There is an interesting article up on Aeon called Status Suicidal that explores an interesting observation about the expressions of depression that people make on social media like Facebook and Twitter. It does raise the question, what do you do if people are making expressions like this on social media?
She sat before me, feet in combat boots tapping an irregular rhythm on our muted yellow clinic floor. She was twirling a strand of long black hair and chewing some gum as she ticked off her symptoms in a bored voice with just a hint of well-hidden angst. There were the heartache symptoms such as sadness, hopelessness and loss of interest in activities that used to be fun. There were brain symptoms such as trouble concentrating, which could affect homework and get in the way of daily activities. ‘It’s hard to make it to your job at the coffee shop on time when you are constantly losing your keys,’ she explained with an exasperated tone. Third, there were physical symptoms such as changes in appetite, difficulty sleeping or sleeping too much, and a feeling like you are moving slowly.
I’m a physician at the Social Media and Adolescent Health Research Team (SMAHRT) at Seattle Children’s Hospital, where depression is a frequent diagnosis. Yet the diagnosis isn’t always simple, because symptoms are so variable and patients and doctors can get confused. Often, patients are sent for evaluation for something else, such as sleeping or eating problems, or the possibility of a grave physical illness of unknown cause. After a diagnosis of depression, the adolescents typically nod their heads in understanding, formerly tense shoulders now visibly relaxing. They are glad there is a name for what they feel, glad to know it’s not just them, and that there are treatment options.
Parents can baulk at the news. Sitting ramrod straight in their uncomfortable clinic chairs, eyes boring into mine and voice quivering, they demand additional tests or CT scans. ‘It can’t be depression,’ they argue. ‘We need to keep looking for something more serious.’ The parents sometimes resist therapy as a treatment. ‘I don’t want him lying on some couch complaining about his childhood to a stranger.’ Some parents argue that they ‘don’t believe’ in antidepressant medications. Does this reaction reflect a generation gap? Overbearing parenting? An expectation that state-of-the art radiologic imaging can find the cause of the symptoms?