Teens Always Nodding Off May Need Help

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Long lasting fatigue in teens may indicate depression or anxiety disorders

May 14, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Teens falling asleep in class are a staple of stereotypical movie scenes about high school. But a teen who repeatedly falls asleep and experiences fatigue is no laughing matter.

A recent study found that about 3 percent of teens experienced severe, long-lasting fatigue. About half these teens also had depression or anxiety, which is linked to poorer overall health.

It's possible that teens with symptoms of prolonged fatigue may have undiagnosed anxiety or depression, the study's authors suggested.

"Talk to a pediatrician about your teen's fatigue."

The study, led by Femke Lamers, PhD, of the National Institute of Mental Health, looked at how common fatigue was among American teens.

These researchers used data from the National Comorbidity Survey Adolescent Supplement, which included responses from 10,123 adolescents, aged 13 to 18.

The researchers asked respondents whether they had experienced prolonged fatigue with at least one symptom. The symptoms included pain, dizziness, headache, sleeping problems, irritability and an inability to relax.

Prolonged fatigue was defined as being extremely tired, without feeling better after rest or relaxation, for at least three months.

Overall, 3 percent of the teens reported having prolonged fatigue, about half of whom (1.4 percent) experienced fatigue alone.

The other half (1.6 percent) with chronic fatigue also reported having depression or an anxiety disorder.

Nearly half of those with chronic fatigue (46.5 percent) had had a major depressive episode, and about a third (34 percent) had a specific phobia about an object or situation.

Specific phobias can refer to a fear of heights, a fear of public speaking or other fears that are specifically tied to a particular experience.

About 27 percent of the teens with chronic fatigue had a substance use disorder, 23 percent had social phobia and 15 percent had generalized anxiety disorder.

Among those with the prolonged fatigue, 60 percent had severe or very severe disability related to their fatigue.

The data on their physical and mental health revealed similar patterns to the physical and mental health of teens who have mood or anxiety disorders but don't have chronic fatigue.

Unsurprisingly, having a mood or anxiety disorder and fatigue presented greater challenges to teens.

"Adolescents with prolonged fatigue and co-morbid mood or anxiety disorders had significantly greater disability, poorer mental health and more health service use than those with either condition alone," the researchers wrote.

The researchers found that teens with prolonged fatigue and depression or anxiety were more likely to be smokers, but they were not more likely to be obese. They were also twice as likely to use healthcare services.

The teens with fatigue only, and without a depressive or anxiety disorder, were less likely to seek healthcare treatment, however.

The authors concluded that having severe, long-lasting fatigue may actually indicate an anxiety or depression disorder in many teens who are not getting the care they need.

“Especially in this modern era, the idea of teens being overloaded and tired all the time seems almost the norm—too many late nights, activities, and sheer stimulation," said dailyRx expert Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences.

"These authors elegantly demonstrate that fatigue also can be an important indicator of more serious problems," Dr. Elliott said. "Teens who routinely nap in the afternoon or never seem to 'catch up' on their sleep may be signaling that parents should look more closely for other, underlying issues such as depression or anxiety.”

The study was published in the May issue of the American Journal of Psychiatry. The research was funded by the National Institute of Mental Health and a Rubicon Fellowship from the Netherlands Organisation for Scientific Research.

One author, Ian Hickie, MD, reported having received travel support, honoraria, presentation fees and/or research funding from a range of different pharmaceutical companies, nonprofit organizations and trade associations.

He also serves or has served on a wide range of advisory boards and panels, including those for governments, nonprofit groups and industry-related groups. His domestic partner, Dr. Elizabeth Scott, also had a business interest in a psychiatry-related partnership called Pearl 100.

The other two authors had no disclosures.