There has been a sharp rise in anxiety, depression and mental health disorders in children since the early 1990s. Approximately 13 to 20 percent of children in the U.S. have a mental health episode yearly. (1) Our medicated children today, think it is commonplace to take these medications to perform, function or maintain relationships. Unfortunately, the disconnection we see in our children may simply be a symptom of the disconnection that exists today, within our homes, our communities and our nutrition.
Anxiety and depression, along with the often accompanying diagnosis of ADHD and OCD, affects children more today than in any other decade. It is interesting that mental health for children is increasing in rates similar to obesity, autoimmune illnesses, allergies and eczema. From an integrative medicine perspective, these are all conditions reflecting that complex interface between genetics, culture, lifestyle, food and nutritional status. Having started my medical career as a pediatrician, I want children healthy, vibrant and active. Here are patterns that I have seen in practice, as children enter with multiple psychiatric medications, that often serve as blocks to their vitality.
The connection between nutrition and mental health is nowhere more obvious than in our children. I have seen countless young and adolescent children heal their anxiety and depression by understanding their nutritional deficiencies. Diets low in protein and healthy fats affect neurotransmitter function. Deficiencies in B and D vitamins also affect mood since these vitamins are the building blocks for neurotransmitter production and break down. In fact, diet is so powerful that maternal prenatal and antenatal diet can even be related to childhood anxiety and depression. (2)
While we don't want to chalk up mental health disorders to simply taking a vitamin, why are we not at least checking for nutritional deficiencies and making this a part of a standard evaluation for adults and children with mental health disorders? The answers may not be a guarantee that a child will be unmedicated, but maybe helpful in having a child on fewer medications or even, smaller doses.
Children with irritable bowel syndrome, recurrent abdominal pain or constipation often also have anxiety, depression or other accompanying mood disorders. This makes sense when we understand that so many neurotransmitters are made in the gut. Almost 95 percent of our serotonin, along with dopamine and gaba, are manufactured and processed in our bellies. Once the gut stops working, neurotransmitter imbalance is soon to follow, resulting again in moody kids. In my practice, we routinely screen children with anxiety and depression for gastrointestinal disturbances. Looking at everything from food allergies, food intolerances, poor gut microbiology and even deficiencies in digestive enzymes or hydrochloric acid are all potential factors that play into both the gut disturbance and mental health. (3)
We may just be on the cusp of understanding the genetic -- neurotransmitter connection, but within families, certain genetic mutations are being passed down that can then be connected to generation after generation of anxiety or depression. I can almost look at a family tree and know when to test for these mutations, the most common of which is known as MTHFR, or methylation defects. This complex genetic pattern results in specific mutations, each individually determined, that in turn affect neurotransmitter production. A methylation defect can cause too much serotonin, too little dopamine or excess gaba -- all critical neurotransmitters involved in balancing mood. Routine testing of methylation defects is becoming more common. In the future, we may have a list of mutations in children with anxiety and depression, that we test and then determine the best course of medication, supplement or lifestyle interventions.
Finally, we may just have a culture that lends itself to anxiety and depression. We live in nuclear families, often away from hometowns, and surrounded by strangers. We have temporary friendships, more divorced families, working parents and separation from a church or spiritual community. Children, I have learned, need to feel part of something, something bigger than themselves and a part of non-stressed community. We instead have a culture of disconnection, where joint custody, iPads, iPhones and selfies become the norm, only creating more isolation. There is not an easy solution to fixing the culture we live in but as parents, we can work hard to build a community for our children. Allowing them to connect and feel supported by multiple adults, not just their parents and limiting time on devices and gadgets that breed more isolation are beginning steps. Children today, just like those of every generation, need family, community and time together to weather the challenges that any family many face.
As summer begins, let's take advantage of the relaxed pace to really evaluate our children, looking at them holistically, and trying evaluate their need for medications. Medication for children with anxiety and depression should be used only after we have taken all of the above into account.