Reset Your Child's Brain. Victoria L. Dunckley, MD
are at higher risk for screen-related depression.11
Alongside these psychological changes are physiological ones, including dysregulation of dopamine and other neurotransmitters (brain chemicals), compounding depression and a sense of isolation. While dopamine is the “feel good” chemical linked to positive moods, another relevant brain chemical is serotonin. Serotonin is important for socialization, stable mood, a sense of well-being, and coping with stress, and it is low in depression, anxiety, and aggression. Serotonin levels are highest in the mornings, and its production is thought to be boosted by bright morning sunlight and physical activity. Lack of morning light and sedentary daytime behavior may therefore blunt serotonin, contributing to depression, anxiety, aggression, and even suicidality.12 Light-at-night may further depress mood, both because serotonin is made from melatonin (which is suppressed by light), and because sleep disturbance itself is linked to mood issues. As dopamine and serotonin become more and more dysregulated, the child starts to seek out screen stimulation to temporarily boost mood, and screen-time literally becomes a form of self-medication.
Dan: A Curious Case of Depression
Dan was a twenty-year-old young man with mild social anxiety and ADD who — despite a genius-level IQ — was failing out of college. His social life had gone from being fairly active to nonexistent, his sleep-wake pattern was almost completely reversed, and he rarely left his room. Although not actively suicidal, Dan reported he often felt he’d be “better off dead” and didn’t “see much point to life.” What was happening?
Upon graduating from high school, Dan had continued living at home. But without the eight-hour school days and no job to go to, he suddenly found himself with a lot of extra time on his hands. His electronics’ use skyrocketed. Even when his college classes began that fall, Dan continued to spend anywhere from six to twelve hours a day on the computer, playing games, chatting, or reading articles. Dan barely scraped by the first two semesters. By the end of his third, Dan had dropped one class and was getting Fs in the other two. Despite his high IQ, he was struggling to keep up.
He’d also lost a lot of weight, even though he was thin to begin with. Dan’s mother reported that he’d stopped going to the kitchen to get food or water, and he was dependent on her to nag him into eating and drinking. By the time Dan came to me, he was gaunt and pale, and his muscles had literally atrophied from sitting and lying down so much.
To see this in a young male was shocking. Dan complained of fatigue, joint pain, back pain, shortness of breath, depressed mood, trouble sleeping, and feeling “flat.” His mother had made the rounds to numerous medical specialists and therapists — for both physical and psychiatric complaints — but to no avail. By the time I consulted with him, Dan was taking three psychotropic medications plus a pain medication, and he had been tried on numerous other “psych meds” but found them all ineffective. Not one person ever suggested he remove the computer and other devices from his bedroom, despite this being a standard-of-care intervention for sleep disturbance.
Naturally, when I suggested an electronic fast, Dan resisted. As is often the case with youths over eighteen, his treatment providers and his parents had been reluctant to force any screen-time rules upon him, which only escalated the problem. I, however, viewed his situation as an emergency; his behavior was showing us he wasn’t able to care for himself. Fortunately, his mother — who had been suspecting that the computer was part of the problem — readily agreed that imposing the fast was warranted, and she removed all the electronics in the home that same day.
Initially, Dan became even more isolated. Most days, he stayed in bed and didn’t speak much at all. Because he was so depressed, we decided to extend the fast for at least six weeks, and this proved to be prudent. Right around the six-week mark, Dan started coming alive again. He got out of bed each day, made spontaneous conversation with his mom, and began going to class. His interest in physics and history revived, and he joined some academic clubs. Initially, we maintained the fast except for school-related work, but as time went on, his mother and I established strict rules for personal use and continued to actively moderate his usage, in part by requiring his schedule be structured. Dan got a part-time job, made friends, and started getting As and Bs in school. Slowly, Dan put on some weight and started walking and stretching regularly with a family friend. As he regained his strength and energy, it became clear that all Dan’s physical ailments stemmed from deconditioning (being out of shape), depression, and stagnant blood flow — not some mysterious medical disease.
Dan’s case underscores the seriousness of electronics’ role in mood disorders, highlights the risk that social anxiety can bring, and demonstrates some of the physical effects that can occur with electronics overuse. Other individuals at high risk for screen-related depression are those with autism spectrum disorders, particularly after graduating from high school (for more on autism and ESS, see page 99). Suffice it to say, it is not enough to address depression in young people solely with conventional psychotherapy and perhaps an antidepressant. Even if screen-time is not the primary cause, it is virtually always a contributing factor.
Bipolar Disorder
Bipolar illness is a mood disorder characterized by severe high and low mood states. While “low” refers to a depressed mood, “high” can refer to a state of either euphoria or irritability. In adults these swings tend to be relatively discrete episodes, but in children, bipolar episodes are less distinct, and both the “highs” and “lows” can be associated with irritability — making the disease mimic a lot of other mental disorders. Thus, the diagnosis can be missed in those who truly have it, but it also tends to be overdiagnosed in children with other difficulties.
When I first began my “Mental Wealth” blog for Psychology Today a few years ago, I wrote a post entitled “Misdiagnosed? Bipolar Disorder Is All the Rage!” in which I proposed that the large increase in pediatric bipolar disorder diagnosis was due (in part) to children who were overstimulated from video games and other screen-time who raged, and thus “looked” bipolar.13 I received emails from mothers all over the world — including the United States, Europe, Canada, South America, and the Middle East — telling me their child had been diagnosed as “bipolar” because he or she was exhibiting rages. Typically, the email would reveal that the mother had long suspected video games were the real culprit, but that the notion had always been shot down by whoever was evaluating the child. When these mothers read my article, however, the sense of validation they felt prompted them to follow their instincts — and out went the electronics. Story after story poured in about how a child’s rages had resolved or at least become manageable when they followed this simple intervention. Although I’d seen this in my practice hundreds of times, it was validating for me to hear that mothers around the world were using the intervention effectively.
However, behind the satisfaction loomed something more ominous. How many children were receiving psychotropic medication unnecessarily? How many were labeled as “bipolar” when they were simply overstimulated and unable to regulate themselves? As I mention in the introduction, the diagnosis of childhood bipolar disorder has increased dramatically in recent decades, and a new diagnosis was created in 2013 — Disruptive Mood Dysregulation Disorder — precisely out of concern that children are being inappropriately diagnosed with bipolar disorder and receiving unnecessary medication. In my experience, disruptive children are sometimes given a “bipolar” diagnosis by a pediatrician during a routine ten- to fifteen-minute visit, while in other cases a teacher or therapist suggests to parents that their child “might be bipolar” and “might need medication,” or worse, “can’t come back until he’s medicated.” Often, a child need only exhibit aggression or explosive rage to get this label slapped on by a well-meaning but misinformed clinician. In some instances, a mother will read a description of pediatric bipolar disorder, feel her child fits the description, and then convince herself and others that bipolar disorder is the correct diagnosis. Of course, childhood bipolar disorder can and does exist (with or without ESS), and it’s not a diagnosis you want to miss — early treatment improves prognosis. But it is relatively rare, especially if there is no family history of the disease (or no genetic predisposition).
So, what is it about ESS symptoms that prompt this mistake and create what seems to be a bipolar “picture”?