage brain is also pretty sharp. I recall testing my powers of argument – and the sanity of my mother – in equal measure, to which she once responded in exasperation, ‘You should be a lawyer!’ It was a rare compliment. However, adolescence is also a time where many mental illnesses start, amongst them, addiction, depression and anxiety.
AUTISM IN GIRLS
It is also a time when conditions, such as autism, become more pronounced and have major implications. Our media trainer, Kate Chacksfield, has a special interest in helping children with communication difficulties, such as those who have Aspergers. Whilst their brains are still plastic, such skills can be learned, and her work in this area is, arguably, more important than any other education on offer. (Assuming it’s available.) Being able to greet people, or even answer the phone in a polite and emotionally intelligent way, can mean the difference between not just a good university career, but also to everyday living and relationships.
A recent report in Wired highlighted just how under-diagnosed autism is in girls, and Prof Sarah agreed that stereotyping autism as a ‘male condition’ has probably contributed to this. Studies into the female autistic brain are only very recent. A member of the audience with an interest in this area asked her what is going on in the brain of these individuals. Prof Sarah explained that brain scans of adolescents affected show no major structural differences to the brains of normal adolescents, rather, it’s the route by which people get to their decisions or thoughts that is different: “It’s like travelling somewhere – there are usually several routes to get from A to B. It’s about the route, not the mode of transport.” It is clear that further research is needed.
NEW WORLDS FOR OLD
Social media and mobile phones are here to stay, and Prof Sarah states that clearly, we need to know more about how these all-pervading aspects of contemporary life affect the developing brain. She suggested that there may be an element of ‘hysteria’ by parents, purely because they didn’t have these technologies as youngsters. That said, as The Guardian recently reported, increases in depression and suicide appeared among teens in 2012 – the same time smartphone ownership became the norm. It was interesting to hear her comment that, “If you have low self-esteem as a teenager, being bombarded by images of the perfect body won’t help. Plus, many teenagers leave their phone on at night, so strong is their fear of missing out [FOMO] despite the fact sleep is crucial to brain development during these years!”
Fortunately, we will have more data soon to explain the teenage depression and anxiety epidemic. An American study called ABCD will follow 10,000 children for a decade as they grow from age 9-10 into young adults. The study will take place at 21 sites in the USA and will examine their behaviour using MRI scanning to record the structure and the activity of the brain. ABCD will factor-in these individuals’ hormones, genes, social media and mobile phone use, amongst other things. The study will collect reams of psychological, cognitive and environmental data about each child, along with biological specimens such as their DNA.
As the journal, Science, points out: “In addition to providing the first standardised benchmarks of healthy adolescent brain development, this information should allow scientists to probe how substance use, sports injuries, screen time, sleep habits, and other influences may affect—or be affected by—a maturing brain.”
As Prof Sarah noted, “It’ll give us a rich picture, but until we have this data, we can’t say much more”. Last month, it released a trove of data from 4,500 early participants into a freely accessible, anonymised database.” As with the Human Genome project, the fact this data will be free to us all, is important.
IT’S THE EDUCATION, STUPID!
But screen time and sleep aside, Prof Sarah warned us that linking the increase in depression and anxiety purely to technology could be dangerous: “It may mean we ignore factors such as the increased stress in the education system. We have constant testing in schools now, and GCSEs are harder than they were 20 years ago.” Education experts, be warned: she also posed a didactic question, “Do kids really need a big public exam at age 16, given they’ll likely stay on until they are eighteen?” In short, she warned us that school is a stressful environment for the developing brain, preventing health functioning.
So, how can we adults help tomorrow’s teens before it’s ‘too late’? Well, here in the UK, Dr Sarah is involved in a Wellcome Trust project involving 7,000 children aged 11-14 which is examining the effectiveness of mindfulness training in schools: 86 schools have been split into two, with mindfulness taught instead of PSHE classes in one of the groups. It will be a few years till we see the results of what is now the largest ever study into this stress reduction technique. And if you’re a parent who, like me, thinks ‘prevention is better than cure’, then Mindset is an important element to get right in younger children, especially if a resilient teenage brain is to result. If you’re curious to know exactly why you should not do your children’s homework for them, then read our blog inspired by the education expert, Will Orde: Teaching Young People to Cope: Time to Turn Off, Tune In, Climb Out.
TIME TO RESET THE CLOCK?
As most parents are aware, teenagers have a different body clock (circadian rhythm) to their younger and older counterparts. Arguably, senior schools should start the day two hours later that they do, for biological reasons because the ‘sleepy hormone’, melanin peaks in the bloodstream of adolescents two hours after it does in the rest of us. Assuming the rest of the family has headed for bed at 10pm, this gives our teens until midnight to use their adrenalin, dopamine and cortisol inducing phones and computers straight before bed! My son’s mobile switches off the blue ‘awake-making’ tones to warmer tones towards the end of the day, but despite this, he’s often awake hours after me, (as evinced by the empty glass of milk and Digestive biscuit packet I find at 7am!) As Prof Sarah pointed, out, this means teenagers’ weekends are infused with ‘social jetlag’, as they try to catch up on lost sleep and interaction.
BETTER THE BRAIN YOU KNOW
Teaching adolescents and adults about how the teenage brain develops is important, and can also be empowering, especially for troubled kids, such as those who take risks or are depressed. If things seem to go haywire, it can help to break down what’s going on into easier to understand chunks, to be addressed one by one.
Sometimes addressing what we consume via our diet can help, as explored in our blog, Gutted: The Inside Story to Staying Slimmer, Harder and Happier. Only last week, The Independent reported on how a Mediterranean diet rich in vegetables is beneficial to mental health. Whatever the ‘cure’ turns out to be – and it’s likely to be multi-factorial – let’s hope that the next decade see us gather rich data and make scientific breakthroughs in many of the relevant disciplines. Moreover, that policy-makers agree to prioritise solving one of the biggest health travesties of modern times.