This episode discusses depression and suicide – listen with care. If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.

“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Stephen Fry English Actor, comedian writer – who struggles with bipolar depression

If you’ve never experienced true depression, count your blessings because it’s a deep dark empty feeling. It’s certainly no feeling a parent wants for their child. And unfortunately, too many teens are in the middle of that darkness and don’t know how they’re going to ever emerge. We discussed the signs and symptoms of adolescent depression in episode 51, you may want to go back to that episode and have a listen before coming back here.

If your teen exhibits more than a couple of those symptoms from episode 51, TITLE for a couple of weeks, or even just one symptom that’s really worrisome, you can’t sit around hoping they’ll just get better on their own. You have to make the first move to help them. Trust your gut – if they seem depressed, they’re likely depressed – they need your support now and they need you to make sure they get the kind of help they need.

This week on Speaking of Teens, I’m talking to you about what you can do to support your teen who’s experiencing depression.

First of all, the most important point I want to make today is that when your teen is experiencing depression, they need your empathy. If you’re not empathetic, if you don’t understand what they’re going through, can’t see if from their point of view and take it seriously, you’re not going to be able to help and things can escalate out of control quickly. You need to understand that depression is serious. It’s not just a matter of them “feeling down”, it’s not something they chose for themselves. Again, go back and listen to episode 51 about the myths and signs and symptoms.

So, as their parent and the person who can get them the help they need, you have to start from a place of empathy – And this can be really difficult, especially if they’re acting out in anger, being less than loving to you, causing disruption in the household, using alcohol or drugs to self-medicate, refusing to accept help. It’s easy to feel that they don’t really want to get better - that they’re not trying to get better, that they’d rather just stay stuck.

But just know – trust this - they do not want to feel this way. They want to feel better, but they just don’t know how, and they may not know how to show it or tell you they want to be better.

And you just can’t go in guns a blazin’ and tell them how! That’s just going to make things worse.

You have to remember that you’re the adult here. You have a full-grown brain and they don’t. This is your baby and they’re hurting and struggling to hold it together. They don’t understand what’s going on in their mind. And they don’t think you or anyone else could possibly understand. They likely feel all alone in this and don’t think they’ll ever feel any better. It’s a horrible, horrible feeling. It’s so scary for them. Keep reminding yourself that it’s absolutely not their fault they feel this way, it’s not a character flaw, they’re not weak or crazy and they can’t just snap out of it or cheer up.

Remind yourself of that constantly. Tell yourself that it’s up to you to get them the help they need and to get them to accept that help. Without you right now, they likely won’t get better.

First, you’re going to need to talk to them about what’s going on and it’s super important that you approach this the right way or you’ll shut down communication before it starts.

• But a word of caution – you’re going to need to manage your own emotions. I know how hard it is not to be sad that your teen’s struggling. How hard it is not to get right in there with them, if you have that tendency. But, that’s not going to help your teen or you, or the rest of the family. Remember, you have to be there for them and if you fall apart, you can’t help them. So, make sure you can keep it together before talking to them.

 

