My Kid Is Fine: How Teen Depression Deceives Us

by Katherine DeVaul, MD, Child & Adolescent Psychiatrist

After Mike and his girlfriend of three years ended their relationship, his parents expected their son to be crushed. For weeks, he was withdrawn and moody; he avoided friends and rebuffed his parents’ well intentioned questions.
The relationship had been a large part of Mike’s life and his girlfriend, Lori, had been like a member of the family. Lori had hoped they would remain friends, but Mike was too devastated. His mood was slow to improve and his parents worried that he would not be able to attend college in the fall.

As the months passed, the old Mike seemed to return. After the first couple of weeks, he reconnected with his large group of friends. They played a big part in drawing him out of his melancholic state. He seemed focused on starting college in the fall and worked on applications for financial aid scholarships, for which he received three awards. He resumed his job helping out at his father’s law practice and joked with clerks and interns in the office. By the time of the family’s summer reunion, his parents thought their son was back to his old self. He seemed to enjoy the vacation and stayed up late talking and playing board games with his cousins.

Three weeks before his departure though, Mike’s mood shifted again. As friends began to leave for college, he grew more isolated. He became withdrawn, rarely leaving his room and snapped at his mother whenever she offered suggestions for pulling himself out of his depressed state.

One morning as Mike made a long reach to grab cereal from the top of the fridge, his father was aghast to see a row of long, dark gashes exposed on Mike’s wrist from underneath his long-sleeve shirt. Shocked and confused, his parents immediately confronted Mike. What was he thinking? How could he do this to himself? Mike, at first stony, broke into tears. He didn’t want to live, he told them. It was too hard. He hated himself. He hated his life. Concerned by Mike’s sustained depression and the violence of his emotions, his parents took him to the emergency room, where they acted on the advice of the on-call psychiatrist to hospitalize their son.

Depression fundamentally changes how a person perceives the world.

As Mike’s parents learned, depression is unpredictable. It can be triggered by one incident or by an accumulation of smaller events. Often an event that a person may have seemed to have overcome can continue to negatively affect his emotional stability. While external signs of accomplishment such as keeping up with commitments, connecting with friends and even achieving good grades in school can seem like positive signs of well-being, they are not always clear indicators of emotional health.

Depression fundamentally changes how a person perceives the world. In certain ways, teens are more vulnerable to depression than adults. They often have a harder time bouncing back from setbacks because they lack the perspective-taking capacity that comes with additional experience. Also their brains are still developing–particularly the parts involved with decision making, emotional regulation, and delayed gratification that are integral for rational thinking. This is particularly true when they are upset. They lack the arsenal of coping strategies that adults have gained through experience. As much as it might seem that your teen is capable, in reality he’s managing more emotional fluctuations with fewer resources than most adults.

In Mike’s case, the break-up with his girlfriend was the initial precipitating event that injured his sense of identity and made him more vulnerable to other stressors. And, even though he appeared to recover from the injury of the break-up, most of the improvement that he made during the summer wasn’t long-lasting. Faced with the additional pressure of starting college and leaving home, Mike crumpled. The glass is seen as less than half full more frequently than not.

This attitude can carry over into other aspects of the person’s life, making him unable to enjoy things and obscuring the positive aspects of life, including hope.

What can you do as a parent to protect your child’s emotional well-being?

Is the high-achievement environment we live in putting too much pressure on kids to be perfect? Do we coddle our children for too long, causing them to be crushed when they experience the first sign of failure?

Mike’s parents were haunted by what could have happened if they hadn’t caught Mike before he made a more serious suicide attempt. They wondered if they missed the signs of his depression. They were baffled by what caused their son’s response and questioned themselves about what more they could have done to prevent his hospitalization. In truth, they were shocked. They never imagined that their son—successful, popular, with so much going for him—would consider suicide.

Mike’s parents are not alone. While we might expect a teen with long-standing mental health problems to be prone to suicidality, we are unprepared when a teen without a history of emotional problems attempts suicide seemingly out of the blue.

Steps to safeguard your teen’s mental well being

The first step to safeguarding your teen’s well being is to realize that the onset of depression can happen to anyone at anytime. Learn the warning signs of depression (see below). If you suspect your teen is at risk, or even if you’re worried but unsure, seek professional help. It’s okay if you are wrong. Follow guidelines, but don’t expect yourself to be able to tease out the difference between typical and concerning behavior. When your teen is undergoing the usual changes of adolescence, including individuating from you, and you are experiencing conflict with her, sorting out the complexity of her changes can be difficult.

Secondly, if your child is struggling with depression or anxiety, take it seriously and seek professional help. It can be difficult to accept that your child may have a problem that is outside of his control or yours. While you are a wonderful resource for your child and he needs your support, you can’t treat your child’s depression or anxiety. It’s not your job, and it doesn’t work.

Thirdly, when dealing with your teen’s depression and/or anxiety, try to encourage continued engagement with activities despite her tendency to isolate. While it’s natural for a person experiencing depression to have less interest in friends and activities, breaking the cycle of isolation is part of combating depression. Be available to your child and work with her therapist and/or psychiatrist around what level of participation will be best in terms of friends, academics, or other activities. For instance, sometimes dropping a class might be a reasonable response for an over-committed teen, but dropping out of school would not be.

