0:04

Welcome to the Attention Deficit Disorder

0:06

Expert Podcast Series by Attitude

0:08

magazine.

0:14

Hello everyone, I'm Carol Fleck and

0:17

on behalf of the Attitude team, I'm

0:19

pleased to welcome you to today's ADHD

0:22

experts presentation titled, A

0:24

Parent's Guide to Understanding Depression

0:27

in Teens.

0:28

Leading today's presentation is

0:30

Dr. Karen Swartz. Dr.

0:32

Swartz is a professor of clinical psychiatry

0:35

and behavioral sciences at the Johns

0:37

Hopkins School of Medicine.

0:39

She is founder and director of the Adolescent

0:42

Depression Awareness Program, which

0:44

educates high school students, faculty,

0:47

and parents about adolescent depression.

0:50

More information about this program is available

0:53

at www.adapeducation.org.

0:59

Rates of teen depression, anxiety,

1:02

loneliness, and mood disorders have

1:04

increased dramatically since the start of

1:06

the COVID pandemic.

1:08

A new study has found that 20% of

1:11

teens and adolescents had

1:13

symptoms of major depressive disorder

1:15

in 2021,

1:17

but less than half received treatment for

1:19

it.

1:20

Signs of teen depression can be

1:22

confounding for caregivers because

1:24

depression can look like sadness or moodiness,

1:27

thanks to big hormonal swings and

1:29

even co-occurring ADHD symptoms.

1:32

In today's webinar, caregivers and teachers

1:35

will learn how to identify teen depression

1:38

and also about the support strategies

1:41

that can help.

1:42

We also have a special bonus for

1:44

today's listeners. We've created

1:47

a new download that explains symptoms

1:49

of major depressive disorder in teens. It

1:52

includes lots of tips for parents and

1:54

it's free.

1:55

The link is in today's show notes.

1:57

We'd like to begin today's webinar by...

1:59

asking this poll question to our live

2:02

audience. How confident are

2:04

you in your ability to differentiate between

2:06

typical sadness and depression in teens?

2:09

And what factors make it difficult for you to

2:11

do so?

2:12

Please select your answers and comment in

2:14

the text box under the video player

2:16

to tell us more. For answers

2:19

to common webinar questions about slides,

2:22

transcripts, and certificates of attendance,

2:25

click on the FAQ tab of your webinar

2:27

screen. If you're

2:29

listening in replay or podcast mode,

2:32

visit attitudemag.com and search

2:34

podcast 477 to

2:36

access the webinar resources, or

2:39

simply click on the episode description wherever

2:41

you stream your podcast.

2:43

If you support the work we're doing here at Attitude

2:46

to strengthen the ADHD community,

2:49

we encourage you to visit attitudemag.com

2:52

slash subscribe

2:53

and sign up for Attitude Magazine. You

2:56

won't wanna miss our 25th anniversary

2:58

winter issue. It's a special commemorative

3:00

issue that examines how far we've

3:02

come in our understanding of ADHD

3:05

over the last 25 years, the

3:07

role genetics plays,

3:09

and what experts say we might expect in

3:11

the future for diagnosis and treatment.

3:14

Sign up for Attitude Magazine today for

3:16

yourself or to share with a teacher

3:19

or a loved one who could benefit from greater

3:21

ADHD understanding.

3:23

Click the magazine tab on screen to

3:25

learn more. So without

3:27

further ado, I'm so pleased to welcome Dr.

3:30

Karen Swartz.

3:31

Thank you so much for joining us today and

3:33

for leading this discussion.

3:36

Well, thank you. I'm really pleased

3:38

to be here. It is so important that

3:41

for those who are dealing with a young person with

3:44

ADD, that they also have an understanding

3:46

about mood disorders, both depression and bipolar

3:48

disorder, because there is so much

3:51

overlap.

3:52

So today we're gonna discuss the symptoms of

3:54

depression in adolescents, how it presents,

3:57

and as Carol was just saying,

3:59

how it's different.

3:59

than just being upset, moody, or disappointed,

4:03

the symptoms of bipolar disorder and adolescence,

4:06

what the treatment options are for mood disorders,

4:08

and the rates of co-occurring mood

4:11

disorders and attention deficit hyperactivity

4:13

disorder.

4:14

And we'll end with

4:15

what you can do if you're concerned about your child.

4:19

So when you think about adolescence,

4:21

teenagers have a lot of skills

4:24

they need to master.

4:26

They start thinking in more abstract

4:28

ways.

4:29

They start thinking about their life in

4:31

perspective in the sense of not just what

4:33

they're doing now, but what their future is going

4:35

to be.

4:36

They get hopefully new conflict

4:39

resolution skills, and they're not just shoving each

4:41

other in the playground

4:42

like little kids.

4:44

They're negotiating new relationships

4:46

with adults, which parents often experience

4:49

as a shovel way, but they're trying to figure

4:51

out how to become young adults rather

4:53

than small children. They

4:55

have very close relationships. This is

4:57

where friends supplant parents

5:00

as their favorite people. It's the

5:02

time that young girls get

5:03

BFFs and young men get girlfriends

5:05

and they become much more important than parents.

5:08

And it's the time that their

5:10

bodies are sectionally maturing, and that brings

5:12

a whole level of hormonal change, but

5:14

also this

5:15

priority of how you manage them.

5:18

So as I'm talking about depression,

5:21

I want you to imagine having to do all

5:23

of this with distorted

5:26

thoughts, negative thinking,

5:29

and with your confidence completely

5:31

knocked down. So this is

5:33

hard enough when you're well, and

5:36

it is sometimes a really daunting task

5:38

for young people that are

5:39

dealing with depression or bipolar disorder.

5:47

So think, what percent

5:49

of young people do you think describe their adolescence

5:52

as a time of severe emotional upheaval

5:56

when they look back on it? And I ask

5:58

this because there was a study that asked

6:01

this question,

6:02

was your adolescence a time of severe

6:04

emotional upheaval? And they were asked

6:06

in their mid-20s, so you're going back a decade

6:09

and said, look back and you tell me. So

6:11

think to yourself, what percent do you think it was?

6:16

The thing that usually is

6:17

shocking to parents is that the teenagers,

6:20

the young adults say

6:23

20%, which makes sense to me because

6:25

it's actually 20% of

6:28

young

6:28

people that will have some sort of serious mental

6:30

illness.

6:31

So they can tell the difference between

6:33

something serious and fighting with

6:35

their parents.

6:36

Now when I asked parents, was

6:38

it a time of severe emotional upheaval and

6:40

turmoil?

6:40

They're only 100% range for them.

6:43

But for the young people, they have the perspective.

6:46

They know the difference between I fought with my mom

6:48

and dad, or I had conflict with

6:50

my teachers and there was something really

6:52

serious going on. They're not the same thing.

6:56

These are older data pre-pandemic

6:59

that showed that it was about 11% that

7:01

had a mood disorder,

7:03

10% with some sort of behavioral disorder,

7:05

and about 8% with anxiety disorders.

7:08

These rates have essentially doubled with

7:11

the pandemic, which is really

7:13

concerning. We don't know if that'll be sustained,

7:16

but at least now it's incredibly common

7:18

for young people to be dealing with anxiety

7:20

and depression.

7:22

So if you look through development. We

7:24

know there are different ages where disorders

7:28

typically start, not always, but typically.

7:30

For example,

7:31

it's pediatricians that are diagnosing

7:33

autism.

