Clinical depression among teenagers is moving from the shadows into the spotlight.
Teens who suffer from depression struggle to talk openly about it, but now cellphone applications are providing a new tool to help them recognize and seek help for it, and theater is providing a stage for them to share their stories with others.
Whether either of these unique approaches can help the statistics — about one in five teenagers suffer from depression by the time they reach adulthood, and suicide is the third leading cause of death among teens — remains to be seen.
The cellphone applications were developed by two professors, one at Harvard University, the other at Dartmouth College. The theater is a nonprofit called “This Is My Brave,” which after two sold-out shows in Virginia last year will hold auditions Feb. 21 for its second show in Boston this May. Cast members use poetry, music, and essays to tell their stories of mental illness.
“I have lots of mental illness in my family and a lot of times there feels like there’s not much you can do,” said Logan Fisher, co-producer and co-director of “This Is My Brave.” “As a parent it’s a horrible feeling that your hands are tied and that there is nothing you can do to help them because of laws that are in place. . . . This was a way for me to do something about mental illness.”
Studies have repeatedly shown that teenagers, tethered to their phones day and night, are sleeping less, spending more time online, and feeling stressed out, and that those behaviors are causing more teenage depression.
But rather than try to pull teens away from their phones, a fruitless exercise, Andrew Campbell, a computer science professor at Dartmouth, and Diego Pizzagalli, a psychiatry professor at Harvard, have developed mobile applications for teenagers to use on their phones to help them recognize the signs of depression. It’s a way of turning the problem into the solution.
“It’s the trend, that’s what goes for teenagers, and knowing most of them are in tune with their smartphones, it’s great,” said Dr. Madhavi Kamireddi, a child and adolescent psychiatrist at New England Center for Mental Health. “It won’t be any different than a clinician asking them to fill in a set of 20 questions. In my office they just check all the boxes and don’t think. Kids are resistant, so for them, an online service, they take it better.”
Kamireddi added that while the apps hold promise, they cannot replace traditional therapy methods.
“Apps could be good for screening or put it into context,” she said, “just the way you can go to a doctor.”
The act of swiping a screen to answer questions is a familiar habit for teenagers, she said, and can help them realize they are at a stage where they need help.
Pizzagalli, director of the McLean Imaging Center, took his 15 years of science and partnered with Canterbury Road Partners to create his app called MoodTune. Much of his work through Harvard has focused on understanding how brain function changes when we are depressed, and how we reignite the signals in the brain to help combat depression.
That’s where MoodTune comes in.
On the app screen, a personalized dashboard tracks a user’s response time, error rate, and responsiveness to games and compares it to an overall average. Another screen appears like a graph and tracks mood history and plots it out and compares it to other users.
MoodTune requires users to spend about 20 to 30 minutes a day completing these simple tasks and it uses cognitive-based therapy techniques to change how the brain responds. These recognition-based games provide the best results when played daily as the tasks are designed to stimulate the areas of the brain that go quiet when someone is suffering from depression. The idea is that by reigniting these parts of the brain it will improve a person’s overall mood, which in turn increases resilience and decreases odds of future depressive episodes.
Campbell’s StudentLife application, slated for release this summer, came from his work at Dartmouth after years of watching the increasing levels of depression, anxiety, and stress in the student body.
“We carry phones 24/7 and the phone has sensors [which] infer signals related to clinical depression such as fatigue, mood, and social functioning,” Campbell says. “You don’t need to wait for your six-month visit to your doctor.”
For 10 weeks, Campbell’s app used automated sensing data to track 48 students in real time, from their sleeping and eating patterns, physical activities, such as the number of steps taken, and sociability, based on face-to-face conversations. Data from the phones’ signals and sensors is used to determine how lonely students are.
The phone knows its user, Campbell explained, and can easily detect changes in habits — such as increased sleep, or being more socially isolated. Campbell found that the students who suffered from depression were often more withdrawn and socially isolated, and having fewer nighttime conversations between 6 p.m. and midnight.
For Campbell, the current version of StudentLife is just the beginning. He is working on adding an intervention component to the application, prior to its release. He wants to be able to assess depression levels and symptoms and to engage with users to connect them with help and resources.
“Not only will phones magically diagnose depression accurately in the future, they’ll also deliver personalized interventions to prevent relapse into a depressive episode,” Campbell said.
The StudentLife application has already helped two students suffering from depression, he said. Professors were provided with data from the StudentLife app and were able to intervene. Instead of receiving a failing grade, the students were allowed to finish their studies over the summer.
Another student who received help from these new approaches to depression was Gabriella Sulzer, or Gabbi to her friends. The Maclean, Va., high school student, 17, says she first suffered feelings of sadness around age 7. Suicidal thoughts, self-harm, and night terrors were part of life, yet on the outside she tried to give the appearance of just another moody teenager.
She said she suffered in silence for years before an official diagnosis. A key to helping her recover was her experience with “This Is My Brave,” which allowed her to speak out during a moving evening of survivors and their families sharing their stories of living with mental illness. Following a successful inaugural show near Washington, D.C., last year, the Footlight Club in Jamaica Plain will host a performance in May.
“I want people to know they aren’t alone,” Sulzer said. “Seventeen or fifty-seven, you have the strength to talk about it and find the help you need.”