The client sat nervously in the program director’s office on the day of her admission to residential treatment. Like many teens Evolve helps, she arrived already having a diagnosis of Major Depressive Disorder (MDD). While the client met with the facility nurse, her parents shared concerns they had hesitated to voice in front of her. They expressed fear that their daughter was lying constantly, struggling with friendships, and using drugs more heavily than she admitted. Most concerning to her parents, was her emotional numbness. She showed a lack of empathy or remorse for her lies, destructive behavior, and the impact it had on others. Both Mom and Dad doubted whether their daughter was depressed at all because she never seemed to cry, feel bad, or care about anything. She wasn’t showing the typical signs of depression in teens.
This fictionalized account of a real-life example highlights the struggle many parents and caregivers face in attempting to learn how to help a teen with depression. The common perception of adolescent depression is of a teen who isolates, sleeps way too much (or too little), lacks any sort of motivation, shuts everyone out, and drops activities they once loved. It is just as common, however, for a teen struggling with depression to not appear sad at all!
When Depression Doesn’t Present As Sadness
There’s this idea about what depression looks like. It’s greasy hair, pessimism, low energy, low self-esteem, and constant sleeping. The truth is that depression can look different on everyone and it’s not always obvious when someone is struggling with it. Often referred to as high functioning depression. There are several reasons your teen could be struggling with these issues such as excessive sleeping, so it’s important to know all the other signs of depression.
Other signs of depression in teens can include:
- Irritability or anger
- Feeling on edge
- Becoming easily frustrated
- Engaging in more verbal and physical arguments
- Chronic fatigue
- Headaches
- Digestive issues
- Feeling of heaviness in body
- Difficulty concentrating or “brain fog”
- Co-occurring anxiety
- Excessive sleeping
- Insomnia
- General sense of dread
It’s important to recognize that depression doesn’t always look the same for everyone, and it can sometimes be subtle, especially when it doesn’t involve overt sadness.
Common Misconceptions About Depression
Depression can have many misconceptions that may lead to a lack of understanding regarding the complexity of the condition. Here are four common misconceptions about depression.
Depression Is Just Sadness
Many people think depression is only about feeling sad, but it’s much more complex. It can involve a range of emotional, physical, and cognitive symptoms, including fatigue, difficulty concentrating, irritability, numbness, and a lack of motivation.
You Can Just Get Over It
Depression is not something that can be overcome with a simple change in attitude or willpower. It’s a chronic condition that often requires treatment, such as therapy or medication, for recovery.
Depression Is a Sign of Weakness
Some believe that people with depression are weak or lack resilience, but depression is a medical condition that can affect anyone, regardless of strength or willpower. It can in some cases involve a chemical imbalance or other factors beyond personal control or other environmental factors.
Depression Only Affects Adults
Depression can affect people of all ages, including children and adolescents. It’s important not to assume that younger people are simply “moody” or “being teenagers.”
Once You’ve Had Depression, You’ll Always Have It
While it can be recurring, there is also situational depression. Many people can experience periods of remission, and with proper treatment, many can lead fulfilling lives without chronic symptoms of depression.
Recognizing these misconceptions helps reduce stigma, and allows individuals greater opportunities to understand the experience of others and themselves.
As a parent or caregiver, how do you respond when…
My Depressed Teen Stonewalls Me?
Teens struggling with depression can do something called stonewalling. Stonewalling is a form of emotional withdrawal where your teen refuses to communicate and becomes avoidant of any difficult topics. Whenever you try to ask them about what’s going on with them, they only respond with things like “I’m fine” or “everything’s good” followed by walking away or closing their door. If your teen is repeatedly stonewalling you, take notice. It could mean that they don’t feel comfortable letting you in at that moment. It’s important to ask yourself things like “is it possible that they feel judged by me”, “am I allowing them to share without immediately trying to problem solve”, and “do I validate them”.
What Do You Say to Someone Who is Depressed?
DO say the following:
- “I can tell you are struggling with something that feels big and hard right now. I might not be able to fix it or understand it perfectly, but I am here to listen without judgment.”
- “If you don’t feel comfortable talking to me about everything, I wonder if you might be willing to share one piece of it? I promise to listen without telling you what to do.”
- “I know you don’t feel like you can open up to me, but I wonder if there is another adult you’d be willing to talk to?”
- “I can see the pain/sadness/grief/hurt you are in, it must be so difficult to sit with that. I am here for you.”
Don’t:
- Say any of the above suggestions and then do the opposite.
- Invalidate their experience with statements like “that doesn’t sound so bad,” “just try not to think about it,” “you’re being too sensitive, dramatic, unrealistic, etc.”
- Fall apart emotionally or become enraged in front of your child. There are absolutely times when us grown ups need to sob, yell, etc., but this should not be done in front of your teen. When you do this, it inadvertently sends the message that you cannot handle their struggles, that you are afraid, or hate them. Teens see this and bury their emotions further in an effort to take care of you, please you, or protect you. It also tends to instill shame because the perception—distorted though it may be—is that their problems are far too bad, disgusting, or weird for you to deal with.
