According to the National Institute of Mental Health, in 2019, 15.7% of adolescents ages 12-17 experienced at least one major depressive episode. That’s no small number, especially when you consider that depression can have a major impact on a teen’s ability to function and thrive.
Teen mental health has come into even sharper focus recently with the COVID-19 pandemic. According to a U.S. surgeon general advisory issued this month, depressive symptoms in young people have doubled during the pandemic, with 25% of youth experiencing depressive symptoms. And in early 2021, emergency department visits in the United States for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys compared to the same time period in early 2019.
When your teen is experiencing a depressive disorder like clinical depression, anxiety, or suicidal thoughts,* it’s hard to know what to do, but we can help you address three key questions:
- What signs should you look for?
- How do you get your teen help?
- What kind of support can you give as they’re working on healing?
Signs of Adolescent Depression
Teen depression is different than depression in adults. The adolescent brain isn’t fully developed yet, and those neural connections are still being formed, so depression can look different.
When we think of someone who is depressed, we may picture someone who is sad, can’t get out of bed, or isn’t as expressive as usual (that is, someone with flat or low affect). This is often what happens, but adolescent depression can also show itself in irritability, mood swings, anger, substance use, and/or acting out.
It can be hard to think of a teen who shoplifts as someone who is dealing with depression, but getting away with a daring act can help them feel something. And even when they’re not engaging in risky behavior, teens often seek out activities that give them the stimulation that depression keeps them from feeling in their normal, everyday life.
Rob Gent, Embark Behavioral Health’s chief clinical officer, shared two signs of depression that could be present in your teen’s everyday behavior — and what might happen before those signs even appear.
They lose interest in the things that they cared about
“There’s a withdrawal from normal social activities,” Gent said. “Your teen no longer desires to do the things that used to excite them. There’s a general sense of hopelessness that comes over them. You’ll notice the day-to-day activities that are usually purposeful and meaningful will decline.”
Schoolwork can suffer, and your teen may avoid many other things that used to interest them, including relationships with friends and loved ones.
They increase their social, computer, or online activities
Your teen may accelerate social interaction such as spending more time on Facebook, in structured activities with friends, or on video games, as if trying to compensate for their lack of interest in what they once cared about, Gent explained.
“But it’s not adding to their sense of identity formation through actual in-person experiences of connection with others,” he said. “It’s just a behavior that’s compensating for and distracting them from their depression.”
There was an activating event
Usually something that can be an onset event occurs before signs of depression even start.
“Has something happened within the last six months or within the last year?” Gent asked. “Have there been big changes? A breakup? Has something happened in school?”
Keep the lines of communication open by engaging in reoccurring activities with your teen where you can express emotional empathy and curiosity with how they are doing. This will provide the relational investment needed to more easily identify these events and be prepared for potential fallout from them, including depression.
Getting Help for Your Teen’s Depression
With depressed teens, Gent recommended looking for a mental health professional who approaches depression from a developmental and physiological lens instead of a purely cognitive lens. Therapeutic modalities such as cognitive behavioral therapy (CBT) are beneficial for effectively changing thinking patterns, but the teen needs to experience emotional regulation before they can cognitively make those changes.
“When your child is developing a relationship with the therapist, the therapist needs to be attuned to what’s happening emotionally, physically, and relationally with your child and not just ‘go for the rational/cognitive fix.’ The rational-fix approach is often misattuned and creates more frustration, self-doubt, and shame for the teen,” he said.
“Getting your teen to use their rational thinking brain to override their emotions is a long-term goal, but right now your teen is depressed, and accurately addressing the depression requires a multifaceted approach. We’re not going to rationally or logically talk ourselves out of depression.”
Gent recommended looking for therapists who are comfortable with experiential psychotherapy because actively engaging the teen emotionally, physically, and relationally can help create spontaneous engagement and interest that distracts them from isolation, hopelessness, and worry, even for a short time. Experiential therapies are activities like equine therapy, art therapy, music therapy, and outdoor therapy, which create a mode of spontaneous play.
“A therapist also needs to be familiar with trauma integration,” Gent said. “Is the therapist able to understand what’s causing the distress, make sense of what’s happened and how your teen has made sense out of their feelings and emotions, and then integrate it into the experiential therapy, which includes family?”
