Internet addiction is about to become a new psychological disorder that apparently leads to depression—and one that can be treated with psychotropic drugs.
about to create a new Prozac generation—and this time, in the queue for
powerful drugs are the adolescents and young adults who ‘excessively’ surf the
Internet, use Facebook or text on their smartphones. From next year, Internet
addiction will be classified as a psychological problem that causes
depression—one that can be treated with powerful psychotropic drugs such as
Prozac, Ritalin and Valium.
who spends more than 38 hours a week on the Internet, uses Facebook, e-mails or
texts on their mobile phones can be defined as an Internet addict—and that
probably includes most teenagers for a start.
year, the prestigious American Psychiatric Association (APA) will recognize
Internet addiction (IA) as a cause of depression. According to the APA’s
governing body, IA has “all the characteristics of a compulsive–impulsive
spectrum disorder that may be treated with powerful psychotropic drugs”. The
‘problem’ is featured in the next edition of the APA’s standard work,
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
which is the reference work for all psychiatrists, to be published next year.
suspected of being an Internet addict could be prescribed a psychotropic drug,
and it won’t just be teenagers who fall into this new category. Researcher Tony
Dokoupil points out that the “gap between an Internet addict and John Q Public
is thin to non-existent. By that definition [of 38 hours’ usage a week] we are
all addicts now, many of us by Wednesday afternoon, Tuesday if it’s a busy day”
(Newsweek, July 16, 2012).
could be a rich harvest for the drugs industry. A survey of regular Internet
users found that the average time spent online each day was around two hours,
although that falls well short of the five hours of an Internet addict, with
education and information-gathering cited as the main usage by 62 per cent.
Most needed to use the Internet every day, although 43 per cent admitted they
stayed online longer than they anticipated. Overall, nearly 4 per cent of
participants could be defined as Internet addicts (Ind Psychiatry J, 2010; 19:
average person of any age sends or receives around 400 texts a month—and that’s
four times the number recorded in 2007—while the average teenager processes
3700 texts each month.
the psychiatrist with prescription pad primed still has a problem. Jerald Block
of the American Journal of Psychiatry, the official journal of the APA, points
out that nobody sees a psychiatrist for IA. This is not surprising, as no one,
other than a few researchers and academics, even knows it exists as a syndrome
or necessarily sees it as a problem.
they seek psychiatric help for a known problem, such as depression, anxiety or
aggressive behavior. In fact, 86 per cent of ‘Internet addicts’ have some other
problem, and the average addict has 1.5 other, recognized, diagnoses (Am J
Psychiatry, 2008; 165: 306–7).
Internet addiction appears to be seen in association with a range of
psychiatric problems, such as mood swings, anxiety and substance abuse, and
could involve psychological, neurobiological and cultural factors.
there’s no evidence to suggest that psychotropic medication could help, say
researchers from the University of Iowa (CNS Drugs, 2008; 22: 353–65).
and government health officials in South Korea don’t seem to have the same
misgivings. They have already identified 168,000 children and adolescents who
need psycho-tropic drugs for their Internet addiction, and 50,000 may require
government has trained more than a thousand counsellors, and 190 hospital and
special treatment centres have been set up to treat the nation’s Internet
fact, Internet addiction has become one of South Korea’s most serious public
health issues. Its escalation—which has put it on a par with drug abuse,
cigarette smoking and obesity—is mysterious, and even those most militantly
opposed to Internet use can point to only 10 heart attacks suffered by visitors
at Internet cafés, and a murder that was triggered by someone who confused a
cyberworld game with reality as possible reasons for the crime.
South Korean government says that Internet addiction is escalating. The average
high school student there spends about 23 hours each week playing computer
games, which means that another 1.2 million children will soon fall into the
‘Internet addiction’ net and be in line for a psychotropic.
are even bigger spoils to be had in China, South Korea’s neighbour. There,
around 10 million children are estimated to be Internet addicts, and the
Chinese government has introduced laws to discourage more than three hours of
PC gaming a day, thereby criminalizing ‘excessive’ Internet use.
there is hardly any evidence to support the theory that excessive Internet use
causes depression, or worse. The one headline-grabbing study published in 2011
that ‘proved’ that Facebook, the world’s most popular social platform, caused
depression has since been discredited.
