How do I know if he’s depressed or if this is just normal teenage behavior?
This mom could no longer tell the difference between teen angst and moodiness and something more serious. She brought her son to my counseling office and asked the question that echoes concerns I’ve heard from parents through the years, both as a therapist and a ministry leader.
Under this mom’s concern is the fear many parents have when it comes to the issue of depression and teenagers: Am I going to miss something crucial in their mental health which could lead to serious consequences?
This is a good instinct, because like many issues related to mental health, there are two really important factors that frequently obscure the true nature of what is going on: First, depression itself can be somewhat tricky to diagnose, not to mention deciding what type of depression is at hand. Second, there are cultural contexts in which talk of depression (like that of anxiety) brings about lots of shame and guilt, often driving those who suffer from it underground in order to avoid any stigma.
Most parents can paint a picture that describe their teenager’s behavior as (though not limited to) moping around the house, spending inordinate amounts of time alone in their room, seeming emotionally short-fused in verbal tone and responses, and generally refusing to engage in family activities. These are some of the things that often stand out when concerns begin to creep up about depression.
The problem, of course, is that most of us can recall times in our adolescent years when we mimicked similar behavior, and we may have not been depressed. I vividly remember a time when I was about 17 years old and my dad sat me down and told me that it felt like they were running a hotel and restaurant for me and that I showed little desire to engage with the rest of the family. Was I depressed? Possibly. But I was also 17 and in the midst of significant transitions in my life surrounding school, identity/relationship/faith formation, not to mention all the changes in brain development. 1
So how do we understand depression at work in the lives of our teenagers?
The Anxiety and Depression Association of America write that:
“Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general. When these feelings last for a short period of time, it may be a case of ‘the blues.’ But when such feelings last for more than two weeks and when the feelings interfere with daily activities such as taking care of family spending time with friends, or going to work or school, it’s likely a major depressive episode." 2
The National Institute of Mental Health (NIMH) reports that “About 11 percent of adolescents have a depressive disorder by age 18" 3 and that in the past it was thought that young people actually couldn’t suffer from true clinical depression. But today we know so much more about depression. The NIMH reports, “We now know that youth who have depression may show signs that are slightly different from the typical adult symptoms of depression. Children who are depressed may complain of feeling sick, refuse to go to school, cling to a parent or caregiver, or worry excessively that a parent may die. Older children and teens may sulk, get into trouble at school, be negative or grouchy, or feel misunderstood." 4
When you look at the research on depression and its symptoms, you will find a list that runs across organizations and resources like the NIMH, ADAA, and the DSM. Some of the symptoms of depression that you might notice in your teenager include:
persistent feeling of being sad or anxious, or describing themselves as feeling “empty”.
a loss of interest in activities that your teenager used to find pleasurable like a particular hobby, sport, or time with friends.
change in eating habits (not eating/overeating) and sleeping habits (inability to sleep/sleeping a lot).
describing themselves in ways that are shaming, as well as talking about feeling worthless and helpless.
decreased level of energy and fatigue, and an inability to concentrate on tasks or make decisions.
change in mood (irritability, irrationality, etc.)
thoughts and talk of suicide.
physical issues such as aches and pain, or digestive issues that don’t seem to go away.
If you are a parent or work with teenagers it can be difficult to determine the difference between “normal” teenage behavior and a teenager who is depressed. Back to my story above, when I was 17 and my dad confronted me about my behavior, was I depressed? I had always excused that phase as some type of adolescent angst, until I began to work more on my own family of origin issues (specifically the death of my mom when I was 11 due to breast cancer) as well as learning more about depression. I’m now convinced I actually was pretty depressed at that stage of my life, but the resources and tools were not available then to help those around me make discerning decisions about what I was going through.
So when you wonder about depression and teenagers, you may find it helpful to ask yourself a couple of questions:
Do the behaviors I am witnessing deviate from the typical and “normal” behaviors of this teenager?
Has there been some recent event that might be related to this change in behavior and mood in this teenager?
Once you can answer these questions, a few follow-ups help the process of discerning what to do next:
Is this behavior some form of depression brought on by the onset of something such as the death of a loved one, a rejection by a close friend, or failing to get onto the team or into the school they had hoped for?
Is this behavior