7:34

Many people that have attention deficit

7:37

and other kinds of disorders, that'll

7:40

start when they're toddlers. Grade

7:43

school and middle school are a time of anxiety,

7:46

separation anxiety, generalized anxiety,

7:49

obsessive compulsive disorder, and

7:51

it's also when Tourette's disorder begins. And

7:54

then adolescence,

7:56

high school,

7:57

young adulthood, early college, where

7:59

we have mood

7:59

disorders, major depression, bipolar

8:02

disorder,

8:02

as well as emerging problems

8:04

with substance use, and then other

8:06

kinds of anxiety

8:07

disorders, eating disorders, schizophrenia,

8:09

when they emerge. We

8:11

think that timing of this relates

8:14

to the developing break. But

8:17

today I'm going to talk about depression.

8:19

And a question that so many parents

8:21

have for me is, what's the difference between

8:24

a moody teenager

8:24

and someone going through depression? When

8:28

we go into high schools and talk with them, we

8:30

try to differentiate little depression,

8:33

which is a normal feeling of sadness everyone

8:35

will have,

8:36

from big depression, a medical

8:39

illness that has very particular

8:41

symptoms. So it's like any other medical

8:43

problem, there'll be a group of symptoms that come together

8:46

and stay.

8:48

If we look at those symptoms, they fall into

8:50

three broad categories. Mood

8:53

changes,

8:54

physical changes, and self-attitude

8:56

changes.

8:57

Now, when you're trying to differentiate being

9:00

disappointed or upset,

9:02

the key of that

9:04

comparison is whether

9:06

you have changes in how you feel about

9:08

yourself.

9:10

Teenagers have moods, especially

9:12

with their developing bodies and the hormonal

9:14

shifts. People can have different physical

9:16

symptoms, as I'll talk about. Sometimes

9:18

they're medically ill, etc. But

9:21

this attacking your confidence

9:23

and not feeling good about yourself, that's at the

9:25

core

9:26

of depression. So

9:29

the mood changes can be sadness,

9:32

feeling irritable,

9:34

or feeling nothing, just sort of a lack of feeling.

9:37

Interestingly, fewer than 50% of those who have depression,

9:40

major depression, feel sad.

9:43

So many feel nothing

9:44

or feel irritable, and young people are most

9:46

likely to report

9:48

an edgy irritability rather than sadness.

9:51

Then the other part of the mood change is

9:54

what we call anhedonia, where you lack

9:56

the capacity for joy or pleasure.

9:59

no positive emotion. So experiencing

10:02

negative emotion and changing your

10:04

capacity, your ability to

10:06

have positive emotions. The

10:09

physical changes are all the things you see on

10:11

a checklist at the doctors changes

10:13

in appetite and weight, which

10:16

can go either up or down. It

10:18

depends on the person

10:19

sleeping more or less.

10:21

Generally, people sleep less, and they

10:24

have trouble both falling asleep and

10:26

then waking up throughout the night.

10:28

So both difficulty falling asleep and then what

10:30

we call early morning awakening.

10:32

They generally feel slowed

10:34

down and fatigued, but it can be punctuated

10:37

by moments of feeling sort of restless and uncomfortable.

10:39

And unfortunately, teenagers

10:42

find that if they use substances, smoke marijuana,

10:44

drink alcohol, that sort of edgy

10:46

feeling can go away briefly.

10:50

They are not treatments for mood

10:52

because they worsen mood and make

10:55

the symptoms worse. But in a

10:57

very short window, a half an hour,

11:00

an hour, people

11:00

will feel relief, which is why they're even

11:03

more addictive. These substances are

11:05

even more addictive for

11:07

young people dealing with mood disorders

11:09

in addition. And then concentration.

11:12

Now that's independent.

11:15

Pre-existing problems with attention

11:17

or attention problems from a condition like

11:19

ADD or other issues. But

11:21

it's everyone going through depression pretty much

11:23

finds that their their thoughts are

11:25

slowed down, their thinking is slowed down,

11:28

and their capacity for making decisions and

11:30

processing information is

11:32

reduced.

11:34

Now the self attitude

11:36

changes, which I mentioned before the core

11:38

when you really say I think this is depression.

11:41

So lacking confidence.

11:43

And so young people,

11:45

it's what you care about. So young girls talk

11:48

about changes in their appearance being very

11:50

critical of their appearance, being critical

11:52

of whether others like them, young

11:55

boys are critical of their strength and

11:57

whether they're a cool person

11:58

that you'd want to be friends with.

12:00

As people get older, it attacks

12:02

different things. For

12:04

example, at middle age, most women

12:06

worry about being a bad mom. Most

12:08

men talk about being a bad provider

12:10

and that's their worry. Then if you get

12:13

to the point of my parents in their

12:15

late 80s and early 90s, then

12:17

people start talking about being a burden to their

12:19

family. It's the same

12:22

symptom over the age span, it's that you

12:24

lose your confidence in the role

12:26

you care about most. In

12:28

the most severe form, that turns into feelings

12:31

of guilt and worthlessness. As

12:33

you can see how those really negative

12:35

feeling link up to thoughts about

12:38

death and thoughts about suicide. The sense

12:40

of I'm not contributing, there's really no point

12:42

of my being here. When

12:45

kids are very young, it's relatively

12:47

rare to have major depression, one or two

12:49

percent, and it's the same for boys and

12:51

girls. It's at least

12:54

five percent of adolescents and probably

12:56

now closer to 10 that have major depression,

12:58

not just some symptoms

12:59

but the whole syndrome.

13:02

There's a doubling of the rate

13:04

for young women when they start getting their

13:06

menstrual periods, and that continues through

13:08

menopause. You

13:10

look at lifetime rates, it's

13:12

at least 20 percent of women and 10 percent

13:14

of men that have the kind of depression that's

13:17

a medical problem. Not just some

13:19

of the symptoms, but the entire syndrome,

13:22

which makes it one of the most common conditions

13:25

that we all are dealing with.

13:28

Now, the symptoms that are different with teenagers,

13:32

as I said before, having an irritable

13:34

mood rather than sad, not

13:39

enjoying things,

13:41

feeling hopeless. When children

13:43

are younger, they don't have that same view

13:46

of the future. Hopelessness

13:48

means I don't see my future, so you

13:50

have to be thinking about it. That's

13:52

why teens that are at particular risk of suicide

13:55

because they

13:55

start getting very negative about their futures.

13:59

Social isolation.

13:59

than dropping out of activity. Parents

14:02

often say to me, my teenager doesn't want

14:04

to go shopping with me or doesn't want to be out with

14:06

me. And I say,

14:08

right, because they're teenagers, they want to be with

14:10

their friends. So I don't worry when

14:12

people are more,

14:14

you know, don't want to do things so much with their

14:15

parents or their families at this

14:17

age. But when they say, I don't

14:19

want to go out with my friends, or I'd rather just

14:21

stay home, that is really concerning.

14:25

Substance abuse, as I mentioned, because

14:27

sometimes it's how people feel better in the

14:29

short term, most teens get

14:31

exposed at some point. And so if you

14:33

are dealing with depression and you have that,

14:36

hey,

14:37

I had a break from how awful I felt, you

14:40

could

14:40

see how it's much more appealing, unfortunately.

14:43

Physical complaints of headaches, stomach

14:46

aches, those kinds of things.

