Revealing the Origin of Adolescent Depression with Dr. Michael Scheeringa

As we move through our teenage years, emotions can feel heavier, more complex, and sometimes harder to understand. For some teens, those feelings go beyond stress and become something deeper: something harder to explain, like a lingering sadness or a sense of disconnection. These concepts made me start to wonder: Why do depressive symptoms often increase during adolescence? How do stress and identity development shape the way teens experience depression? To help us explore these questions, I’m honored to welcome Dr. Michael Scheeringa.

Transcript

SPEAKER_02 0:00

Hey everyone, and welcome to Growing Forward, a podcast by Positive World, Positive People. I am your host, Sadie Sonoborn Maliki, a 15-year-old girl from Southern California, and I'm really glad that you're here with me today. If you're new to the podcast, welcome. Growing Forward is a space where we explore what it truly means to grow up, socially, emotionally, and mentally, through thoughtful conversations with researchers and professionals who study adolescent development. As we move through our teenage years, emotions can feel heavier, more complex, and sometimes harder to understand. Stress builds from school, friendships, expectations, and the pressure to figure out who we are. For some teens, those feelings go beyond stress and become something deeper, something harder to explain, like sadness that lingers or a sense of disconnection. That made me wonder why do depressive symptoms often increase during adolescence? How does stress and identity development shape the way teens experience depression? And what can research teach us about prevention, resilience, and support? To help us explore these questions, I'm honored to welcome Dr. Michael Sharinga. Dr. Sharinga is a professor of psychiatry and behavioral sciences at Tulane University, whose research focuses on trauma, stress, and emotional disorders in children and adolescents, including how early experiences shape mental health outcomes. So without further ado, Dr. Sharinga, thank you so much for being here today and welcome to Growing Forward.

SPEAKER_00 1:25

You're welcome. Looking forward to it.

SPEAKER_02 1:27

So before we get into all of the nitty-gritty stuff around depression, I want to learn about you. So what led you to study childhood and adolescent mental health, particularly depression and trauma-related conditions?

SPEAKER_00 1:40

Well, unlike most people, I'm not going to say it happened because of some life experience that changed me into a different kind of person. I think I just have inherent personality issues that I think led me certain directions. And I say that because I think that's an important thing for adolescents to hear is you're you're in the process of figuring out who you are, your strengths and weaknesses, and that's going to be what decides your life course to a large degree. So anyway, I was always good in high school in science and math. And my dad was a doctor, so I figured I'll be a doctor. I like helping people. So that got me into medicine. And then in medical school, I thought I was going to be a small town private practice doctor, you know, like in Doc Hollywood or something. And then I discovered psychiatry. And I thought, well, this seems more challenging. And then when I got into psychiatry residency, I discovered there's child and adolescent psychiatry. And that seemed more challenging and difficult. So I went there. And then in child psychiatry, I realized there's this other career called research. And that seemed even more challenging. So the lesson was about myself is I gravitate towards the more challenging things and things that are hard to untangle. And then within Research World, I ended up really focusing on infant and preschool children, even more challenging because they can't talk to you, and trauma and PTSD. So that's how I got there.

SPEAKER_02 3:05

Wow. I love that your mentality of just keep trying to find those things that are so difficult keeps popping up throughout your life, starting from just being such a rigorous high school student and wanting to go into the medical field, which by itself is, as you said, challenging. And then you kept diving into all of these different fields and subtopics that additionally were these challenging pieces that most people, most professionals of this nature don't go into. So I love that you just kept digging deeper and deeper because it is really important that we still have individuals like yourself researching about these things and learning more and allowing us, adolescents, to learn about ourselves. Because without you guys and the people that find all this research and find the information and find support tactics and whatever it may be, we can't change, we can't grow. So I'm so glad that you did choose those challenging parts and that you have grown that kind of mindset to become such an amazing thing that can help and benefit so many different individuals. So back to the main question that I was addressing is research shows that depressive symptoms often increase during the teenage years. Once you hit 12, 13, 14, things become stressful. Life becomes this whole new web of unknowns, and so many different components are just ifs. You don't know what's going on, you don't know what's going on with yourself, with your friends, whatever it may be. So stress rises, and this is where we see an increasing number of depressive cases in adolescence. So, from your perspective, what are some of the key reasons that this happens developmentally?

