TEENS

Diabulimia, Drugs, and Mental Illness in Teens With Diabetes

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A mother shares her story of loss and devastation, exposing how teens with diabetes may be suffering silently, tormented by the effects of a disease they don’t want to accept. Knowing the early signs of trouble and getting prompt care means prevention is possible.

Rachel Wilke was 14 years old when she was diagnosed with type 1 diabetes. It was her first day of high school. She came home from school and told her mom that she had fallen asleep in English class. Later, she was so thirsty that she drank the entire case of Capri Sun punch that her mom had bought for school lunches. Her mom rushed her to the doctor, where they both cried as they learned of her diagnosis. Rachel asked why it had to happen to her. 

This was the beginning of a long journey full of anger at the disease that came crashing into her life.

Rachel quickly gained around 15 pounds as a result of insulin therapy treatments, which devastated her. She wanted to voice her concerns, but her first two endocrinologists moved out of state early in her diabetes journey. Her third discontinued seeing Rachel for “noncompliance.” Finally, she brought up the weight issue with her fourth doctor. 

“If insulin doesn’t cause weight gain, why are so many diabetics fat?” Rachel asked. Her mom, Carolyn DiPasquale, describes this doctor as a petite woman who was also living with diabetes. She had hoped this would help them “click,” unlike with Rachel’s previous doctors. But this new doctor snapped back, “There’s no evidence to substantiate that,” even though studies pointed to weight gain as a side effect of treatment. The doctor brushed off the weight gain as normal, not a big deal. So, Rachel took matters into her own hands and started adjusting her insulin doses to lose weight. 

Up to 15% of adolescent girls and almost 40% of women with diabetes develop “diabulimia,” an eating disorder that involves altering medication doses to lose weight or to achieve the “perfect” body.

“She was covertly cutting back on her insulin. Her blood sugars ran high, but she also ate a lot of food…she was very stressed out and she’d get sick,” says DiPasquale. “She had allergies and asthma that would cause her [blood] sugars to rise, so I just thought there were other issues…I never knew she was cutting back on her insulin.” Her mom wouldn’t learn of this until a decade later, as Rachel carefully guarded this secret.

Rachel quickly developed a “full-blown case of bulimia,” DiPasquale explains, as well as mental health struggles stemming from her intense anger toward her diagnosis.

“Rachel had two very separate eating disorders — diabulimia and bulimia — with distinct symptoms and risks. Her journals suggest that both surfaced shortly after her diabetes diagnosis, though the diabulimia came first,” DiPasquale says. “Alarmed over her increased appetite and weight gain, Rachel began to obsessively diet and exercise. When [the] purging didn’t cut it, and especially after Rachel acquired a boyfriend, she resorted to more radical means, quickly discovering that by shorting her insulin or skipping her evening shot, pounds melted overnight.”

Before long, she was “self-medicating” with alcohol, then drugs such as marijuana, then harder drugs. Her mom believes that Rachel tried to “numb” her pain; she developed a heroin dependency at 17 or 18, and when she eventually got off heroin, she got addicted to  prescription medications. She started college but had to drop out, since binging and purging six times per day required too much time and money. 

She attempted various rehab programs. 

“With one physical illness and three mental illnesses, the programs could not begin to address Rachel’s needs,” DiPasquale says. The programs were “absurdly inadequate for Rachel, considering the longevity and severity of her bulimia and diabulimia, not to mention the fact that her co-occurring illnesses often interfered with her therapy.” 

Just weeks after being discharged from one program, Rachel wrote in her journal, “With heroin, I get to boss the bulimia around. I get a break. A foolish vacation of sorts, one I assuredly cannot afford to take. But I don’t want to spend one more day being held hostage by these [eating disorders].”

At 28, Rachel died of a drug overdose while pregnant with her first child. 

DiPasquale shares her daughter’s story in her book, Reckless Grace: A Mother’s Crash Course in Mental Illness, with the hope of educating others about the far-reaching potential consequences diabetes can have beyond the medical complications associated with the condition.

The connection between diabetes, mental health, and eating disorders 

Rachel’s struggle with eating disorders after her diagnosis isn’t unique; 7% of adolescents with type 1 diabetes develop an eating disorder versus 3% of their peers without it, a study shows. Dr. Ann Goebel-Fabbri, a psychologist who specializes in eating disorders, explains the multiple factors that may lead to increased odds of eating disorders among people living with diabetes. 

“There is a lot of evidence that diabetes, both type 1 and type 2, have higher rates of depression and anxiety. Recently, there’s been a lot of emphasis on the concept of diabetes distress…related to the ongoing burden and stress of having a chronic condition like diabetes, which requires so much monitoring and effort,” says Goebel-Fabbri. 

She explains that mental health conditions, including eating disorders, can surface after chronically worrying about low blood sugar levels, diabetes complications, and feeling defeated when blood sugar levels are out of range, not to mention the weight stigma that is frequently  associated with having diabetes. 

Another reason Goebel-Fabbri says people with diabetes might be more prone to eating disorders (especially women with type 1, who she says have a 2.5 times greater risk of developing one) is that their focus has to be on food for large parts of their days — and their lives. 

