“Sometimes I feel like we are just running a hotel and restaurant around here!”
I still remember my dad making that exasperated statement when I was 17 years old. I was moody and irritable, and made little effort to engage my dad or stepmom in any meaningful way. Twenty-four years later, I continue to think about that comment—not because I think my dad was a bad parent (quite the opposite, and he probably doesn’t even remember that exchange), but because I think this scenario is indicative of the challenges that parents and others face when it comes to properly discerning and diagnosing depression in adolescents.
Was I depressed? Possibly.
I had lost my mom to a five-year battle with breast cancer when I was 11 years old, creating an immediate stuttering issue in school. This only fueled my anxiety in social settings and left me isolated. As a teenager I was also in the midst of significant life transitions surrounding school, identity, relationships, and faith formation. And that’s not to mention all the changes in brain development.1
So what was going on with me?
Typical teenage behavioral development?
Probably a mixture of all of the above, which is why seeing and responding to depression in young people can be complicated.
My story is similar to the stories that I hear frequently in my therapy practice related to depression and adolescents. The underlying instinctual fear in parents seems to become, “Am I going to miss something crucial in my child’s mental health that could lead to serious consequences?”
This is a good instinct, because like many issues related to mental health, two important factors frequently obscure the true nature of what is going on. First, depression itself can be somewhat tricky to diagnose, not to mention determining what type of depression is at hand. Second, there are cultural contexts in which talk of depression (like that of anxiety) brings about shame and guilt, often driving those suffering underground in order to avoid any stigma.
As a Christian and former pastor, I have encountered many adolescents who are fearful of this very stigma when it comes to talking about depression, especially if they are part of a faith community in which depression is frowned upon. As a Christian, I take comfort in knowing the biblical text presents people in the midst of all kinds of life struggles, and many prominent biblical characters struggle with what could be characterized as depression. I love the words of the psalmist David when he laments in Psalm 38:7–8, “I am bowed down and brought very low; all day long I go about mourning . . . I am feeble and utterly crushed; I groan in anguish of heart.” Not only me, but also many of my adolescent clients can take comfort in biblical texts like these. Through these stories, they realize that their own experiences of depression are part of the human condition.
Most parents are privy to occasions when their teenagers mope around the house, spending inordinate amounts of time alone in their room playing video games or texting, seeming emotionally short-fused in verbal tone and responses, and generally refusing to engage in family activities. These are some of the behaviors mentioned by family members and other caring adults when they begin to wonder if a young person is experiencing depression.
The problem, of course, is that most of us can recall times in our adolescent years when we mimicked similar behaviors, and we may not have been depressed. So how do we understand depression at work in the lives of teenagers? The Anxiety and Depression Association of America writes:
The National Institute of Mental Health (NIMH) reports that “about 11 percent of adolescents have a depressive disorder by age 18.”3 In the past it was thought that young people couldn’t suffer from actual clinical depression, but today we know this is not the case. The NIMH further states the following:
If more intense and lasting signs of sadness, hopelessness, anger, or frustration continue more than a couple of weeks, these are signs that more help may be needed.
So when you wonder about depression and teenagers, you may find it helpful to ask a few questions:
1. Do the behaviors I witness deviate from the typical and “normal” behaviors of this teenager?
2. Has there been some recent event that might be related to this change in behavior and mood in this teenager?
3. Is it possible that something I always thought was part of their personality actually could be a form of long-term depression?
These questions often help me, as a therapist, formulate some type of possible diagnosis so that I can know what steps to take. But sometimes it is hard to know what to do next. If you find yourself unsure of what the next steps are for your child, I recommend that you seek professional help.
WHAT CAN WE DO TO HELP?
Depression, like talk of suicide, is one of those mental health issues that many people find overwhelming. It’s easy to feel helpless. However, I believe all of us can utilize a specific set of skills to help the teenagers around us suffering from depression.
1. Do not judge.
One of the worst things we can do to a young person who is suffering with depression is to judge him or her. When someone is depressed, he or she is already wrestling with feelings of worthlessness and shame, and further judgment only perpetuates this shame cycle and drives the person further into hiding. Often people look at those with depression and think, “If they would just do this . . . or that,” but what we fail to realize is that depression can have a destructive effect on basic actions like eating, sleeping, exercising, and prayer.
Instead, work toward approaching those with depression with empathy and compassion. Ask yourself the question, “What do I need to do to get in their shoes and see things from their perspective?” Understanding diffuses judgment and makes it safe for the person with depression to come out of isolation and hopefully reengage others in a way that is life-giving.
Unfortunately, one of the more unsafe places for teenagers to talk about their depression has been in the Christian community, which has historically been laced with a host of unfortunate stigmas related to mental health. We still have a long way to go.5
2. Explore all options.
Depression is multifaceted and needs a very robust approach. If you know a teenager struggling with depression, I recommend you keep your options open and explore all kinds of possible treatment. Pastoral caregiving, professional counseling, and psychiatric medication could all be helpful at different times, as well as an exploration of various aspects of self-care and the young person’s physical, emotional, mental, and spiritual life.
Begin by engaging the teenager in a non-judgmental way to best determine what they may need. In my experience, some teenagers navigate through depression in a healthy way because there is someone present in their life who cares about them. Sometimes a teenager may need the safe space of counseling for a few months to work through depression, and other times ongoing social support may do the trick. The point is that no one size fits all, and it’s helpful to experiment with different approaches and see what works.
3. Be present.
One of the most powerful transforming agents in the life of someone who is struggling with depression is the healing presence of another: a presence that is non-judging, compassionate and empathetic, and willing to be with the person suffering from depression. Too often we find ourselves wanting to try to do something to fix the person who is depressed, when one of the best responses we can offer is our ability to sit with them. One of the reasons people struggle to be with someone they know who suffers from depression is because it bumps up against their own feelings of inadequacy and inability to find a quick fix.
AN OPPORTUNITY FOR GROWTH
I know few teenagers who escape adolescence without a brush with some form of depression. The teenage years are full of difficult transitions, broken relationships, peer pressure, and struggles at home, school, and work, all of which make this time of life a ripe environment for depression to take root.
Ultimately, I believe one of the best responses we can offer a teenager who is struggling with depression is the opportunity to help them see their pain and suffering as a catalyst for growth in their lives. But it is a journey they can’t enter into on their own. Author and educator Parker Palmer has been helpful to me in his description of learning to reframe his ongoing struggle with depression as an act of grace. Parker writes this about the theological reframing his therapist offered him in the midst of depression:
You may be that trusted guide a young person needs—and wants—to help them take the next step.