Root Causes of Adolescent Depression

A recent report from the CDC showed that three out of five teen girls shared they experienced persistent feelings of hopelessness in 2021.

While this statistic is staggering, I listen without batting an eye. Why?

I was one of the three.

I believe there are many things contributing to adolescent hopelessness, and while there are differences between the world of today and the world when I was diagnosed, the treatment options haven’t changed. The treatment options available in the 90s are the same being offered today, 30 years later: medication and therapy.

Unfortunately, those limited options are not treating the root of the issue, and in some cases, may make things worse.

I’ve created a list of contributing root causes to my depression, in hopes that it will help someone take a closer look at potential factors that are not being offered through traditional treatment. The information I share is widely studied and should be well-known, yet it is not.

And our teen girls continue to fall through the rabbit hole of darkness.

Common contributors to teen depression:

1. The oral birth control pill. I was prescribed this in 8th grade due to a heavy menstrual flow and anemia. Within a year I experienced debilitating depression, which is not uncommon, according to the research. The pill depletes B6, crucial for creating serotonin, supporting mitochondrial function, the methylation cycle, and maintaining the gaba/glutamate balance (which we need for calm feelings). The pill affects the gut microbiome, increases enhanced intestinal permeability, and because over 90% of serotonin is produced in the gut, this is another risk factor for depression. The pill depletes magnesium, which is needed for the gaba/glutamate balance, among so many other mood-benefiting needs. There are indeed a myriad of nutrient depletions occurring from oral contraceptives. Because the pill depletes the very things needed to counter hormonal issues and premenstrual stress, it is no surprise that a further imbalance occurred in my body, leading to depression symptoms. While for some people this may be a useful tool, ensuring there are enough nutrients available to make up for the lack is crucial.

2. Antidepressants (SSRIs). But wait – aren’t antidepressants supposed to help? Studies show they only work about 30% of the time, and when you remove the placebo, it may be closer to 15%. While in some cases, the use of these drugs are helpful, in others, the drugs can cause worsening depression. There is a black box warning on antidepressants for teens, and as one study cited, the risks of increasing depression and suicidality may not outweigh the paltry benefits. Antidepressants also create a further depletion of much needed B vitamins as “building blocks,” due to the demand on serotonin, and newer studies are showing they alter the gut microbiome. Furthermore, for anyone with a family history of bipolar disorder, keeping serotonin in the synapses of the brain for longer may lead to mania, which is exactly what happened to me. Remember – SSRIs don’t give you serotonin. They take the available serotonin and inhibit the reuptake, making it stick around for longer. The body in its wisdom has a compensatory approach via the MAO enzyme and long-term will wipe it out, leading to further serotonin depletion. Like with the birth control pill, this may be a useful tool for some people in some circumstances, but it is important to be aware of any negative impact created and look for more tools in the toolbox to support healing.

3. Low self-worth and poor body image. Yes, I went to a counselor. However, I constantly critiqued myself and compared myself to images in magazines. No, there was no social media but I was obsessed with Entertainment Tonight, People magazine, and anything that could tell me how to be skinny like the celebrities. That negative self talk was toxic for my body, leading to low secretory iGa at the intestinal barrier level, leading to tissue damage and opening me up to poor immune function which led to…

4. Antibiotics. I constantly took antibiotics for any little thing, from infancy to pre-adolescence, when trauma wore down my immune system (which I’ll get to). By the time I was in college, I experienced chronic tonsilitis and was diagnosed with mononucleosis… at the same time I was diagnosed with bipolar disorder. Thanks to what we know about psychoneuroimmunology, there is a connection. However, I received more antibiotics, which led to worsening gut health, which led to more medication changes, and my body and brain continued to suffer.

5. Unresolved trauma. One area of mental health has improved since the 90s, and that is trauma therapy. Now that I understand Polyvagal Theory, I see that I was on a dorsal vagal state (“freeze” mode) for a very long time. This looked like days I couldn’t get out of bed, low energy, fatigue, dissociating when situations were overwhelming, and feeling completely overwhelmed by everything. Talk therapy, while helpful in the short term, didn’t address my trauma. A therapy such as EMDR, or even a tool like tapping or yoga could have been extremely impactful to bring me back into my body.

6. An insatiable desire for overly processed foods. Because of my depression, I gravitated toward food that made me feel good. I craved hyperpalatable processed foods that are designed to play on my neurotransmitter response and hook my brain. It wasn’t a failure of willpower on my part, my brain was doing exactly what the food companies were banking on my brain doing. Wheat and dairy are notably suspect, due to the way they play upon the opiate receptors in the body and for me, have a drug-like addictive quality. They also lead to further nutrient depletion, and newer studies are showing that those who consume overly processed foods are more at risk for depression and anxiety.

7. Exercise. I played sports every year until fall of my senior year of high school, when my depression hit yet another low and isolation overtook me, to the point where I would turn down social activities to stay home and read. When swim team started in the second semester, my mood improved. Yes, there is a connection. In my opinion and research, exercise continues to be the most powerful antidepressant studied to date. In fact, a recent research review of almost 100 published articles showed that exercise may be 1.5 times more effective than medication and therapy.

Further considerations that must be examined in regards to adolescent depression:

• How much sleep is happening? Too much? Not enough? Inconsistent sleep schedules can wreak havoc on mood health!
• Is there thyroid dysfunction?
• Is there an autoimmune dynamic at play?
• Is there a food sensitivity? Food sensitivities can contribute to leaky gut, which leads to inflammation, which can lead to an imbalanced nervous system and result in depression and anxiety.
• What is the use of screen time like?
• Is there loneliness and social isolation at play? Loneliness is more harmful than smoking cigarettes, so this must be examined.
• What is the parent-child relationship like? What is the parent’s mental health and stress management like? Thanks to the science of interpersonal neurobiology, we know that when parents experience untreated depression, anxiety, poor self-esteem, or lack of self-regulating skills, it negatively impacts children’s mental health.
• Is there any time in nature? What are vitamin D levels like?
• What other nutrient deficiencies are at play? Is there enough protein consumed for neurotransmitter support? In a world of convenience and fast food, is your child getting enough bioavailable vitamins, minerals, and/or omega 3 fatty acids to support brain health?

As a parent, I will turn over EVERY stone to get to the root of my child’s health issues. Thanks to a functional medicine approach at healing, we reversed chronic disease twice in my family. Finding a practitioner trained in integrative medicine gave us many more tools in the toolbox that promoted healing.

If you are a parent, I encourage you to take this list, these resources and have an open heart-to-heart with your child’s pediatrician. If your pediatrician is unwilling to turn over every stone with you, and examine all the available research, then it’s time to find someone who will advocate for your child with you. That person exists. I promise.

If you are a medical professional or pediatrician reading this, I urge you – fight for these girls. Leave no stone unturned. If that means thinking outside the box, and digging into unfamiliar research, do it. If it means asking more questions, do it. If it means outsourcing support from a trauma therapist, health coach or nutritionist, or someone trained in functional medicine – do it. Find someone who will partner with you for the benefit of your patients, who you work so hard for and care about so deeply. These girls are worth it. They need all the support we can give them.

We simply cannot keep repeating the cycle of insanity, doing the same thing over and over again, expecting a different result.

As a mother, as a survivor, as a health coach and researcher – I refuse to accept the way things are.

Our daughters deserve better.

**Listen to a longer version of this on the podcast, linked here or wherever you get podcasts.

Author’s Note: While this article was reviewed and fact-checked by both a pediatrician and psychiatric nurse practitioner, it is not intended to be used to cure, treat, or diagnose an illness.