American Academy of Pediatrics (AAP) had issued a report that concluded that
excessive Facebook use could lead to depression, and advised adolescents in
particular to severely limit their time on the platform.
researchers from the University of Wisconsin say the AAP had been alarmist.
Their own research, involving 190 students at the university, found no
association between Face-book and depression, let alone as a cause. Parents
shouldn’t worry as long as their children’s behaviour and mood haven’t changed,
and they still have friends and their schoolwork is consistent, they say (J
Adolesc Health, 2012; doi: 10.1016/j.jadohealth. 2012.05.008).
you won’t ever discover that the Internet causes depression because there’s no
link, say researchers from the Missouri University of Science and Technology.
They carried out a ‘fly-on-the-wall’ study, which came up with the conclusion
that the Internet doesn’t cause depression, but is a symptom of it. In fact,
the way people use the Internet can help to diagnose depression, say the
collected data on Internet usage unobtrusively and anonymously—making their
study one of the first to collate a true picture rather than relying on
participants’ honesty when completing a survey form. In all, 216 students
participated and remained anonymous through-out. Before beginning the study,
the students were tested for depression, and the researchers noted that those
who were depressed used the Internet differently. The depressed students used
file-sharing services, sent more e-mails and chatted online more than the other
students; they were also more likely to watch videos and play games. Overall,
the depressed students used the Internet randomly, frequently switching between
applications, which suggested poor concentration levels, one clear sign of
depression (IEEE Technol Soc Mag, 2012; accepted for publication).
the Missouri researchers discovered—and as many other hundreds of researchers
have also found—there is an association between excessive Internet use and
depression. In fact, there is an association to even worse social problems, such
as suicide, substance abuse and aggressive behaviour.
an association doesn’t prove a cause. Instead, the Internet and its many
digital manifestations is the comfort zone for the already depressed and
at the University of Leeds came to this conclusion when they looked at the
Internet usage of 1319 people, 18 of whom were identified as Internet addicts.
The IA group were far more depressed than non-addicts, and all fell into the
moderate-to-severe category of depression.
who show symptoms of IA are likely to engage proportionately more than the
normal population in sites that serve as a replacement for real-life
socializing,” the researchers concluded (Psychopathology, 2010; 43: 121–6).
similar conclusion was reached when researchers analyzed the mental well-being
of 722 online gamers. Those who were in front of their screens the most also
had more severe depression and social phobia. However, although women spent
less time gaming, they suffered more acute depression and social phobia. Again,
the study does not necessarily prove that excessive Internet use causes
depression; instead, it again demonstrates that those who are more depressed
sit longer in front of their screens (BMC Psychiatry, 2012; 12: 92).
after study has seen a similar association, such as the one that discovered
307 university students monitored, 4 per cent had IA and 12 per cent had
moderate-to-severe depression (BMC Med, 2011; 9: 77).
researchers confirmed such findings when they profiled 30 Internet addicts—who
they call ‘pathological Internet users’ (PIUs)—and compared them with 31
intensive Internet users who were not ‘pathological’ in their use. Half of the
PIUs had a preexisting psychiatric disorder, such as anxiety, compared
12.9 per cent in the
group (Psychiatr Prax, 2008; 35: 80–3).
not just depression that’s associated with Internet addiction. One analysis of
previously published studies discovered an association with anxiety, ADHD
(attention-eficit/hyperactivity disorder), obsessive–compulsive symptoms and
(Psychopathology, 2012, July 31; Epub ahead of print).
have established an association with substance abuse and even suicidal thoughts.
In a study of 275
students in Florence, Italy, 5.4 per cent were classified as Internet addicts,
and they were also more likely to drink excessive coffee,
submissive relationships, gamble, and have patterns of starvation and bingeing (CNS
Spectr, 2006; 11: 966–74).
researchers found an association between Internet addiction and conditions like
hostility, depression and severe psychiatric problems when they studied the
Internet habits of 3662 students (Psychiatry Clin Neurosci, 2008; 62: 9–16).