Lastly, think prevention. While we don’t know all the reasons for teen depression and suicide, we can examine parenting strategies that help and hinder teens. At the same time, it’s important to realize that as parents we only have so much control:

Pushing your teen–how much is too much?

Typically, teens need less pushing from their parents than we might expect. Giving your teen opportunities and choices, combined with being part of a community that values success, is enough in most cases to launch your child in a successful direction.

Pushing that is less helpful resembles statements like “You need to try harder” or “We expect better from you.” While having a certain degree of expectations for your child is helpful, you get into tricky territory when the image you have of your child is too limited or too fixed.

More than our words, our actions powerfully influence our children. What values are you modeling? Does this fit with what you believe? Are you unconsciously modeling values that send mixed messages? Even if your teen doesn’t seem to be acting on what you’re modeling, your influence is still likely to emerge in the long run.

Some pushing is helpful when it supports your child’s interests. Encourage your child to pursue a goal, cheerlead a little bit and communicate that it’s okay to fail or to not to know everything all at once.

The easy going parent—Are you too lenient?

On the other hand, some parents give up on their job as a parent by following their teen’s lead when he pulls away. Your teen still needs your involvement and support as a parent, even if everything he does communicates the opposite. Stay engaged–despite his protests. It’s your job to gather information (who, what, where) and provide boundaries such as enforcing an agreed upon curfew. Rules provide valuable structure for teens by setting limits. When your teen pushes back on limits, he is doing his job; it’s an opportunity for you to continue the conversation about what’s going on in his life.

The meaning of conflict or no conflict

Adolescence is a tough period for kids and parents. It’s easy to think that, because you and your child are fighting or not agreeing, your relationship will always feel tumultuous or distant. Take comfort knowing that arguments are not as damaging as you might think. Some amount of arguing helps your teen practice independence. Arguing, in fact, can be a sign that your child is sharing enough of her life with you to have a frank discussion and openly disagree. If your teen is not arguing with you, it is not always a good sign. It can mean your teen doesn’t feel comfortable enough to share things with you. Balance is key. If being at odds with each other becomes your primary means of interacting, your pattern of communication has become unhealthy.

Help your teen manage self-imposed pressure

Many parents are worried about the pressure teens put on themselves. If your child comes home from school and is upset about a “B” on his paper, listen. If top grades are important to your child, balance your support with setting realistic expectations. Reassure your teen that a “B” isn’t the end of the world; we can’t be “A+” students all the time. Find out what this particular grade means to him, and help him put the experience into perspective. Experiencing disappointment now, with your support, can help your teen practice how he will cope with obstacles in the future. (See tips for starting early below.)

Stay in contact with your teen

While it’s developmentally appropriate for your teen to be more interested in his friends than his family, it’s also appropriate to ask your teen to continue to participate in family activities. It might be too intrusive to sit down your teenage daughter and ask her tell you everything about her relationship with her new boyfriend,   but it’s important you insist on talking about issues relating to dating and the concerns and expectations that you have. It’s crucial to find a balance between giving your teen autonomy and staying connected.

Differentiate between what works for you vs. your child

Before you offer your teen solutions to his problems, consider differences in temperament between you and your teen. For example, you might deal effectively with stress and anxiety by being organized, scheduling and planning far in advance. If your child is more inclined towards free-thinking and spontaneity, what works for you might not work for him. In fact, a child like this might need to procrastinate a little bit to build up the energy to fulfill his obligations. Recognize when your child needs a different approach.

Start early—Let your young child fail

For parents of young children, start practicing positive strategies for coping and talk through challenges at an early age. While it may be difficult, take a step back to allow your child to meet obstacles and learn how to resolve them. If you lay the groundwork early enough, by the time your child is a teen, she’ll be better prepared to handle setbacks.

We live in an increasingly anxious and stressful world. For teens, learning how to cope with emotional ups and downs, a changing world and the unknown of preparing for an independent life can be overwhelming. They’re grappling with the monumental questions of who they are and what’s important to them. Striking the right balance of support for your teen is a subtle art that differs from family to family.

When you’re concerned about depression or anxiety, don’t try to handle these issues on your own. Reach out for professional advice from people who deal with teen emotional problems on a daily basis. Parenting during the teen years may test you in ways you haven’t been tested, and it can often raise new issues for both parent and teen. Take up the challenge as an opportunity to learn and grow, but do it with temperance. Instead of striving for perfection, allow yourself to be human and humble. The challenges you and your teen weather together have the potential to form the basis of a long-lasting relationship based on mutual trust and respect.

Warning Signs of Depression and Suicide

Look for signs that your teen isn’t coping or if big changes develop that are outside of your teen’s typical behavior. Changes that occur on a prolonged basis are more serious cause for concern than those that occur day-to-day. Changes may include:

• Persistent moodiness, especially with close peers
• Dropping activities without adopting new ones
• Poor hygiene
• Increased fearfulness
• Unrealistic standards
• Chronic sleep changes
• Increased physical complaints
• Marked changes in appetite, up or down
• Self harm
• Suicidal ideation
• Physical aggression towards people or objects
• Withdrawal, isolation
• Use of alcohol or other drugs beyond casual experimentation
• Sexual promiscuity

A version of this article was published in M magazine.

If you’re concerned about your teen, we’re here to help. Call, email or book a phone call with our CHC Care Team.

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