“Doc, I’m not sure what’s wrong with me. I’m tired a lot. I can’t sleep and when I can sleep I still have no energy when I wake up. I cry easily and I seem to get angry real easily too. I just need some sleep.”

After running through some medical and behavioral causes for her sleeping trouble, I asked her if she thought she might be depressed. Her response was what would I have to be depressed about?

Sometimes depression is not just a symbol for weakness especially in determined and capable teens, but it’s a symbol of crazy. “I’m not crazy” is what I hear a lot. That same strength and determination that can get them through very difficult times is the same weakness that won’t let them realize something like a cause for depression. They experience something that really affected them and it makes them so vulnerable they push it outside of them as in not a part of them. They don’t associate it with them. Hence, the question, “Doc, what would I have to be depressed about?”

The answer is I don’t know. I don’t know what you might be depressed about, but if your teen is exhibiting any of the symptoms I mentioned above and they have no obvious medical or behavioral cause for their issue like sleep, you might want to consider having a therapist ask the question next time. It’s quite possible in a safe place like therapy they might figure out what they could be depressed about.

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Depression is the most common cause of suicide and suicide is the second leading cause of death in teens. Teens who are depressed rarely have the coping skills to realize this, or at least realize the importance of it so what they do is isolate themselves. They stay in their corner and assume no one wants to come in because no one cares. They forget that no one realized they were in the corner to begin with.

Pay attention to a teen that doesn’t want to be around people and doesn’t want to participate in social things like they may have in the past. This is suspicious for poor coping skills like drug use or eating disorders, but it’s also important in your teen who has depression.

Related posts:

1. Teen Depression Isn’t Always Sad
2. 5 Warning Signs of Depression in Your Teen

Being a survivor of a loved one’s suicide can cause feelings of anger and frustration at the helplessness of it all. Your teen may wonder why their loved one didn’t love them enough to stay, or ask them for help. They may even have anger at the loved one’s seemingly selfish act. These questions can create other feelings that there must be someone to blame for this. Who did not do what they were supposed to do to stop this? The questions are endless, but the answers are nil. This is even when there is a suicide note which is less than 40% of the time.

Because teens are impulsive it can be difficult to predict warning signs that they are in enough pain to want to kill themselves. They require 24-hour watch to be certain and at some point you’re going to need to do something that leaves your teen alone. Furthermore, you can’t help someone who doesn’t want to be helped. In this case, they’re not going to let on that something is wrong.  Some things that place people at higher risk include: 

• A history of attempted suicide
• A family history of suicide
• A history of psychiatric or mental health disorders
• behaviors or a diagnosis of a psychiatric or mental health disorder
• A history of drug or substance use

Girls tend to attempt suicide while boys seek more aggressive means like guns.  This is not to say that teen girls don’t complete suicides.  Because these teens want the pain to stop, they can use substances to ensure their commitment to their plan.

For the living, the struggle becomes living without answers in a pain that seems insurmountable.  There may be people who’ll say you’ll get over it and this can never be done.  But, there is hope that your teen can get through the pain:

1. Reassurance

Reassure your teen that their feelings and questions are normal and common.  Let them know that truly suicidal people are focused on their goal and that focus is very powerful. There was nothing to be done without the person’s willingness to have something be done.

2. Counseling

Counseling is a good way to get your teen talking about their feelings rather than keeping them in and having them explode at some point down the road.

3. Talk

Talking about it may make your teen sad, but it’s also one of the only ways to truly feel better.  Ask your teen if they have ever felt so sad they wanted to hurt themselves.  Be direct and let them know you want to know the answer.  Depressed teens isolate themselves and feel alone. This supports their feeling they are alone in this world. Let your teen know this is not true.  The fact that your teen has thought about suicide may scare you, but now that you know you can do something about it.  Let them understand that talking about their loved one helps honor them. Talk about their loved one’s strengths, but don’t be afraid to talk about their weaknesses too.  People are complicated and should be remembered as such.

Resources:

Web:

Share your suicide stories at suicide project

More survivor stories to read and add are at survivors of suicide

Books:

Suicide Survivors Handbook

Hotline:

1.800.273.TALK

1.888.SUICIDE

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1. Your Teen May Consider Suicide (Eminem’s Going Through Changes)
2. Helping Your Teen Find Their Voice

Depression can also be angry. After all, depression is anger turned inward. If you don’t know that deperssion can be anger towards others, you might misinterpret your teen’s outbursts, desire to punch the wall or seemingly punch you. It can look like they are well, angry and anger doesn’t pull sympathy like the depressed teen girl who can’t get out of bed.