“Disease management itself is so focused on having to monitor food and portion size, and the relationship between food and blood glucose or food and how people are feeling, that it sort of mirrors the kind of mindset that can develop into an eating disorder…people can develop very rigid rules about what they allow themselves to eat or don’t,” she says.

DiPasquale wishes doctors were more attentive to her child’s conversations with them about how she didn’t want to gain weight. When Rachel’s psychologist reported her diabulimia symptoms to her endocrinologist, Rachel confirmed to the doctor that her weight was causing her to “panic.” Not getting the help Rachel needed in balancing her insulin, other medications, and weight pushed her to look for her own solutions instead, DiPasquale explains.

Goebel-Fabbri says praising people who are losing weight can also be harmful because it could reinforce unhealthy behaviors and disordered eating practices. Health care professionals who take the time to look deeper into the cause of weight loss can help prevent and flag concerning behavior and mental health challenges.

Substance use in people with diabetes

Lacking the help she needed from doctors, Rachel turned to her journals, where she meticulously documented her diabetes and mental health battles for a decade. She also turned to drugs and alcohol before she was out of high school. Research shows people with diabetes are much more likely to have alcohol and substance use disorders than the general population, including with opioids.

The irony, of course, in turning to drugs or alcohol while living with diabetes, is that it worsens the condition in many cases. For example, the study mentioned above shows that people with type 2 diabetes are more likely to have higher consumption of alcohol, and that heavy alcohol use increases the risk of developing diabetes complications. 

Dr. Lawrence Weinstein, chief medical officer at American Addiction Centers, says, “Those with diabetes who are also experiencing addiction are more likely to endure exacerbated side effects and health conditions due to their alcohol/substance use disorder. Diabetes and addiction are two co-occurring chronic health conditions that can cause a great deal of complications, and the severity of those complications can be compounded depending on the substance used.”

He adds that a higher likelihood of developing alcohol or drug dependency isn’t diabetes-specific but applies to other chronic conditions as well. “Utilizing alcohol or another substance to cope with the diagnosis of a chronic health condition is a possibility not unique to diabetes; there are many variables and other unknowns that play a role in that taking place. Addiction is a disease in which genetics, environmental surroundings, and a host of other factors play a role,” he says.

Prevention is possible

Eating disorders and substance use disorders in people with diabetes are preventable. DiPasquale has spent much of her time since her daughter’s death teaching other parents about these preventive strategies. Her top message is to stay extremely involved in your children’s care, even when they become teens and want privacy. 

One of the signs of an eating disorder for Rachel was secrecy. “Don’t let your kids lock themselves in their room. I thought I was giving my daughter privacy, and they do need privacy, but that can also be very dangerous,” she says.

Goebel-Fabbri adds that it’s essential to work with a health care team you can be honest with, who won’t make you feel blamed or shamed. “People need to feel like they are free to speak with their health care providers about what’s really going on, as opposed to sort of having to put up a squeaky clean image.” She adds that support from family and friends is essential, and boundaries need to be clearly communicated. For example, they can ask others not to talk about dieting, food, weight, or bodies in front of the person with diabetes. Goebel-Fabbri also recommends finding a mental health professional who is trained in both diabetes and eating disorders, not one or the other. 

Weinstein adds that if someone with diabetes is struggling with substance abuse, they need to be in close contact with their providers, as the combination can lead to severe outcomes. Finally, he says to work towards eliminating triggers that might lead to relapse as part of an aftercare plan, once the substance dependency is more under control. 

DiPasquale says to keep an open dialogue with your family member with diabetes. “Talk about how they’re feeling…my daughter was so angry, she wouldn’t talk about it.” In such cases, she hopes others find mental health professionals who can help. She says diabetes was just the beginning of “a whole string of losses” for her child. 

“She lost her education,” says DiPasquale. “She lost her pride. She lost her self-respect. And, ultimately , she lost her life.” With these tips, she hopes to prevent the same devastation in other families.

Perfectionist Teens Reported More Depression, Stress During COVID-19

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Stress and depression are common among teens during COVID but particularly significant among teens plagued by perfectionism. (PeopleImages.com - Yuri A/Shutterstock

Stress and depression are common among teens during COVID but particularly significant among teens plagued by perfectionism.

Perfectionists are sometimes thought of as superheroes: people who are high achievers and seem to always have it all together.

Perfectionism is different from simply trying to do a good job or even seeking excellence. Rather, perfectionism refers to rigidly requiring nothing short of absolute perfection and being highly self-critical.

Our recent study, published in the journal Child Development, examined how perfectionism is affecting teens’ mental health and stress levels in the age of COVID-19.

Exacting Standards

While research shows some forms of perfectionism are related to small achievement gains, it also reveals perfectionism is commonly associated with experiencing more health problems along with relationship difficulties.

People higher in perfectionism even show signs of dysregulated immune system functioning.

Perfectionists don’t fare any better with respect to their mental health: Research indicates perfectionistic individuals report higher levels of depressive symptoms, stress, disordered eating, and anxiety compared to their less-perfectionistic peers.

Perfectionistic people are particularly susceptible to experiencing these adverse consequences when they’re stressed or faced with difficult and uncertain situations, because they tend to be unable to or at least reluctant to adapt to changing situations.