In addition to connecting your teen with a mental health professional, if you haven’t already done so, schedule a physical with your adolescent’s primary health care provider, as some physical health conditions can show themselves as depression or other mental health issues:
- Hypothyroidism and pituitary issues.
- Vitamin and mineral deficiencies.
- Hypoglycemia, diabetes, and other issues involving blood sugar.
- Heart issues.
These (and other health problems) disrupt the way the body manufactures energy on a daily basis, so it’s good to get a physical complete with blood tests that assess for these conditions.
A physical could also determine whether your teen needs a psychiatric consultation. The physician can do a primary assessment of your teen’s symptoms of depression, family history, and risk factors, and then work with a psychiatrist to determine if antidepressants or other psychiatric medications are necessary.
What if My Teen Is Hesitant To Get Treatment for Their Depression?
Provide your teen with resources that explain what depression is and isn’t. One good resource is this brochure from the National Institute of Mental Health.
Communicate that mental health treatment is a normal part of dealing with depression. Accessing professional help for emotional health reasons is just like going to the doctor is a normal part of treating tonsillitis or going to physical therapy is a normal part of dealing with a sports injury. When something hurts, we fix it.
Supporting Your Teen
Gent recommended three key ways you can support your teen during the healing journey.
1. Invest regular time in being empathetic and curious about how your teen is doing
Make it a priority to schedule activities where you can use empathy and curiosity to explore how they are emotionally, physically, and relationally doing. Don’t be afraid to say, “If I am you, I have been feeling down, sad, unmotivated … ” You as the parent have to express that you are not afraid of those emotions and are able to talk about them, and we do this through empathy. After an expression of empathy, use curiosity like, “Did I get those feelings right?” Repetitive and reliable interactions like this provide the emotional safety for teens to open up about how they’re feeling and events that may have contributed toward their depression.
Child Mind Institute, a nonprofit that helps children and families struggling with mental health and learning disorders, recommends trying to validate teens’ emotions with questions like “It seems as though you’ve been really down lately. Is that true?” It also advises “letting them know that you hear them, you see them, and you’re trying to understand — not fix them. People don’t like to be fixed.”
2. Make sure your teen is getting their physical needs met
When your teen is dealing with difficult times, the basics become even more important. For example:
- Help your teen get enough sleep. Teens ages 13-18 need eight to 10 hours of sleep per day, according to the Centers for Disease Control and Prevention.
- Make sure your teen is eating well. According to Dr. Mark Hyman, a family physician and functional medicine advocate, healthy food choices include primarily a whole food, plant-based diet with unprocessed proteins.
- Give opportunities to spend time outside. According to the CDC, spending time outdoors not only offers opportunities to be physically active but may also promote mental health and stress reduction.
3. Spend time with your teen
The best way to show your teen that they’re worth your time is to actually spend time with them. Make it a point to do activities with them on a regular basis, even if it’s just going out to lunch, taking a walk, listening to their music, or watching something beneficial on Netflix together.
When giving teens the chance to do things, Child Mind Institute recommends avoiding critical statements like “You really should get up and do something.” Instead, say something like “I’m going to the store to run an errand. Let me know if you want to come with me, and maybe we can get lunch together.”
The institute also suggests noticing the positive things your teen is doing, such as helping with errands, going to school, and helping with chores. This shows appreciation for your teen and, as CMI notes, “We all like to be appreciated and recognized for doing a good job even when it’s expected of us.”
Because depression interferes with so many other life functions, the best thing to do is seek treatment as soon as possible so your teen can return to a healthy life filled with friendship, motivation, and interests.
“Depression is devastating for everyone in the family, not just the teen suffering with the symptoms,” Gent said. “Through consistent and reliable emotional and physical engagement from caregivers and professionals, teens can experience long-lasting change, improving their physical, emotional, and relational responses that contribute to depression so they can live healthy, meaningful lives.”
*This article is for informational purposes only and not to be considered medical advice. If your child is having a mental health emergency, contact the 988 Suicide & Crisis Lifeline for immediate support by calling, texting, or chatting 988. You can also text HOME to 741741 -the Crisis Text Line- from anywhere in the country to talk with a trained crisis counselor.
Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today!