 Studio at Davis Media Access. Thanks for tuning in. The topic today is teen depression and addiction. And my guest is Dr. Aijing Singh, a psychiatrist specializing in child psychology and addiction. Welcome Dr. Singh, very happy that you're here. So let me introduce you. Dr. Singh has been practicing medicine for about 20 years and he's an American board certified physician in general psychiatry, child and adolescent psychiatry and addiction medicine. He's also a member of the Yolo County local mental health board and the chair of the boards education and planning committee. He and his wife have a daughter who is 16 and a sophomore at Davis Ahai and a son who is one year old. Dr. Singh treats psychiatry patients of all ages but his special interest is in young people's substance use problems again. Thank you very much. Thank you very much. This is a sobering topic as you know and it's reaching epidemics and in terms of teen substance abuse. So it is good that we're talking about it. In addition May is the mental health month which provides us more even more awareness and focus to this problem. So Dr. Singh, could you tell us what are typically the changes that an adolescent, a child rather, is experiencing when he or she go into adolescence? Adolescence is a stressful period of a child's life. You know they're going through separation and individuation. They're trying to establish their own identity, they're separating from the family, developing peer relations. This is a very anxiety-prone period for them as well so there's a lot of confusion. Sometimes they do things which they think are good under peer pressure but doesn't turn out to be great. A lot of time they have difficulty understanding or differentiating right from wrong so that's the time when we as parents need to provide full support with the feeling, giving them a feeling that they have their own individual space but also that parents are available to figure out if they have any confusions, any stress or any other problems going on where they need support. As a physician, from a physician's point of view, what are the physical, again the most common physical and psychological changes that you see in this change between a child and adolescence? Obviously there is the change of the physical aspect. It's a growing time and for both children and boys and girls, yes. What other things happen in the brain do you think? In addition to the physical changes which we all see, they have developed their own identity so they want their own space on time and then another big aspect of this phase is experimentation. So they try new things to learn and that always doesn't work out well and experimentation with drugs is rising pretty top on the list. Yes and we're going to talk about that of course. Other than that, sometimes they develop their own, you know, the teenage years, sometimes it's perceived as irritability, then they have the sense of competition with the peers that develops and that brings in stress and they cause a lot of changes in the thought and also lays down the foundation for future thinking, planning and the future. And personality. Personality development as well, yes. How do you spot depression in adolescence? Versus the normal behavior. Versus the normal behavior because sometimes moods and moodiness is overshadowed or vice versa with depression. So how do you extrapolate what is just normal moodiness for a teenager and the serious signs of something more pathological? So with the normal moodiness of teenage, usually our adolescents and children, they return to the baseline sooner or later. It's more like a transient change, some of the typical symptoms of clinical depression that we should monitor as ongoing irritability, decline in school performance or decline in sports. They are not comfortable with social situations, anxious and pure relationships, pure pressure. Their sleep is affected, their appetite is affected. They may start to sleep more to escape or they may not sleep at all. Appetite changes, a lot of guilt associated with this, a lot of confusion. School performance, as I said, concentration and attention is usually the reason why they experience those symptoms, hopelessness, helplessness. Sometimes they start to self, start self-harm behaviors, suicidal thoughts. And there are times I've heard from parents that everybody goes through a time when they had the suicidal thoughts. Even a transient suicidal thought is not normal until it actually warrants an evaluation. Yes. And so these are the symptoms that a parent should be watching for. Now there's a question here. Suppose you're a parent and you notice, well you are a parent, but suppose a parent notices some of these traits exhibited by their child, do they and want to take the child to a psychiatrist or a psychologist or even the primary care physician? Do the parents have the authority to take the permission to take them there? Or do they need their son or daughter's permission to go and visit a doctor? In California, it's 12 years and older, kids can consent for their treatment. So it reflects the other way around. Yes, we should ask them. But before we get to that point, we need the child to understand or we need to make them feel that they are being supported and that the family is there. The child may agree in pressure from the parents to go for an evaluation