American teens are stressed and depressed. As a pediatrician, I see the suicide attempts, the overdoses, and all the new methods that teens are finding to intentionally hurt themselves—to somehow dull the pain.

It’s getting worse. According to recent results from the Stress in America Study, teens are now more stressed out than adults:

40% feel irritable or angry

or 36% feel nervous or anxious

or 31% felt overwhelmed due to stress in the past month

due to stress in the past month 36% feel fatigued or tired , and

or , and Almost 30% feel depressed or sad

I’m not surprised. Here’s what teen stress and depression look like in my ER, and what parents can do to ease the pain:

1) Prescription drug seeking

Here’s the classic story—teen comes in with perfect story for kidney stones. He’s rolling on the waiting room floor in pain. We put in an IV and give morphine. He feels better. After thousands of dollars of tests and the radiation of a CAT scan, we find no evidence of a stone or any other illness. We were duped. Then he has the nerve to ask for a prescription for Percocet “in case the pain comes back after the morphine wares off.” I tell him the morphine wore off about 2 hours ago. Oops.

I also see kids whose parents are using them as drug seekers. One child sat through about six hours of blood tests and imaging, but we couldn’t find anything wrong with him. He continually rated his pain as “8 or 9” on a scale from 1-10. No matter how much pain medicine we gave him, he didn’t feel better. Then the charge nurse figured out his mother was on our list of patients with a history of drug seeking behavior…

2) Salt and ice burns

Just recently I’ve started to see “salt and ice” burns in the ER. They come in screaming, trying not to cry. The pain is horrific. Sometimes it starts as a dare, but I’ve also seen salt and ice burns as a form of masochism in depressed patients. You start by putting salt on your skin, then hold a hard ice cube on the salt and see how long you can stand it. The problem is that the burns keep getting worse, even after the salt and ice are removed. At first the area is just very red and painful, often requiring narcotics for pain control. Later the burns can blister, and, if not treated appropriately, become infected. Sometimes I see these patients when they come in for pain control, other times I see the old burns on the skin of patients with depression.

3) ADHD drug abuse

Nearly 1 in 10 U.S. children has been diagnosed with ADHD, including some of my own. Although it is counter-intuitive to give a hyperactive child a stimulant, stimulants are one of the most effective and most heavily researched treatments for ADHD. Accordingly, more than 4 million Americans take prescription amphetamines, and US amphetamine production more than quadrupled in ten years. It’s no surprise that so many teens turn to amphetamine abuse to manage stress and depression. ADHD meds are a quick fix to help you stay up late to finish school work, concentrate during an exam, or get a quick high when you’re feeling down.

It’s not hard to get ADHD meds. Most kids can find some in their own medicine cabinet, usually prescribed for a sibling. No one notices until that child ends up short for a few months in a row. Any teen on ADHD meds knows they can sell their meds whenever they need extra cash. I see these patients when they come to the ER with a racing heartbeat, or when they overdose on all the meds they can find.

4) Suicide attempts—with a gun

A few times a year I see teens brought to the ER after they were caught holding a gun to their head. I never see the ones who pulled the trigger. Teens who attempt suicide with a gun are the most likely to be successful. I’m a moderate on gun control, but wherever you stand on this issue please get rid of the guns in your home if you have a teen with depression or other mental illness. Every parent whose child attempts suicide tells me a story about why they thought the gun and/or bullets were secure.

5) Fad diets taken to the extreme

The Stress in America study also showed that teens aren’t managing their stress well—they aren’t eating well, exercising and getting enough sleep. And our children are getting fatter. According to the National Health and Nutrition Examination Survey (NHANES):

31.9% of children and adolescents were overweight (BMI at or above the 85th percentile)

16.3% were obese (BMI at or above 95th percentile).

What do overweight stressed out teens do? They try a fad diet. At St. Louis Children’s Hospital we’ve had many inquiries from parents regarding the safety of “Plexus Slim” also known as “The Pink Drink.” This diet can be safe (although expensive) when used appropriately, but the recommended “accelerator” contains multiple stimulants and can be abused. Teens that are using fad diets or diet pills often have eating disorders.

If your child is overweight, find a pediatric weight loss program in your area, such as St. Louis Children’s Hospital’s Head to Toe program .

6) Heroin

My heroin patients are middle-class, suburban teens who have good high-school attendance records. Heroin, stress and depression are a toxic mix. Heroin has permeated St. Louis and St. Charles counties in the past few years, and it’s very hard to find any treatment program that will accept these high risk minors.

7) Psychedelic mushrooms—in peanut butter and jelly sandwiches

In 2006 the U.S. government actually funded a study at Johns Hopkins University regarding the effects of psilocybin, a chemical found in psychedelic mushrooms. Two months after the study, Symptoms of anxiety and depression were improved or totally gone. 79% of the participants also reported increased well-being or satisfaction. It’s no wonder that so many teens with depression and anxiety are trying psychedelic mushrooms.

The problem with mushroom patients is that I have no idea what they really took. True psychedelic mushrooms are expensive and hard to get, so lots of “shrooms” are just regular grocery store mushrooms that have been laced or injected with other substances. Since not every teen loves to eat raw mushrooms, they are often consumed in peanut butter and jelly sandwiches, ice cream, brownies, or other choice foods. Mushroom patients often consumed other street drugs, too, such as marijuana. So when they show up in the ER with irregular heart beat or anxiety, I usually have to admit them for cardiac monitoring.

8) Alcohol

I see more teens in the ER from alcohol than any other drug. Snow days and school holidays are the worst—days when teens are left home alone while their parents are at work. Mix some Red bull with vodka and you’ve got a quick fix for your stress, anxiety and boredom, until you break your arm and don’t notice it’s broken until your mother comes home from work. The stimulants in energy drinks can blunt the sedating effects of the alcohol, so that teens (and adults) don’t realize how intoxicated they are until it is too late.

Teens usually get their alcohol from their parents. If you have a teen who is showing signs of depression or anxiety, get the alcohol out of your house.

Our teens can’t manage stress and depression without us. The Stress in America study found that about 40% of teens reported they aren’t doing enough to manage their stress. We need to teach our children healthy living—what to do when you feel overwhelmed, tired, angry, depressed or anxious. Here are 15 ways to help your teen overcome sadness, depression, and anxiety.