'Am I depressed?': How teens can find mental health help online

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Teens don’t need to read the headlines to know that they and too many of their peers are feeling lonely, sad, anxious, and suicidal. Recent headlines, however, confirm what’s happening in their lives.  

This week, a Pediatrics study documented a 28 percent increase in psychiatric visits to the emergency room for American youth. The research, which looked at survey data collected between 2011 and 2015, found even higher rates of increased visits for adolescents and African American and Hispanic youth. The rate of suicide-related visits more than doubled. 

“This study unmistakably reveals that adolescents are a population with urgent mental health needs,” the study’s authors wrote. 

Meanwhile, new research also published this week used survey data to reveal a “steady rise” in youth rates of mood disorders and suicidal thoughts and behaviors between 2005 and 2017. 

Yet many young people grappling with psychological distress or mental illness are hesitant to tell someone who could help them. Instead, they may look for answers online, where Google searches can lead them to both information about effective treatment and therapy and to misleading or bad advice. 

Teens looking for hope amidst a sea of online resources can arm themselves with the following tips: 

1. Take a reputable mental health screening. 

There are countless online quizzes designed to tell a user whether they’re experiencing a mental health condition. These tools can help verify that something is wrong, but only some of them are based on science. You’ll want to look for scientifically validated screening tools, which you can often find through mental health organizations or government websites.

“Sometimes taking the screening is the first step before having a conversation with someone.”

Mental Health America, a nonprofit organization, offers 9 screening tools that focus on mental illnesses like depression, anxiety, and disordered eating. One screening is specifically for youth 17 and younger, and many users arrive at the site by Googling phrases like “Am I depressed?” and “depression test.” Once they’ve received the results, users can print or email them to share with others.

“Sometimes taking the screening is the first step before having a conversation with someone,” says Theresa Nguyen, Mental Health America’s vice president of policy and programs. “People think, ‘Now I have something tangible that I can give to my parents or someone I trust.'” 

2. Educate yourself with accurate information. 

If you’ve taken a screening indicating you should seek help, or received a diagnosis from a pediatrician or mental health professional, Nguyen recommends telling a trusted adult as well as learning more about your symptoms or condition. While it can be helpful to hear from friends or seek insight from social media, it’s important to remember that everyone’s mental health experiences are different. (MHA offers a tip sheet for vetting online mental health resources.)

To get basic information about symptoms or illnesses, you can check out evidence-based resources provided by government agencies like the National Institute of Mental Health and the Centers for Disease Control and Prevention as well as nonprofit organizations like Crisis Text Line and the National Alliance on Mental Illness. Effective Child Therapy, a website created by the Society of Clinical Child and Adolescent Psychology, also offers helpful definitions and descriptions. 

MHA maintains a comprehensive roundup of answers to numerous questions about depression, anxiety, bipolar disorder, psychosis, and self-harm. They tackle questions such as, “Am I just sad or depressed?,” “Will I always have anxiety?,” and, “Can an app help my mental health problems?” 

“The most powerful thing we can give young people first is education, so they have more of a sense of what they’re going through,” says Nguyen. 

That education, she adds, can help them push back when a parent, adult, or healthcare provider minimizes a child’s concerns about their mental health. 

“It’s really empowering for young people to feel strong,” she says. 

3. Find treatment and recovery resources. 

There are science-backed treatment options for mental health conditions, but finding such information online can be difficult unless you know where to look. 

Effective Child Therapy provides a thorough list of various evidence-based therapies in addition to explanations of which treatments work best specifically for illnesses like anxiety, depression, bipolar disorder, schizophrenia, disordered eating, and post-traumatic stress disorder. The site also offers a collection of search tools for finding a therapist as well as advice on how to choose a provider. 

Getting the right help early on can be critical to recovery, says Amanda Jensen-Doss, director of the child and family division in the department of psychology at the University of Miami and a member of the Society of Clinical Child and Adolescent Psychology. 

She encourages young people and their parents to ask psychologists and psychiatrists more about the treatments they offer, how patient progress is tracked, and why a certain approach is the right one to use. That information can help young patients make informed decisions about their care versus trying to handle the situation on their own. 

“So often the problems linger for a long time before they come to someone’s attention.”

“So often the problems linger for a long time before they come to someone’s attention,” says Jensen-Doss. “Kids are suffering until the point where they need to be in the ER.” 

If you’re searching online for information about suicide or hospitalization, Jensen-Doss says it’s time to contact a hotline that handles emotional crises, like the Crisis Text Line, the Trevor Project, or the National Suicide Prevention Lifeline.   

MHA’s research does suggest that the majority of young people who use their resources don’t want to see a therapist. That’s why Nguyen often recommends the organization’s resources, including “DIY tools” comprising worksheets, fact sheets, and activities that help explain, address, and manage your symptoms. 