• Start by telling them what you’ve noticed –
  • Actually, this technique that you can use with any behavior that troubles you about your teen - you simply describe to them the exact behavior you’ve noticed (“I’ve noticed you’ve been staying at home a lot lately”, “I’ve noticed you’re having a really hard time sleeping lately”, or “I’ve noticed you’ve seemed really sad lately.”
• And follow that statement up with, “do you want to tell me what’s going on?” Be gentle and compassionate and show with your tone and expression that you care – that you’re not upset with them or scolding them. A hand on their shoulder or back will provide a little oxytocin to their brain and let them feel that connection in that moment.
• You’re not drawing attention to the negative here or making things worse by getting them to open up and talk. A lot of people feel that just ignoring their mood will help them get over it. That’s the opposite of true. They need someone to listen and hear them out. They need to feel someone is interested in how they feel and takes them seriously and wants to understand.
• Hopefully, they’ll open up a little bit and tell you why they’re having such a hard time. But they may be unable to articulate it – they may not even know or understand it themselves. Sit there with them and see if they can come up with the words. Don’t push them or press them with more questions at this point. Don’t jump in with suggestions on how to “fix it”. If they need to just cry, hold them while they cry and assure them you’re going to get them the help they need.
• If they do open up and give you some insight on what’s going on or what may have triggered their depression, listen attentively, don’t interrupt, show them you’re interested in every word. If your instinct is to think what they’re saying is silly or overblown or dramatic, don’t dare show that. It’s obviously serious to them – enough so that they’re in this state, and that’s all that matters. You can reflect what you hear them say - you can summarize it but be sure to use some of their own words. For example, “I get it. You feel sort of lost and unattached to anyone right now and like everything’s lost its color.”
• You may have the urge to tell them you’ve felt this way before or you went through something similar at their age – that’s probably not going to be very helpful and may even agitate them. In their mind, what they’re going through is different than what anyone else has ever felt – certainly different from anything you’ve ever felt.
• But do validate their feelings – Let them know you understand they’re in pain, that they feel deep sadness. Don’t try to cheer them up, don’t tell them it’s not as bad as they think, tell them not to worry or that all kids go through this, make light of it or tell them they just need to do XYZ and they’ll feel better. They don’t want to hear that and it won’t help at all. Saying anything like that will make them feel that you’re not taking them seriously, that you don’t believe that this is a real problem for them. It will make them feel like you think they’re just being silly or exaggerating things - they’ll feel totally “invalidated”– just the opposite of what they need from you right now. You want them to trust that they can tell you these things – that they see you as their ally – on their side. Think about how you would want someone talking to you in a moment like this.
• Do tell them what is concerning you about what you see by using “I statements” (“I worry that… “I’m concerned that…”.) Make sure to talk to them in a loving and non-judgmental way, without lecturing, criticizing, or blaming them. They already feel horrible, and this would just make it worse. You might say something like, “I just hate seeing you so down and not spending time with friends.” Or “I’m just really worried about you spending so much time alone.”
• But that’s where it ends – this isn’t a lecture. You’re telling them your concerns – not what you think they should do about it and certainly not what you think they’ve done to cause (“if you just wouldn’t spend so much time on social media”). They don’t need to feel judged or shamed or criticized.

Whether they will talk to you or not, it’s time to get them professional help. Adolescent depression is not something you can take care of on your own. If it’s gone on for a couple of weeks and it’s interfering with any aspect of their daily life, seek help as soon as possible. You can call your pediatrician and make an appointment and also ask for a recommendation to a child and adolescent therapist. Because it takes weeks to get in to see a therapist, I would go ahead and make that appointment. You can always cancel if it turns out that you don’t need it.

In the meantime, visit your pediatrician and let them conduct a depression screening (a simple questionnaire). Your pediatrician may suggest they don’t yet need a therapist and that you just need to support them (as I suggest in this episode) and monitor them closely. They may suggest that if they don’t improve or if they get worse, that you seek help from a therapist and perhaps from medication. Luckily, you will have already made an appointment.

You might rather have your child evaluated by an adolescent psychologist or psychiatrist – but those folks are really hard to come by these days and can take months and months to get in to see. Listen to episode 7 of the podcast to learn about what these different mental healthcare professionals do.

The important thing is to get in to see someone as soon as possible to start the ball rolling. If gone untreated, adolescent depression can lead to all sorts of other issues like substance abuse, self-harm and even suicide. Do not delay getting help.

And if your child makes any type of suicide threat, take it seriously and get them help immediately via your hospital’s emergency room. If they won’t go, call 911, tell them what’s going on and ask for assistance. You should take every hint of suicidal ideation or threats seriously. Again, listen to episode 7.

I also have the American Academy of Child & Adolescent Psychiatry’s Parent’s Medication Guide that you can download directly from the show notes. It’s a very good comprehensive guide on adolescent depression and suicide risk as well.

But I do always recommend that you get information from a variety of reputable sources. I’ll have a list in the show notes.

Now, what if your teen refuses to go to a therapist?

Therapy can’t work without a willing participant and often, teens simply aren’t willing.

They may not think they need any help, they may think it’s just the way they are and that there’s no way they can change. Maybe they’ve been in therapy before and didn’t feel like it worked, or they just have no hope that it will work for them, they don’t believe in antidepressants, they’re just too embarrassed, think it makes them look weak or weird, or they just think it’s too uncomfortable to sit and talk to a total stranger about their problems.

You need to understand why they don’t want to go before you can really address it with them. With teens it’s super important that you support their autonomy (their need to have a say in their own life) unless you want to cause conflict and damage to your relationship. Threatening or trying to force them to go isn’t going to do much good since, again, they need to participate in the therapy willingly for it to help.

So, in this situation you might say to your teen, “Tell me what you think about going to see a therapist to help you with how you’re feeling right now.” Listen to everything they say without interrupting them. Reflect what they say.