14:47

And then anxiety symptoms,

14:49

where people are having worries about

14:51

being away from family, having the onset

14:53

of panic attacks with really intense anxiety

14:56

or ongoing anxiety. So

15:00

how long will a major depressive

15:02

episode last? This is severe, impairing

15:04

depression. Typically in a teen

15:07

untreated, it will last for seven to

15:09

nine months. And given that an entire

15:11

school year is nine months, you can imagine

15:14

that young people start

15:16

thinking of themselves differently. I'm

15:18

not a very good student, I'm not a very good athlete,

15:21

I'm not very confident about that next

15:23

step.

15:24

Maybe I

15:25

shouldn't try

15:26

to be part of that activity or shouldn't

15:28

try out for the team or the school play. So

15:31

there's a trajectory that students

15:33

will change

15:35

in a really negative way because of depression

15:39

changing their sense of confidence for

15:41

a sustained period. It's not for a week or two.

15:43

We can all recover from something that goes on

15:46

for a week or two, but not months and

15:48

months and months.

15:50

So when adolescents are diagnosed

15:52

with depression, 66% of

15:56

them will have recurrent episodes. So

15:58

the younger you have your first...

15:59

depression, the more likely it is to be recurrent. 10%

16:04

will have episodes that are very

16:06

long. 90% is limited in the time, like

16:09

I said, but about 10% will have these

16:11

very long episodes that are very impairing.

16:14

And about 20%, 5 to 10% will go on to develop

16:18

bipolar type one disorder.

16:20

About 5 to 10% will go

16:22

on to develop bipolar type two.

16:25

We're going to talk about bipolar disorder

16:26

in just a moment. But the difference between

16:29

one and

16:29

two is that with bipolar one, you have full

16:31

mania,

16:32

really dramatic elevated mood.

16:35

With bipolar two, you can have very

16:37

severe depression,

16:38

but the elevation and mood is pretty

16:40

mild. That's the difference.

16:44

So with mania, it's the

16:46

same three areas mood changes,

16:48

physical changes and self attitude changes.

16:51

But as you can imagine, with bipolar disorder, with

16:54

the depression, you're low

16:55

and the mania you're high, these

16:57

changes are what you might expect the mood changes,

16:59

you get elevated,

17:00

you're expansive.

17:02

But if it gets really bad,

17:04

people are often irritable, they often are annoyed

17:06

that people can't keep up with them. And others

17:09

are saying, Look, you're you're

17:11

not as smart as I am, you can't keep up with me and

17:13

you're annoying me. So there's an edginess

17:15

that often comes with mania. The

17:18

physical symptoms are the opposite of depression.

17:21

I don't need sleep.

17:22

I'm going a mile a minute. I

17:24

have so many thoughts, I want to share them. They're

17:27

going really fast. I can't get

17:29

anything done. Because I'm

17:31

distracted. Now, both with the concentration

17:34

problems of depression and the distractibility

17:36

of mania.

17:38

Obviously, this is a change from baseline

17:40

for mood disorder. A

17:42

young person with the challenge of ADD

17:44

may have that all the time. Now,

17:47

it could worsen if they also have

17:49

a mood disorder. But I'm talking about

17:51

someone who's typically not distractible

17:53

now being distractible, or the intensity

17:56

and the impairment with the distractibility

17:59

going up. So there's a baseline

18:01

and then it gets

18:01

worse for

18:02

either depression or mania. The

18:06

part of mania that's dangerous, obviously

18:08

with major depression, the part that's dangerous

18:11

is that it could lead to having suicidal thoughts. With

18:14

mania, the dangerous part comes from someone not

18:16

believing that

18:18

there are

18:20

limits.

18:21

So they think they can do anything. They will do dangerous

18:24

things. They might, I mean, in the most extreme

18:26

thoughts, you might think you could fly or something

18:28

and then do something really dangerous. But

18:31

you go and engage in activities you would typically

18:34

never do.

18:35

And then the sole attitude change is that your

18:37

confidence is too high. So

18:40

you could imagine telling off your teacher

18:42

or having an idea that you have such a great idea

18:45

to make money or have an invention

18:47

or something that you're going to drop

18:48

out of school. So your good

18:50

sense leaves you in your manic. And

18:53

so you make decisions that later, typically,

18:55

you really regret.

18:58

The bipolar disorder is

19:02

two poles.

19:04

So for bipolar disorder, manic

19:06

symptoms are typically

19:09

three symptoms for at least one week.

19:12

Whereas depressive symptoms are usually five

19:14

symptoms

19:15

for at least two weeks.

19:17

In general, someone with bipolar disorder

19:19

spends a lot more time in the depressive phase

19:22

than in the manic phase. And the manias

19:24

tend to be shorter. So

19:26

your mood goes

19:26

up and then unfortunately will crash into

19:29

depression.

19:30

So sometimes the elevated moods get

19:32

missed or they're misunderstood

19:34

as someone,

19:35

often young people have someone say,

19:38

oh, you're using drugs or something

19:40

like that rather than rather than

19:42

something else.

19:45

I want to make the point that with depression,

19:47

there

19:49

is typically

19:51

an eight year delay from

19:53

having depressive symptoms start to actually

19:56

getting treatment.

19:57

Now that seems unbelievable, doesn't it? There could be

19:59

an eight year delay.

19:59

ear delay. Well,

20:01

the point of this is that

20:03

it's not continuous. You don't

20:06

have symptoms continuously that whole time.

20:08

What you have

20:10

is

20:11

a period of symptoms

20:13

and then it goes away

20:14

and then it comes back and then it goes away

20:16

and then it comes back because it's that kind of episodic

20:19

illness, it will get missed.

20:21

So a teenage episode gets written

20:23

off to being teenage angst

20:26

and then maybe a college episode,

20:29

people will party through it and say, oh, you were just

20:31

partying too much. So it's later

20:33

when someone wants to focus on raising

20:37

their family, keeping their job, doing

20:40

those things that they'll get into treatment. And

20:42

with bipolar disorder, there's typically

20:45

a six year delay. And

20:47

so given those long delays, usually

20:51

teenagers don't have these conditions

20:54

identified, which is terrible because it interrupts

20:57

their functioning and also interrupts their development.

21:01

So

21:03

much less common, 20% of

21:05

women, 10% of men have depression, it's

21:08

only 1% that have bipolar one.

21:11

So we think about ways to treat mood

21:14

disorders. The core treatment is

21:16

usually a combination of medication

21:18

and psychotherapy.

21:20

Now, for some individuals, it's psychotherapy

21:23

alone. For others, it's primarily medication.

21:25

That's very individualized, but almost

21:27

every study that's looked at this has found that the

21:29

combination

21:30

is far superior to

21:32

either one alone.

21:33

And part of that is that you need to learn about

21:36

yourself and how to manage symptoms

21:38

you have,

21:38

how to recognize them,

21:40

and what it means to have a serious

21:42

medical problem. Young people,

21:44

thankfully, are usually pretty healthy.

21:47

Or if you're already dealing with one challenge,

21:50

there'll be a resentment saying, I don't want to have another

21:52

thing.

21:53

I don't want to have to deal with a second thing. And so

21:55

sometimes people will not be open to that.

21:58

Now, in addition to these

21:59

treatment. It's

22:01

actually important to include education

22:03

and support so people understand what

22:05

they have and how they're going to manage it.

22:08

Family involvement is critical, as

22:10

is interrupting other behaviors

22:13

like substance use, eating

22:15

disorder behavior, cutting, those kinds

22:17

of things, because they destabilize

22:19

mood. And then other things

22:21

like mindfulness meditation, relaxation

22:24

techniques. This time of year when

22:26

the days are getting shorter, I think too about

22:29

bright light therapy, which can be helpful for some.