Internet users are also more likely to commit suicide, or to at least have
suicidal thoughts. One study of 1670 high-school students in Korea concluded
that 38.1 per cent of them were “in the early stages of Internet addiction” and
1.5 per cent were heavily addicted. There was a direct association between
Internet usage and levels of depression and suicidal thoughts, said the
researchers (Taehan Kanho Hakhoe Chi, 2004; 34: 102–10).
as if to put the final flourish to the argument, researchers have discovered
that Internet addiction changes the physical brain—in particular, gray-matter
changes. One magnetic resonance imaging (MRI) study of 18 Internet addicts—who
were compared with 15 adolescents who were not frequent Internet users—found
that the brain of the addicts had undergone structural changes (Eur J Radiol,
2011; 79: 92–5). A different team of Chinese researchers noted similar changes
in the brains of Internet addicts (PLoS One, 2011; 6: e20708), while yet other
researchers from China have also detected abnormal white matter in the brains
of 17 Internet addicts. They believe the white-matter abnormalities could
impair behaviour (PLoS One, 2012; 7: e30253).
John Grohol, founder of the PsychCentral Web portal on mental health and an
advocate of the Internet, argues that brain changes mean little. “A whole host
of activities ‘rewire the brain’,” he writes, “from learning to drive a car or
learning a new foreign language. Every action we take changes our brain
Internet may not cause depression, much as the drug companies would like it to,
but it can be compulsive, addictive and socially isolating, just as television
can be, too. However, Internet addicts tend to have addictive personalities,
and are likely to be heavy smokers, drinkers or drug-takers, as one study of
Greek students discovered. The researchers, from the Technological Educational
Institute of Athens, have also coined a new term to describe Internet addicts—’problematic
Internet users’ (PIUs). PIUs tend to be male, unemployed and to have addictive
habits such as smoking, drinking alcohol and/or coffee, and drug use. Their
Internet addictions seem to focus on pornographic sites and online games
(Cyberpsychol Behav Soc Netw, 2011; 14: 51–8).
researchers, who prefer the term ‘pathological Internet users’ (PIUs), reckon
that they represent between 1.5 per cent and 8.2 per cent of all users, and
they often have preexisting psychiatric disorders such as ADHD and affective
disorder (Fortschr Neurol Psychiatr, 2009; 77: 263–71).
they are called, Internet addicts appear to have an uncontrolled and harmful
access to gaming, pornography and e-mails, chat rooms and text messaging.
Overuse seems to
associated with higher levels of aggression and anxiety, say Polish researchers
(Postepy Hig Med Dosw [Online], 2009; 63: 8–12).
extension of Internet behaviours, especially game-playing, into real life for a
tiny minority of users has also been recognized by researchers at the Hadassah
Medical Organization in Jerusalem. However, nobody truly understands the
psychol-ogical mechanisms as to why this happens, so suggesting a treatment is
currently not possible (Am J Drug Alcohol Abuse, 2010; 36: 277–83).
hard to find any good news about the Internet and texting. Instead, we read a
stories about cyberbullying, Internet ‘trolls’ who leave abusive and upsetting
messages, teenagers who spend every
waking hour on Facebook or texting, and psychopaths who act out a violent
online game in real life.
we hear that Internet addiction is a cause of depression, to be treated with
all of this is true, and it’s also true that the Internet can be isolating and
addictive, it all seems to be confusing the medium for the message. As TV
presenter Kirstie Allsopp said after she was a victim of abusive ‘tweets’, to
blame Twitter is a little like blaming the existence of paper for the printing
for every case of social isolation, there is one where the Web has helped to
bring people closer together. For example, the parents’ community website
www.mumsnet.com attracts around five million visitors every month who are
looking for advice from their virtual extended family about bringing up their
children (see box, page 13).
doubt, the Internet is a siren call for the
socially maladroit, the depressed and the psychotic—and these, in the main,
become Internet addicts—but it has also been a force for good for the vast
majority of users.
there is scant evidence to suggest that the Internet causes mental or
psychological problems; at worst, it may exacerbate a problem that is already
the idea that this is just cause to drug a whole new generation is frightening
for anyone outside of the pharma-ceutical industry, and is far more terrifying
a prospect than anything conjured up by the Web.
