Teen Mental Health Newsletter

 In a greater effort to share mental health knowledge with families, youth, health professionals and educators teenmentalhealth.org is launching a new newsletter! If you would like to received updates about the work of the Chair please sign up. Visit any page on our website (except the homepage) and on the left hand side you can join our mailing list. Whenever we update parts of our site or find research or news related to youth mental health issues we'll pass it along. But we promise not to do it too often 

 ~ Dr. Stan Kutcher

Risk-taking Behaviour in Adolescence

Teenagers are known for risk-taking, novelty seeking, reckless behaviour and impulsivity.

Risk-taking behaviour can take on many different forms, including the misuse of alcohol or drugs, engaging in unprotected sexual activity, some types of criminal activity or risky, adrenaline-producing sports like skydiving or motocross. While you may not have done all of these things, the majority of adolescents and young adults report participating in one or more risk-taking behaviours.

One reason for this is that the teenage brain is less able than the adult brain to inhibit impulsive behaviours. Adolescents become more able to control their behaviour as their brains mature, but efficient control of impulsive acts is not fully developed until adulthood. When teenagers are faced with a reward, the “reward” systems of their brains are disproportionately active compared to the “control” systems (which are later to mature). This makes it difficult for teenagers to be in command of their reward response, and makes them biased towards immediate gain over long-term gain.

A recent article on medicalnewstoday.com highlighted this shortsightedness of youth

According to popular stereotype, young teenagers are shortsighted, leaving them prone to poor judgment and risky decision-making when it comes to issues like taking drugs and having sex. Now a new study confirms that teens 16 and younger do think about the future less than adults, but explains that the reasons may have less to do with impulsivity and more to do with a desire to do something exciting.

Compared with adults, the researchers found, teenagers consider the future less and prefer immediate rewards over delayed ones (for example, $700 today versus $1,000 a year from now). But it may not be impulsivity that guides their lack of forethought. Instead, the study found that teens are shortsighted more due to immaturity in the brain systems that govern sensation seeking than to immaturity in the brain systems responsible for self-control.

While the origins of risk-taking behaviour in adolescents have been debated for a centuries and many explanations ranging from hormones to social pressures have been endorsed. But the truth is we are still not completely sure why adolescents and young adults are more prone to risk-taking behaviours.

We do however know that part of the answer lies in the way that brain development occurs during this part of the life-span and that risk-taking behaviors often decrease as the young person matures into adulthood. It’s the complex interplay amongst brain development, personality characteristics and the environment that lead to differences in risk-taking behavior amongst young people.

Interestingly, recent research suggests that the perception of risk does not vary greatly with age, but rather within the type of decision-making information that adolescents and adults use. So even though adolescents may be more prone to engage in risky behaviour, they are not irrational, unaware, or believe they are more invulnerable than adults. These findings suggest that young people certainly have the frontal lobe capabilities to self modulate risky behaviors – provided they understand how to do so.

(Great article from UC Davis Magazine about "What parents should tell college students about risky behavior . . . even if they don’t listen.")

~ Dr. Stan Kutcher

Setting the Goals to Guide a Mental Health Strategy for Canada

From the Mental Health Commission of Canada:

Canada is the only G8 country without a mental health strategy. The Mental Health Commission of Canada has been given the responsibility to work with Canadians to address this gap.

The first step is to work out shared goals to guide the development of a mental health strategy. The Commission is seeking public and stakeholder input on the eight goals that are set out in the document "Toward Recovery and Well-being- A Framework for the Mental Health Strategy for Canada".

This draft framework document proposes a vision of WHAT a transformed mental health system should look like. Your input will help to finalize the draft document, and to set the stage for developing a detailed roadmap for HOW to achieve the eight goals it contains.

To participate online, go to http://mentalhealthcommission.ca and follow the links for stakeholder consultation or public consultation.

Your contribution to this exercise is important: it is only by working together that we will keep mental health issues out of the shadows – forever.

This online consultation is being hosted by the Mental Health Commission of Canada – an independent, not-for-profit organization dedicated to improving the health and social outcomes of people living with mental health problems and illnesses as well as to promoting the mental health and well-being of all Canadians.

Teen Vogue Talks Teen Depression

Came across this good article about stigma and teen depression by Leigh Belz over at Teen Vogue. Check it out!