22:33

If we look at cognitive behavioral therapy,

22:35

I'm going to just mention that as one form of

22:37

psychotherapy. The theory behind

22:40

it is that if you can challenge the

22:42

distorted thoughts you have,

22:44

you'll be able to feel better.

22:47

Now, both depression and bipolar disorder,

22:49

the manic

22:50

episodes,

22:50

significantly distort your

22:53

thoughts. They get you to think the most negative

22:55

version of everything. So you have an interaction

22:58

with your friends,

22:59

you're going to say, oh, I can tell they're mad at me

23:01

based on nothing. You have an interaction

23:03

with the teacher or parents or family, your

23:07

instinct is going to take the most negative

23:10

view of what happened. And so the

23:12

goal with cognitive behavioral therapy is

23:15

to work to change your behaviors, but

23:17

also the problematic thoughts you have.

23:21

It's been very well studied and shown to be

23:23

very effective for depression and anxiety

23:25

disorders in teens and in adults.

23:29

And the idea of CBT comes from

23:31

this idea that thoughts,

23:33

feelings, and behaviors are all

23:36

interacting.

23:37

And so CBT focuses

23:40

on challenging the negative thoughts and

23:42

changing behaviors.

23:43

So

23:45

when you don't feel like getting out of bed, you don't.

23:47

When you feel like drinking instead of doing

23:49

something else, you do changing

23:51

to more positive behaviors and also challenging

23:54

the negative

23:54

ideas with the thought.

23:57

And I can tell you from experience, demonstrate.

24:00

benefit of actually changing feelings

24:03

by targeting thoughts and behaviors because

24:05

they're all interactive.

24:11

As far as medications, I'll just mention

24:13

antidepressants

24:14

as the core treatment for both depression

24:18

and serious anxiety problems. The

24:20

group that are used most frequently

24:22

for young people are the SSRIs

24:25

or selective serotonin reuptake inhibitors.

24:28

I have Prozac and Luxapro in gold

24:30

because those are the two specifically

24:33

approved for the treatment of

24:35

depression and those under 18. However,

24:38

they've all been approved for

24:40

the treatment of anxiety disorders too, so we're not

24:43

limited for only those two.

24:45

Another group that's used fairly commonly

24:48

in young people are the SNRIs

24:51

or serotonin and norepinephrine

24:53

reuptake inhibitors. Those are medicines

24:56

like effectorins and baltin for steak.

24:59

There are others, well

25:01

butrin, Remeron, et cetera. I

25:04

will make the point that

25:06

well butrin is the one antidepressant

25:08

that doesn't also have effectiveness

25:11

for anxiety. So

25:12

if young people have the mix, that is

25:15

sometimes what we don't use. However,

25:17

it is an antidepressant that

25:19

is sometimes used in the treatment of attention deficit

25:21

symptoms, so sometimes if a young

25:24

person is dealing with both, that could be an

25:26

excellent choice if you're trying to minimize

25:28

the number of medications.

25:31

Tricyclics are an older group that we

25:33

typically don't use as frequently

25:35

in teens unless other things haven't

25:38

been effective,

25:39

but they're still excellent. Monamine-oxidase

25:42

inhibitors are also an older group

25:44

that we tend to not use in teens. We

25:47

tend to reserve those

25:48

for the individuals

25:49

where many things have not worked because there are

25:52

potential drug interactions and

25:55

interactions with food that are, you know,

25:58

they have to be very careful.

25:59

sometimes impulsive teenagers are not

26:02

able to be careful in the way that they need

26:04

to be.

26:06

For the treatment of bipolar disorder,

26:09

lithium

26:10

and then anticonvulsants, so medicines

26:12

typically

26:13

used to treat seizure disorders of the

26:15

core treatment. So those include

26:18

things like Depicote, Tegretol, and Mixel,

26:20

Triluptol. Lithium has

26:22

the strongest and longest evidence,

26:25

but there are also good options.

26:26

And then when young people are very

26:29

acutely manic, they're often

26:31

also treated with medications, which

26:33

we call

26:34

neuroleptics, atypical neuroleptics,

26:36

like Resperidone or Cyprexa.

26:41

Now in addition to medication,

26:43

psychotherapy,

26:46

young

26:49

people are gonna

26:50

be healthier if they can engage in other

26:53

healthy behaviors.

26:54

I talk to the people I work with about

26:57

whether something is good for your mood or bad for

26:59

your mood. And you can think about that. Almost

27:01

everything we do, we know it's either gonna be good for us

27:03

or bad for us. But there are certain

27:05

things that are particularly

27:07

important

27:08

if you are dealing with a mood disorder.

27:10

So getting

27:11

enough sleep, I cannot emphasize

27:14

that. And unfortunately, the schedules that

27:16

our young people

27:17

have make it really hard

27:19

to do that. Getting

27:21

enough exercise.

27:23

Eating something healthy.

27:25

Not drinking, using drugs.

27:27

Spending time with family and friends and

27:30

following some kind of a schedule. So

27:32

those all contribute in a good way.

27:36

We know from this study that was done

27:38

in New Zealand where they were not treating,

27:40

they were just following young people from birth.

27:43

So it's a long cohort study. And

27:45

when the young people were around 15,

27:48

they went about every five years.

27:50

They checked to see if they had depression or

27:52

not. And then they went back at 10 years

27:56

after the initial assessment. They were

27:58

comparing how the young people that

28:01

had depression as a teenager and

28:03

those who did not have depression. Since

28:05

most of them did not get treatment, again, this

28:07

was a study done

28:09

by

28:09

sociologists, not psychiatrists,

28:13

this is what we know.

28:15

Having adolescent depression puts

28:17

you at higher risk of having

28:20

recurrent depression, not surprising.

28:22

Anxiety disorders, substance

28:25

dependence or abuse,

28:28

making suicide attempts, not

28:31

going as far in school as would have been predicted

28:33

from your earlier performance,

28:36

either fathering a child or having a child

28:38

at a young age

28:39

and being unemployed. Now

28:42

I will say that I talk about

28:44

this study with parents when they're reluctant

28:46

for their child to have

28:48

care because you can just say

28:50

this is not what anyone wants for

28:52

a young person. Depression interrupts

28:55

your ability to function

28:56

so it interrupts your ability to go

28:58

forward in a positive way.

29:01

So what are some misconceptions about mood

29:03

disorders? Well, one is it's a sign of

29:05

weakness,

29:06

that's just preposterous. The people that are able

29:08

to live with these conditions are some of the

29:10

strongest people I've ever met in my life.

29:13

That antidepressants are addictive, which is just

29:15

medically wrong,

29:17

that you can just decide not to be depressed,

29:19

you can just get your attitude adjusted and that

29:21

will work. It's kind of like telling someone in the

29:23

middle of an asthma attack to take

29:26

some deep breaths and it'll go away.

29:29

But it's always due to circumstance. It's

29:31

true that life stresses can worsen

29:34

depression and trigger episodes, but

29:36

it's also true that sometimes they come out of

29:38

the blue.

29:40

And that it only involves a change in mood. Often

29:42

the cognitive changes, the distorted

29:45

thinking, the slowed thinking are

29:47

some of the things that make or with

29:49

mania, the sped up thinking and the bad

29:51

judgment

29:52

are the symptoms that cause the most trouble

29:54

rather than the mood symptoms. Now,

29:57

when I talk to parents,

29:59

I hear... two kinds of myths.

