The Teen Anxiety Epidemic: Possible Perinatal Factors

December 13, 2017 at 1:22 pm

 

Teen Anxiety Epidemic graphic

Lately I’ve seen a lot of press about the anxiety epidemic among adolescents. It always piques my interest because I have experienced severe anxiety and depression, and I’m especially interested in helping others who struggle with these horrific challenges. Here’s a small sampling of the headlines:

It’s all very troubling to me, and it hits close to home as well. Most of the teen and young adult nieces and nephews on my side of the family are struggling with mental health issues, primarily anxiety and depression. My own teen daughter and several of her friends struggle with anxiety. It’s becoming so common that I’m almost surprised when I find a teen who isn’t anxious or depressed. How did we get to this place?!

Lots of possible causes have been addressed in the media–smartphones and social media are definitely considered primary contributors. I don’t doubt that these technologies are largely to blame. But I’ve been studying pregnancy, birth, natural health, and mothering for long enough that I can’t help noticing some other trends that may also be playing a big part in this mental health crisis. Below I’ll share just a few of those possible perinatal contributors I’ve been thinking about.

1) Pitocin Inductions

Over seven years ago, I wrote one of the most-shared and viewed (and most controversial) posts on my blog, Pitocin’s Untold Impact. It discusses the potential negative impacts of Pitocin, the synthetic form of oxytocin used in hospitals to speed or start the childbirth process. There has been a huge rise in labor inductions within the past twenty years. The CDC reported that “the rate of induction of labor more than doubled from 1990 through 2010, from 9.6% to 23.8%.” The year my first baby was born (she is now a teenager), the New York Times reported that “one baby in five is now born after the birth process has been started by a drug.” In 2006, in a study of 5500 low-risk, first-time mothers, 40% were induced and 70% received Pitocin at some point during labor (see Jennifer Block, Pushed, p. 5-6).

All of this means that a significant portion of today’s young adults and teens were exposed to large quantities of artificial oxytocin at birth. Could mental and emotional challenges be one of the long-term consequences of their exposure to Pitocin? It’s my personal belief that it’s very likely a factor.

Hungarian researcher Dr. Gregory Saba believes that the oxytocin receptors of Pitocin-exposed infants can be significantly impaired. It’s his theory that “the first time the receptor in your brain encounters the neurotransmitter that it’s supposed to bind with, that sets its level of reaction.” So, when a woman is administered Pitocin in labor, the drug “may flood the oxytocin receptors in the fetus’ brain and overwhelm them. . . . So much oxytocin is flooding the cells, the receptor doesn’t need to be very sensitive. It’s going to be very insensitive. Later on, when normal levels of oxytocin are released in the brain, receptors can’t pick it up. They aren’t sensitive enough” (Source).

Oxytocin is one of our mind and body’s best defenses against stress, anxiety, and depression. A society full of human beings with impaired oxytocin systems would be a society lacking in social connection and overwhelmed by stress and mental health challenges. Sounds sadly familiar.

I think it’s also worth noting that Pitocin exposure has been found to increase postpartum depression and anxiety in mothers. A study published in Depression and Anxiety found that “exposure to peripartum [synthetic] oxytocin increased the risk of depression or anxiety in the first postpartum year by about 32%” (Source). I was administered Pitocin (per hospital routine) following my first baby’s birth, and I’m certain it impaired our bonding, breastfeeding, and early postpartum transition.

I want to be sure to emphasize that I’m not saying Pitocin should never be used. It is an important tool, and I’m very grateful it is available for emergencies. However, it’s definitely the case that the drug is being used far too often. Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists, puts it well: “Pitocin is the most abused drug in the world today.”

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2) Cesarean Births and Altered Gut Microflora

Years ago I read an article that had a profound impact on me. It was Jeff Leach’s “C-sections, breastfeeding, and bugs for your baby.” His piece changed the way I viewed the birth canal. Cesareans aren’t just another way to give birth. Being born through an incision bypasses an extremely important step in the birth process–being colonized by the “base population” of the mother’s vaginal and fecal microflora. The findings from one study:

Babies born vaginally were colonized predominantly by Lactobacillus, whereas cesarean delivery babies were colonized by a mixture of potentially pathogenic bacteria typically found on the skin and in hospitals, such as Staphylococcus and Acinetobacter, suggesting babies born by CD were colonized with skin flora in lieu of traditionally vaginal type of bacterium (Source).

Following birth, breastfeeding continues the transfer of healthy microflora (probiotics) from the mother to the infant. This transfer can help cesarean-born infants restore healthy bacteria, but vaginal birth is still the preferred method of colonizing the infant with good bacteria. Cesareans can absolutely save lives, but they also put babies at increased risk for infections, allergies, asthma, intestinal problems, and future health problems. When there is an absence of breastmilk, those potential problems can become exacerbated.

Cesarean rates have increased dramatically in the last twenty years. It’s sad to acknowledge that with each new cesarean, the chance of a mother have cesareans for all of her future births is very high, and the risks of complications with each cesarean increase as well. Compare these maps from 1997 and 2015, via Birth By the Numbers:

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Those deep blue and purple states totally blow my mind. Kudos to Idaho, Utah, and New Mexico though.

