Why Talk About Depression?

Written By:  JoAnn Kukulus, MFTi, Site Coordinator, ACS On-Campus Counseling Program

Why do we need to talk about teen depression? What do we need to know? What can we do for our adolescent children?

Fewer than 40% of the teens diagnosed with depression get treatment. The numbers are staggering: an estimated 1 in 5 adolescents will experience depression before the age of 19, with around 2 million teens experiencing depression each year.  Research indicates a strong link between depression and suicide; each year approximately 1 in 50 teens makes a suicide attempt that requires medical attention, and suicide is now the 2nd leading cause of death among 15-24 year olds.

Sadly, the stigma associated with mental health issues prevents many young people from talking about what they are truly experiencing, thus discouraging them and/or their families from seeking treatment. On a more hopeful note, early detection and treatment is highly effective for most teens, especially when provided early in the course of the illness. Depression impacts teens in every community and early awareness and intervention can greatly increase the likelihood that teens will recover and lead healthy lives. By allowing and encouraging conversation/discussion around the topic of mental health, and what can threaten it, it may be possible to avert many crises and reduce the occurrence of suicide deaths.  

Boston Children’s Hospital Neighborhood Partnerships Program created a curriculum, “Break Free from Depression” to be used with high school populations, or shared with students/teens, parents, and educators. This curriculum is designed to instruct teens in recognizing the signs of depression in themselves and their peers, demonstrate a variety of strategies for coping with stressful life situations, and empower teens to seek help. The ‘Break Free from Depression’ curriculum recognizes that all “teens face emotional and psychological challenges as they grow to adulthood, although the responses of individual students to these challenges may vary from disabling disorders to transient problems to amazing resilience.” These variances highlight the necessity of early detection, and intervention or treatment when needed. This curriculum itself is not an intervention, nor does it expect educators, parents, or teens themselves to treat depression, but rather is an ongoing approach to help prevent the development of depression, detect signs earlier, and build up students’ strengths. Included in the materials is a powerful documentary depicting real teens talking about their struggles and strategies for managing depression, anxiety, and suicidal thoughts.

Depression occurs as a result of a combination of factors, and these risk factors are counterbalanced by protective factors. A common model for looking at how multiple risk factors interact is the Biopsychosocial Model of Depression – comprised of biological, psychological, and social factors.

• Biological factors include: genetics, which contribute a stronger tendency toward depression if family members also experience depression, chemical imbalance in the brain, and chronic medical issues;
• Psychological factors can include: protective qualities (a positive outlook on life, healthy coping strategies, positive self-esteem) and risk qualities (negative thought patterns, unhealthy coping strategies, poor self-esteem);
• Social factors include: Protective qualities (supportive family, basic needs being met, supportive and long-lasting peer relationships, etc.) and risk qualities (abuse, neglect, trauma, divorce, domestic violence, death/loss, financial difficulties, unsupportive educational relationships, bullying, etc.)

The interaction of all of these factors is unique to each individual as is the combination of risk and protective factors; in general, the greater number of risk factors in a person’s life, the more vulnerable they are to depression.  

What are some of the signs of depression? What behaviors/patterns can parents look for to tip them off that depression might be developing in their child?

Keeping in mind that many of us experience these conditions at some time or other in our lives, depressed individuals often have symptoms lasting for weeks or months and don’t just go away without treatment. 

• Depressed or irritable mood most of the day, nearly every day; in teens it’s anger or irritability, manifested as appearing quick to “snap back” at people/arguing more than usual, that indicates a change in mood
• Decreased interest of pleasure in all or almost all activities; teens may suddenly lose interest in their favorite things or withdraw from activities they have previously enjoyed
• Significant weight loss or gain; a teen may experience loss of appetite, or seek comfort in food
• Sleeping too much or too little; teens may begin with naps after school that then stretch into sleeping all afternoon plus sleeping most of the weekend, or they may have trouble sleeping due to negative thoughts or increased worry
• Agitated, unable to be still, restless; teens may be experiencing negative thoughts that are uncomfortable to sit with, which causes them to feel unsettled or needing to move around to stop thinking
• Fatigue or loss of energy; a teen may exhibit difficulty getting up/ready for school, staying engaged at school, or feeling like they don’t have the energy to do homework or hang out with friends
• Worthlessness, or excessive/inappropriate guilt; teens may feel that they can’t do anything right, that things are their fault or people are blaming them
• Difficulty concentrating or thinking; teen has a great deal of trouble focusing because the depressive thoughts/symptoms are so pervasive
• Recurrent thoughts of death; some teens may turn to suicidal thoughts to eliminate the emotional pain, in which case it’s important to get professional mental health assistance immediately; it’s important to know that not all people with depression become suicidal