30:01

First, there's the maximizing fault myth.

30:04

This is terrible that I missed it. This

30:07

is terrible because it is in my family,

30:10

which is, you know, the guilt of

30:11

genetics,

30:13

or

30:14

blaming the other parent, which is, as you

30:16

can imagine, the least productive of all of

30:18

them, this is all your fault because, you

30:20

know, your fault because you did X or Y

30:22

or Z. But unfortunately,

30:25

there's also the myth of it's a

30:27

phase, they'll

30:28

be over it soon.

30:30

It's a reaction to the divorce to

30:32

our moving to

30:35

the grandparent dying, or it

30:38

can be overcome by willpower.

30:40

The difference with depression, of course, compared

30:42

to a reaction or a phase is

30:45

that it's sustained. You

30:47

know, reactions are usually short lived.

30:49

Depression is typically sustained

30:52

and gets sustained in a way

30:54

that it ends up being impairing.

30:59

So importantly, for today, as

31:01

we're talking with parents who are very savvy

31:04

and aware of how things go together

31:06

with

31:07

attention deficit, I just wanted to

31:09

share results from one recent, very

31:11

well done meta analysis where they put together

31:13

multiple studies, looking at

31:16

how common ADD and

31:19

mood disorders are. So we just

31:21

look at whether they're common, 40

31:24

to 70% of the time,

31:27

a young person with depression or bipolar

31:29

disorder will have a second condition.

31:32

That is not fair, but

31:33

it is factual.

31:36

Attention deficit hyperactivity disorder

31:38

being one of the most common

31:39

anxiety disorders

31:40

and substance use also being very

31:42

common.

31:44

So if we look at the numbers,

31:46

this is this meta analysis that put together

31:48

multiple studies.

31:50

And what do we find that if you have childhood

31:52

onset bipolar, so

31:54

that's child BD,

31:56

about 70% of those

31:58

young people will

31:59

also have attention deficit.

32:02

If you have childhood onset major depression,

32:05

then it's more in the

32:07

about 30, a little more 30, 35%. If

32:11

you have the onset of bipolar disorder as

32:13

an adolescent, then you're at about 45%

32:15

that will

32:17

also have ADD. Adolescent

32:20

onset major depression, it's about 20%. And

32:23

then if you have the first symptoms of

32:25

bipolar disorder or major depression

32:27

as an adult, it's

32:30

lower. But

32:31

these are incredibly high co-occurring

32:33

rates. The other, I

32:36

think very helpful figure they did was looking

32:39

at ADHD prevalence,

32:41

the estimate of that, and comparing

32:44

for both bipolar disorder on the top

32:47

and depression below, these

32:49

two different graphs,

32:50

they looked at in the red, the

32:53

rates of North America, and in

32:55

the aqua, it's the rates in

32:58

other parts of the world.

33:00

So it shows that especially

33:02

for bipolar

33:04

disorder, there are higher

33:06

rates

33:07

here in the US, but

33:09

they're pretty significant everywhere.

33:11

And then

33:13

with depression, it's less of

33:15

a difference in that, for example,

33:17

for adolescent onset depression,

33:20

the rates of the co-occurring rate of

33:22

ADD is actually higher in other parts

33:24

of the world. But

33:25

if you just take the average, we're looking

33:27

at 70% of

33:28

youth that have onset

33:31

of bipolar disorder when they're young, less

33:33

than when they're

33:34

in middle school, say, are gonna

33:37

also be dealing with ADD.

33:39

If you have the onset of bipolar disorder

33:42

or major depression, either as a

33:44

child and adolescent, there's a very

33:46

high percent chance that you're dealing with both,

33:48

which of course contributes

33:50

to complexity

33:52

in treatment.

33:54

And we have to think about that.

33:58

For...

34:01

Just to share something with you, for 25 years

34:03

I've been running a program where we go into

34:05

schools to teach kids about depression.

34:07

I feel like I have

34:09

heard from doing 25 years of parent

34:11

night what parents are really worried

34:14

about. And so I'm just sharing the

34:16

resource that was mentioned in the introduction,

34:18

adepteducation.org, where

34:21

there are a series of webinars that are available

34:23

for free and also more information

34:26

for parents and students.

34:27

So just to offer that as a resource.

34:34

So to conclude, talking about

34:37

attention deficit and mood

34:38

disorders. Mood disorders are very

34:41

common in adolescents. It's one of the most common

34:43

psychiatric problems adolescents face.

34:46

Suicide unfortunately can be a major cause of

34:48

death and so you want to take it very seriously.

34:51

And attention deficit

34:52

hyperactivity disorder and mood disorders

34:55

commonly co-occur. So you have

34:57

to think about that. These are two conditions

34:59

that come together.

35:00

And having the onset of attention

35:03

deficit when you're younger,

35:05

parents want to be on the lookout for the development

35:07

of either anxiety disorders or

35:09

mood disorders because there are very

35:12

high co-occurring

35:12

rates of all three of those. But

35:15

mood disorders are treatable.

35:17

That the reason to know about this

35:19

and distinguish them is so

35:21

that you cannot miss something

35:24

that could actually be really helpful

35:25

for your child.

35:27

And sometimes people will say, well, one thing's

35:29

enough. Like, well, not if the

35:31

young person has two.

35:33

Because the same treatment,

35:35

the primary treatments for

35:36

attention deficit obviously are the stimulants

35:39

primarily. They don't

35:41

hurt major depression. Sometimes they're

35:43

an adjunct treatment, but they're not a primary

35:45

treatment. And with bipolar disorder,

35:48

it complicates treatment because the

35:50

stimulants actually can,

35:52

for some, trigger mood cycling.

35:55

And certainly in those who are not being treated with

35:57

a

35:57

mood-stabilizing medicine can

35:59

definitely Trigger mood cycling

36:01

the things you have to think about So

36:04

the parents what can you do to support

36:06

your child? Well, if you're

36:08

concerned talk to a child about those

36:11

concerns and have a conversation that's

36:13

not

36:13

superficial Now I do understand

36:15

that this is not an easy

36:17

thing to do with someone who is

36:19

a teenager Because their response

36:22

to many things is fine.

36:24

That's fine. The day was fine. What are you talking about?

36:26

But if you have specific things you're

36:28

observing, you know, I've noticed you haven't

36:31

been out with your friends much I've been concerned

36:33

that you've seen they're

36:34

not quite yourself

36:38

That's an opportunity Really

36:42

importantly is to always be talking about

36:44

mental health concerns seriously and respectfully

36:48

If you've made disparaging comments or made

36:50

fun of people not that hopefully

36:52

anyone is doing this But we know some people

36:54

do

36:55

Then they're going to think that they

36:57

shouldn't have that or mean something

36:59

terrible about them

37:01

if you have those kind of conditions

37:05

And consider an evaluation One

37:08

other thing I'll add is if you're not sure

37:11

Often getting in touch with the school counselor

37:14

who can in a thoughtful way maybe

37:16

get a little information When

37:18

people have depression, it's not just at home

37:20

because they're they're having arguments with their parents

37:23

It's affecting their interactions with peers with

37:26

their academics With

37:28

their activities be they sports or other

37:30

activities

37:31

at school

37:32

as well as you know How they're feeling about

37:34

themselves so often that's an

37:37

opportunity to find out what's going on at

37:39

the eight hours a day They're not around

37:41

you or not at home, which can be really helpful

37:43

information sometimes

37:49

Okay, with that we'll take questions, okay, thank you. Dr. Schwartz really appreciate

37:51

that important information Before

37:54

we start the Q&A I'd like to share the final

38:00

results from today's poll question, how

38:03

confident are you in your ability to

38:05

differentiate between typical sadness

38:07

and depression in teens and what factors

38:09

make it difficult for you to do so? Here's

38:12

what you said, 43% said

38:15

somewhat confident, 32% said they

38:17

weren't sure, 16% said

38:20

not very confident. And the factors

38:23

that made it difficult to discern teen depression

38:25

symptoms, 35% said

38:28

onset of puberty and mood shifts, 23%

38:32

said lookalike

38:32

ADHD symptoms,

38:34

20% said lack of communication

38:37

from their child, 14% said

38:39

impact of the pandemic.