SPEAKER_00 4:36

Well, make a distinction first, and I think you kind of already made it between normative sadness and depression and disorder level. Caitlin, what you called cases, the kind that leads needs uh, you know, clinical treatment. And uh the distinction is important because uh of the other things going on in society, people conflate the two. Um but in terms of disorder level, it's there's a large part that's we would say endogenous or genetically based. Um honestly, we don't know why it happens more in depression. I mean, another example is like schizophrenia.

SPEAKER_02 5:15

Yeah.

SPEAKER_00 5:16

The most common age of onset is between 18 and and 22. And we have no idea why, uh, but it's pretty consistent finding. And I think depression is partly in that area too. It's just a kind of a mystery of development. But then if we just if we just talk about the other side, the the non-disorder cases and the kind of normative, maybe a bit more than average sadness and depression, uh, that would be more due to the stresses of adolescent. And those are legion. Like it's the time of people trying to figure out who they are, what's their status in the world, what's their status to themselves. And um, those weren't really issues you grappled with before the age of 13 or so. And so that kind of makes sense why that gets worse in adolescence.

SPEAKER_02 6:06

Definitely. I like that you noted that there are two different sides of the story. There is the disordered side and there is the everyday feeling that, or maybe not the everyday feeling, once in a while, feeling that you're stressed and it's becoming consuming. How do we as adolescents make that distinction? Or how does all of the how do all of the people around us make that distinction? Because when we hear depression, it's very vague in our minds. We just think of being sad all the time or being sullen, but we don't actually know what it means. So for an adolescent member who maybe doesn't know yet, what is depression actually in terms of scientific research?

SPEAKER_00 6:43

The diagnostic criteria are pretty helpful in this sense in the DSM that psychiatrists use for making diagnosis. There's nine symptoms. One in one is sadness, one is loss of interest in things that you used to like to do, lack of sleep or excessive sleep, changes in eating pattern, gain weight or loss weight, thoughts of worthlessness, hopelessness, guilt, thoughts of suicide, things like that. So there's a pretty nice list of nine items. It's not everything that's in depression, but it's a it's a good starter. And then I think when people should worry about it, it should be one month is a pretty good landmark that's actually in the criteria in DSM for almost every disorder, that the symptoms have to be there for at least a month. And that's pretty well supported by research that if you haven't bounced back and you're after a month and you're wondering, then it's it's probably time to start thinking about help.

SPEAKER_02 7:36

Okay. Okay. So there are little markers or little things that we can notice. And I haven't heard of that month distinction before and just being aware of that concept and just being aware of a time frame. I think for a lot of individuals can be a way to acknowledge what might be going on in their lives, especially when you can't always keep track of these things, and then eventually it turns into more than a month in all of these different factors. So I really like that you gave this time frame because it does allow individuals to make that next step and make a further decision into, okay, maybe I should get help, maybe I should do different things to support myself. So we briefly mentioned stress, but I really want to go deeper into it or stress on the baseline per se. So school, relationships, or life events, especially as adolescents, all of these different things are becoming bigger in our lives. They're becoming more, there's more emphasis on trying to incorporate them in new ways into our identity and whatever that might be. So, how do these stress factors interact with depression in adolescence? And at what point do these factors begin to turn into something more serious?

SPEAKER_00 8:40

So, stress, let's start there. The question is I just want to make sure I understand it right. How does stress interact with or cause depression?

SPEAKER_02 8:51

Yes, how does it cause? How does it lead to that? Because everybody day-to-day as an adolescent member may feel stressed to some extent, but when does it get to that extent where it is too much and it is consuming in all of these different things?

SPEAKER_00 9:05

Okay. That's different for each person, I would say. Some people have a low stress tolerance, other people have a high stress tolerance. And I think that's there's no single answer that works for everybody. Some people are resilient and some people are, and and then that could be the next question is who are those people and what are the each level? But there's some also pr pretty good research about people who are vulnerable to that have features of what we might call neuroticism. That's an old term, but it's it's still a pretty good term. It's people just because of their makeup, they get upset more easily and they stay upset and have a hard time calming themselves down just physiologically or cognitively. And that's a real well-known trait. Some people have it more than others, and that's is probably true for other things like anxiety disorders and post-traumatic stress of who's vulnerable to that versus who's not. I think it's also worth saying that most people are resilient. I I mean, I know we're talking about the problematic aspects, um, and that's in the news is the problem cases, but by far and away, most human beings are very resilient to stress. And very true. And they don't buckle to the to these kinds of pressures.