Thus, there’s good reason to be highly concerned about perfectionists during the continually evolving pandemic that has been exceptionally stressful for most people.

Perfectionism as Personality Trait

When measuring perfectionism as a personality trait, psychology researchers identify different “flavors” of perfectionism.

Self-oriented perfectionism refers to requiring perfection from oneself. People high in self-oriented perfectionism demand perfection from themselves and are incredibly hard on themselves when they don’t meet those demands.

Socially prescribed perfectionism refers to the belief or perception that others require perfection. Individuals who are high in socially prescribed perfectionism think others demand perfection from them, are critical of them, and believe that they’ll never measure up to others’ expectations.

These forms of perfectionism are commonly observed in teens, a group that experiences relatively high levels of perfectionism. Research published in the journal Psychology in the Schools shows that approximately 1 in 4 youth are highly perfectionistic.

Lack of Closure, Opportunities

It’s important to focus on how young people are doing during these difficult times. Unlike adults who have already gained their sense of independence, the pandemic and its accompanying restrictions have held teens back in a state of suspended reality.

For example, many teens have completely missed out on significant developmental milestones such as graduations and proms, leaving them feeling lost due to a lack of closure on important chapters of their lives.

Government-mandated lockdowns that were put in place to slow the spread of COVID-19 forced young people into isolation where they were often separated from friends and family for extended periods of time. School closures also led to substantial interruptions to young people’s schooling, which is associated with gaps in educational achievement.

It isn’t hard to imagine how difficult gaps would be for young perfectionists who often define themselves by their ability to achieve.

Effects of Lockdowns

Our study shows the significant effects lockdowns have had on the self-reported mental health of teens.

We assessed 187 adolescents’ levels of perfectionism, anxiety symptoms, stress, and depressive symptoms before the pandemic began and then again during the first and second government-mandated lockdowns that took place in Ontario, Canada.

Results showed an interesting pattern of change with respect to depressive symptoms and stress levels. Depressive symptoms and stress decreased slightly from before the pandemic began to the first lockdown and then increased dramatically from the first to second lockdown.

Although we cannot be sure, one possible explanation for these findings is that teens were able to take a much-needed break from their busy and possibly overscheduled lives during the first lockdown, which resulted in some relief of depressive symptoms and stress.

However, by the time the second lockdown occurred, teens may have been feeling demoralized and hopeless as the pandemic continued to take its toll on everyone, resulting in higher levels of stress and depressive symptoms.

How Perfectionists Fared

A key finding is that teen perfectionists are not faring as well during the pandemic compared to their non-perfectionistic peers. Teens who demanded perfection from themselves (self-oriented perfectionists) were more depressed, anxious, and stressed than those who didn’t tend to demand perfection from themselves over the course of the pandemic.

Results also showed that when teens experienced higher than their typical levels of self-oriented perfectionism, they were also more anxious but not more depressed or stressed.

Teenagers who believed that others demanded perfection from them were more depressed and stressed than those who didn’t have such beliefs during the pandemic.

We also found that when teens experienced more of these beliefs than usual, they were more depressed but not more anxious or stressed.

Struggles Behind the Mask

Taken together, these findings support the idea that perfectionistic teens are more vulnerable to mental health problems and greater stress compared to their non-perfectionistic peers during the pandemic.

It’s important to recognize that although teen perfectionists often appear to be doing well on the surface, they aren’t superheroes who are impervious to hardships.

Instead, they’re young people who are often in distress and struggling behind their mask of perfection and in need of support during these difficult times.

Vaping, cannabis use increasing among US teens

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The increasing use of cannabis and vaping among U.S. adolescents may be associated with how teens spend their time, according to a study published in Substance Use & Misuse.

Specifically, several factors, such as social engagement, participation in structured activities, level of adult supervision and paid employment, correlated with substance use overall.

Marijuana leaf

Using data from 536,291 adolescents in the Monitoring the Future Study gathered through annual, nationally-representative surveys from 1991 to 2019, Noah T. Kreski, MPH, data analyst for Columbia University Mailman School of Public Health, and colleagues analyzed trends in use of cigarettes, alcohol, cannabis, other substances and vaping of nicotine for those in grades eight, 10 and 12. They then categorized respondents into six groups based on amounts of social time, level of engagement in organized activities, paid employment and, for those with high social time and high engagement, whether activities were more supervised, such as sports, or less supervised, such as dating or parties.

Noah T. Kreski

“We had seen such strong patterning of internalizing symptoms (like depressive symptoms and low self-esteem) based on how young people spend their time [in our previous research]. Extending that work to substance use seemed like a natural next step,” Kreski told Healio.

Substance use tied to time use patterns

Study results revealed declines across decades for most substance use outcomes, including alcohol, cigarette and other substance use, with the largest decreases noted among groups with significant paid employment or high levels of social time, either with low engagement in other activities or lower levels of supervision. Notably, initial prevalence of substance use was highest in these groups. Conversely, the smallest decreases were observed among groups with low levels of peer socialization, although these groups had very low prevalence of substance use in general, according to the researchers.