38:42

Now to your questions,

38:44

how can we help the teen who resists

38:46

getting help such as going to therapy or

38:49

taking medication?

38:52

So that is a huge challenge, right?

38:54

When children are very young,

38:56

they'll typically do what their parents

38:58

say, as they get older, they have more agency

39:00

and they have a lot, they

39:01

have much stronger opinions.

39:03

And so I think having,

39:06

if someone's saying I'm not going to do this,

39:08

rather than having infinite conversations,

39:11

having some other trusted adults

39:14

be part of the conversation can be helpful,

39:16

whether that's a pediatrician, a counselor

39:19

at school, a coach, you

39:21

know, someone else in addition, not

39:23

that the parents shouldn't start, of course you should,

39:25

they're your child, but getting some

39:27

others involved. And I also think it's important

39:31

to be able to share with them

39:33

what you expect to get better.

39:36

Not just look, I think you have this, you need

39:38

to do this treatment, but identify

39:40

the symptoms that are most problematic to them

39:43

and say, I know you haven't been able

39:46

to enjoy yourself, or I know you're having trouble

39:48

thinking, I really think this is going

39:50

to help change that. You know, a line

39:52

I've used with my own friends and family who

39:55

have been resistant to getting

39:57

treatment is to say that I think you're

39:59

suffering with it. you don't need to. I

40:01

just don't want to see you suffer when you don't

40:03

need to.

40:05

But the main thing is to not have

40:08

any thought that you're going to have one conversation

40:11

and go forward. If you're that lucky, I'm thrilled

40:13

for you. Typically,

40:15

you have to have multiple conversations

40:18

and even bring in other

40:20

really trusted adults. You don't want to get

40:22

random people because then they'll be angry that

40:24

you're sharing their private business. But

40:27

if they have a really

40:28

trusted coach, really trusted teacher,

40:31

someone in the community that they're part of

40:33

an organization, someone like that might be

40:35

helpful to include too sometimes.

40:38

Someone asked, what

40:41

are triggers for depression for

40:43

school-aged children? And is it possible

40:45

for depression to be prevented?

40:47

Sure. So

40:49

prevention we're not sure about. What

40:52

I can tell you

40:53

is that

40:54

depression is like other medical problems.

40:57

If you think about something really common

40:59

for young people, asthma,

41:01

sometimes asthma comes out of the blue, sometimes

41:03

it's because you cleaned out your grandmother's dusty

41:06

attic, sometimes it's because you visited your

41:08

friend with three cats.

41:10

We don't treat it differently

41:13

if it's out of the blue or from

41:15

the cats. We don't say out of the blue, you

41:17

get an inhaler and the cat, you should have known

41:19

better, you don't get an inhaler. We

41:21

say you're having an asthma attack, we're

41:23

going to treat it. So

41:24

there are certainly life stressors

41:26

and triggers, including hormonal

41:28

changes and

41:31

major stress,

41:34

major losses, the loss

41:36

of a parent, God forbid, or

41:38

the loss of a grandparent. But

41:40

sometimes it comes out of the blue. The

41:42

tricky part

41:43

is that

41:45

yes, those things could trigger it, but also

41:47

if you're depressed,

41:49

your reaction

41:50

to things that happen in life gets

41:52

way out of proportion.

41:54

So often people will say to me, well, I think it

41:56

was all because that girl broke up with him.

41:59

I'll say, well, I think

41:59

from speaking with him that the depression

42:02

started before, so

42:03

his reaction to that was out

42:05

of the blue.

42:06

So if you said, well, what are some things I could do

42:09

that maybe would help?

42:10

We don't know a surefire way to prevent,

42:13

but

42:14

having young people not smoke pot,

42:17

not drink alcohol,

42:19

and get enough sleep are pretty

42:21

basic things that could be helpful. And

42:24

they're also really challenging

42:27

things to achieve.

42:29

A

42:32

parent asks, what are the less obvious

42:35

signs of depression that often go

42:37

unnoticed by parents?

42:39

Right. So the parallel to ADD

42:42

is that obviously a person who is,

42:44

to quote one of my teachers, wiggly and squiggly,

42:47

and calling out and getting in trouble, you might

42:49

not miss that. But if you have the inattentive

42:51

type,

42:52

so the big thing is who

42:54

is the person? So depression is

42:57

a change.

42:58

People don't have this from such a young

43:01

age. They're going along, and then there's a clear

43:03

change. But the change is subtle

43:05

and gradual,

43:07

so each day isn't that different day

43:09

to day.

43:09

And so there's a subset of young people where

43:12

it's really subtle, quieter,

43:13

more introverted, maybe

43:15

not so much

43:17

social

43:17

or interacting. So if they get a little

43:19

more socially withdrawn, well, they were never that

43:21

social. And I will tell you, the

43:23

pandemic screwed that up because we

43:26

changed how kids were interacting. But

43:29

subtle kinds of things are very

43:32

subtle changes in confidence. No

43:35

one's saying I'm a terrible person or I don't

43:37

think you care about me, but they're saying,

43:41

I apologize, being at the Johns Hopkins Hospital,

43:43

there's an ambulance going down

43:45

the street.

43:46

There are these subtle things like,

43:49

I don't think I would get a part

43:51

in the place, maybe I won't try.

43:54

Or it's

43:55

a lot of work to spend

43:57

time with my friends. So maybe

43:59

I'll just.

43:59

home. So

44:01

those are some things

44:03

that are more subtle. Someone looking miserable

44:06

and talking about what a terrible person they are,

44:08

the parents are not going to miss that, at least

44:10

the quieter ones.

44:12

The bigger problem is that it changes so

44:15

slowly

44:15

that it might take two months

44:17

for it to get really bad. Each

44:19

day is not that different than the day before,

44:22

so you might miss it, unlike getting

44:24

sick with the flu or COVID where you're fine

44:26

and then you feel really awful and

44:29

then you sort of get better over time.

44:32

Is it better to treat depression

44:35

and ADHD together or focus on

44:37

one condition first before the other? I'm

44:40

biased.

44:40

I think it's best to treat

44:42

both because

44:45

they're going... If you don't treat... Say

44:47

you treat the depression ignore the ADD,

44:49

that's a stress.

44:51

I'm not able to focus and concentrate

44:53

and that's causing me difficulty. If you

44:55

treat the ADD without the depression,

44:57

your concentration may be significantly

45:00

impaired

45:01

by the depression.

45:02

And so you're treating... You're

45:05

over... In that way, over-treating or escalating

45:07

the dose of the medication or other treatments

45:09

for ADD. So I think it's best

45:12

to have a plan where you're working

45:14

on both. Now you might say,

45:16

let's start one medicine

45:18

and make sure that it agrees with the person or

45:20

one kind of therapy with the focus and then

45:23

add, but

45:23

I wouldn't wait a long time. Like,

45:26

well, let's get this done and give it six months

45:28

and we'll see.