So what does gut microflora have to do with anxiety? A lot, actually. Research within the last decade has uncovered a strong connection between the gut and mental health. Dr. Emeran Mayer, a professor of medicine and psychiatry at the University of California, Los Angeles has found that “certain kinds of bacteria may led to particular brain structures or wiring that makes someone more susceptible to anxiety than might exist in another person whose gut was colonized by different bacteria” (Source). Dr. James Greenblatt, a Boston-area psychiatrist has found that roughly twenty percent of his anxiety patients’ symptoms can be traced to dysbiosis (an imbalance of microbes). He gives these patients powerful probiotics, and many see their psychiatric symptoms disappear (Source).

The federal Department of Health and Human Services has set a goal for C-section at 23.9 percent in low-risk births by 2020, and many hospitals are working to reduce cesarean rates. I applaud these initiatives. Neel Shah, MD, is one doctor leading the crusade to reduce cesareans. At a meeting of the American College of Obstetricians and Gynecologists earlier this year, Shah spoke with refreshing honesty during a President’s Program presentation: “About half the C-sections we do in the United States today are probably avoidable. . . . According to our own guidelines, we shouldn’t be doing any C-sections on labor progress alone before 6 centimeters. If we just did that, it’s worth tens of thousands of C-sections per year” (Source).

3) Maternal Separation in the First Year(s) of Life

In the United States, most new mothers return to work much earlier than they would like. In 2012, a shocking 1 in 4 mothers returned to work within just two weeks after giving birth! I can’t even fathom how difficult that must be for both the mothers and their newborn babies. Most children are now growing up with working mothers (71% in 2012 as compared to 53% in 1970), and most of those mothers are unable to take a prolonged maternity leave after giving birth. Could early separations of mothers and infants be contributing to the anxiety epidemic? I don’t know, but it seems likely to me.

If there is one thing I have learned in the last 14 years of immersing myself in literature, research, and personal experiences relating to birth and motherhood, it’s that babies need their mothers. The attachment formed between a mother and her infant is so crucial. Let me highlight just some of the maternal-infant attachment research I’ve gathered over the years:

  • “Early life stress has been implicated in many psychiatric disorders ranging from depression to anxiety. Maternal separation in rodents is a well-studied model of early life stress. However, stress during this critical period also induces alterations in many systems throughout the body” (Maternal separation as a model of brain–gut axis dysfunction).
  • “This paper highlights the profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant” (Science Daily, Maternal separation stresses the baby, research finds).
  • “Maternal availability is particularly important within the first two years of life because of the infant’s limited understanding of the reasons for maternal absence and the timing of her return. As a result, experiences of separation may be particularly salient. Even those as brief as a few hours in duration can result in distress”(Early Mother-Child Separation, Parenting, and Child Well-Being in Early Head Start Families).
  • “Studies have shown that when an infant is taken away from his mother he experiences a ‘decreased heart rate, temperature decreases, sleep disturbances and EEG changes’- representing an impairment in the regulating processes of his own little body (Archer, 1992). On separating mother and baby, his immune system weakens. His body literally stops producing as many leukocytes. But when mother rejoins him, he strengthens again (Montagu, 1986)” (Strollers, Babycarriers, and Infant Stress).
  • “Adult anxiety may be rooted in childhood experiences that leave a child uncertain of the availability of a protective figure in times of trouble” (Generalized Anxiety Disorder: Connections With Self-Reported Attachment)
  • “Full-time daycare for infants and toddlers is stressful. . .  activating each child’s hypothalamic-pituitary-adrenal (HPA) axis on a daily basis causing . . . an ongoing release of abnormally high levels of stress hormones such as cortisol. . . . These stress-induced impairments are implicated in an enduring vulnerability to various later-forming psychiatric disorders such as depression, chronic anxiety, attachment disorders, dissociative disorders, learning disorders, and attention deficit-hyperactivity (ADHD)” (Short and Long Term Effects on Infants and Toddlers in Full Time Daycare Centers).

My own personal experience lends weight to the theory that maternal-infant separation can contribute to later anxiety disorders. My parents divorced when I was an infant, and my father took full custody of the children and moved to another state. That early separation from my mother led to a great deal of anxious behavior in my childhood, adolescence, and adulthood. As an adult I was diagnosed with full-on generalized anxiety disorder, and I am certain that the separation trauma I experienced in my infancy played a huge part in the development of my anxiety disorder.

For many mothers, going back to work is a necessity, even when their infants are very small. I certainly don’t wish to make these mothers feel guilty. I just wish there were some way to enable more mothers to remain with their infants for an extended period of time following birth. I really do believe it would help reduce many of the mental health challenges teenagers are now facing.

 

Other Factors to Consider

I don’t have time to go into detail on these other items, but I want to at least mention them.

 

What do you think is contributing to the anxiety epidemic among teens? I’d love to hear your insights.