It all started in the sixth grade," says Jenny,* a seventeen-year-old from Sacramento, California. "I was heavier than a lot of the other girls in my class, and that made me feel self-conscious. My mom and dad were having problems at the time, too, and I kept it all to myself. That's how my depression began. And it got worse as I got older--I became more anxious and withdrawn, and it became something I couldn't control. You never would have known it, though. I always had a smile on my face." By eighth grade, Jenny says her depression was something she could no longer hide. "That year, when I was fourteen, I tried to commit suicide," she reveals. "Afterword, I was so ashamed of myself. But I didn't know how to deal with it. I didn't want to talk to anyone." According to Harvard Medical School, about 8 percent of teens will experience depression before they reach adulthood. In addition, the U.S. Surgeon General reports that between 10 and 15 percent of teenagers have some symptoms of depression at any given time.

What separates depression from regular, everyday sadness? "Time," says Richard E. Nelson, Ph.D., author of The Power to Prevent Suicide (Free Spirit Publishing). "Depression is something that lasts at least ten days," he says. "Many students may get to school by 8:00 in the morning and feel sad, then are happy by 10:30, and then get sad again at 1:30. That's normal." Depression, he says, is more of a constant. According to experts, many teens experience mood swings simply as a result of surging hormone levels. But the condition of depression is also often characterized by behavioral changes like low energy levels, oversleeping (or, conversely, trouble falling asleep), irritability, changes in appetite, and isolation. "Teens don't show symptoms of depression the same way adults do. Generally, I break teen depression into three categories," Nelson explains. "Ten percent is clinical, 10 percent is chemical, and the largest category in young people is what I call situational--related to something happening in their lives. For this reason, depression can manifest itself in different ways and intensities." Being depressed doesn't just mean you're crying all the time--instead, you also may not want to hang out with your friends or you may have constant stomachaches that land you in the nurse's office.

Your Brain and the Internet: Use it or Lose it

Your brain and the internet.

Yes, strange as it may seem there actually is a “Google” center in your brain. This was discovered by researchers who did brain scans on people who had never used Google (yes apparently there were some of those) compared to people who had often used Google.

Both groups received brain scans as they read books and as they Googled. In the google experienced group a part of their brain lit up on the scans, showing that their brains were adapted to using google. In the Google naïve group there was no such activity. For both groups when they read books the same parts of their brains lit up.

So, the researchers gave the Google naïve group some homework to do. You guessed it – go and Google. If my memory serves me correctly is was a couple of hours a day for a couple of weeks. When the brains of this group of new Googlers was scanned again, the same brain region as had been lit up in the previously Google experienced group now lit up in the new Googlers. Their brains had developed a Google center!

WOW. So what does this mean? And do you only find it with Google? The answer to the second question is easy – no. The answer to the first question is much more complicated and is currently being answered with research that explores the complex interactions that occur between your brain and your environment.

Basically, you find this happening with any activity that your brain is engaged in. The more you use your brain for something the more it develops. The less you loose your brain for something, the more likely it is to loose that development. It’s a case of “use it or lose it”.

And, there are many examples of this already well described and more being reported as researchers study the complex interplay between the environment and the brain. For example, did you know that the brains of taxi drivers in London, England have a larger area for spatialinformation than the brains of bus drivers do? That is because of the greater demand for processing and storing “maps” of the city of London. Another example – if you do not play the violin and then start playing, the part of your brain that controls the fingers you need to make the notes (by touching the strings) expands. And we know that if parts of the brain are not used, they shrink in size! So it really is “use it or loose it”.

Why does this happen? This occurs because the brain is the ultimate source of our ability to adapt to our environment. Therefore, as we spend longer periods of time in a particular environment (such as driving a taxi, playing a violin, googling, etc.) our brains become much more efficient at operating in that environment and pay more attention to it. This happens both by the expansion of brain cells dedicated to that activity and to improved connections amongst those cells. You can think of it is both growing and communicating better. The more “traffic” (that is to say – communication signals) there is as a result of doing things, the better we get at doing that thing because the “traffic” creates its own improved road system.

What does this mean for us? Many things. For one, it means that if we really want to excel at something we need to practice and to practice and to practice. Wayne Gretzky did not become a great hockey player just because he was born with the ability to play hockey. His greatness grew through constant practice. In the words of my father – “success is 10 percent inspiration and 90 percent perspiration”. So there is something to be said for memorizing the times tables and the soliloquies of Hamlet!

Another thing this means for us is that our brains will change as our environments change.That is, they will adapt their structure and functions to optimize our interface with our environments. In other words, we are what we eat (at least a bit). Certainly we become what we do!

