"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, and often a clean break can provide the missing link in treatment."
by Victoria L. Dunckley M.D., psychologytoday.com, 29 October 2015
The face of depression in today's screen-bound world is changing.
Dan was a twenty-year-old young man with mild social anxiety and attention deficit disorder 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 with parents. 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.
When he began college classes 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, he had dropped one class and was getting Fs in the other two. Despite Dan's 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 Dan had stopped going to the kitchen to get food or water, and that he was dependent on her to nag him into eating and drinking. By the time Dan came to see 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 had been tried on numerous other “psych meds” but found them all ineffective. Dan and his mother had even started looking into electroconvusive therapy (ECT), where the brain is "shocked" with electricity to produce a therapeutic seizure; it's thought that ECT may work by resetting brain chemistry. 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 he try a month-long 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 from 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 a total of 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 screen-time use and continued to actively moderate his usage, in part by requiring that his schedule be structured and his week "full" to earn it.
Over the few several months, 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 virtually all of Dan’s physical ailments stemmed from deconditioning (being out of shape), depression, and stagnant blood flow — not some mysterious medical disease.
Does Dan still struggle with controlling his electronics' use today? Yes. It's been three years or so since we first met, and we revisit screen management on a regular basis. But his mood, focus, and functioning are all greatly improved. He has friends with whom he hikes and goes camping. He gets excited about his classes and is motivated to get good grades. He is no longer "stuck."
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. His case also shows how a sustained break from screens can help lift a severe depression, especially in the presence of excessive daily use. In general, youths with shyness, poor social skills, low self-esteem, or few "real life" activities/friends are at high risk for screen-related depression-- particularly after graduating from high school.
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, and often a clean break can provide the missing link in treatment.
Adapted from Reset Your Child's Brain: A Four Week Plan to End Meltdowns, Raise Grades and Boost Social Skills by Reversing the Effects of Electronic Screen-Time
For more on electronics' influence on depression and suicidality, see "The Link Between Light-at-Night, Depression, and Suicidality."
For more on how screentime can affect mood and behavior in general, see "Screentime is Making Kids Moody, Crazy and Lazy."
Victoria L. Dunckley, M.D. is an integrative child, adolescent and adult psychiatrist, the author of Reset Your Child's Brain, and an expert on the effects of screen-time on the developing nervous system.