Whether you decide to seek help for your mental health or not, it’s key to know that the right online research and resources can put you on a path toward healing and recovery. 

If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.

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FDA approves esketamine nasal spray, the first new major depression drug in more than 30 years

In one of the most significant milestones for depression treatment in decades, the U.S. Food and Drug Administration announced today that it has approved a new drug with esketamine, a derivative of ketamine.

Made by Johnson & Johnson under the brand name Spravato, the drug is meant to be taken as a nasal spray in conjunction with an oral antidepressant and is targeted to patients who have not responded to other treatments. Spravato is the first major new depression treatment to be approved by the FDA since Prozac, which had less side effects than older antidepressants, hit the market more than 30 years ago, and is especially notable because it is supposed to work much more quickly than other drugs.

This is the first time the FDA has approved esketamine for any use (it approved ketamine as an anesthetic in 1970). Despite ketamine’s reputation as a recreational drug, doctors have been prescribing it off-label for years to patients who have not responded to antidepressants and other treatments. The FDA’s advisory committee voted 14-2 (with one abstention) for its approval last month.

The FDA approved esketamine with the caveat that Spravato will only be available through REMS (Risk Evaluation and Mitigation Strategies), its restricted distribution system for drugs with major safety concerns, citing the risk of sedation and dissociation, as well as potential for abuse and misuse. Patients administer the nasal spray themselves, but they will only be allowed to do so in a doctor’s office or clinic, and cannot take Spravato home with them.

Spravato’s effectiveness was evaluated in three short-term clinical trials, as well as one longer trial. One of the short-term studies, each four weeks long, found that the combination of Spravato and an oral antidepressant demonstrated a “statistically significant effect” compared to a placebo, sometimes within two days (the other two short-term trials did not meet pre-determined statistical tests for effectiveness).

In the longer trial, patients who had stabilized and continued with the medication combo took a “statistically significant longer time” to relapse than patients who received a placebo nasal spray with their oral antidepressant.

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This is why mindfulness isn't working for you

When mindfulness doesn't seem to be working out -- even if you're on the beach and there's a nice sunset.
When mindfulness doesn’t seem to be working out — even if you’re on the beach and there’s a nice sunset.
Image: Bob Al-Greene/Mashable

March Mindfulness is our new series that examines the explosive growth in mindfulness and meditation technology — culminating in Mashable’s groundbreaking meditation bracket contest. Because March shouldn’t be all madness.

In a culture obsessed with self-care, feeling like you’ve failed at the practice of mindfulness can breed unique feelings of frustration, resentment, and even shame. 

It seems so simple: Quietly observing your thoughts, you remain open to and curious about the present moment without judging the ideas that ping back and forth in your consciousness. You expect to experience the benefits that research says mindfulness can offer, including reduced stress, increased attentional focus, less emotional volatility, and improved relationship satisfaction. 

Except, for some people, that’s not what happens. They might find it hard to stay in the present moment, feel anxious after attempting mindfulness, and abandon their practice. Such frustration is often rooted in a misunderstanding of how mindfulness works, and what it’s meant to do, say experts. People’s expectations of mindfulness are sometimes far higher than what the tool could ever deliver. 

“There’s a lot of hype and buzz around mindfulness,” says Alex Haley, assistant professor and mindfulness program lead at the University of Minnesota’s Earl E. Bakken Center for Spirituality & Healing. “[People think] everywhere I turn it’s mindfulness-based something. I’m going to have all these expectations that mindfulness is a cure-all, that it’s a panacea. It’s not. There are limits to what it’s able to do.” 

Those misconceptions can be cleared up with just a little research. Yet there’s another, more complex reason why some people feel mindfulness isn’t effective. An emerging field of research is exploring how people who’ve experienced trauma may feel significantly worse during or after mindfulness practice. Researchers working to understand that dynamic believe it’s still possible to use mindfulness approaches, just with important modifications. 

So before giving up on mindfulness, or feeling ashamed that mindfulness isn’t producing the results you wanted, make sure you’ve considered the following things: 

What does mindfulness even mean? 

Mindfulness has multiple definitions and those can look different depending on your teacher, or whether you’re getting mindfulness tips or instruction from an app, best-selling book, YouTube channel, Instagram influencer, yoga class, or news stories like this one. 

“Mindful awareness is paying attention to present moment experiences with openness, curiosity, and a willingness to be.” 

Perhaps the most widely-known definition of the secular practice of mindfulness comes from researcher and meditation teacher Jon Kabat-Zinn, who said: “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”

Though Haley uses Kabat-Zinn’s definition, he frequently invokes another one from Diana Winston, director of mindfulness education at UCLA Semel Institute’s Mindful Awareness Research Center: “Mindful awareness is paying attention to present moment experiences with openness, curiosity, and a willingness to be with what is.” 