Despite decreases in substance use over time, cannabis use increased, with the smallest increase seen in the group with low levels of social time and low engagement in organized activities and the largest increase seen in the paid employment group.

Vaping, for which data were available from 2017 onward, also substantially increased during the study period. The largest increase in nicotine vaping occurred among adolescents in the highly social and engaged group with less supervision. In contrast, the largest increase in cannabis vaping occurred among those who were highly social but disengaged. Vaping of both substances was most prevalent in the highly social and engaged group with less supervision.

Substance use overall was lowest in the groups with low levels of social time and highest in the highly social and employed groups, according to the data.

“While some of the results aligned with expectations (like low supervision or high time with peers contributing to higher substance use), it was surprising to see that working a paid job was a risk factor for substance use as well. While the pathways are unclear, future research should look at this group more and provide support where needed,” Kreski said.

In terms of specific substance use, data also showed the following:

  • 15% of respondents reported any past 2-week binge drinking.
  • 27.4% reported drinking alcohol in the past month.
  • 14.7% reported smoking cigarettes in the past month.
  • 12.6% reported any past-month cannabis use.
  • 8.6% reported past-month use of other substances.
  • 12.3% reported nicotine vaping.
  • 6.2% reported cannabis vaping.

Importantly, these data perhaps indicate the need for greater public health measures, particularly those targeting vaping and cannabis use, the researchers noted.

“With how universal the rising trends are, parents should check in with their adolescents about substance use — not from a place of judgment or punishment but open discussion and support. Empowering all young people to make the best, informed choices they can while focusing interventions on cannabis and vaping is a great next step,” Kreski said.

Looking ahead

In the future, Kreski and colleagues are planning to evaluate how these time use patterns relate to externalizing symptoms, such as theft or fighting, but other areas, especially those that interest adolescents themselves, warrant further study.

“Apart from that, I’d love to encourage the development of a system where young people can directly provide feedback on the topics and problems that they find most important, what they think should be studied further. Research should always be guided by the population being studied, and empowering young people is incredibly important,” Kreski said.

Teens benefited from extra sleep during COVID-19 lockdown

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Adolescents who were homeschooled during a COVID-19 lockdown slept longer on school days and drank less alcohol and caffeine than before the pandemic, according to a cross-sectional online survey of nearly 9,000 students in Switzerland.

Researchers found that longer sleep durations were associated with better health-related quality of life among the participants. However, these gains were offset by an increase in depressive symptoms during the COVID-19 lockdown period.

An infographic with a quote that reads "We should continue to push for later school start times to improve sleep quality and quality of life for school-aged children and teenagers." The source of the quote is Cora Collette Breuner, MD, MPH.

“Although negative associations of COVID-19 pandemic high school closures with adolescents’ health have been demonstrated repeatedly, some research has reported a beneficial association of these closures with adolescents’ sleep,” Joëlle N. Albrecht, MSc, of the Child Development Center at the University Children’s Hospital Zurich in Switzerland, and colleagues wrote in JAMA Network Open. “The present study was, to our knowledge, the first to combine both perspectives.”

The researchers analyzed survey responses from 5,308 students (65.1% girls) that were collected in 2017 as well as survey responses from 3,664 students (66.3% girls) that were collected during a partial COVID-19 lockdown in 2020. The median age of both cohorts was 16 years. Since depression symptoms were not assessed in the pre-pandemic group, the researchers conducted a subsample analysis to ascertain if there was a link between sleep duration and health-related characteristics.

Albrecht and colleagues reported that students who were surveyed during the lockdown slept a median of 75 minutes longer than students who were surveyed before the pandemic (semipartial R2 statistic [R2*] = 0.238; 95% CI, 0.222-0.254) and experienced better health-related quality of life (R2* = 0.007; 95% CI, 0.004-0.012), drank less caffeine (R2* = 0.01; 95% CI, 0.006-0.015) and drank less alcohol (R2* = 0.014; 95% CI, 0.008-0.022). Further analyses revealed significant associations between longer sleep times and better health-related quality of life (R2* =0.027; 95% CI, 0.02-0.034) and lower caffeine consumption (R2* =0.013; 95% CI, 0.009-0.019).

In the lockdown cohort, the prevalence of depressive symptoms was 4.5 times higher than “the expected level of 2%,” with 9.1% of students having clinically relevant levels of depressive symptoms, the researchers wrote. An inverse association was found between depressive symptoms and health-related quality of life (R2* = 0.285; 95% CI, 0.26-.0311) and a positive link was found with caffeine consumption (R2* = 0.003; 95% CI, 0-0.008).

The researchers said that the most important limitation to their study was its pseudo-longitudinal approach.

“The two samples consisted of students from mostly the same schools, and it is likely that some students participated in both samples,” they wrote. “However, because the surveys were answered anonymously, quantification or even paired analysis was not possible. Therefore, the data only allowed investigation of associations between measures, not the investigation of associations among changes or causality.”

According to the researchers, other study limitations included differences between the two cohorts, the passage of 3 years (and the potential increase in digital media use) between surveys and the lack of information on survey participants’ specific school start and stop times during the partial lockdown.