Teens who don’t want to seem weak, may choose to hide their depression behind rage. They have outbursts, seem to hate everyone and have no problem starting a fight with anyone who does the slightest misstep towards them. They want someone to do something so they have a reason to be provoked. This doesn’t garner sympathy from teachers, the community or parents.  This can make your teen even angrier.

Angry depression can also be seen with substance use, eating disorders, cutting and other self-injurious behavior. These poor coping skills are so emotionally intense they simply obscure the underlying issue of depression associated with a quieter or calm behavior.

Ways you can help:

1. Recognize the anger

If the anger seems out of proportion to the event, then it might be. This can be hard because in general teens manage their emotions poorly. They are highly sensitive at baseline and easily misinterpret things said by those around them, but consistent anger may give you a clue there is something going on.

2.  Ask

Never underestimate your ability to get your teen talking. An act of kindness and willingness to listen may make your teen feel safe talking to you about what is wrong.  You can gain insight into your teen’s actions so you can help.

3. Counseling

Sometimes you need a reality check and other times you simply need help. Arranging an appointment with a therapist can give you and your teen an objective perspective on their anger and what it may mean.

Whether depression is soft-spoken or angry, it is important to remember that depression is the leading cause of suicide and suicide is the 3rd leading cause of death among teens. Neither presentation should be permitted to exist because you are afraid of one more than the other.  Both teens need your help. 

Resources:

Hotlines:

1.800.SUICIDE

1.800.273.TALK

Websites:

SuicideHotlines.com - helps you find a suicide hotline in your state.

Suicidepreventionlifeline.org - A comprehensive resource on information for prevention as well as survivors.

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1. 5 Warning Signs of Depression in Your Teen
2. Your Teen In Over Their Head
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1. Grades

They are what every parent looks for, but they don’t always know how to interpret them. Since not every teen is destined to earn a high score, average scores can also be a sign your teen is doing well. However, a sudden change in grades or grades that seem to stay low with each grade level is concerning.  A lower grade can mean they have met their academic limit this is common in 2nd or 3rd year in high school. The work does get harder, but for teens in regular classes sudden low grades or a change in grades can mean:

• A learning disability that was not challenged before
• Attention deficit disorder (earlier signs may ave been missed or dismissed)
• Depression or even ongoing sadness called dysthymia
• Home conflict (divorce, family tragedy)
• Recent trauma (sexual, physical or verbal abuse)
• Substance and Alcohol use
• They are unsure about their future and confused about the role of school in that future

2. Illness

A sure way to avoid school is illness sometimes called somatization.  When an illness that seems very real is a mask for emotional problems.  If the doctor is not clever enough to ask how school and the rest of their life is going, this avoidance can be missed entirely.  Sometimes teens will tell a stranger things they won’t tell their parents. The reasons behind the illnesses are:

• Bullying
• Teasing
• Socializing difficulties (no friends)
• Unusual anatomy or delayed puberty (changing in the locker room when you have gynecomastia, breast development in boys or appear very young)

3.  Truancy or missing class

If you can’t get a legitimate excuse, skip.  There are other teens not doing well in class and these teens tend to socialize with each other outside of school.  This is a terrible cycle since teens that skip class are in danger of or have already failed out of school. It can be difficult to motivate someone so behind on class work. It may take a lot of convincing that these teens may not be the best influence to return to school especially since these are their friends, their support, and they understand what they are going through. 

4. Your teen tells you.

If you are in the fortunate position to have your teen tell you what their needs are, “I need an alternative type of schooling,” “I’m really not enjoying school” or “I’m more miserable than I think I should be at school.” Please listen to them. They are frequently correct.  The hard part about this is as a parent you have to let go of your fantasies of what you thought your teen would become AND you have to let go of how you think your teen can get there, to happiness.

School concerns are better dealt with early.  Once you get too far behind it may seem impossible, but even then, things are not what they seem.

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2. 5 Ways School is more than Grades
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Don’t get me wrong. I have read about cutting and I understand where it comes from and what it is and is not, but I also know that it represents something and tells you about who the teen is that is doing the cutting. And that teen who chooses to cut may not be strong enough to shrug off Mom’s absence or Dad’s absence. So, listen to her.