J. David Creswell, an associate professor of psychology at Carnegie Mellon University who studies mindfulness, thinks of it as an “open or present attention to your present situation.” 

While different from each other, these definitions share a core element: attention to the present. If you embrace one definition over another, just remember that it’s meant to help you understand how to practice mindfulness, and it’s fine to consider what it might leave out. This approach will help guide your practice and refine your expectations.   

“It’s not unicorns and rainbows”

Creswell says popular misconceptions of mindfulness portray it as a tool for relaxation or “blissing out.”  

“It’s not unicorns and rainbows,” he says. “I liken mindfulness meditation practices to aerobic practices for the brain. [Exercising] hurts, it’s a little unpleasant, but at the same time it’s building muscle. With mindfulness, you’re building a brain that’s more resilient.” 

That mental strength develops over time as you focus the brain’s attention on the present moment and learn how to observe positive, negative, and neutral feelings without being carried away by any of them. This is no easy task for human beings, whose powerful thoughts and feelings can rip them from the present moment and thrust them into a stream of consciousness that’s confusing, exhilarating, fulfilling, or exhausting. 

Some people mistake mindfulness as a surefire way to avoid that overwhelming experience, but Creswell says that’s not the case. Developing mindfulness skills can mean, for example, staying observant and curious about what’s happening when you’re having a panic attack. From Creswell’s perspective, the goal is to cultivate “equanimity” in the face of uncomfortable experiences. That objective is why mindfulness is so frequently associated with formal, seated meditation, which can prompt physical discomfort and mental fatigue. 

Why should this make me feel better? 

Haley believes that mindfulness works because it puts people in a different state of mind, one where they’re actively aware of and paying attention to events happening in the present moment. As they take in that information, they better understand the situation and can make a choice about how to respond. With regular practice, this can create a “positive feedback loop” that leads to more moments of mindfulness, and our resulting choices become wiser and more compassionate, says Haley. 

“It allows us to understand our experiences, and most importantly, is the choice to how we respond to the things we’re feeling,” says Haley. “If we notice things that are really challenging, we can say, ‘I want to make a different choice.'” 

“If we notice things that are really challenging, we can say, ‘I want to make a different choice.'” 

That sense of agency is empowering, but it’s important to know that mindfulness is a state of mind that comes and goes.  Feeling calm and observant one day and at the mercy of your thoughts and emotions the next doesn’t mean you’ve failed at mindfulness. It just presents another opportunity to strengthen your skills, or to try again the following day. 

Haley says frustration and difficulty with mindfulness can come from overly strict ideas about how to practice it. People commonly believe that mindfulness means you must practice formal, seated meditation, but Haley says that’s just one option. He sometimes recommends people start with movement by observing how their body feels when its been moving for long periods of time. Haley also relies on a slight variation of the “STOP” technique in which you slow down, take a breath and extend the exhale, observe what’s happening in the body, and consider the possibilities before proceeding. That approach can shift people into a state of mindfulness and away from being reactive. 

Creswell’s own research has found that there are three types of evidence-based mindfulness programs: an 8-week mindfulness-based stress reduction course founded by Kabat-Zinn and offered by credentialed instructors around the world; apps like Headspace and Calm that use teachers trained in mindfulness; and mindfulness meditation retreats. Creswell recommends exploring various options to find research-backed programming and resources, or a qualified teacher.

What if mindfulness still isn’t working for me? 

Despite the clear benefits of mindfulness, science still can’t say who might benefit most or least from the practice. Creswell says it’ll be five or 10 years before researchers can confidently answer that question. In the meantime, some scientists and meditation practitioners who study mindfulness are focusing on the possibility that mindfulness might actually create the possibility of harm for some people who try it, particularly those with a history of trauma. 

David Treleaven, author of Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, says that for some people struggling with trauma the basic tenets of mindful meditation practice, including focusing on the breath and remaining still for periods of time, can actually exacerbate trauma symptoms. Paying close attention to anxious or threatening feelings may heighten the body’s fight-or-flight stress response, elicit intrusive thoughts of harm or danger, and prompt flashbacks to traumatic events. 

For some, focusing on trauma symptoms because they’re happening in the present moment can lead to physical immobilization akin to freezing in place. Treleaven describes that response as a “deeply wired survival response in humans.”  

A meditation teacher unaware of these dynamics might insist that remaining curious and nonjudgmental about these sensations is a necessary part of mindfulness meditation. 

“People feel isolated and ashamed that a practice that seems to be working for so many people isn’t working for them.”

While Treleaven believes that mindfulness can be very beneficial for people who’ve lived through trauma, he disagrees with an approach that diminishes or minimizes their unique experiences. 

“People feel isolated and ashamed that a practice that seems to be working for so many people isn’t working for them,” he says. “They end up feeling like, ‘I’m broken beyond a point that even meditation can’t work for me.'” 