Even so, “the findings suggest that school closures allowed students to better align their sleep schedules with adolescents’ late sleep phase,” Albrecht and colleagues wrote. “Of most importance, to our knowledge, this study provides the first scientific evidence for the beneficial sleep-related associations of school closures with adolescents’ health … [and] provides further support for delaying [school start times] in countries with early [school start times].”

PERSPECTIVE

Cora Collette Breuner, MD, MPH

Better, longer sleep is protective against a number of health issues. This study by Albrecht and colleagues, in which a mostly homogeneous, teenaged Swiss population got more sleep during the pandemic than before it, shows the importance of a good night’s sleep in preventing some negative health consequences in the short term (eg, lower alcohol consumption, decreased caffeine consumption) and trending towards lower depression scores.

I was on the AAP’s Adolescent Sleep Working Group when the AAP published recommendations on the issues of inadequate sleep. These recommendations included pushing for later school start times. Many schools now have later school start times but not all have pivoted in this direction. Over the 7 years since that AAP publication, sleep in teenagers has continued to suffer. We also know that behavioral and mental health issues have been on the rise in adolescents before the COVID pandemic began.

In this study by Albrecht and colleagues, teens who received about 1 hour more of sleep nightly were less likely to drink alcohol or caffeine or be depressed. Layer the Albrecht and colleagues’ findings on top of the existing data that support later school times and there is a sounder, more valid argument for later school start times. We should continue to push for later school start times to improve sleep quality and quality of life for school-aged children and teenagers.

Reference:

Owens J. Pediatrics. 2014; doi:10.1542/peds.2014-1696.Cora Collette Breuner, MD, MPHSpokesperson, AAP
Physician, division of adolescent medicine and orthopedics and sports medicine, Seattle Children’s Hospital
Professor of pediatrics and adjunct professor of orthopedics and sports medicine, University of Washington School of MedicineDisclosures: Breuner reports no relevant financial disclosures.

PERSPECTIVE

 Carol L. Rosen, MD)

Carol L. Rosen, MD

Albrecht and colleagues’ study about sleep duration and health in Swiss teenagers with homeschooling during COVID-19 high school closures is a “good news/bad news” story.

The good news is that during pandemic lockdown, teens got more sleep on school nights. With those 75 minutes of extra sleep time, they got up to 9 hours! These sleep gains translated into better health-related quality of life with less caffeine and alcohol use. The bad news is that these pandemic-related sleep gains were offset by the appearance of depressive symptoms with worsening health-related quality of life. The prevalence of depressive symptoms in teens increased more than fourfold during the lockdown period.

These findings may be of no surprise to some physicians. Studies of later school start times consistently show that increasing sleep improves adolescent health. At the same time, pandemic-related school lockdowns show a negative impact on teen mental health and well-being. However, this study adds a unique perspective by modeling several factors at the same time. The findings confirm longer sleep duration as a key driver of improved health-related quality of life in teens. However, these sleep gains can be canceled out by other life-disrupting changes related to the pandemic like school closures.

Most physicians understand that sleep is essential for optimal health in adolescents. However, some providers may not be aware that more than two-thirds of U.S. teens are short on sleep, getting less than 7 hours on school nights. The American Academy of Sleep Medicine recommends that teens 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health and daytime alertness. Regularly sleeping fewer than the recommended number of hours is associated with injury-related risk behaviors, school and learning problems, hypertension, obesity, diabetes, depression and risk for self-harm.Carol L. Rosen, MDSpokesperson, American Academy of Sleep Medicine
Board member, American Academy of Sleep Medicine and American Academy of Sleep Medicine Foundation
Pediatric sleep medicine specialist and professor of pediatrics (emerita),
Case Western Reserve University School of Medicine, Cleveland

DISTURBING report finds that 20 million American schoolchildren have been prescribed antidepressants

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Image: DISTURBING report finds that 20 million American schoolchildren have been prescribed antidepressants

In many ways the world is a far more complex, difficult place to live in now than it was 20 or 30 years ago. Social media places children under increasing pressure – and at an ever decreasing age – to look perfect, have limitless “friends” and lead apparently perfect lives. Many parents work longer hours than in previous decades, leaving them with little time and energy to spend with their kids. And children are under immense pressure to perform academically and on the sports field.

In previous years, kids could generally be found playing outside with their friends or chatting to them on the phone, but modern society leaves children isolated from one another, spending more time with virtual “friends” than real-life ones. Many spend most of their time online, hardly ever venturing outside.

This toxic mix of external pressures and isolation can leave children, particularly those struggling through adolescence, feeling depressed and confused. The solution for many parents and healthcare professionals is to simply prescribe them antidepressant medications like selective serotonin reuptake inhibitors (SSRIs). This “solution” is so widely favored, in fact, that a disturbing report by the Citizens Commission on Human Rights found that around 20 million American schoolchildren have been prescribed these dangerous drugs.

Antidepressant use in children rises sharply in seven years

Antidepressant medications are, in fact, not recommended for children under the age of 18, but you would never know that if you were to judge by the way doctors hand out prescriptions for these drugs like candy.

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According to the Daily Mail, a study recently published in the European Journal of Neuropsychopharmacology, which studied antidepressant use in children under the age of 18 in five western countries, found that there was an alarming increase in the number of prescriptions for these drugs between 2005 and 2012.

