Exercise, yoga, and talk therapy may be alternative options for treating teen mental health issues. Here’s what parents should know.
According to some accounts, doctors overprescribe prescription drugs, such as antidepressants and psychostimulants, for teen mental health issues. American teens, the story goes, may as well be zombies.
Some data, however, tell a different story. In fact, only a very small number of teens may be taking prescription medication at all, according to a report from the Centers for Disease Control and Prevention (CDC).
About 6 percent of teens have serious mental or emotional health conditions, says the CDC. In the study, two-thirds of that group reported receiving some form of mental healthcare, which included school- and community-based treatment, seeing a therapist, and support groups for emotional or behavioral difficulties.
Yet just 29 percent of those receiving mental healthcare also took a prescription medication. These data come from the National Health Interview Survey, which is conducted continuously. Another report from the CDC found a higher number, 7.5 percent, of children and adolescents 10 to 17 in a nationally representative sample taking a prescription medication for mental health from 2011 to 2012.
The truth may be somewhere between those numbers. Either way, there doesn’t appear to be a lot of medicating going on in teens with mental health issues.
Teens may simply lack access to healthcare, particularly for mental health problems. As many as a third of adolescents don’t get the care they need, whether because they don’t have health insurance or simply don’t seek it, according to the National Center for Children in Poverty. That figure is in line with the most recent CDC study. But more may simply be benefiting from other forms of care.
Carl Tishler is a psychologist and adjunct associate professor of psychiatry and psychology at The Ohio State University who has worked with children and teens for more than 30 years. Tishler says many good options exist aside from medications to help teens suffering from anxiety, depression, or other mental health problems. Prescription medications involve side effects, he says, such as “from interference with driving, to drowsiness, weight gain, and being thirsty all the time.” If teens are reluctant to experience those side effects, non-medication therapies may be a better fit.
Tishler cautions that medication is sometimes essential to proper care and treatment. “Certainly we have a group of kids in our practice who come in and need to talk about their problems, and they seem to find that as helpful, if not more helpful, than the medications. But … there are also a group of kids who really severely need their medications.”
Whether you’re seeking help for yourself or a teenager you know, Tishler suggests the following non-medication options for mild-to-moderate depression and anxiety, as well as attention deficit hyperactivity disorder in teens:
Exercise. Zumba, karate, swimming, tap dancing — all are strenuous forms of exercise that provide significant health and mental health benefits. “Sweat-provoking is really the key. Aerobic exercise needs to be really running around for a good solid 40 to 50 to 60 minutes,” Tishler says. “I really like to see it four or five times a week.”
Exercise in a class is “particularly helpful,” he says. If a teen is not athletically inclined, he suggests classes that offer less competitive environments, such as those at a local YMCA, Boys or Girls Club, or community center. “A lot of times something like a class at the Y is a much better and more accepting place for them to go rather than to the local high schools, where there's a lot of competition.”
Just don’t exercise too close to bedtime, which can exacerbate sleep problems — a major marker of depression and other mental health issues, Tishler says. Instead, a good time to exercise is right after school.
Mindfulness, yoga, and biofeedback. Mindfulness, a practice of meditation that involves focusing on the present moment, is "another thing that has become quite popular these days that seems to be helpful for kids," Tishler says.
Yoga can also help get “kids through periods of debilitating, sometimes, anxiety and depression,” he notes, while biofeedback — in which physiological indicators like heartbeat and breathing rate are measured — is “just one more way of helping a person … be more aware of their body so they're not feeling as bad as they were.”
Journaling. It may seem “old-fashioned” to some teens, Tishler says, but the practice of writing down thoughts and feelings is “good for kids that wouldn't want to be in a class or do exercise or yoga or group mindfulness.”
Talk therapies. Studies have shown cognitive behavioral therapy and more traditional therapies are “extremely helpful for kids,” Tishler says. Family therapy is another option, but may not always be realistic. “If a family is fairly accepting and they can listen to what their teenagers have to say, that can be an extremely helpful way for a kid to deal with anxious feelings or depressive feelings. It just depends on a particular family whether they can tolerate family therapy. If a family's going through their third divorce, to bring all the players together I'm not so sure is always a great idea.”
Adopting a pet. Pets are helpful for troubled teens, Tishler has found. “Adolescents can talk to them and not receive judgment from the pet, such as why’d you go out and get drunk,” he says. A pet “has total unconditional positive regard as long as they're walked and fed.”
February 27, 2020
Christopher Nystuen, MD, MBA