Using a lifestyle approach to manage adolescent depression

“Adolescent depression has nearly doubled since the pandemic, from 13.3% to 25.2%,” noted Christina Low Kapalu, PhD, a child psychologist at Children’s Mercury in Kansas City, Missouri at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition. “We also know that older adolescents, women, and people of 2 or more races have the highest rates.” The situation is further exacerbated, Kapalu argues, by the fact that “There is less primary care screening for depression and anxiety and an increase in emergency department (ED) presentation for mental health problems,” Kapalu continued.

When we look at the core symptoms of depression: amotivation, fatigue, psychomotor retardation, change in appetite, hopelessness, and difficulty concentrating, it becomes clear, Kapalu says, that “lifestyle changes can be incredibly helpful in addressing some of these symptoms.”

In addition, emerging research in children and adolescents shows that poor nutrition, physical isolation from peers, sedentary lifestyles, and poor sleep are additional risks for mental health depression, opening the door to using lifestyle medicine to manage some of these symptoms. to grab. “Lifestyle medicine,” she explains, “involves the application of environmental, behavioral, and psychological principles to improve patient outcomes.” These specifically include sleep, physical activity, contact with others, nutrition, mindfulness/relaxation, and reduced screen time, all of which are used to treat unipolar depression. And while these treatments have been used as guidelines for treating depression in adults, the pediatric guidelines were “less specific,” Kapalu points out, recommending instead active support and monitoring, psychoeducation, and peer support. Ideal candidates for lifestyle medicine for children and adolescents are those with mild to moderate depression, who are motivated to change, have few co-morbidities, and depression of shorter duration. “While there have been studies demonstrating risk factors for suicidal ideation in teens, such as sleep dissatisfaction, stress, substance use, smoking, Internet game addiction, interpersonal factors, and binge eating, there have been fewer studies looking at modifying these lifestyle habits to reduce suicidal risk,” Kapalu noted.

So, how can we help these patients bring about a change that sticks? It is important to note that when recommending lifestyle changes (such as physical activity or diet), your patient may not be ready to change. Here she puts forward a classic model of behavior change from Picasa and DiClemente, which shows change as a process. They include precontemplation; contemplation; preparation; action; and maintenance. In addition, these changes must be implemented through SMART goals: specific, measurable, achievable, realistic and time-bound. Finally, Kapalu urges practitioners to follow the ‘rules’ of behavior change: don’t resist telling the patient what to do; understand their motivation; listen with empathy; and empower them.


1. Kapalu CL. Using a lifestyle approach to manage depression in adolescents. American Academy of Pediatrics 2021 National Conference and Exhibition; virtual. Accessed October 10, 2021.

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