One of the joys of being a clinical psychologist is the privilege of seeing teens grow and mature. When I meet with Nick now, two years after we first met, I often smile to myself when he leaves my office or more recently when our zoom session ends. Nick is one of the kindest people I’ve ever met. From what he tells me he was always a bit sensitive as a child but not particularly shy as is the case with many socially anxious children.
I believe that one reason Nick is sensitive to others is that he has struggled with depression since he was a young teenager. He has a kind, empathic manner. Two years ago, I was not smiling but feeling concerned. When Nick trudged into my office waiting room one winter morning, he had that empty look that makes me worry. It seemed to take him forever just to walk the few steps from the waiting room into my office. He said he hadn’t slept well and looked tired and forlorn; his jeans and parka were dirty, his sweat shirt stained, and his sneakers drenched by melting snow.
Most major psychological problems begin before 14
Nick clearly hadn’t been taking care of himself. His eyes were downcast; his speech was slow, and he sighed a lot as he started to tell me his story. Nick was so withdrawn that when he stood straight I was surprised to see that he was six feet tall. A second year student, this was at least the third time he had been clinically depressed, each time after a major loss.
How parents can support teen mental health
1. Understand the scope and the facts about depression
You’ve probably read many headlines about depression in students, but let’s get more specific. People use the word depression in a number of ways. I find it helpful to think of depression as being on a continuum—from least to most severe—as a state, a symptom, or a disorder. Many people use the word “depression” to mean sadness.
Although persistent sadness is indeed part of a depressive episode, it’s much more complicated. It is human to respond with sadness to a loss or significant disappointment. If sadness continues over time for most of the day, it may be a symptom of a larger disorder, including a major depressive disorder (MDD) or other condition.
A major depressive episode (MDE) involves sadness or irritability most of the day, every day. Severity, duration, interference with daily functioning as well as the presence of other symptoms are factors that distinguish ordinary sadness or worry from a depressive episode.
If the mood has lasted for more than two weeks and is interfering with the teenager’s functioning and there are changes in appetite, sleep, weight, movement (either agitation or lethargy), concentration and hopelessness, then that constitutes an MDE. Nick has many of these symptoms. He said he had thought a lot about death, but not suicide. This was a relief to me because suicide is the second leading cause of death in Nick’s age group.
Nick had experienced his second major depressive disorder when his parents separated and his father moved far away and now as he was struggling after a girlfriend broke up with him. A severe depressive episode can be very serious and no one should say something dismissive or minimizing like, “Oh, just try to move on. ” Or, “look at the bright side.”
A full 13% of teens suffer from a major depressive episode at any point and for girls, 36.1%. Depression is not to be taken lightly; in 2010, Major Depressive Disorder (MDD) was the 11th leading source of global disability burden, and the greatest cause of disease burden among the psychological disorders.
A survey by the Harvard School of Education’s Making Caring Common project revealed that the pandemic has caused 61 % of teens to feel extremely lonely. This is due, in part, to the lockdown and resulting social isolation that teens face during the pandemic but stress, anxiety, and depression were all common before the pandemic as well. I am reviewing the statistics not to be alarming but to emphasize that we have neglected adolescent mental health for too long. It’s time to do more.
2. Actively listen
Communication is the foundation of a strong relationship. If you reflect on your life and any difficult times, you’ll remember how meaningful and affirming it feels to have someone who is there for you and listens in a nonjudgmental fashion. It is important for teenagers to be able to share thoughts, feelings, and the events of the day, and to know that they will have an engaged and attentive parent to talk to.
This is not as easy given the busy schedules of daily life and the fact that teenagers are not always emotionally available. Depressed teens may have difficulty expressing themselves and may also be ashamed of their feelings. Here are some general tips:
• Ask open-ended rather than closed questions (those that can be answered with “yes” or “no”). Instead of saying, “did you have that test today in Spanish?” try, “Tell me how things went in Spanish class today.” Use additional open-ended questions for follow-up. Rather than asking more rapid-fire questions (“Was it this? Was it that?” etc.), try something like, “And what about the rest of the day?”
