Episode 72 - Depression in Adolescents - a podcast by Rio Bravo Family Medicine Residency Program

Episode 72: Depression in Adolescents.  

COVID-19 vaccine updates including booster shots and mix and match options. Depression in adolescents is discussed by Virginia Bustamante, Charizza Besmanos, and Hector Arreaza. 

Introduction: COVID Vaccines Update October 2021
Written by Hector Arreaza, MD. Participation: Lillian Petersen, RN, and Nathan Heathcoat, MS3.  

The FDA granted emergency use authorization for a booster shot with the Pfizer/BioNtech COVID-19 vaccine in September 2020.

On October 20, 2021, the FDA also granted emergency use authorization for a booster shot with the Moderna AND Johnson & Johnson (also known as Janssen or J&J) COVID-19 vaccines. 

Pfizer/BioNtech: Brand name Comirnaty®. It has full FDA approval for patients who are 18 years and older for the prevention of COVID-19. The rest of the indications of this vaccine are under the Emergency Use Authorization (EUA). It is authorized for 12 years and older. Total of two doses, 21 days apart. Authorized for 3rd dose in immunocompromised patients (on active cancer treatment, organ transplant recipients, taking immunosuppressive or high dose corticosteroids, have moderate to severe immunodeficiency). 3rd dose is given at least 1 month after the second dose. It is authorized for a single booster shot in special populations (older than 65 years of age OR 18-64 years of age at high risk of severe COVID-19 or with frequent occupational exposure). The booster shot must be given 6 months after the primary series is complete.

Moderna: No brand name yet. All uses are under emergency use authorization. It is authorized for 18 years and older for the prevention of COVID-19. Give a total of two doses, 4 weeks apart. A third dose is authorized to be given 1 month after the second dose. Patients who can receive a third dose include patients on active cancer treatment, organ transplant recipients, taking immunosuppressive or high dose corticosteroids, or have an immunodeficiency. It is authorized for a single booster shot 6 months after completing primary series. The booster shot of Moderna should be half dose. People who may receive a booster shot are those who are older than 65 years of age OR 18-64 years of age at high risk of severe COVID-19 or with frequent occupational exposure.

Johnson & Johnson (Janssen): No brand name yet. Authorized as a single dose vaccine. Authorized for a single booster shot 2 months after the first dose. 

Mix and Match Approval: The FDA authorized on October 20, 2021, heterologous booster dose for currently approved or authorized COVID-19 vaccines. You can give a booster shot with a different vaccine than the one you received primarily. For example, a patient who received J&J vaccine may receive a booster shot with Pfizer or Moderna 2 months later. Another example, a patient received primary series of Pfizer vaccine, may receive a booster shot with Moderna, Pfizer or J&J 6 months after completing primary series. Booster shots are authorized, again, for patients who are 65 years and older, 18-64 years of age at high-risk for severe COVID-19 or with frequent occupational exposure.

The vaccination of children 5-11 years old is still under discussion, more updates coming soon.

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

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Depression in Adolescents. 

By Virginia Bustamante, MS4; Charizza Besmanos, MS4; and Hector Arreaza, MD.  

Vicky: We will talk about adolescence and depression today. I was reading a piece on the Impact of COVID-19 Pandemic on Adolescent Mental Health on Psychiatry Advisor by Tori Rodriguez. She is a licensed professional counselor with a master’s in arts in counseling psychology. 

This article really got me thinking, how prevalent is depression in adolescents? Even before COVID-19. I read the article and I wasn't even aware of the numbers. So, I decided to do some research on the topic. 

Charizza: When you brought up the topic for discussion, I asked myself how much do I even know? I found that the CDC reported that “more than 1 in 3 high school students had experienced persistent feelings of sadness or hopelessness in 2019.” This was a 40% increase since 2009. 

It also said that, “in 2019 about 1 in 6 youth reported making a suicide plan in in the past year. That was a 44% increase since 2009.” 44% increase! That is almost unbelievable. Now I’m asking myself what is causing such a drastic increase.

Vicky: When I read Rodriguez’s piece it really got me thinking. What is or are there even known causes linked to this huge increase?