45:29

That would not be my recommendation.

45:33

I love this next question. How

45:35

can students best support a classmate

45:38

who may be experiencing periodic or

45:40

persistent depression?

45:41

That's a fantastic

45:42

question. So

45:44

many people talk about the fact that when

45:46

they have depression, they feel like they can't

45:49

share it because it's personal or that people don't

45:51

understand. So what do we do

45:53

for our friends if they're going through something? We

45:57

take them to lunch. We suggest

45:59

they come over.

45:59

We say, why don't we watch a movie? So

46:02

what's great is for friends to reach

46:05

out, but also to suggest

46:07

things they can do together that won't

46:08

be stressful. So going

46:10

to a big party when you're feeling depressed is overwhelming

46:13

instead

46:13

of saying, why don't you come over and

46:15

we'll get a pizza and we'll watch a movie.

46:18

So something quieter, but

46:20

just showing

46:21

that you're okay spending

46:23

time together and that you want to spend

46:25

time together, I think is really important.

46:27

At the same time, I just want to add, I

46:30

think it's important that we give young people the message

46:32

and we do this with our high school project.

46:34

They shouldn't be trying to be their friend's

46:36

therapist. If they're

46:38

worried about their friend, they need to share that

46:40

with their own parent or their friend's

46:43

parent because they shouldn't be in

46:45

the position of trying to provide that level

46:47

of

46:47

support.

46:48

They should be watching a movie

46:50

and eating a pizza.

46:52

The flip

46:54

side of that question is, how can I help

46:56

my teen who has no friends?

46:59

Sure. So when you have no friends,

47:01

think about it. It's when people have to move, they'll

47:03

say, I'm moving to a new city, what the heck am I

47:05

going to do?

47:06

I'll say, well, think

47:08

about something you

47:09

like to do because often a good way

47:11

to make friends is with an activity

47:13

base, right? So maybe you don't click with the people

47:16

at your school or you get

47:19

involved with the school play or you

47:21

help to make the scenery for it or

47:23

something, but you start doing

47:25

things with other students or you

47:27

get involved with a community group

47:30

that's doing certain things. And so, you're

47:33

hoping to clean up the bay here in Maryland,

47:36

but you're out and interacting

47:38

with people. And if you have a shared interest, then

47:40

you often have something to talk about for

47:42

young people who are very shy or maybe

47:45

have had, it's more challenging because

47:47

of the things they've,

47:48

the challenges they've had to face. Sometimes that's

47:50

a way to start. Okay.

47:54

How does depression affect the students academic

47:56

performance? Sure,

47:58

so academic performance.

47:59

with depression is classically

48:02

impaired.

48:03

Now,

48:04

sometimes I've had young people tell me

48:06

that their freedom was based on their grades,

48:09

what they're allowed to do. So sometimes

48:11

grades will be OK, but what you'll

48:13

find is that students start limiting

48:16

everything else. They're not playing soccer

48:18

anymore. They didn't try out the play. You

48:20

ask them why, and they'll say, look,

48:22

it's taking me three or four times longer

48:24

than usual to do my homework. I

48:27

can't process after

48:28

re-reading things. They can't think as quickly.

48:31

But I know I'll be in trouble if my grades go

48:33

down. So typically, there

48:36

will be a drop in grades because of

48:38

concentration, that you really just can't

48:40

process information. But occasionally,

48:43

kids will keep them up. But

48:45

the effort they have to put into doing it

48:47

goes way up.

48:49

A parent asks, are there

48:51

school accommodations for depression?

48:53

Absolutely.

48:54

Now, obviously, all school

48:56

accommodations are on an individual basis.

48:59

But I've been part of organizing that for students.

49:02

And I think that in general,

49:04

the schools have gotten a little

49:06

more sophisticated about this.

49:09

There is nothing good about COVID

49:11

and what that did across the world. But

49:14

it has opened people's eyes a little bit

49:16

to the fact that some

49:17

of these psychiatric issues are real

49:20

and that we have to be more serious about them.

49:23

And they often are things related

49:24

to

49:25

time because if you're not processing

49:28

quickly, it might take you more time

49:30

or some

49:31

ability to delay turning

49:33

things in and stuff like that. The typical

49:35

kind of accommodation.

49:38

How can I help

49:40

my college student who has depression

49:42

but who lives away at school?

49:45

So

49:46

sometimes college

49:48

students were getting treatment at home with

49:50

the great support of parents reminding them

49:52

about medicines and things. And then they go to college

49:55

and then they think,

49:57

antidepressant or beer?

49:59

And they picked

49:59

fear, which isn't good, and then things

50:02

fall apart.

50:03

Almost every college has

50:05

a counseling center, which is

50:07

a good place to start, because they

50:09

can do an evaluation and then often

50:11

link the college students

50:12

to local services

50:14

and local support. Some colleges

50:17

have support groups,

50:18

others at least can get you connected

50:20

with what local resources are.

50:22

So it's a trusted place to

50:25

start when you're just trying to look for resources

50:27

in other places.

50:29

If my team

50:31

with ADHD has had a depression

50:34

episode with suicidal thoughts,

50:36

is it likely that he will have another

50:39

episode like that?

50:41

You know, it's very interesting and challenging

50:44

because when

50:45

you've had a really

50:45

serious depression, like you're describing,

50:48

there are three possibilities.

50:50

One is that you'll never have another one.

50:53

The other possibilities, you'll have another one,

50:55

but it won't be for years, 10

50:57

or 15. And the other is that

51:00

another episode will come relatively

51:02

quickly, especially if you don't stay on

51:04

medicine.

51:05

The problem is, we have

51:07

no way of predicting,

51:09

which is why if someone is

51:12

doing well and not having bad side effects,

51:14

we ask people to be really thoughtful

51:17

if they've responded to treatment about stopping

51:20

that treatment.

51:21

It's a little bit of a stress test to figure

51:23

out which group you're in. Now

51:26

there's some data that supports that if you

51:28

have that first episode when you're young,

51:31

it's more likely that you'll have recurrent episodes.

51:34

But not everyone does. Some people are very lucky

51:36

and just have one. But if you are just

51:38

looking at the likelihood, the odds

51:41

of it,

51:41

the odds is you had a very serious

51:43

episode when you were younger, you will have

51:46

other episodes in the future, which sometimes

51:48

you can prevent by staying

51:51

in treatment and continuing

51:54

to do the psychotherapy, continuing

51:56

medication.

51:58

Someone asked, If depression

52:00

is under control, will this prevent

52:03

bipolar onset?

52:07

There's no real study

52:09

that's ever looked at that, as you can imagine.

52:13

The thing with bipolar disorder, what we think

52:16

is that every one of us is born

52:18

with different biologic vulnerability

52:21

to depression, to ADT, to bipolar disorder,

52:23

to all of these different conditions.

52:26

You can't know, but

52:27

we do think that life

52:30

matters.

52:31

Let me share this with you. If you

52:33

look at identical twins that

52:35

have exactly the same genetics, if

52:38

one twin has bipolar disorder,

52:40

it's only 50% of

52:42

the time that the other twin also has this.

52:45

Then you say, okay, what were the differences?

