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Generation Anxious

700 000 children in the U.K. are currently registered with an emotional disorder, that’s 7.2%, of 5-19 year olds, or about 1 in 13, according to a recent survey by NHS Digital.

emotional disorders NHS

And that’s just those children who have been formally diagnosed. That figure of 7.2% represents those children who have reached the clinical diagnoses threshold – where their distress impairs them so much that it gets in the way of their daily functioning.

The Children’s society says there are many who can’t get help because their problems are not serious enough, maybe as many as 3-4 times the above figure.

Mental health disorders have a huge economic impact, costing the UK 4% of GDP.

In this blog post I summarize a recent podcast from Radio Four’s ‘Bringing Up Britain: Generation Anxious’ which explores why so many of today’s children suffer with anxiety.

The show explores various possible contributors such as social media, pressurized exams, genetics and parents passing on their own worries to their children, as well as changing cultural norms which remove children’s agency.

What is anxiety?

Anxiety is the buzz word of the moment, but the anxiety which stops children going to school is different to butterflies in tummies before going on stage at the school play. The word covers both, a human experience we all feel and a clinical diagnosis.

The later type of ‘ordinary’ anxiety can be helpful in some senses, and anxiety is a normal response to stress and entirely normally developmentally – e.g. up to the age of three separation anxiety is normal as are phobias for pre-school children, and for teens there is a heightened sense of awareness of our selves and how others see us.

In order to be diagnosed with an anxiety disorder, the level of distress must be so debilitating that one cannot function – it’s where you can’t face going out because you’re so anxious.

There are also different types of anxiety: such as social anxiety – not being able to be scrutinized without going bright red, and generalized anxieties – about anything that can go wrong, for example.

If you get serious anxiety as a child, it harms your development – you’re behind your peers and with schoolwork, and it’s reinforcing – the more you get behind, then the more there is to be anxious about!

Anxiety Increases with age, more common with girls, strong link to deprivation and family history. It’s also affect by personality types – some are more cautious and socially shy.

What is it that’s making children feel more anxious?

Social context is important – not so long ago, children would be out playing at ages 6-7, away from their parents, developing a sense of their own agency, but we’ve now starved them of these chances to be independent in primary school – primary schools forbid children to travel their alone – hence why secondary school is now seen as more of a challenge!

It could also be parents are increasingly transferring their anxieties onto their children – linked to the fact that there are too many experts telling parents what to do and the increased pressure on ‘getting parenting right’ – anxious parents makes anxious children: they do share an environment, after all!

A recent column in The Times likened GCSEs to a type of child abuse, but increased exam pressure is dismissed as being linked to increasing anxiety, because we’ve been doing them for thousands of years, and they’re probably less stressful now than they were 30 years ago.

However, it doesn’t help that children are more sensitive about the future nowadays and that more creative subjects which many children prefer are now squeezed out in favour of English and Maths.

The show also considers the effect of Social Media – it makes sense because your social media presence is fundamentally linked to your social identity – and it doesn’t switch off, and this is especially likely to impact teens at the time of life when they’re thinking about their identities.

However, there is a lock of good evidence of the relationship between social media usage and anxiety levels: its just cross sectional but we don’t know what comes first, we don’t know what kind of social media activity teens are involved in and we don’t have longitudinal data.

Socioeconomic factors also play a role – giving time to children, both physically and emotionally is important for their development, but the lower an income you earn, then the more time you need to spend working, and the less time you have for your children.

Body Image and anxiety

There does seem to be evidence of a relationship between body image and anxiety.

A recent Mental Health Foundation Survey found that ¼ people aged 18-24 believed that reality TV shows such as Love Island makes them worry about body image.

1/3rd of young people worry every day about their body, feeling things such as shame.

Over 1/5th 17-19 year old girls have anxiety depression or both. Around 11-14 there is a relationship between obesity and anxiety, but the relationship is complex.

How to help children control anxiety…

Various solutions are offered

  • More resources for mental health services
  • Cognitive behavioural therapy is mentioned as a good way of dealing with more serious anxiety.
  • Forest Schools and meditation lessons in schools are day to day things we could be doing socially
  • Giving young people more of a sense of agency
  • Being prepared to listen to children and talking about anxiety.

We also need to remember that ‘normal’ levels of anxiety are helpful – without it, we probably wouldn’t care about how we perform in society, it’s a natural part of going through changes, and the best things in life don’t tend to happen in comfort zones!

Relevance to A-level Sociology 

This is of relevance to the sociology of childhood, especially toxic childhood, and also research methods: we need to question whether these anxiety stats are valid or whether they’re socially constructed. The growth of anxiety might just be because there are more experts more willing to diagnose anxiety.