Next, address the issues they brought up if they’re things they misunderstand about therapy. And tell them why you think it’s important they go (you want them to get better, etc., you know that therapy can help with depression, it’s shown to work with adolescents)

Ask them if they’ll brainstorm some ideas with you to see if you can work out something out. Let them throw out an idea first. Maybe they’ll just want to choose when to go or who to see – which they should be allowed to do anyway. Maybe they’ll want to go out of town so no one will see them or want you to promise not to tell anyone – even teachers and friends (despite your telling them there’s no stigma is seeking treatment). Just see if you can agree on something to get them through the door.

Something else you can try and suggesting that the whole family go to counseling. Speak to a counselor in advance and tell them the issue and see if you could all go in together at first and then they could talk to your teen separately and each of the other kids as well. But maybe they just spend more time with your teen. Sometimes, if someone feels singled out for therapy, knowing the whole family is going could help.

You can also approach it by asking your teen if there’s anything about their life right now they’d like to change. Maybe they’d like to be able to listen in class better or make more friends or have a boyfriend. These are issues that could be discussed in therapy in the context of the depression. Again, if you can just get them in the door, the therapist can take it from there. And if they don’t mesh, you try another therapist.

Something else you can do is make an appointment with the therapist yourself and get their input into how to get your teen in there the first time. Many times, after the initial session, they won’t have a problem going back.

So, what does your kid need from you while you’re waiting to get in to the a doctor or therapist or while they are under active monitoring by their pediatrician?

The most important thing they need, at the beginning and throughout their recovery, is to know to their core that you’re there to support them unconditionally, that you’re not angry with them for feeling and acting the way they are, that you’re not disappointed in them or ashamed of their behavior or think they’re overreacting. They may feel a lot of guilt or confusion about why they feel the way they feel. They may think no one else in the world feels this way. They may think they’re going crazy. Put their mind at east that you’re there to help them through it and will find the help they need.

What else can you do that may really help them?

Let them know depression is not their fault – make sure they understand that depression can be genetic, environmental (due to their experiences and they way their brain has interpreted them – let them know it’s like any other issue that you’d get them help for – a broken leg or a kidney stone or migraine headaches. Let them know they’re not “broken” but they need help for this issue just as they would these others.

Encourage socialization – do what you can (without scolding or fussing at them or making them feel judges or criticized) to get them hanging out of the house and with friends again. But here’s the thing you need to understand. When you’re depressed, often being around friends – people who are happy and having a good time, makes you feel really crappy. You look around at everyone else having a good time and you think, “why can’t I just feel that way” and it makes you even more sad. Perhaps having one friend over to your house so they feel comfortable in their own surroundings and can relate to one friend without feeling isolated among a group. This is a delicate dance. If they try it either way and end up feeling worse, respect that’s not going to work right now and just get them into see a therapist as soon as possible.

But if hanging out with friends doesn’t work, you can always try to get them out of the house just to go hang out with you. Take walks, go for drives, run get their favorite treat together. But don’t be pushy about it. Instead of saying something like, “you’ve been in your room all day, come with me and let’s go get lunch” you could say something like, “I’m craving a giant salad for lunch, want to join me?”

You may feel like you’re not doing enough this way, but it IS enough – anything more will pit you against them and make it more of a tug of war. You don’t want that.

Remember the “magic ratio” and the emotional bank account – research shows that to maintain a stable, loving marital relationship, you need 5 positive interactions with your spouse to every one negative. Experts believe this applies to all relationships including that with your teen. However, the teen brain tends to accentuate the negative – even interprets neutral expressions, statements, tone as negative (especially when it’s mom talking). So, unfortunately, it appears that balancing out the negative with your teen requires a bit more doing. Dr. John Duffy talks about this in terms of the emotional bank account. Negative interactions are withdrawals and positive are deposits and the positives have to outweigh the negatives for you to have a positive emotional bank account with your teen. It may be that 8, 10 or more positive interactions are needed for every single negative encounter you have with your teen, depending on just how big that negative is. Every reminder (nagging as your kid sees it), every time you scold them, say anything they interpret as critical or negative in any way, requires a ton of positives to get you back in the black in that account. This is multiplied ten-fold when your teen is showing signs of depression. When they’re depressed, reminding them to do their homework, clean their room, go outside, get off the game, call a friend, even take a shower, can come across as nagging and negative. You have to consider only what is truly crucial at this point – is their room really that big of a deal in the grand scheme of things right now? Your kid’s in pain. They’re struggling to feel human right now. Put things in perspective and cut them a TON of slack. Their mental health is the top priority right now.