SPEAKER_02 10:22

Yeah, and you and you mentioned how in some people it's not innate, but it more people or different people are a little bit more susceptible to having depression like symptoms or getting more stressed easily. Are there factors in our genetics or what is it that makes certain people more susceptible to certain disorders, including depression, anxiety, PTSD, than others?

SPEAKER_00 10:44

Yes, I would say it's genetics. But if you talk to about 95% of the other people in my field, they're not gonna say it's genetics, they're gonna say it's environment or nurture. And uh I don't think you picked me for that reason to talk to, but uh that that's my viewpoint on things based on research and all, is is that uh you know, people have all sorts of genetic differences we can obviously see. And that translates into behavior and cognitive abilities and emotional abilities too. But historically, that has not been the way social sciences and psychology like to think about it. But that would be my answer. Um, is I think if you ask any parent who's raised two or more children, they know that there's genetic differences between their children, and it and it's not because of their parenting. So, and I think that's that will connect to some of the other things I think you're gonna ask about is is um is how to deal with it, is how to understand those genetic differences.

SPEAKER_02 11:48

For sure. And if it is a genetic thing in your research in specific, are you trying to find ways to maybe identify it earlier on? Because we're talking about adolescents right now, which the age range is above the age of 10, 12, if I'm not mistaken. But could we identify these susceptible factors earlier on when a kid is maybe five, six if they're not showing the traits yet, but they have the genetic features that might indicate in the future they will experience those types of thoughts or depression or whatever it may be?

SPEAKER_00 12:21

Theoretically, yes, we can measure genes and differences in gene alleles between different people. The problem is geneticists have been really working hard to find them, and they're not finding them because you know, initially we thought, oh, it'd be one gene that'll be the difference. And it's not that way at all. It's gonna be the answer is eventually gonna be a gene profile, and you have to then assay nearly all the genes. And that's only become possible in the last 20 years or so with genetic-wide assays uh to do it cheaply anyway. So they're they're still trying to figure out that. And then even if you can find a genetic profile of one person, psychiatric disorders like depression are so heterogeneous, like one person's depression is not another person's depression. That's why there's nine different symptoms. So the profiles are gonna be different. There could conceivably be a million different genetic profiles that make you susceptible to depression. So don't hold your breath for that to unravel.

SPEAKER_02 13:31

And you mentioned the nine different factors, and I know we briefly talked about them before. However, does a person to be clinically diagnosed need to fit into a majority of those things or just severely in one? Or how does a clinical psychiatrist determine that someone or an adolescent member in specific is in a depressive state with those certain markers or factors?

SPEAKER_00 13:53

If I remember right, I'm pretty sure it's you need at least five of the nine. And not exactly in any combination. You have to have at least sadness or loss of interest, I think. And then any of the others to get a total of five.

SPEAKER_02 14:08

So Okay. And those early signs, I know that someone else might be able to help us, but a lot of the times, adolescent members where we find this kind of struggling point is people don't know how to reach out. Adolescents don't feel like there's maybe an adult they want to talk to or a friend because they don't want to be a burden. However, is it important for adolescent members to seek help? Because not most of the time we can't dig ourselves out of these depressive states. So, what does an adolescent member need to do? What are these steps that an adolescent member needs to do to advocate for themselves in those situations?

SPEAKER_00 14:45

I think just knowing the nine symptoms is a good start. Um watching your podcast would be another good start. And then uh, you know, these days it's it's gotten a lot easier. Yeah, I mean, with the internet, you can find all sorts of podcasts and interviews and and educational videos that you can help. And then AI is probably gonna change everything. I think it probably already has. You could go into uh AI and type in your symptoms and ask, do I need to worry? And it will g give you a pretty good answer. I've tried it and I'm pretty impressed with that aspect of AI.

SPEAKER_02 15:28

However, there is a downside to AI as well, because I know in a couple of adolescent cases, or when these adolescent members have been suicidal or have had suicidal thoughts, AI does the reverse and doesn't actually help them. So do you have any ways to structure your kind of interaction with AI, especially for adolescent members, or how should we approach it? Because it is a new thing to us, and especially in the mental health world, there's so much kind of conflict and controversy over the use of AI instead of just going to a person.

SPEAKER_00 15:57

Yeah, I'm aware of those cases I think you're referencing. And those are cases I think where those individuals had really prolonged back and forth conversations with AI. And that's not what I'm advocating, not not like where it becomes your only or main source of support. I'm saying type into AI asking for help and maybe and even asking for a plan. And I've you know, I've done that in like Chat GPT, and it'll give you a really nice systematic step-by-step plan, and then it stops there. It only keeps going if you make it keep going. So I I wouldn't worry. I'm not worried in that sense of for most people. I think there's there's a minority that get into it excessively.