Young people today live in an environment that differs fundamentally from that of their parents and their grandparents. People my age (ok – it's in the fifties) are digital immigrants. If you are 30 years of age and younger, you are a digital native, and the younger you are, the more of a digital native you are. The brains of digital natives are shaped by the digital environments in which they live. What kinds of things may be going on as a result of this?

For one thing, the way we interact with people has changed greatly. Electronic interconnections such as Facebook and My Space have greatly altered traditional face-to-face social network development and maintenance. Where a few decades ago the “usual” social network consisted of about a couple of dozen people who mostly keep connected by face to face conversation and site based (usually at home) electronic links (remember that telephone was in the hall and you could not take it with you), today’s social networks number in the scores of “friends” and communication is primarily electronic – using personal communication devices that transmit not only sound but text messages.

These networks greatly expand the power of social interaction (we have recently seen how they operated during the campaign of Barrack Obama) but we do not know how they will ultimately influence the development of our social brains, and thus – us. Will the important evolutionarily developed abilities to read meaning in non-verbal facial messages diminish as we turn away from face-to-face contact or will these abilities be even further enhanced and honed as we build on those capacities (which we learn very early in life) and expand that ability to electronic means of communication? Or will there develop completely new ways for brains to communicate with each other – using digital technology as the impetus for this? We have no idea really --- but stay tuned – time will teach us.

In the meantime, it’s a good idea to get to know more about the most important part of you – your brain. A good place to start would be to check out the brain area of our website. If you are interested in learning more about the impact of the digital world on our brains you can pick up a copy of the new book written by Don Tapscott – Growing up Digital, and settle down, put your feet up and read. Oh yes, your brain knows how to read and the more you read the better you get at it. Go ahead!

~ Dr. Stan Kutcher

“Off Label” Medication Use: What does this mean? (Part II)

Medication regulatory agencies (such as Health Canada, the FDA, etc.) have no authority in deciding on how medicine is practiced. That is the role of professional and licensing bodies. Thus, while a medication may be “off label” as far as the medication regulatory agency is concerned, that medication may be a useful part of accepted medical practice as far as professional and licensing bodies are concerned.Therefore, medicines may be frequently used in a medically appropriate manner, even if they are “off label”.

Fundamentally, the lack of a “label” for use does not mean that the medicine is not appropriate for use in any particular medical condition (that is a professional and licensing oversight decision). What this means is that the medication has not received medicine regulator approval for treatment of the condition in which the physician is using the medication, frequently because the company making the 

medication has not submitted for regulatory approval.

There are many useful criticisms that can be made of this state of affairs, not the least of which is the confusion that the concept of “labeling” has created in the minds of the public and health providers alike. Another criticism is the concern that the standard of proof for safety and efficacy required by medicine regulatory agencies prior to the awarding of a “label” for use may be less for those uses not labeled. Other criticisms may relate to concerns that the public may be less protected from “off label” use than it is from “on label” use. Some commentators point out however that all “over the counter” medications and “health supplements” (including herbal remedies) and all psychological treatments never receive regulatory approval – despite their widespread use.

So what is the patient or the family to do in such a confusing situation?

Just because a treatment is “off-label” does not mean that it is not appropriate. If that were the case then many of our medication treatments would be deemed inappropriate and all of our psychological treatments would be deemed inappropriate.

First, is to understand what the tem “off label” use means, and what it does not mean.Hopefully, the information in part one of this post helps with that. Unlike what the mass media suggests, “off label” use does NOT mean dangerous, ineffective or inappropriate use. So gaining clarity and understanding is a good start.

Second, is to understand what questions you should ask your health provider about ANY treatments that you are receiving. All treatments should be based on best available evidence of effectiveness and safety. This is called “evidence-based medicine”.

All treatments should be subjected to the same degree of rigorous scientific scrutiny and judged by the same high standards. All patients and their families have the right to know the evidence upon which any treatment is based and it is the ethical duty of their health provider to provide them with that information.

So, here are the questions to ask:

• Why are you recommending this treatment?
• What is the evidence (effectiveness and safety) supporting the use of this treatment for people who are like me and who have the same diagnosis (or problem) that I have?
• What regulatory or professional bodies support the use of this treatment?
• What are other treatments that could be used?
• What is the evidence for those treatments? Is it stronger or weaker than the evidence for the treatment you have recommended?

There are many other questions you should ask about your treatments. Reading the evidence-based medicine information guide for patients and seeking more information about medications at www.teenmentalhealth.org should help with that.

~ Dr. Stan Kutcher