If these behaviors are concerning to a parent/other adult, peer, or someone else, the next step is to meet with a mental health professional for evaluation.

Note also that symptoms may appear differently across settings as well. A teen who presents sad and withdrawn in class could behave excessively aggressive or self-critically during sports activities. Depression impacts the way an individual “thinks about themselves and the world around them,” and these thoughts tend to be negative in a debilitating way. Jumping to conclusions and engaging in distorted thinking are ways that negative thoughts impact depressed individuals: “no one likes me,” “I don’t have any friends,” “I’m not smart enough, I’ll never amount to anything,” “everything is my fault,” overly focused on negative feedback and self-judgment. An individual experiencing depression may describe themselves as feeling empty, hollow, broken, damaged.

Is there a difference between depression and stress?

A typical teen may experience several mood swings in a day, ranging from feeling fine when they wake up, to becoming stressed over an unexpected quiz at school, to an elevated mood on seeing friends at lunch, back to feeling stress or worry around homework, and finally ending the day in a pleasant mood while watching a favorite show. These shifts in mood may occur until a stressful event is over or removed.

With depression, the mood remains low and negative – even when stressful events/activities have ended. In other words, stress is caused by an external event and the feeling of stress goes away, but depression lasts for a noticeable or significant length of time, sticking around even when “good” things are happening in a person’s life. Depression can be treated with therapeutic support (individual or group therapy), support from trusted adults, learning healthy coping skills, medication, or sometimes more rigorous inpatient/outpatient treatment plans.

If parents are concerned about their teens, it is important to approach them in a gentle, non- judgmental way to avoid the teen feeling criticized, judged, or dismissed. Reach out to your teen with your full attention, asking encouraging questions that acknowledge and validate your teen’s feelings and will open a conversation for the teen to share their point of view. Work with your teen to problem solve and come to agreement on a plan of action. This may take more than one conversation; let your teen know that you are available for support whenever they need you.

There are many ways that parents can help their teens promote coping skills!

• Help your teen learn relaxation techniques (deep breathing exercises can be helpful), strategies for getting up and organized in the morning, and encourage/model consistent routines.
• Assist your teen in breaking up large tasks into smaller portions.
• Encourage your teen to do their best, and not try to be “perfect.”
• Help your teen develop their ability to create back-up plans and support if their first solution doesn’t work; encourage your teen to think of several people who could be helpful implementing plans.
• Assess and ensure that your teen has a reliable support network (friends, teachers, coaches, siblings, etc.)
• Suggest, and model, scheduling time for healthy relaxation (exercise, play, enjoyable activities) every day.
• Collaborate with your teen to create and maintain structure on typically unstructured days like weekends, holidays, vacations.
• Talk with your teen about their preferred healthy coping skills (exercise, music, writing/ reading, meditation, etc.) and brainstorm how/when to use them.

Reducing the health and wellness risks that result from undiagnosed and untreated depression can be facilitated by informing parents, teens, educators how to recognize the signs and symptoms of depression, and empowering teens to seek and receive treatment. Increasing the community’s knowledge about depression and suicide, developing the community’s confidence in its ability to recognize/identify signs of depression and suicide in individuals and peers, increasing the community’s skills in obtaining help for depressive and suicidal feelings in individuals and peers can serve to destigmatize depression and promote healthy, productive responses to mental health issues.

Read more about the ‘Break Free from Depression’ program here.