SPEAKER_02 16:45

Yeah, there's just boundaries we need to set, and in those moments, we still have to be aware of our interaction. It's like interacting with our friends. We have to set boundaries and we have to set boundaries with the tech technology that we're interacting with as well. So a little bit on a side quest, but we briefly mentioned identity in all of this web of different things. So, how does the identity formation through our adolescent years really affect depression? And can it affect it in a positive way or a negative way?

SPEAKER_00 17:13

Both. And I think it's more relevant to the side of the coin of where we're talking about non-disordered kind of depression and not the more biologically driven disorder level. And identity is kind of everything in adolescence.

SPEAKER_01 17:31

Yeah, it pretty much.

SPEAKER_00 17:33

I mean, you you got two big tasks in terms of that one is figuring out your status to yourself, like am I worthy of the good things in life or not, and being confident in that. And then the other is figuring out your status in the eyes of others. Are you seen as worthy to other people? Are you a worthy person that has the back of other people? Are you a good friend? Are you someone to go to for advice or someone you want in a fight with? So it's it's that self-status and the status with others, and that's basically describing the life of a human.

SPEAKER_01 18:11

Yeah.

SPEAKER_00 18:12

There's no such thing as a human alone. We we developed in clans and tribes, and it's all about figuring out identity. So adolescence is where that really gets launched.

SPEAKER_02 18:25

Yeah, it blooms like a flower pretty much in adolescence. And every discussion that I've had, it's somehow traced back to identity and identity formation because during this period of time, we're learning so much about ourselves, and we're learning so much, as you said, about the people around us and who we want to be with, who we want to become, and all of these different factors. And it leads to a lot of kind of open spaces and opportunity to fall into a really happy place or maybe not such a happy place, but it kind of makes us vulnerable in a sense because it is such a time of what ifs, what's gonna happen, what's and the positive side of that.

SPEAKER_00 18:58

I didn't want to miss the positive side. Sorry to interrupt you there. But when you when you figure out and convince yourself that you're worthy, then you reach for the good things in life and you don't hold yourself back. And that gives you self-esteem and leads you to do things you may not have otherwise done. And and that's you know, not only in normal everyday life, but that's also when people get into psychotherapy. That's one of the core tasks. And that's why it takes months and years of psychotherapy for some people, is that's that's a hard thing to figure out and come to grips with for a lot of people.

SPEAKER_02 19:35

And it's but it's so important to do that because you can never be fully satisfied with who you're becoming, who you're interacting with, your future, whatever's going on in your life if you're always looking at it from a negative way. You have to believe that you found this place and this time of this is me, this is who I want to be, this is all these things. And as you said, it can take years, and especially with people who are in therapy or whatever it may be, these ideas of identity formation can take a very long period of time. And it really never stops. However, it does really prove to be such a benefit in our lives and just becoming satisfied with our everyday and satisfied with who we are and who we've become just proves to be so, so beautiful. And I want to tie that into my next question about resilience. As we mentioned earlier, resilience is such an important piece, especially for adolescent members who might find themselves in these depressive states because they have to try to get themselves out. You want to get yourself out of that place where you don't know what's happening. You feel sad, you feel sullen, you're experiencing all those nine symptoms potentially, but you have to try to get yourself out no matter the amount of therapy, no matter the outreach sources, you have to do it. You have to put yourself out there. So, how does resilience tie into all of this? How does resilience bloom? And how do we make ourselves just stronger and more supportive to work our way up?

SPEAKER_00 20:56

I think people should think of resilience as how you bounce back. Because everybody's gonna get tripped up, everybody's gonna make mistakes, everybody's gonna fall down. But the people who are more resilient than others relatively are the ones who can kind of bounce back, brush it off, rub some dirt on it, and learn about self-reliance and and independence of that. And sometimes in large respect, it's it's just you got it or you don't, but you can also build it. I mean, that's and that's a good message. And I think the main point of of people listening, I would say, about building it is be patient. You you don't have to throw everything out and do an overhaul in one week. Aim small, go for small wins, aim for like small percentage of improvements in whatever you're trying to prove in and and think of it as the long game.