You should concentrate as much as possible on whatever you can find that’s positive about their very existence. If they got their homework done tonight – let them know you recognize that and know it wasn’t easy for them. Did they take out the garbage (and yes, they’re supposed to but – yay, they did it. Thank them). Did they run an errand for you? Give them a hug and tell them how much you appreciate it. But now, don’t start gushing about things you’ve been wanting them to do – that’s the quickest way to ensure they don’t do it again. Be careful – you know your kid. Think.

Just remember your tone and how you word things with them. Being demanding, raising your voice, making unilateral decisions is never a good way to parent a teen, but especially when they’re experiencing the pain of depression, choose your words carefully and watch your tone. Remember to respect their autonomy, discuss, negotiate, hear them out on anything that concerns them.

And I know how hard it can be to not get into arguments with your teen when they’re depressed. Depression can cause them to act out in anger, to use substances, to get in trouble at school. It’s hard to look beyond that outward behavior and see the pain they’re in.

But just keep reminding yourself that what you see on the outside is not necessarily reflective of what they’re feeling on the inside. Channel that empathy for them, remind yourself daily that they do not mean to act this way. They want to feel better! That leads me to the next issue

We mentioned this in episode 51 – don’t punish them for acting out. If they could act better right now, they would. The fact is, they don’t have the capacity to do better. They don’t want to feel this way. They don’t want to act this way. They’re brain is not finished yet so it’s really hard for them to use self-control. And while their emotions are so dysregulated during depression and they are so confused about how they’re feeling, punishment, which is never good for any teen, is going to only make matters worse. Consequences can be used if appropriate but just be careful. Please go back and listen to episodes 15, 16 and 22.

Make time to talk and connect with them daily – talking about how they’re feeling is not going to make matters worse. Giving them the opportunity to share how their day went or what things made them feel bad or upset them, will help them process those feelings. Not talking about it will not make it go away. They need to feel you care so check in with them daily. Avoid the generic, “how was your day?” or “how was school today?”. Ask them to tell you how they felt sitting in the classroom today. How was walking through the halls. Ask them how they felt at lunch –

did they feel up to talking to anyone? A ride in the car is always good for a chat like this, or a walk around the block, anything you can do to take the pressure off of them making eye contact.

The social media issue I think can cut both ways. If you know that their use of social media is making their depression worse, then talk to them about the specifics. Maybe there are accounts they shouldn’t follow for a while or maybe they can turn notifications off during certain times of the day or night.

But on the other hand, social media may be keeping them in touch with friends that they just don’t feel they can be around in person right now. It’s important to get them back out there with friends but if they simply refuse, limiting their time with friends on social could make matters worse. This is something you’ll need to discuss with them and with their counselor or therapist once they get involved.

Here are a few more very generic suggestions that could work with a kid who is just feeling really down and could work with a teen experiencing depression, but I know from my own experience that once your child is in the depths of depression, it’s really hard to get them interested in much of anything. But it never hurts to try. Also, I’ve heard therapists say that in some situations, offering a bribe may not be such a bad thing. When you’re talking about your child’s mental health, promising them a new game or hoodie to get them to try something a couple of times, especially if it ends up helping, that can’t be a bad thing.

See if you can involve them in new activities. Sometimes trying something new, being around new people could be what it takes to let them see things can feel different. They could pick a new hobby or do something they’ve always been interested in but never tried. Maybe there’s something you could do as a family.  that they’re interested in –

Helping someone else is usually great for feeling better about your own life too. I’ve seen family members do a complete 180 once they started volunteering. So, this is something to really consider. Again, you could do volunteer work as a family. Be sure and ask first, don’t just go sign them up for something without discussing it and giving them options of different things they could do.

Exercise has been shown to help with depression if you can get them going. Maybe a gym membership or again, something they’ve never tried before, like rock climbing, tennis or hip-hop dance classes. It could be anything as long as they’re moving. And bonus points if they’re out there meeting new people.

And these 2 things seem so basic, but it can’t be overstated how important, diet and sleep are. Eating processed foods and refined sugars can really mess with their energy and their mood. Try to focus on healthy meals even more.