or see a doctor, but unless they open up, unless they feel themselves, they feel the need for this, it's not going to be very fruitful. So even before we go to a doctor or a psychologist or a psychiatrist, we should have a conversation and parents should gently explore not too much into their private life, but they should gently explore what's going on and that the child should feel supported and should be able to come up with a plan with their parents and should be agreeable. That has the best outcome. I see that and also I think one thing parents can do is certainly not frighten the child because this is a very frightening stage of their lives. Isn't that right? Do you see a difference between boys and girls in terms of the frequency of this serious depression or I don't know probably there is research. Before puberty the rate is almost similar in boys and girls. Oh, okay. And after 50-50, but after they hit the puberty the girls have twice as more at risk than the boys to develop these symptoms. Very interesting and it seems to linger into an adult hood I believe because women are more prone to depression or at least that's what is believed. But let's talk about addiction because everybody's talking about addiction and especially this opioid addiction. So what I'd like you to do is give us Dr. Singh, give us an overview of what this teen addiction is like in our community. Is it a lot? Not enough. No, it's growing for sure. Traditionally alcohol, cannabis and nicotine cigarettes are the first steps. They used to be. They are still but now the new addiction, opioid addiction is slowly creeping up. We don't have exact numbers in Yolo County. They're still calculating the Yolo County mental health services but the numbers are increasing and that also corresponds with the opioid epidemic. Our nation is currently going through an epidemic. It's almost an epidemic and they almost declared a national health emergency on opioids. Yes, and during one of our conversations you mentioned that these drugs, the opioids are very easily to get. Isn't that perhaps one of the reasons why everybody's abusing them? Yeah, 80% of opioid addiction starts from prescription medications. Really? And when it comes to teen, they think that it was a prescription medication. Their family members, their grandparents were prescribed. It's safe to take it. Yes. So that is a notion sometimes misconception they have and that leads them to prescription, starts with trying, experimentation and one aspect of if there's an ongoing depression, many people will feel euphoric effect. It's like an instant antidepressant effect but that doesn't stay long and it has its own serious problems. And that manifests itself into being addicted of course because they want to feel good. Now I'd like to mention you've been doing extensive research and even into a way to limit the taking of opioid. You're patenting a bottle that... It'll be in the form of a box. It's a temper proof opioid pill dispenser. Excuse me. It'll have a camera and only the authorized person can take it and if somebody tries to break through it, it'll destroy all the remaining opioids in it and there is no way that a person can take out the medication, give it to someone else or store it or sell it. Dr Singh, we've talked about the drugs and the opioids and the bad remedies that teenagers go to to overcome their challenges. Let's talk perhaps you and your practice prescribe some good medicine that can help the brain with depression and other abnormal behavior that these children have. Would you like to expand on that? The most common disorders being anxiety and depression, we try to first treat them with psychotherapy. Different types of psychotherapies are available, supportive cognitive behavioral therapy, dialectical behavioral therapy. And for moderate to severe depression, we resort to medications. The first line drugs used for treat depression and anxiety are selective serotonin reuptake inhibitors, we call them SSRIs. The SSRIs, yes. The most common ones being Prozac, Selexa, Zoloft. These are the common names. There are six members in this family and they tend to have good results if given the right patient under correct monitoring. Are there any side effects to these serotonin based medicines? As a matter of fact, all medications have side effects, so these do too. And one most important side effect which we always recommend the patients and the parents to monitor is for any new onset suicidal thoughts or worsening of suicidal behaviors or thoughts, they need warrant immediate attention. And is these suicidal talks more prominent in teenagers adolescents? Yes, to 25 years and under where the warning is for these age groups, yes, for adolescents, it's more common. I'm afraid our time is basically up, it went so fast. What I wanted to add is that there is a website that will be displayed where you can find Dr. Singh. And if you have questions or if you want to simply know a little more about Dr. Singh, you can just go there. Thank you so much for joining us. I know how busy you are, so I'm really grateful that you help us today to understand a little more what this topic, this very important topic is all about. And I wish you the very best of luck in your practice and for your family. Thank you. And to all of you who have been watching, thank you so much and see you next time.