SPEAKER_02 21:48

Yeah, I like that analogy a lot. I've used this kind of reference before of you can't cross a river in one jump. It's nearly impossible. It is impossible for any single c human. However, if you look and there's a path of stones, you're going to take it one stone at a time. But that's okay. At the end of the day, you're going to get to that other side. You're going to find the opposite side of whatever struggle you're facing, whatever down you're feeling, you're going to find the positive side. You're going to feel happy once more. But as you said, it's going to take time. It's going to take those individual steps to get there. But you have to believe that eventually you're going to have belief in yourself that you can make it there. And you mentioned that there are strategies to build up your resilience, which is really directly to coping strategies as well. So, what are some coping strategies in these moments in time where maybe we are feeling just borderline stressed or we are experiencing these depressive episodes? What are some ways that adolescent members can cope in these different experiences?

SPEAKER_00 22:49

A lot of them come from cognitive behavioral therapy or CBT. And that I think that's why CBT is so popular and so effective. And it's the most well-researched treatment for depression and anxiety. And it's things like, first of all, being able to identify those negative thoughts that automatically pop in your head. You have a lot of people have them, but they never stop and think, you know, what was that thought I just had? But it's there's a skill to it of kind of slowing things down and just identifying it. And then the next step is reframing it into something more positive, less negative. And that gets into kind of the bigger issue. Even if you're not doing CBT and you're doing more psychodynamic work, it's the task of a lot of people in therapy is reframing and recalibration. And that's way, I think, the best way to think of it for people is again like stop blaming other people. Don't look for a big overhaul. You're learning about yourself, probably more than anything, and recalibrating like what did I bring to this problem? What are my strengths and weaknesses? How do I optimize my strengths? Like what are what are they? And be honest about your weaknesses and figure out how to minimize those. And that's kind of describing CBT in a lot of ways.

SPEAKER_02 24:08

Yeah, we're always gonna have these strengths and we're always gonna have weaknesses. We're human, we're gonna make mistakes, we're never gonna be perfect. And emphasizing that idea of, okay, what are my strengths? How can I amplify them so that they're shown every day and that I can bring them into my life so I feel better about myself? But how can I also acknowledge my weaknesses so that I can just intertwine them in every now and then and accept them for what they are instead of trying to rebel against them and having these thoughts of, oh my gosh, what did I do? Why am I stressing? What and spiraling? Take a deep breath, acknowledge them and embrace them because they're never gonna just be completely torn away from you because we are human, we're gonna make mistakes. There's gonna be points in time where we feel like we can't get out of bed maybe in the morning or we don't want to go to our job. However, if we tweak it a little bit and we say, okay, maybe I don't want to do it today, but tomorrow I'm gonna amplify that and I'm gonna challenge that mentality so I grow, so I learn. And that's when we become so much greater, and that's when we become a benefit of our own doubt. So, in the end, what do you want to tell people that might be struggling from depression or maybe never experienced it before? What do you want to close out this episode with? And what do you want to tell adolescent members that are listening in today?

SPEAKER_00 25:25

It's normal a lot of in a lot of ways to have periods of depression and struggle through this time, but also be willing to recognize when it's more than you can handle and be willing to seek help. There's a lot of resources, not only with but therapists, even medications. That helps a lot of people if it's right for you. Keep hope, be patient. There's a lot of good help out there.

SPEAKER_02 25:51

That's awesome. Just a few simple words that truly mean so much and could change someone's life right here today. So, Dr. Sharinga, thank you so much for sharing your insights with us today on growing forward. Conversations like this help bring understanding to something that so many people experience, but don't always talk about or fully understand in our school life, home life, or whatever it may be. So, to everyone listening, growing up isn't always easy. And there are moments when emotions feel heavier or harder to navigate. But understanding what's happening and learning the why behind those feelings can make them feel a little less overwhelming and a lot less isolating. So, as we continue moving through our teenage years, it is important to remember that growth doesn't always feel positive in the moment. Sometimes it feels confusing, challenging, or even discouraging. But remember what I said: take that stepping stone and embrace it. Cross that river eventually, and you will get to that other side. But you have to want to do it. So thank you so much for being part of this episode again, Dr. Sharinga. I am so grateful that you're here to have these conversations and to have shared this information with our audience.

SPEAKER_01 27:00

You're welcome.

SPEAKER_02 27:02

And until next time, everybody, join us on the next episode of Growing Forward or Change Starts Mall. This is your host, Sadie Sunaborn Maliki, signing off with loads of positivity.