What’s interesting is that if you are paying attention, they need so few dramatics to get your attention. They need only be. Your teen is talking to you, but they are using a different language. I know it can seem like they are sullen and simply sulking all of the time, but it can be hard to get a thought out when there is so much doubt going on in your head.

So, many teens tell me that they like that their parents are involved in their lives. “Sure,” my male patient said, “I don’t always answer audibly, but I like that they have asked.” What better feedback can you get? My patient’s mom works a lot and I understand that, but this child needs something. This child needs her. Will anything need you that much and make you feel that valued and appreciated even as they seemingly push you away?

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Teens are concrete thinkers initially and at some point they switch to abstract thinkers. Thank Goodness because concrete thinkers have no ability to think of how their current actions can have an effect on the future. Abstract thinkers do. One question that I ask when my patient has attempted suicide is, “What was your intention with this attempt? Were you hoping to die?” Believe it or not sometimes they aren’t. The finality of death hits them soon after the attempt and they realize that they just wanted the pain to stop.

This pain can be paralyzing. It does not allow grades to stay up, or homework to be done. They are a different kid. Boys who may think that depression is too “girly” may get angry and lash out or get into fights. Depression can affect their lives in so many ways that they ultimately stop maturing. These teens become stuck in this stage of adolescence. When they finally come out of it, they pick up where they left off emotionally and this can leave a teen who should be heading off to college sitting on the couch unable to do anything. The price is simply too high to ignore the warning signs. Almost all teens give warning signs. Their survivors talk about them.

1. Change in grades

2. Keeping to themselves and not wanting to hang out with friends or family.

3. Giving things away or losing interest in things that once made them happy.

4. A change in eating or sleeping behavior.

5. Some teens will actually say that they want to die or they just don’t want to live.

The best treatment we have for depression is therapy and/or medication. They work very well together, but the therapy is very important. Therapy does not mean that you are crazy and I know this is what teens are afraid of when I mention it. Therapy is a great place to develop coping skills to handle the feelings before the feelings take control over you. Taking the medication does not meant that you will be on it forever, but it does mean that you need a boost right now to get you started on the road to recovery. Treating depression also involves treating family and friends. Teens may communicate how sad they are to friends. Not wanting to be disloyal, friends may keep information to themselves thinking that their friend would never do that. So treatment includes:

1. Be sure everyone in contact with the depressed teen agrees that any thoughts of the teen wanting to hurt themselves will prompt a 911 call.

2. Since contracts have not been shown to work, attempts will be handled by scheduling a visit with the therapist and if needed admitting the teen to a hospital for a mental health hold.

3. An appointment with your medical doctor is important because there are other illnesses that cause or look like depression.

Depression is the leading cause of suicide. Suicide is the third leading cause of death among teens. Although we do not need to be paranoid, we owe it to our teens to pay attention in the event that they need our help.

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It seemed like when birth control and the Sixties Love Fest began people were thinking, “What about the children?” And when this topic first came up, I immediately wondered,”what it would do for the gay teens and their parents that I see in my clinic to know that they could get married?” You see, this populations of teens, gay teens, are in the difficult position of having to pretend they are something else, heterosexual, in order to make others more comfortable. No parent gives birth thinking their child might be Gay and even if they are understanding and open minded, they may make negative comments about gays.

Teens are smart and they know the expectations of their parents and their community. The discomfort of pretending to be what your parents want and not what you are has caused stress in this teen population like depression, substance use, school failure and drop out, and suicide. Among non-gay teens suicide is the third leading cause of death, this number has been higher in gay teens. Gay teens have a higher chance of being bullied or teased in school, they are more at risk of abuse in their homes and they have a higher chance of dropping out of school because, who wants to attend school when you are picked on and beat up every day.

There are opinions about what marriage should be and what the image on the cake should look like, but if you consider that when gay teens are in a home and school where they are supported, loved and given appropriate discipline, they end up being like every other teen they attend school with, normal.

Parents who discover their teen is gay mourn what they thought their teen would have a family, a career, and no safety concerns. However, if more states pass the same-sex marriage law, joining the ranks of Iowa, Maine and New Hampshire, parents are going to mourn less and realize that they can still dream about their teen’s wedding and family that they will have one day. These parents and the community will realize that when gay teens feel supported and loved you end up with, well, normal.

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