My Depressed Teen Gets Angry With Me?
It is so hard to remain calm in the face of an angry, disrespectful, or maybe destructive teen. You might even find yourself thinking, “if they are going to express themselves like that, then they’re going to see my anger too!” After all, it can feel good to get angry and let all that energy out. The problem is that it feels good in the moment…and not so good afterwards. Teens go through this too. There is a common cycle in teens with anger issues wherein they blow up in one way or another, calm down and then feel shame for their actions. They then often try to escape that shame by acting out against themselves or someone else and start the cycle all over again.
Again, self-reflection is key here. What is my teen doing that is a reflection of what they have seen adults around them do? How was anger modeled in our home while my child was growing up? Do I know the difference between expressing anger in a healthy way and expressing it in an unhealthy way?
If you don’t or you aren’t sure, seeking support can be crucial because we cannot teach what we do not know how to do ourselves. The anger your teen demonstrates is a big, loud, and sometimes offensive way of expressing their pain—and knowing this makes most parents and caregivers feel stuck. Many ask us, “I want to be there for them and support them, but they treat me like crap and walk all over me.” Others express, “Ok, I get that they are in pain, but am I won’t tolerate that sort of language/behavior in my house—they need to shape up if they want my support.” The appropriate response lies somewhere in the middle of these two extremes—allowing your angry teen to run the show and say whatever they want to you and getting increasingly restrictive and unbudging the louder their anger gets. Boundaries and consistency are absolutely key, and there should be consequences for disrespectful or destructive behavior.
However, those consequences cannot come in the absence of empathy and warmth. Dan Siegel, a clinical professor of psychiatry at the UCLA School of Medicine and director of the Mindsight Institute, and Tina Payne Bryson, a psychologist and author of many books on adolescence and child rearing have a book titled, No Drama Discipline: The Whole-Brain Way to Calm the Chaos and Nurture Your Child’s Developing Mind. The book is devoted to setting boundaries and disciplining out of control children in a way that is likely to result in change. Siegel and Payne make an impressive case backed by well-established clinical research for an approach they call “connect then redirect.” They describe the brain state of an acting out child as being hijacked by the limbic system of the brain—the part of our brain that controls emotions and behaviors. In these triggered, heightened states, the cortical structures of the brain responsible for analysis, abstract thinking, empathy, reasoning, and problem solving are offline and unavailable. Cortical structures only come back online once the body has calmed down and the central nervous system is more regulated.
What does this mean? It means that a parent or caregiver has two primary jobs in the face of a teen’s anger. First—connect. Sometimes this looks like simply being present for the anger and letting them know that you are here for them and want to support them but that this can only happen once they’ve calmed down and you are happy to help them calm down if they are open. Second—redirect. This is the stage where the boundary setting and consequences come into play…but ONLY after they have calmed down and can give some indication, they are ready to listen (sometimes this might just look like a shrug of the shoulders in response to you asking, “are you ready to talk now?” In this stage a loving re-direction can look something like, “You had a LOT of anger just now and I think it’s important for us to explore it and try to figure out what might be lying underneath the anger. In the meantime, it is unacceptable for you to speak to me/your brother/your sister/etc. like that. It is also unacceptable for you to use your body in a way that is destructive or hurts someone else. This home needs to feel safe to everyone living in it, and when you behave in that way, it doesn’t feel safe. The consequence in this situation is going to be that…”
The truth is that although Siegel and Bryson’s book is written for parents of younger children, all of our brains work in the same way when we are triggered—even yours and mine! None of us are responsive and open to taking accountability when we are triggered so all of the talking in the world when we are in that state won’t make much difference, AND it is exhausting.
For more on this, visit our dedicated in-depth blog on the topic.
My Depressed Teen Is Engaging in Risky Behaviors?
When teens engage in risky behaviors such as substance use, drinking, sneaking out, chronic lying, self-harm, violent behavior, unsafe sexual practices, or even suicidal ideation, it can be very scary for a parent or caregiver.
The tendency of many parents or caregivers is to wait and observe to see how bad the problem really is before intervening. Unfortunately, in these situations, time is of the essence and risky behaviors that are ignored tend to get riskier. Think of your teen’s risk-taking behaviors as their way of saying to you, “I have emotional needs that are not being met and the build-up of this unmet need is too much for me to handle. I am going to get your attention in a big way so that you’ll be forced to help me.” This is true even of the teens whose verbal and non-verbal communication screams “stay away from me!”
In these situations, seeking support for your teen in the form of research, contacting mental health professionals, asking others in your teen’s life what they are observing is crucial. Seeking support for yourself in the form of taking care of your own emotional and mental needs, reaching out to trusted friends to see if any of them have faced similar issues with their teens, and leaning on loved ones is also crucial.
Additionally, where there is are serious questions around whether or not your teen can keep themselves or others safe, it is sometimes warranted to insist that your teen share their social media accounts and text history with you.
How to Help Your Depressed Teen and Your Family
Supporting a child with depression can be incredibly physically, emotionally, and mentally challenging, but there are important ways to care for both yourself and your family during this time.