Making sure they have some protein in the morning and get some fresh fruits and vegetables if possible, it can really make a difference. And sleep is actually a huge issue. It can be really difficult to go to sleep when your depressed. The thoughts all start sneaking in at night. Even turning the light out can be depressing. Be aware of this and talk to them. Maybe they could benefit from a mindfulness app like Calm – a little brown noise or nature sounds, even a guided sleep meditation. And you can actually learn how to talk them to sleep with a guided meditation. I used to help my son this way. If you’ll download my free guide called Emotional Awareness Strategies (right, there in the description where you’re listening) there are some good resources for you that can help. Do whatever you can do to help them get between 9 and 10 hours of sleep a night if at all possible.

I have all sorts of information on teen sleep in the free guide right there in your description called “Why Doesn’t My Teen Sleep”

Always be there with your support – Make sure they feel your love every single day. They to hear it, and they need to feel it - hugs and kisses in abundance. If they’re not open to that, even a pat on the back or a touch on the shoulder can convey that you care.

Remember to be patient and understanding – they’re not depressed on purpose – they’re suffering and in pain and don’t think they’ll ever feel better. So be patient with them. Work on your emotional awareness and regulation. Exploding at them will only make things worse. Tell them you’re not going anywhere, that you plan to get them through this.

Know that no one’s mental health recovery is the same so don’t compare them to anyone else. Setbacks are normal and no one’s fault. Just keep moving forward. You may need to switch therapists if the just don’t click for them or change medications if the first doesn’t help. This is just part of the process. Do not get discouraged.

Stay on top of treatment – Make sure your teen makes all appointments, takes medication as recommended and follows any other instructions issued by their provider. Teens are still not good at this, so you have to help. And especially with medication, even taking it a few hours past the time they were supposed to take it, can give them some odd or uncomfortable side effects.

Give them plenty of hope. When someone is in the middle of depression, it seems impossible to imagine they’ll ever feel better again. Talk to them about that. Let them know it won’t last forever and that you’re going to make sure of it. Tell them it may not happen over night but that it will absolutely happen and that they can look forward to that.

Don’t forget to take care of yourself – You can’t help them if you’re falling apart yourself. See your friends, go out, go run, go to your yoga class, if nothing else go sit at Starbucks for a few minutes. You have to stay mentally and physically healthy to help keep your kids stay healthy. Put that oxygen mask on first. If you’re having a hard time, ask friends and family to pitch in. With multiple kids, you may need help with activities or even meals. Your friends want to help you and may not know what to say – so let them help the way they know how.

Make sure the other kids know what’s going on in terms they can understand. If you have younger kids, there’s no reason to try and hide anything from them. They can see something’s up and they may end up more worried if you try to act like it’s something they should be shielded from. They don’t. They need to know the truth. Explain what’s going on as clearly and as honestly as you can. They may actually be able to help. If you’re not spread too thin, see if you can spend a little time with the other kids one-on-one each week so they don’t feel ignored. If things start to be too stressful on you or any member of the family, family counseling or individual counseling might be warranted.

Watch it and don’t let blame sneak in. It can be easy for us to blame ourselves or our spouse or mother-in-law or the kids down the street for what’s going on with our teen. Be careful about that. Depression is multi-faceted and likely not one person’s fault except in cases of abuse or neglect. Especially when it comes to your spouse, ex-spouse, co-parent, you two need to be on the same page right now. You need to help each other through it rather than being at each other’s throats. Blame will not help your kid get better.

Now, here’s what you need to take away from this episode:

If your teen exhibits more than a couple of those signs and symptoms from episode 51 for two weeks or more, you need to have a discussion with them if you haven’t already. Let them know you’re there for them.

And get them in to at least see their pediatrician and get a recommendation for a child and adolescent therapist. Keep an open mind about the possibility of medication, (which I also discussed in detail in episode 51).

Your kid needs all the love, patience, empathy, and support you can muster right now.

They don’t want to feel this way, they’re not acting like this on purpose, they may have lost hope that they can feel better and they need to know you’re not giving up until they do.

Thank you so much for being here and listening to the show – it means the world to me.

Go to neurogility.com/53 for links to all the resources mentioned in the episode along with a transcript.

If you know of another mom who’s teen may be struggling with depression, please share this episode with her.

And stay tuned for the announcement that the Facebook group is ready – I need to get a few things ready and organized first - but I’m looking so forward to meeting you and doing Facebook lives and so much more.

Speaking of Teens is sponsored by neurogility.com, where I help moms build stronger relationships and decrease conflict with their teens.

Our producer and editor is Steve Coleman, researched, written and hosted by me, Ann Coleman.

Until next time – go hug your teenager.