 

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Why are we relying more on drugs to treat teenagers’ mental ill-health?

In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise the section of part 2 of this documentary (which deals with teen mental ill health and antidepressants) and throw in a few links and additional commentary.

You can watch the documentary on BBC iPlayer here at least until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.

You will also find this post on ‘steemit.com‘ – a most excellent crypto-currency based blogging platform where users get paid in cryptocurrency (steem) for posting, commenting and even just upvoting other people’s work. I recommend you check it out!

Introduction: why are prescriptions for antidepressants in the UK increasing?

The general gist of the documentary is that we’re relying more on drugs to treat teenagers’ mental ill-health, but we could be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.

The number of British teenagers prescribed antidepressants has almost doubled in 10 years: in 2005, 30 000 teenagers were prescribed antidepressant drugs, increasing to 58, 000 in 2015.

The Increase in antidepressants: a visual representation

Each ping pong ball represents 4 teenagers prescribed antidepressants

2005

increase teenage depression UK.png

2015

teenage depression UK

This increase might be because more people are getting diagnosed and more effectively treated, however it might reflect the fact we are quicker to seek medicalised solutions to ‘depression’, and that these drugs are not effectively dealing with the underlying causes of depression, and maybe this doubling of prescriptions in 10 years is no a long term solution to depression.

A case study of teenage depression

To provide us with a ‘human face’ of depression, the documentary now visits Jess, 15 year old teenager who has been on antidepressants for 8 months and  whose suffered from anxiety since she was a young girl, finds school stressful because she feels trapped (30 odd kids in a class, with everyone close together). She hasn’t been in lessons for 10 months, and may not be doing her GSCEs.

Following counselling, she was put on Sertraline to combat her depression, 100 mg, double the normal dose of 50 mg. We now get the usual trawl through the possible side effects of the drug, and it’s not pretty: clinical trials have shown an increased risk of suicidal behaviour in adults aged less than 25 years, and Jess says she has felt more suicidal since starting the medication.

Interestingly, Jess states a desire to be free of the drugs, while her mother appears more relaxed, saying that there’s evidence that they work, and that her daughter shouldn’t be afraid of the stigma attached to taking antidepressants: the idea of just ‘pulling yourself together’ and coping is outdated.

Research evidence on the effectiveness of antidepressants

Dr CVT now looks at a recent study conducted by professor Andrea Cipriani of the University of Oxford. This study summarised all available evidence of how effective 14 antidepressants are in children and adolescents specifically, (rather than just evidence from adult trials). The basic research question was ‘do these drugs work’ (not ‘how do these drugs work), and they compared the drugs with each other and against the effectiveness of a placebo, a sugar pill.

depression drugs don't work.png

They found that only one drug: fluoxetine, or prozac, was more effective than a sugar pill in combatting depression among teenagers, which is worrying given that around 40% of teenage prescribed antidepressant drugs are on Sertraline. However, there is still a level of uncertainty around the research on the effectiveness on Fluoxetine – because people respond very differently to the drug.

Where Sertraline  there is good evidence that it works for adults, but the problem here is that teenagers brains are wired differently, and professor Cipriani’s research suggests what works for adults may not work for teenagers.

Wilderness Therapy as an alternative means of treating mental ill health

Dr CVT says there’s lots of evidence that being active out of doors is effective in treating mental ill health, especially depression.

To test this out, the documentary now returns to Jess, one month on, who has now had her prescription of Sertraline increased to 125 milligrams, and feels increasingly panicky and has upped her rate of self-harm, and expose her to a ‘therapeutic intervention’, in the form of the ‘Wilderness Foundation’ which uses activities in wild spaces and one on one counselling to help teenagers suffering from mental ill-health.

Research conducted by the University of Essex suggests that 83% of the kids on the charity’s leading scheme have successfully gone on the further education or full time employment.

Jess gets taken along to the the Wilderness Foundation for a day to do ‘stuff’ outdoors, and we get treated to footage of Jess in an extremely pleasant wooded glade sparking a fire to life and putting up a hammock. Wilderness therapy is apparently well established in the USA, and it certainly seems to work for Jess, who spends 6 hours out of doors.

Do antidepressants ’cause’ an increase in teen suicides?

The documentary also visits one mother, Sarah, whose daughter Rachel killed herself within 11 days of an increase in her dose of Sertraline.