Learn About Depression
Understanding depression—how it can manifest, its causes, and its treatments—can help you be more compassionate and proactive. The more you know, the more equipped you’ll be to support your child and manage your own emotions during the process.
Encourage Professional Help
It’s important for your child to see a medical provider or trained mental health provider who specializes in treating depression. Therapy can provide your child with coping skills for depression, a safe space to express themselves, and assist in creating structured support for your child and family.
Open Communication
Let your child know they can talk to you about what they’re going through. Make sure they feel heard without judgment or trying to immediately “fix” the problem. Sometimes, simply listening can provide significant comfort.
Encourage Self-care
Encouraging your team to engage in self-care that they enjoy such as journaling, exercise, hanging out with friends, or even spending five minutes engaging in a personal hobby can help them regulate their emotions less than the impact of depression.
Take Care of Yourself
Caring for someone with depression can be emotionally taxing. Here are ways to ensure you don’t neglect your own well-being:
- Seek Support for Yourself: Don’t hesitate to reach out to a therapist, counselor, or support group to help you cope with the stress and emotions you’re facing.
- Validate Yourself: Supporting a teen with depression is often hard on the entire family. Connecting with others in similar situations can provide validation and understanding. You can also read our letter to parents of depressed teens.
- Practice Your Own Self-Care: Make time for activities that help you recharge, whether it’s exercise, hobbies, time with friends, or simply resting. Taking care of yourself makes it easier to be there for your family.
- Ask for Help: It’s okay to lean on extended family or friends for support, whether it’s to give you a break or to help with other responsibilities. You don’t have to do it all alone.
Be Patient and Understanding
Recovery from depression can take time, and the process might not be linear. There will be good days and bad days. Be patient with your child, your family, and yourself. Small steps forward are still progress, and there may be setbacks along the way.
Stay Connected with School
Stay in touch with teachers and counselors at your child’s school to discuss what they may observe from your child and to ensure they are getting the support they need during school hours.
In short, caring for a child with depression involves providing emotional, physical, and mental support while also ensuring that you and your family have the tools to cope and thrive. Depression is tough, but with the right support, both for your child and for yourself, healing is possible.
Boundaries
Setting boundaries when your teen is depressed is essential not only for their well-being but also for maintaining your own mental and emotional health. Depression can be emotionally draining for both the person experiencing it and those around them.
Here are some healthy boundaries to consider when supporting a depressed teen:
Setting Healthy Boundaries With Your Depressed Teen
Avoid Enabling Unhealthy Coping Mechanisms
While being empathetic is important, it’s also crucial not to enable behavior that worsens depression, like excessive isolation, self-harm, or unhealthy coping mechanisms. Set clear boundaries about what behaviors are not acceptable (e.g., not engaging in self-destructive behaviors) and provide encouragement and/or incentives for children when they are not engaging in self-destructive behaviors.
Limit Harmful Distractions
If your teen is using substances or other distractions (like excessive screen time) to numb their feelings, set limits around these activities. While these may be coping mechanisms, they are not healthy solutions and can make depression worse.
Avoid Being a “Fixer”
Set a boundary in your mind that you don’t have to solve everything for your child. It’s natural to want to make things better, but sometimes the best way to help is by listening, validating their feelings, and supporting them in finding their own solutions.
Set Expectations for Daily Responsibilities
Balance Compassion with Accountability. While it’s important to understand that depression can make it difficult for your child to follow through on responsibilities, it’s also important to maintain reasonable expectations. Work together to set achievable goals (like doing one chore or completing homework), and offer support when they’re struggling to meet them. Don’t forget to celebrate all the small victories to help build their confidence and motivation!
Know When to Seek Outside Help
For a teen, depression can be challenging, especially since depression can manifest in various ways. However, there are key signs that indicate it may be time to involve a mental health professional. Here are some important indicators to watch for:
- If their mood or behaviors are consistently negative, and you notice that they are no longer engaging in activities they once enjoyed for a period of time, it may be time to get help.
- If your child is isolating themselves from family and friends, avoiding activities they once enjoyed, or retreating into solitude, this can be a sign that their depression is worsening.
- If your child is not able to engage in activities of daily living (showering, brushing teeth, personal hygiene, eating, sleeping, etc).
- Increased Substance Use: Children struggling with depression may turn to alcohol, drugs, or other substances to cope with their emotions. If you notice an increase in substance use, or risky behavior such as reckless driving or dangerous actions, it is essential to get help.
- Expressing Thoughts of Death or Suicide: If your child expresses feelings of hopelessness, talks about death, or makes statements like “I wish I were dead” or “You’d be better off without me,” this is a clear warning sign that immediate help is needed. If your child expresses suicidal thoughts or intentions, it’s critical to seek emergency help right away (call a crisis hotline, visit the emergency room, or contact a mental health professional).
- If your teen is engaging in self-harm (cutting, scratching, etc.), this is an urgent sign that they need professional support. Self-harm is often a way of coping with emotional pain, but it signals a deeper mental health issue that needs attention
While it can feel overwhelming, seeking help early can provide your teen with the tools and support they need to manage their depression.