In Denmark, prescriptions for children increased by 60 percent; prescription numbers soared more than 54 percent in the United Kingdom; in Germany, they rose by 49 percent; the United States saw a 26 percent increase; and there was a 17 percent increase in antidepressant prescriptions for children in the Netherlands during that period.

This is shocking because a 2016 study published in the respected British Medical Journal, which evaluated the mental health of 18,500 children prescribed antidepressant medications, found that not only are the benefits of these drugs “below what is clinically relevant” (i.e. they don’t work), but children taking them are twice as likely to exhibit suicidal or aggressive behaviors than children who do not.

The study also found that the drug manufacturers are not only aware of this fact but that they actively try to hide the risks by labeling suicidal thoughts and suicide attempts as “worsening of depression” or “emotional liability” rather than admitting that they are side effects of the medication.

“Despite what you’ve been led to believe, antidepressants have repeatedly been shown in long-term scientific studies to worsen the course of mental illness — to say nothing of the risks of liver damage, bleeding, weight gain, sexual dysfunction, and reduced cognitive function they entail,” warned holistic women’s health psychiatrist, Dr. Kelly Brogan, writing for Green Med Info. “The dirtiest little secret of all is the fact that antidepressants are among the most difficult drugs to taper from, more so than alcohol and opiates.

“While you might call it ‘going through withdrawal,’ we medical professionals have been instructed to call it ‘discontinuation syndrome,’ which can be characterized by fiercely debilitating physical and psychological reactions. Moreover, antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top 10 most violence-inducing drugs have been found to be antidepressants.”

This doesn’t mean that our children need to be left to struggle through depression and isolation without any help, however. Experts recommend family, individual and other therapies, lifestyle changes including exercise and dietary changes, and spending more time outdoors with family and friends as healthy, side-effect-free ways to help kids cope.

Learn more about the dangers of antidepressant drugs at Psychiatry.news.

Sources include:

GreenMedInfo.com

Independent.co.uk

DailyMail.co.uk

ScienceDaily.com

Teens Are Being Bullied ‘Constantly’ on Instagram

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A woman stares at her phone in bed.

No app is more integral to teens’ social lives than Instagram. While Millennials relied on Facebook to navigate high school and college, connect with friends, and express themselves online, Gen Z’s networks exist almost entirely on Instagram. According to a recent study by the Pew Research Center, 72 percent of teens use the platform, which now has more than 1 billion monthly users. Instagram allows teens to chat with people they know, meet new people, stay in touch with friends from camp or sports, and bond by sharing photos or having discussions.

But when those friendships go south, the app can become a portal of pain. According to a recent Pew survey, 59 percent of teens have been bullied online, and according to a 2017 survey conducted by Ditch the Label, a nonprofit anti-bullying group, more than one in five 12-to-20-year-olds experience bullying specifically on Instagram. “Instagram is a good place sometimes,” said Riley, a 14-year-old who, like most kids in this story, asked to be referred to by her first name only, “but there’s a lot of drama, bullying, and gossip to go along with it.”

Teenagers have always been cruel to one another. But Instagram provides a uniquely powerful set of tools to do so. The velocity and size of the distribution mechanism allow rude comments or harassing images to go viral within hours. Like Twitter, Instagram makes it easy to set up new, anonymous profiles, which can be used specifically for trolling. Most importantly, many interactions on the app are hidden from the watchful eyes of parents and teachers, many of whom don’t understand the platform’s intricacies.

“There is no place for bullying on Instagram, and we are committed to fostering a kind and supportive community. Any form of online abuse on Instagram runs completely counter to the culture we’re invested in —a platform where everyone should feel safe and comfortable sharing their lives through photos and videos,” an Instagram spokesperson told The Atlantic in September. This week, the company also announced a set of new features aimed at combatting bullying, including comment filters on live videos, machine-learning technology to detect bullying in photos, and a “kindness camera effect to spread positivity” endorsed by the former Dance Moms star Maddie Ziegler.

Still, Instagram is many teens’ entire social infrastructure; at its most destructive, bullying someone on there is the digital equivalent of taping mean flyers all over someone’s school, and her home, and her friends’ homes.

After a falling-out with someone formerly in her friend group last year, Yael, a 15-year-old who asked to be referred to by a pseudonym, said the girl turned to Instagram to bully her day and night. “She unfollowed me, blocked me, unblocked me, then messaged me days on end, paragraphs,” Yael said. “She posted about me constantly on her account, mentioned me in her Story, and messaged me over and over again for weeks.”

Yael felt anxious even just having her phone in her pocket, because it reminded her of the harassment. “Every time I logged on to my account, I didn’t want to be there,” she said. “I knew when I opened the app, she would be there. I was having a lot of anxiety over it, a lot of stress.”

But still, she hesitated to quit the app entirely. Her friends on Instagram serve as a source of support. Also, quitting wouldn’t stop her tormentor from talking about her, and she’d rather know what the girl was saying. “You know someone’s talking about you, they’re posting about you, they’re messaging about you, they’re harassing you constantly,” she said. “You know every time you open the app they’re going to be there.”

