The Surgeon General's Warning

On May 23rd, the Surgeon General attempted to call the American people’s attention to an urgent public health issue. Will we listen?

On May 23rd, the Surgeon General’s Advisory released a warning. An advisory from the Surgeon General is reserved for significant public health challenges that require the nation’s immediate awareness and action. Its purpose is to call the American people’s attention to an urgent public health issue and provide recommendations for addressing it.

The document accompanying the announcement is one that every parent, educator, and decision-maker should read, but since many of us are struggling with too much information and not enough time, here are some important takeaways from the report released by the Department of Health and Human Services.

• Adolescent social media use is predictive of a subsequent decrease in life satisfaction for certain developmental stages, including for girls 11–13 years old and boys 14–15 years old.

• As of 2021, 8th and 10th graders now spend an average of 3.5 hours per day on social media.

• A longitudinal cohort study of U.S. adolescents aged 12–15 (n=6,595) that adjusted for baseline mental health status found that adolescents who spent more than 3 hours per day on social media faced double the risk of experiencing poor mental health outcomes, including symptoms of depression and anxiety.

• A study conducted among 14-year-olds (n = 10,904) found that greater social media use predicted poor sleep, online harassment, poor body image, low self-esteem, and higher depressive symptom scores, with a larger association for girls than boys.

• A systematic review of 42 studies on the effects of excessive social media use found a consistent relationship between social media use and poor sleep quality, reduced sleep duration, sleep difficulties, and depression among youth. Poor sleep has been linked to altered neurological development in adolescent brains, depressive symptoms, and suicidal thoughts and behaviors.

• In a unique natural experiment that leveraged the staggered introduction of a social media platform [Facebook] across U.S. colleges, the roll-out of the platform was associated with an increase in depression (9% over baseline) and anxiety (12% over baseline) among college-aged youth (n = 359,827 observations).

  • The study’s co-author also noted that when applied across the entirety of the U.S. college population, the introduction of the social media platform may have contributed to more than 300,000 new cases of depression. If such sizable effects occurred in college-aged youth, these findings raise serious concerns about the risk of harm from social media exposure for children and adolescents who are at a more vulnerable stage of brain development.

Dopamine Nation

I was particularly encouraged by the nuance and candor of the HHS report. The section on excessive and problematic use, in particular, does a great job of supporting the arguments of scholars such as Dr. Adriana Stacey, who has been a leader on this topic for years. Stacey importantly notes the “dopamine dump” in the brain that occurs when we check our smartphones and especially when we use social media.

According to Stacey, “When we do things that are addictive, like use cocaine or use our smartphones, our brains release a lot of dopamine at once. It tells our brains to keep using that.”

Features designed to maximize our engagement with these platforms — such as autoplay, infinite scroll, and engagement metrics such as likes and comments — dump dopamine into our systems.

Some more key points from the report:

• Further, some researchers believe that social media exposure can overstimulate the reward center in the brain and, when the stimulation becomes excessive, can trigger pathways comparable to addiction.

• Small studies have shown that people with frequent and problematic social media use can experience changes in brain structure similar to changes seen in individuals with substance use or gambling addictions.

Now dopamine is an important neurotransmitter (it also acts as a hormone) because it is responsible for human motivation (if you block the dopamine receptors in mice, they will die from starvation because they don’t have the motivation to eat enough to survive). The trouble comes when the balance of these hormones in our brains is out of wack. Dopamine, specifically, can become highly addictive when it is not balanced (like the aforementioned smartphones and social media, dopamine is also released when we drink or gamble, activities that can be controlled, but that can also get out of control).

Dr. Anna Lembke, the author of the compelling and enlightening book Dopamine Nation: Finding Balance in the Age of Indulgence, has written extensively about the pleasure-pain balance in the brain and how the excessive pursuit of dopamine (pleasure) actually causes pain. This is because our brain wants to be in homeostasis. So when we push on the pleasure side of the brain (checking social media), the response in the brain is not neutral; it is negative (making us feel sad or anxious afterward).

The inverse is also true — which is why activities such as exercise and ice baths can be effective treatments for depression because they push on the pain side of the brain balance. The brain, wanting to be in homeostasis, responds with hormones that make us feel happy, stronger, and more confident.

Finding Balance

The HHS report also reviewed the results of studies on the effects of reducing or abstaining from social media. Here are some of those key findings:

• Limits on the use of social media have resulted in mental health benefits for young adults and adults. A small, randomized controlled trial in college-aged youth found that limiting social media use to 30 minutes daily over three weeks led to significant improvements in depression severity.

• This effect was particularly large for those with high baseline levels of depression who saw an improvement in depression scores by more than 35%.

• Another randomized controlled trial among young adults and adults found that deactivation of a social media platform for four weeks improved subjective well-being (i.e., self-reported happiness, life satisfaction, depression, and anxiety) by about 25–40% of the effect of psychological interventions like self-help therapy, group training, and individual therapy.

The inclusion of this abstention data in the report is important because it reinforces that social media and smartphone use are in fact the cause of this spike in depression and anxiety among young people throughout the Anglosphere.

What else can we do? Nearly 70% of parents say parenting is now more difficult than it was 20 years ago, with technology and social media as the top two cited reasons.

I think there are a few things to keep in mind that might be helpful.

First, there are four chemicals in the brain that we come to understand as happiness:

• Endorphins

• Dopamine

• Serotonin

• Oxytocin

The first two — endorphins and dopamine — are the “selfish chemicals,” — meaning we can get them on our own. We can go for a run or cross something off our to-do lists, and we get a hit.

The second two — serotonin and oxytocin — are “social chemicals,” — meaning we get them through our interactions with other human beings. Serotonin is what we recognize as pride or being recognized in our tribe. Oxytocin is what we recognize as love. It is the reason we love our children. Women release oxytocin when they nurse their babies for example; it is the chemical that bonds us to other human mammals.

I would think about how to get more of the social chemicals — serotonin and oxytocin — into your life and bring them into your children's lives — to help bring into balance these other happiness chemicals when compared to the amount of dopamine we are dumping into our systems in this “dopamine nation.”

Essentially, to rely less on dopamine for fleeting hits of happiness and lean more into serotonin and oxytocin, which are more satisfying and longer lasting.

The second suggestion is to consider the work of Dr. Stephen Ilardi, who describes depression as a disease of civilization. After years of throwing medication at his patients only to see more and more people needing treatment and the effectiveness of the medicine mixed — he knew he needed to try something else for his patients.

Data from Kessler et al. 2003, JAMA. I tried to find a more recent chart, but I would have had to create one. If you include the most recent statistic, in the current birth cohort, the percentage is now about 1/3.

According to Ilardi:

“We were never designed for the sedentary indoor, socially isolated, fast-food-laden, sleep-deprived, frenzied pace of modern life.”

Illardi’s research articulates that the more we get away from living in a manner that our brains and bodies were designed for (literally running around and chasing food — environments of scarcity are what the human being excels at), the more likely we are to have these negative mental health effects (as well as negative physical health effects).

His remedy is to bring the fundamental tenants of our natural design for living into people’s daily lives, including:

• Physical Exercise

• Omega-3 Fatty Acids

• Exposure to Sunlight

• Healthy Sleep

• Anti-Ruminative Activity

• Social Connection

These are just a few things to consider —I am sure there are many more things we can think of to help ourselves and young people if we put our minds to it. This is what Vivek Murthy is asking us to do—to recognize that we have a dopamine addiction problem in America—so that we can start considering some solutions and offer our compatriots a path toward living more meaningfully connected lives.

Enjoy the weekend. Spend some time with the people you care about.

— Erin