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.