Charizza: Are adolescents more open to talk about mental illness? Or are there other factors affecting their mental illness? For example, increasing social media presence or other home/ social pressures. 

Vicky: Actually, that may be partially why. The U.S. News and World Report wrote a piece that highlighted the possible contributing factors that have led to this increase. They stated that data hasn’t really shown a conclusive answer but there are some common themes that have emerged. And I’d like to spend much of this podcast really going into those themes and discussing them. 

The U.S. News and World Report listed five common themes. Theme one, what they called “a modern-day diagnosis” - where they reference a John Hopkins Health Review which explained that adolescent depression is somewhat of a new diagnosis. 

Charizza: Up until about the 1980’s mental health professionals were reluctant to diagnose adolescents with a mood disorder. Because their brains were still developing, they thought it was not appropriate to diagnose someone so young with, for example depression. 

Vicky: Yes exactly, so the current thought is, that perhaps this change of thinking has played a part in the increasing numbers in the form of increased reporting and/or documentation. 

The second theme they listed was “hyper-connected & overstimulated.” This stems from how our world is today. Where electronic devices and social media are a big part of young people’s lives. The idea that they have a life in the real world and the virtual world. 

 

Charizza:  I read a study on Teens, Social Media and Technology, a Pew Research Center study, that more than 95% of teenagers have access to a smartphone and 45% of them described themselves as being online “almost constantly.”  

Vicky: To think, how does this affect the way they see themselves? For maybe a lot of us listening right now we’ve been on social media. That could be Facebook, Instagram, Tik-Tok, and going way back Myspace. We know that social media can be an amazing place to share our lives but can also be filled with a lot of criticism.

Arreaza: Have you heard of “FOMO”? It’s “Fear of Missing Out”. It’s a condition that can cause severe anxiety because others are having fun, or you missed a particular event, memorable experience, or an opportunity to connect with someone famous, or an online investment. People with FOMO need to stay always connected. 

Vicky: The Journal of Abnormal Psychology explained that the spike in depression and suicidal tendencies may be connected to social media among young people. They went on to describe how it's not uncommon for young people to measure their self-worth based on the likes. I've been there. Questioning myself whether to post or not post a picture based on whether it's “Instagram worthy”? Will it get enough likes to be posted? Rather than sharing moments of my life with friends and family as the platform was intended to. 

Charizza: It’s not something I’m proud of but I’ve gotten sucked into the fake reality of online. That's why I reduced my social media presence. 

Vicky: Was there a specific reason or situation that led to that?

Charizza: I just felt like that it was taking more energy than it was meant for. And honestly I’ve felt happier since not really using my Facebook anymore. 

Vicky: If that makes you happier, I support it. I mean I might consider it myself. 

Arreaza: Yes, a social media “fasting” may be beneficial for some people. 

Vicky: For the third theme, the article referred to what they called “uncertain times.”

Charizza: What does that even mean?

Vicky: Each generation is influenced and shaped, in a positive or negative way, by the events happening at that time in history. And sadly, today’s young people have grown up in a post-9-1-1 world, mass terrorist attacks, and shootings whether that be high schools, malls, and even churches. All these events mean that young people may know the fear of terrorism. A sense of security has been taken from them by these awful and cowardly attacks of others. 

Charizza: I had a friend who was afraid to go to the movies after the 2012 Aurora Colorado shooting. For a long time, every time she went, she couldn’t sit there and enjoy the movie. She kept turning around looking at the door every time it opened. Afraid something would happen. So, thinking of that and thinking that others may be going through similar and even more difficult times, I can completely understand this contributing depression among young people. 

Vicky: This fear and stress appears to be contributing to the increase in depression. The fourth theme was “not enough sleep.” The Nation Sleep Foundations recommends teens get 8.5 to 9.5 hours and instead teens get around 7 hours. When I am well rested, I perform my best. My energy, memory and overall mood is better. But with school, work, and everything else it’s hard sometimes to get the hours I need. I mean I don't know about you Charizza, but I can work on getting more sleep. 

Charizza: Sadly, I struggle with it too. But for adolescents where they're still developing and undergoing different physiological changes those hours are especially important. The Sleep Foundation stressed the importance of sleep for teens. 