52:47

Things like

52:49

exposure to

52:52

drugs and alcohol, sleep

52:55

disruptions,

52:56

maybe other medical conditions,

52:58

they all come into it. There are

53:00

all these factors in life that

53:03

maybe triggers it for one person and not

53:05

another.

53:06

Certainly, having well-controlled

53:08

depression is certainly

53:11

a positive thing in the way these

53:13

other things are positive things. It's not a guarantee

53:17

because we also don't know whether that young person

53:19

was vulnerable or not

53:22

at all. The majority of young people

53:24

that have depression

53:25

will not have bipolar disorder.

53:27

It's 10 to 20%, but later

53:30

gone to develop bipolar disorder, but it's

53:32

easy to 90% that you're not.

53:36

Someone asked, what are some early identifiable

53:39

symptoms that are unique to teens with bipolar?

53:43

With bipolar disorder,

53:45

I've

53:47

said to many young people, you

53:50

get really

53:52

imperious

53:53

and impatient and annoyed with

53:55

everyone. It's not just, oh,

53:58

parents. It's There's

54:01

an edge to it. I'm smarter than

54:03

you and you can't keep up with me. And

54:06

then the other things you might observe are the

54:08

changes in need for sleep and the

54:10

amount of activity someone's

54:11

involved with before it perhaps

54:14

progresses to the point that's really worrisome.

54:17

So

54:18

need for sleep,

54:19

amount of sort of buzzing activity

54:22

going on, and this

54:24

sort of,

54:26

I'm annoyed with everyone because they can't keep up

54:28

with me. I would say those are some subtle things we

54:30

often see earlier than the more dramatic

54:33

sense of like, I think I

54:35

have special, I'm disorganized

54:36

and I think I have

54:38

special talents or abilities.

54:44

Someone asked, how much of an impact

54:46

do you think social media has such

54:48

as TikTok and Instagram on

54:51

an adolescent's perceptions and beliefs

54:53

that they're depressed?

54:56

You know, it's hard to know because on

54:58

one level you want people to learn

55:00

and identify. I mean, I've been going

55:02

to schools for 25 years for a reason. I

55:04

want young people to have information about this. So

55:07

I

55:07

want them to have information about smoking and

55:09

lung cancer and other kinds of medical things.

55:12

And the kind of things that

55:14

a healthy diet is good for your long-term

55:17

health, all of that. There

55:19

are probably some people that decide

55:21

they have depression when they don't because of TikTok.

55:24

They know there are some people that identify

55:26

symptoms they might not have known about because of

55:28

TikTok.

55:29

My worry is not so much the

55:31

sort of public service things.

55:33

My worry is someone

55:36

getting sucked into

55:38

very negative

55:40

parts

55:41

of all of that, where they're comparing

55:43

each of themselves

55:44

to others negatively, where

55:46

they spent, nobody

55:50

has the life that they have posted

55:53

on Facebook or Instagram

55:55

or any of it. No one says,

55:57

look how messy my kitchen is. What

56:00

a disaster.

56:01

Everyone is curating, they're

56:03

choosing, they're putting forward something

56:06

that's unrealistic. And now these young

56:08

people are

56:09

throwing up filters

56:10

and this and that, and so it's not

56:12

even realistic.

56:14

And I think

56:16

different

56:17

young people have different levels of sophistication

56:20

about whether they should believe anything they see on

56:22

the internet. And so overall,

56:25

it is greatly, the actual

56:27

sort of being and interacting in social

56:30

media, I think has real potential,

56:32

real negative potential. Maybe

56:35

there are

56:36

some groups, very marginalized groups,

56:39

and some studies have been shown to find

56:41

community and support. So it's not all

56:43

bad, but

56:44

it's a lot bad.

56:47

Yeah.

56:50

Someone writes, how can I find a balance

56:52

between supporting my child without

56:55

being a helicopter parent and giving

56:57

him space?

56:58

Yeah, that's the billion dollar question, isn't

57:01

how involved should I be?

57:03

I think part of it

57:05

is

57:06

when you're trying to decide how involved

57:08

to be should be how well they're functioning.

57:12

I think you can reward

57:14

reasonable behavior and reasonable

57:16

and good

57:17

choices with

57:19

less helicoptering.

57:21

To say, look, if you're able to do

57:23

the following things and I don't have to remind

57:25

you, then I know I can trust you. So

57:28

setting up opportunities for young people

57:30

to thrive and

57:33

incentivizing, I'll take

57:35

care of this, I'll take care of that.

57:37

I think of a friend of mine

57:39

whose mother was forever showing up at the high school

57:41

with whatever he didn't bring

57:43

with him and fussing at him and everything

57:46

else. It's like, well, why don't you just work

57:48

on remembering your lunch? Like

57:50

I don't have to, my mom will do it.

57:53

And I remember thinking in high school,

57:56

I remember thinking that is messed up.

57:59

Your mom going to college. with you. So

58:01

I think that's, I think setting it

58:03

up where you can incentivize the

58:05

kind of independence that people would

58:08

like and might be

58:09

good for them would be great.

58:12

And someone

58:14

asks if bipolar symptoms are treated

58:17

early in life, would that help prevent

58:19

more severe issues later in life?

58:22

There haven't been

58:24

formal studies of this because you can imagine

58:26

you can't say let's take the

58:28

group and we'll treat you and let's take a

58:30

group and we don't treat you. But from

58:32

my personal experience of being

58:34

a psychiatrist focusing on mood for

58:36

almost 30 years, the earlier

58:38

you identify and treat the less chaos

58:41

it creates. It

58:43

doesn't interrupt. You know I said that there's

58:45

this long delay for many people. In

58:48

that time many people get caught up in

58:50

substance use, eating disorders, other kind

58:52

of problematic behaviors

58:55

but also problematic relationships.

58:57

And so the earlier you can identify

58:59

and treat

59:00

I think the better outcomes without question

59:03

because it gets managed

59:05

instead of taking

59:06

over.

59:09

Okay

59:12

and then our last question is how

59:14

do you get a child to open up about their feelings

59:17

without making them seem uncomfortable?

59:20

That is another million dollar question.

59:23

Yes. So if someone figures that out please

59:25

share with everyone. I mean I think

59:27

the

59:28

way a way to

59:29

that can help is to

59:32

routinely

59:33

have opportunities. You know that

59:35

you say we're all having dinner together and

59:38

we're going to sit here and I'm going to talk about my

59:40

day and you're going to talk about your

59:41

day even if you think it's silly. But

59:43

if you

59:43

as a family routinely and I don't

59:45

mean every night necessarily you

59:48

know sometimes kids activities,

59:49

parents of activities but if regularly

59:52

you're interacting then they're

59:54

used to interacting with you so it's not that you're

59:56

marching into their room when you're worried and

59:58

saying what is going on.

59:59

on,

1:00:01

right? Then you feel

1:00:02

like you're the investigator as opposed

1:00:04

to

1:00:05

you're someone's different

1:00:06

in the discussion you have say

1:00:08

at dinner. And they

1:00:10

you can say well I just want to ask you another question.

1:00:13

Everyone leaves like I just have a question for you, okay?

1:00:15

But you're used to having interactions. I think

1:00:17

that can help a lot.

1:00:19

Yeah.

1:00:20

Well Dr. Schwartz, thank you

1:00:22

so much for joining us today and

1:00:24

for sharing your expertise with our ADHD

1:00:27

community. We really appreciate it.

1:00:29

No, thank you very much for the invitation

1:00:31

to join you all today.

1:00:33

And thank you to today's listeners.

1:00:36

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