Because bullying on your main feed is seen by many as aggressive and uncool, many teens create hate pages: separate Instagram accounts, purpose-built and solely dedicated to trashing one person, created by teens alone or in a group. They’ll post bad photos of their target, expose her secrets, post screenshots of texts from people saying mean things about her, and any other terrible stuff they can find.

“I’ve had at least 10 hate pages made about me,” said Annie, a 15-year-old who asked to be referred to by a pseudonym. “I know some were made in a row by the same person, but some were from different people. They say really nasty things about you, the most outrageous as possible.”

Sometimes teens, many of whom run several Instagram accounts, will take an old page with a high amount of followers and transform it into a hate page to turn it against someone they don’t like. “One girl took a former meme page that was over 15,000 followers, took screencaps from my Story, and Photoshopped my nose bigger and posted it, tagging me being like, ‘Hey guys, this is my new account,’” Annie said. “I had to send a formal cease and desist. I went to one of those lawyer websites and just filled it out. Then she did the same thing to my friend.”

The scariest thing about being attacked by a hate page, teens say, is that you don’t know who is doing the attacking. “In real-life bullying, you know what’s doing it,” said Skye, a 14-year-old. “Hate pages could be anyone. It could be someone you know, someone you don’t know—you don’t know what you know, and it’s scary because it’s really out of control at that point. Teachers tell you with bullying [to] just say ‘Stop,’ but in this case you can’t, and you don’t even know who to tell stop to.”

Aside from hate pages, teens say most bullying takes place over direct message, Instagram Stories, or in the comments section of friends’ photos. “Instagram won’t delete a person’s account unless it’s clear bullying on their main feed,” said Hadley, a 14-year-old, “and, like, no one is going to do that. It’s over DM and in comment sections.”

Mary, a 13-year-old who asked to be referred to by a pseudonym, said that relentless bullying on Instagram by a former friend gave her her first-ever panic attack. It started, Mary said, after she made the cheer team and her former friend did not. “She would DM me, or when I was with my friends, if they posted me on their Story, she would [respond] and say mean stuff about me since she knew I would see it since I’m with them,” Mary said. “She would never do it on her own Story; she’d make it seem like she wasn’t doing anything.”

“There was literally a group chat on Instagram named Everyone in the Class but Mary,” she added. “All they did on there was talk bad about me.”

On Instagram, it’s easy to see what people are up to and whom they’re hanging out with. For teenagers who are acutely aware of social status, even a seemingly innocent group photo can set a bully off. Teens say that tagging the wrong friend in a photo can unleash a bully’s wrath. Every location tag, comment, Story post, and even whom you follow or unfollow on your finsta (a secondary Instagram account where teens post more personal stuff) is scrutinized.

“Lots of bullying stems from jealousy, and Instagram is the ultimate jealousy platform,” Hadley said. “People are constantly posting pics of their cars, their bodies. Anything good in your life or at school goes on Insta, and that makes people jealous.”

Many high schools have anonymously run “confessions”-style Instagram accounts where users submit gossip about other students at school. For instance, an account like Greenville High School Confessions will pop up with a bio asking followers to “send the tea,” i.e., gossip. Students will follow the locked account and submit texts of people saying bad things about one another or gossip they’ve heard about people at school. The account admin or admins will select the juiciest rumors and blast them out on Stories or on the main feed, sometimes even tagging the student’s handle.

When someone who runs a school’s confessions account doesn’t like you, it can feel like the whole school has turned against you. “There was a page made called DTS.gossip, the initials of our school,” Riley said. “The account was made to post rumors and crap about people in my school, but a lot of them were about me.”

Rory, a 15-year-old, said that confessions accounts had gotten so out of control at her high school that administrators had banned taking photos of other students on campus. “People at my school would … expose drama or make up stuff, Photoshop people’s faces, bully them basically. It’s all anonymous.”

But Rory said that the no-picture rule hasn’t really curbed bullying. Not long ago, someone posted an entire diss track saying awful things about a 15-year-old girl to SoundCloud, which students promptly set as the link in their Instagram bio.

“I think a lot of kids get really invested in drama,” Riley said, “with beauty gurus, YouTube, stuff like that. When it happens at school, they’re very interested in it. It’s fun. Which is horrible.”

In Rory’s case, Instagram has been both the catalyst and the medium for bullying. When she was 13, she was featured on the official Instagram account of Brandy Melville, a popular teen clothing brand.

“Tons of people from my school saw it immediately and started to make memes of me, calling me anorexic,” she said. “Then there were others suggesting I wasn’t thin enough. On their finstas, people were posting these mean things, people I thought I was friends with. I would block their finstas and they would tag my main account.”

But even in the midst of the worst bullying, teens say they’re wary of logging off. Rory is still active on the platform, though she only uses one account.

“Everyone has friends from Instagram,” said Liv, a 13-year-old. “Everyone makes friends that way. It’s inevitable. Everyone does it.” Some teens did say they’d deactivate or take a break if their parents forced them to, but quitting forever “wasn’t an option.”

“You can message someone on insta ‘Hey, you’re a bitch’ so easily,” Liv said. “People need to think more about what they say before they say it, even if it’s a DM you forget about and log off. The person you sent that message to, it can impact them. You can really screw someone’s life up.”