Treleaven instead advocates for adjustments to mindfulness meditation. He urges people to take breaks as needed in favor of pursuing lengthy sessions or weeks-long meditation streaks. He advises teachers against touching students without their explicit permission. If focusing on the breath is anxiety-provoking, Treleaven recommends finding an “object or anchor of attention,” like sounds or the feeling of your bottom touching a cushion or the floor. When sitting for long periods of time is uncomfortable for those who’ve experienced trauma-related freezing, Treleaven suggests mindfulness that incorporates movement. 

The goal, he says, is to create a consistent practice that builds mindfulness skills while reducing the risk of harm. He recommends people who’ve experienced trauma look for mindfulness resources, classes, and instructors with a trauma-informed approach. 

“It doesn’t need to be a one-size-fits-all practice,” Treleaven says. “We can modify it for people so that it enables them to have a sense of success.” 

No matter why you’re struggling to feel the benefits of mindfulness, that flexibility is key to starting, continuing, or pausing a practice. Mindfulness, after all, is never about perfection. 

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Two Chairs nabs $7M for its client-therapist matching app and brick-and-mortar clinics

The future of healthcare isn’t entirely digital. For encounters as intimate as the client-therapist dynamic, a face-to-face relationship is still key.

For those able to afford tech-enabled therapy services, Two Chairs, a San Francisco-headquartered mental healthcare business, may be of interest. The startup believes in the power of in-person therapy, as opposed to the new variety of affordable digital tools meant to replace or coexist with therapy services. Today, the company is announcing a $7 million Maveron-led Series A financing to open additional brick-and-mortar clinics and build out its client-therapist matching app, which leverages technology to pair its customers with a therapist best-tailored to their needs.

The company currently operates four clinics in the Bay Area, where patients can access individual or group therapy. Each of those clinics was built with modern, young professionals in mind using “thoughtful design” to create “non-judgmental spaces.”

A Two Chairs clinic, which emphasizes “non-judgmental” design

The mobile app and clinic interior design are the key differences between Two Chairs and a neighborhood private practice, it says. As far as pricing, at $180 an hour, a session doesn’t differ terribly from a typical session at a Bay Area private practice (the company does accept insurance). The startup currently employs 30 therapists, who also are available over video chat should a client be sick or traveling, with a customer base of 2,000.

Two Chairs was founded in 2017 by former Palantir employee Alex Katz (pictured). In a conversation with TechCrunch, Katz admitted procuring real estate for Two Chairs’ brick-and-mortar clinics has been an expensive and difficult endeavor. It’s no wonder venture capitalists tend to favor IT startups devoid of the overhead costs associated with firms in the real estate business. Katz is hoping the latest investment, which brings Two Chairs’ total raised to $8 million, will help the business quickly sign additional leases outside of the most expensive city in the U.S.

The cash will also be used to advance Two Chairs’ matching app. The app surveys potential clients on their history, preferences and goals, then uses a library of data to match the client with the most suitable therapist in its roster and to create a customized treatment plan. Katz says they’ve provided clients with an accurate match 95 percent of the time.

“We know that the client-therapist relationship is the best predictor of an outcome with care and while it sounds intuitive, matching is not a concept that has existed in the mental health field historically,” Katz told TechCrunch.

Two Chairs is one of several mental health startups to capture the attention of venture capitalists lately. Basis, which helps people cope with anxiety and depression through guided conversations via chat and video, emerged from stealth in 2018 with a $3.75 million investment led by Bedrock. Wisdo, a community-focused app that connects people seeking help with those who can offer help, brought in an $11 million investment in December and emotional well-being app Aura raised $2.7 million from Cowboy Ventures in October.

Those three businesses have one thing in common: they are digital-first endeavors looking to innovate on top of a broken mental healthcare model. Two Chairs’ plan to build additional therapy clinics, however, doesn’t feel particularly inventive. Opening a chain of therapy offices, rather, sounds like a hard-to-scale, expensive business idea.

As for the uptick in capital for mental health tech, Katz is satisfied Silicon Valley has finally acknowledged the problem: “I think Silicon Valley venture has had a preference for models that don’t involve brick-and-mortar and minimize the use of people; they prefer software businesses,” he said. “The reason we are taking this approach is we know from the research that really well-matched in-person therapy is really effective. Still, at a high level, it’s exciting. There are a lot of people thinking in innovative ways of how we can provide improved mental healthcare.”

Goldcrest Capital also participated in Two Chairs’ Series A.

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Mandy Moore wants you to know mental health is important

“This is Us” has captured the hearts of millions over the course of its three seasons. Its success is largely due to the show’s emotional plot lines and relatable characters. Actress Mandy Moore, who plays mother Rebecca Pearson, believes candid representation of mental health is a vital step forward.

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