They talk about how it helps with physical development - with all the changes they are undergoing, academic achievement - by promoting attention, improving memory (like you brought up), and definitely helps with emotional health. The website states that mental health disorders for example anxiety, depression, and even bipolar disorder have been linked to poor sleep. They even stated that sleep deprivation in teenagers can increase the risk for suicide.

Arreaza: A poor sleep also can lead to obesity in adolescents and adults. Something we should remember is also the timing of sleep for adolescents. The sleep pattern changes over the lifetime of people, and it’s not only in duration, but also the time they sleep. Normally, a teenager tends to go to bed late and wake up late. For this reason, high school schedules are being changed in California to start at 8:00 AM. 

Vicky: It sounds like improving sleep in adolescents can be a great way of preventing mental health disorders or even reducing their symptoms. The last and fifth theme discussed in The U.S. News and World Report as a possible contributing factor to the increase in adolescent depression is a “lack of community.” 

This goes back to the world we live in today. We live with this - what the article quotes as - “go-go mentality” and the community we would have previously built or created around us have gotten smaller. So as they quoted “our face-to-face connections” have decreased.

Charizza: Is there anything they suggest?

Vicky: The U.S. Preventive Services Task Force recommends primary caregivers screen adolescents 12-18 for depression. But this doesn't always happen. They suggested that identifying adolescent depression should NOT be something that only falls on the medical provider but something we should ALL be responsible for. We can do this by building healthy and trusting relationships with our young people. Hopefully also rebuild this sense of community. 

Today we highlighted some themes that are possibly related to the increase in adolescent depression. Those were: the idea of a modern-day diagnosis, second being hyper-connected & overstimulated, third the uncertain times we live in, fourth not enough sleep, and lastly the sense of a lack of community. 

Charizza: We hope you guys all really enjoyed listening. And remember if you are or know someone struggling with depression and/or suicide thoughts reach out to someone. Let someone know how you are doing. Tell a teacher, adult, someone.

 

Vicky: If you for whatever reason don't feel comfortable doing that or feel you may not have someone to reach out to and are in danger of hurting yourself or others please call 911. 

Charizza: There are also national suicide prevention hotlines. That is 1-800-SUICIDE and that’s 1-800-SUICIDE. There is also 1-800-273-TALK, again that's 1-800-273-TALK

Vicky: There is also the Mary K Shell Mental Health Center with a walk-in crisis center. They are located here in Bakersfield on College and Mt. Vernon. They are actually in the same parking lot as Kern Medical Center. Their number is 661- 868-8123.

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Conclusion: Now we conclude our episode number 72 “Depression in Adolescents.” Our adolescent patients are a special population, so special that you can even do a fellowship after finishing your residency. Our adolescents are under a lot of pressure, especially during this era of social media. Remember to screen for depression and start treatment right away with behavioral therapy and medications as needed or refer your depressed patients to a psychiatrist to start treatment promptly. Do not forget to assess risk of suicide and act fast to prevent suicide in your patients. Even without trying, every night you go to bed being a little wiser.

Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Lillian Petersen, Nathan Heathcoat, Virginia Bustamante, and Charizza Besmanos. Audio edition: Suraj Amrutia. See you next week! 

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References:

Mental Health, Adolescent and School Health, Centers for Disease Control and Prevention, CDC.gov,  https://www.cdc.gov/healthyyouth/mental-health/index.htm, accessed on September 20, 2021. 

 

Lohmann, Rachel Cassada, What's Driving the Rise in Teen Depression?, US News, April 22, 2019. https://health.usnews.com/wellness/for-parents/articles/2019-04-22/teen-depression-is-on-the-rise. 

 

Anderson, Monica and Jingjing Jiang, Teens, Social Media and Technology 2018, Pew Research Center, May 31, 2018. https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/. 

 

Rodriguez, Tori, Impact of the COVID-19 Pandemic on Adolescent Mental Health, Psychiatry Advisor, April 30, 2021, https://www.psychiatryadvisor.com/home/topics/child-adolescent-psychiatry/adolescent-mental-health-issues-are-further-exacerbated-by-the-covid-19-pandemic/. 

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