Rachel’s story seems similar to Jess’: she found secondary school difficult and hit a wall at GCSEs, finding it difficult to cope with the stress. After a visit to the Child and Adolescent Mental Health Services, she was prescribed fluoxetine and experienced the following side effects after 2 weeks:

  • Violent thoughts
  • Disturbing dreams
  • Bodily shaking
  • Nosebleeds

Rachel tried to hang herself at one point, and after several months of this, she was prescribed a different drug: Sertraline. She actually wanted this herself, she wanted something to work, but within 11 days of an increase in her dose of this second antidepressant Rachel killed herself.

Rachel’s mum Sarah doesn’t blame the Doctors as they were just following the approved ‘pathways’ to treating mental illness laid down in the formal guidelines, she blames the system which seems to based on inadequate knowledge of the harmful side effects of these drugs.

NB – we cannot actually prove a causal link

Could antidepressants actually be harming our children’s health?

Drug trials should not only tell us if the drugs are effective, they should also tell us if the drugs have any harmful side effects. The problem is that many of the drugs trials are run by drugs companies, with a vested interested in making their drugs look both effective and sage.

Dr David Healy is one of the few people to have done independent research into the effectiveness and safety of antidepressants with the raw data provided by the company. He argues that we need to see the raw data to uncover how the drugs affect individual patient – and this raw data can run into several reams of paper if there 100s of people in a trial.

It is extremely rare for drugs companies to release this original data, in fact, it’s only happened once when in 2004 legal challenges were made against claims made about the effectiveness of Seroxat, and antidepressant manufactured by the pharmaceutical company GlaxoSmithKline.

Dr David Healey analysed this original data and found that the claims made in the original 10 page article summarising the findings of the trials which claimed the drug was not only effective but also sage, were basically false, with Healey’s team finding that not only did the drug not work, but that the number of teenagers who developed suicidal thoughts following the use of the drug was three times greater than intimated in the original study, in which this side effect was described as ‘some teenagers becoming more emotionally labile’.

This research actually led to GlaxoSmithKlein being fined $3 billion in penalties and fines for health care fraud.

Dr David Healy says that in between the raw data and the sometimes misleading ‘main articles’ on the research findings published by the drugs companies, there are ‘company reports’, and even if we dig into these, there is cause to be concerned over the safety of many of antidepressants.

The rest of the documentary

The documentary returns to Jess, who has kept up her therapy for 6 months (I think it’s 6 months, it’s not that clear) and after some ups and downs (including one suicide attempt at school) the therapy seems to be working – she gets taken through a process of gradually having things she finds difficult added into the programme, and eventually manages to cope with going shopping and buying something (progress for her, in dealing with crowds).

After 6 months, Jess even manages to return to school and sit her mock GCSE exams, and at the very end of the documentary, we even see her at her 16th birthday party on stage singing, in front of friends and family.

The documentary also pays the standard visit to the Clinical Lead for Child Mental Health Care Services who reiterates that all Doctors are doing in prescribing antidepressants is following NICE guidelines, which are based on the best available evidence, however, Dr CVT’s point is the best available evidence is shaky at best.

NICE refuse to be interviewed, but do say they are reviewing their guidelines

Conclusions

The whole point of the documentary seems to be to inform us of the uncertainties surrounding the effectiveness and safety of many of the antidepressants we are increasingly prescribing to our teenagers.

Dr CVT suggest we are far too trusting of the research done by drugs companies, and we shouldn’t allow them to control the information we have about these drugs… we should be much more sceptical, and in the meantime, we should pursue alternative treatments such as wilderness therapy and mindfulness which are unlikely to cause harm.

K.T.’s Commentary

One thing I want to pick up on his the ‘social causes’ of Jess’ anxiety. Basically, it seems she just hates the crowded environment of the school, along with all the stress of testing that goes along with it….

Personally, I get this, it has exactly the same effect on me as a teacher.

I also get the ‘wilderness therapy’ as a solution  – I love being outdoors, walking: it’s just that I don’t need anyone to structure it for me, I also don’t really regard it as ‘therapy’ – rather it’s just ‘doing something enjoyable’.

It appears to me that Jess’ depression is pretty much 100% socially induced – by the school system. Get her back to nature, and doing something ‘naturally’ empowering, and she’s O.K, as she is singing in front her friends and family – surely it’s the social context that’s the problem?

It’s not rocket science is it! What needs to change here is society, although that’s easier said than done.

I also have to admit being a bit taken aback by the size of that GSK fine – $3 billion for health care fraud, that’s something I’m going to have to come back to later!

Sources/ find out more!

Disclaimers/ health advice provided in the documentary

Doctor Chris Van Tulleken reminds us that it might be dangerous to stop taking antidepressants suddenly and that any change of dose should only be made with medical supervision.