• Ask clarifying questions to indicate that you understand. “It sounds like you were feeling a little worried about time pressures, but you knew that you understood the material. Is that right?” Don’t feel bad if you get it wrong and your teen answers, “No that’s not it.” Usually he will clarify, which keeps the conversation going.
• You might talk while sharing an activity; if it can be outside and involve physical activity, all the better. It maybe is easier for your son or daughter to open up during a walk or doing an errand rather than have an intense face-to-face conversation.
Most of all, resist the opportunity to lecture. Of course, as parents we often feel that if teens would just accept our wisdom, their lives would be better! But even if that were the case, lecturing does not work, it does not foster communication; it causes a shut down. If you see your teen’s eye glaze over, that’s one signal that you’ve been lecturing!
Don’t feel too bad if your teen doesn’t open up right away or if a conversation didn’t go well. If they are depressed or anxious, it may well be hard for them to focus. There will be other times and you have let them know that you are there for them when the time is right.
If we accept the premise that a depressive disorder reflects a change from normal functioning then it is important to notice behavior. You can see changes better than anyone. And trust what you see. If your teen looks disheveled, irritable, tired, and lethargic or agitated, you should follow up. Also try to notice sleep patterns because an unusual lack of sleep or disrupted sleep is associated with depression, although causation is not clear.
Teens really need 8-10 hours of sleep per night but rarely get it. Nick had been away from home for almost five months. His mother, who was by then divorced from his father, could see on his rare FaceTime calls, that something was wrong and arranged for him to see me.
Also notice if your teen has started to ruminate. Depressive rumination is the repetitive, compulsive focus on thoughts that cause feelings of sadness, anxiety, and distress. Nick had begun to ruminate about failing in college. He had struggled in only one course, chemistry, but that was a new experience for him and he became convinced he would never be able to graduate and was repetitively thinking about failure.
4. Instill hope
Nick had been to see his physician, who started him on an antidepressant. It was important to see me before his medication started working which can take up to six-eight weeks.
One of the cruel factors of depression is that it clouds a person’s ability to see the future clearly because of hopelessness. Teens don’t have the larger life experience to know that they will get better.
As a parent, it’s important for you to express that you will hold hope for them because you have a longer viewpoint. A relevant concept for a depressed person is the understanding that feelings and worries are not permanent. Negative emotions will ultimately pass and do not need to be feared. This idea can reduce worrying about the future.
In Nick’s situation he and his mother knew that he had overcome depression before but you might need to point out that treatment for depression, especially cognitive behavior therapy, sometimes in combination with antidepressant medication, are all effective. In general the problem is not therapy but that so many people are not treated.
5. Take Action
Nick’s mother helped him take action when he returned home. If you have observed your teen suffering and not getting any relief and this is been going on for many weeks then it’s time for a mental health referral. Please do not allow shame or hesitation get in the way. Conditions like depression and substance abuse, though common in teens, often bring up a fair amount of guilt and shame in parents.
Many therapists are happy to a schedule a short phone call for you or your teen so you can ask general questions and get a sense of what the person is like. Nick’s mother had gotten my name from his previous psychotherapist and had called me.
After letting her know a bit about me and answering her question, I told he that I’d be happy to see Nick when he contacted me. Most pediatricians are knowledgeable about therapists in the community and members of the clergy and guidance counselors can also be helpful.
Family is an important support system
Finally, remember that your family is a powerful support system. In everyone’s life, an empathic connection with a consistent, caring person is a profound experience. Social support is a powerful buffer against pain. This is especially true for people suffering from depression, a condition that can lead to withdrawal, isolation, and disconnection. Warm, ongoing family support has been shown to be a powerful, positive force for everything from self-regulation to mood management to fostering positive relationships.
Don’t forget that siblings, especially those close in age, can help provide support or pleasant distractions. All families have experienced stress from the pandemic but a solid family foundation remains powerful and is needed now more than ever. We can’t control what happens to our teens, but we can provide them with the reassurance, skills and unfailing support that they deserve.
As for Nick, he will be graduating soon. (“It’s online,” he says, “but still…pretty great.”). At one time he feared that he couldn’t finish a semester. Now he will begin to teach history at a high school in the Midwest in the fall. The students and faculty will be lucky to have him.
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