Now for the good news
and the Web can be a force for good, and there’s plenty of research to back up
regular computer use with moderate exercise helps to protect against memory
loss. In a study of 926 people aged between 70 and 93, those who exercised
regularly and used the computer were less likely to suffer mild cognitive
decline, the intermediary stage between normal memory loss with ageing and
Alzheimer’s. Nearly 38 per cent of those who didn’t exercise or use a computer
were showing signs of mild cognitive decline compared with just 18 per cent of
those who exercised and were on their PC (Mayo Clin Proc, 2012; 87: 437–42).
Internet also acts as an important support when people feel isolated, or need
some friendly advice or sympathy. A study of 1000 women who had suffered a
miscarriage discovered that they used website message boards to help them
overcome their grief. Astonishingly, many were still coping with the emotional
impact up to 20 years later. The most common reason for posting messages was to
confirm a feeling that their problem was not unique, researchers from the
University of Michigan found (Women’s Health Issues, 2011; doi:
addition, the Internet doesn’t just provide psychological support. It can also
be used as a therapeutic aid, and it can be as effective as attending group
sessions. Tinnitus sufferers who used the Web-based Tinnitus Handicap Inventory
therapy programme for 10 weeks saw their ‘distress levels’ drop to the same
measure as those who attended cognitive behavioural sessions (Johannes Gutenberg
University Mainz; www.uni-mainz.de/eng/15114.php).
Stopping the cyberbully
Web—and especially the social-networking platform Facebook—has its dark side.
Children and adolescents who are singled out for bullying—characterized by
offensive remarks left by ‘trolls’, usually anonymously—can become social
outcasts, sometimes leading to suicide or suicidal thoughts.
case involved an Irish girl, 15-year-old Phoebe Prince, who hanged herself
after being tormented by hurtful text messages and posts on Facebook. In
another case, teenager Megan Meier committed suicide after the mother of a
former friend harassed her.
might suspect your child is a victim of cyberbullying if he or she:
- shows signs of
distress during or after being on the Internet
protective or secretive about their digital connections
- withdraws from
friends and activities
- avoids school
and after-school parties
- slips in grades
and seems more angry at home
- shows signs of
changes in mood, behaviour, sleep or appetite.
you suspect cyberbullying, talk to your child about any experiences of bullying
you suffered when you were at school. This may help your child put the
experience in context, and may provide an invitation to start talking.
measures you can carry out include:
- blocking the
bully, which can be achieved by changing the computer’s settings
- limiting your
child’s access to computers and mobile phones
- knowing your
child’s online world by checking their postings and the sites visited
- using the Web to
find resources and support groups against cyberbullying.
The Web stops depression
therapy can help to ease depression, the very condition it’s supposed to cause,
and its benefits have been established in numerous studies. In one,
Internet-based cognitive behavioural therapy worked just as well as a
face-to-face session, with the added benefit that patients could choose their
own time for the therapy. It’s also easier for people to access therapies that
often have a long waiting list of patients. The Internet therapy programme
helped to ease existing symptoms, and just 10 per cent suffered a relapse,
according to a doctoral dissertation by Fredrik Holländare at Örebro University
Web can also help to prevent depression in the elderly, as several studies have
demonstrated. In one, older people who regularly use the Web—dubbed the ‘silver
surfers’—are one-third less prone to being depressed. A third of over-65s
regularly use Facebook and Twitter and, according to University of Alabama
researchers, it helps them stay in touch with family and friends (The British
Psychological Society, 27 July 2012; www.bps.org.uk/
WDDTY vol 23 no.6