Using a lifestyle approach to manage adolescent depression

At the virtual 2021 American Academy of Pediatrics National Conference & Exhibition, Christina Low Kapalu, PhD, discusses evidence-based lifestyle interventions that should be part of an adolescent depression management and treatment plan.

“Adolescent depression has almost doubled since the pandemic, going from 13.3% to 25.2%” noted Christina Low Kapalu, PhD, pediatric psychologist at Children’s Mercury in Kansas City, Missouri at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition. “We also know that older adolescents, females, and those with 2 or more races have the highest rates.” The situation is further exacerbated, Kapalu states, by the fact that “There has been reduced screenings in primary care for depression and anxiety and increases in presentation to the emergency department (ED) for mental health concerns,” continued Kapalu.

When looking at the core symptoms of depression: amotivation, fatigue, psychomotor slowing, change in appetite, hopelessness, and difficulty concentrating, it becomes clear, says Kapalu, that “lifestyle modifications can be incredibly helpful in addressing some of these symptoms.”

Additionally, emerging research in children and adolescents reveal that poor diet, physical isolation from peers, sedentary lifestyle, and poor sleep convey additional risk for mental health depression, which opens the door to using lifestyle medicine to address some of these symptoms. “Lifestyle medicine, she explains, “involves the application of environmental, behavioral, and psychological principles to enhance patient outcomes.” Specifically, these include sleep, physical activity, connecting with others, nutrition, mindfulness/relaxation, and reduced screen time, all which are used for the treatment of unipolar depression. And while these treatment have been used as guidelines in adult treatment for depression, the pediatric guidelines “have been less specific,” Kapalu points out, instead recommending active support and monitoring, psychoeducation and peer support. Ideal child and adolescent candidates for lifestyle medicine would be those with mild to moderate depression, who are motivated to change, have few comorbidities, and depression of shorter duration. “While studies have been done that show risk factors for suicidal ideation in teens include sleep dissatisfaction, stress, substance use, smoking, internet game addiction, interpersonal factors and binge-eating disorders, there have been fewer studies that looked at modifying these lifestyle habits to reduce suicidal risk,” observed Kapalu.

So, how to help these patients make change that sticks? It is important to note that when recommending lifestyle changes (such as physical activity or nutrition), your patient may not be ready to change. Here, she brings up a classic model of behavioral change by Picasa and DiClemente, which shows change as a process. They include precontemplation; contemplation; preparation; action; and maintenance. Additionally, these changes should be implemented through SMART goals: specific, measurable, attainable, realistic, and time-limited. Finally, Kapalu urgers practitioners to keep the “rules” of behavioral change: resist telling the patient what to do; understand their motivation; listen with empathy; and empower them.

Reference

1. Kapalu CL. Using a lifestyle approach to manage adolescent depression. American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 10, 2021.