Teens who were severely bullied as children at higher risk of suicidal thoughts, mental health issue

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https://speciality.medicaldialogues.in/teens-who-were-severely-bullied-as-children-at-higher-risk-of-suicidal-thoughts-mental-health-issue/

Over-the-Counter Birth Control Safe for Teens, Research Finds.

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Birth control pills

Days could be coming when birth control is harder to get, with no-copay contraception potentially dropping off the map. Even though costs could increase, researchers say there’s no reason oral contraception should remain restricted by prescriptions. While some have been recommending over-the-counter birth control pills for years, some have worried about safety. But new research shows birth control pills are very safe and effective — especially for teens.

NPR reports that a review of birth control pill research published in the Journal of Adolescent Health makes the most comprehensive case yet for allowing over-the-counter birth control for teens. In fact, the research found birth control pills might be safer for young people, because your risk for negative side effects such as blood clots is greater if you’re older.

“There is a growing body of evidence that the safety risks are low and benefits are large,” Krishna Upadhya, an assistant professor of pediatrics at the Johns Hopkins University School of Medicine and the lead author of the review, told NPR.

And when you’re young, Upadhya added, research shows you are less likely to experience some of the negative side effects of the Pill. While pills containing estrogen and progestin increase risk of a certain type of blood clot, Krishna said teens are less likely to develop that side effect and others, meaning the pill is “potentially safer the younger you are.”

 Research shows that good things happen when we reduce barriers to birth control. According to a 2016 research report from Urban Institute, about 63 percent of women reported that birth control reduces stress in their lives, about 54 percent said it had provided them health benefits, about 49 percent said it had helped them get their education, and about 49 percent reported more stable romantic relationships. On top of that, The American College of Obstetricians and Gynecologists backs access to over-the-counter birth control, as do many doctors.

With this new research, Upadhya told NPR, everyone, regardless of age, should be able to get the Pill from her local pharmacy, no prescription needed.

“These pills are safe and effective and we should reduce barriers to using them,” she said. “And teens should benefit just as adult women do.”

Source:http://www.teenvogue.com

Stores Defy Experts to Recommend Sports Supplements to Teens Study Says

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It’s generally agreed by health experts that teens shouldn’t be using certain supplements, particularly some of those used to boost athletic abilities. Yet, according to CNN, more than two-thirds of vitamin stores still recommended a popular sports supplement — creatine — even when they were told the supplement was for a teen. It’s estimated that 30 percent of high school athletes are using this supplement, CNN said.

Creatine is one of 8 nutrients you can’t get from foods, and that’s why some people choose to take a supplement for it. Creatine is an amino acid found in animal foods that is important for muscle energy, proper function of your central nervous system, and brain health. But, it’s noteworthy that creatine can also be produced by the liver, so unless you’re a vegetarian who isn’t getting animal foods, you don’t really need a supplement for it.

Three important factors of fitness nutrition are a sufficient protein/high-fat/low-carb diet — which in and of itself will give you a source of creatine; getting enough essential amino acids, the most notable of which is leucine; and timing of meals. And while many athletes do this, carb-loading is not the most beneficial way to lose fat, gain muscle or boost your performance.

The bottom line is, in sports nutrition, the food you eat has an immense impact not only on your general health, but on the benefits you will ultimately reap from your workouts. This means making sure you have a proper balance of proteins, leucine and other essential amino acids that play a part in energy and sports nutrition ― and timing meals correctly. You also need to ditch energy drinks, sports drinks, most energy bars and even “healthy” drinks like vitamin water.

One Question Could Help Spot Drinking Problems in Teens

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One simple question may reveal a lot about a teen’s risk of developing an alcohol problem, a new study finds.

The study focused on teen alcohol screening, or questions that doctors can ask to flag those who may be at risk for problem drinking. Results showed that one question — how many days they drank in the past year  — was particularly good at spotting those at risk for a drinking problem, which researchers call alcohol use disorder.

women, alcohol, party, drinking

Among teens who said they had one drink on at least three days, 44 percent were later found to have alcohol use disorder on a diagnostic test. Among the teens who answered no to the 3-days-per-year drinking question, 99 percent did not have alcohol use disorder, the researchers said.

he researchers took the screening a step further. They found that a screening test that included just this question, which was then followed by a detailed diagnostic test for teens who answered yes, could accurately identify 91 percent of teens with alcohol use disorder, the study found. Alcohol use disorder is drinking that is causing people harm or distress, including problems at school and with relationships.

Because doctors often have only a short time to spend with patients, researchers have tried to come up with ways to assess a patient’s risk for alcohol disorder with just a few questions. A two-question screening test based on people’s age already exists for teens. But the new study suggests that just one question about a teen’s frequency of alcohol use “would be a simple, brief, and cost-effective clinical assessment procedure,” said the researchers, from the University of Pittsburgh.

The study was based on surveys of nearly 1,200 teens ages 12 to 17 in rural Pennsylvania. Participants answered not only screening questions, but also questions to diagnose alcohol use disorder based on the latest definition in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

About 10 percent of participants in the study over age 14 met the criteria for having alcohol use disorder, the researchers found.