Depression

Brandon came through the door after school with a sad look on his face— again. His mom, Andrea, had noticed that lately he seemed to be down more than up, and he’d also mentioned something about not sleeping very well. At the dinner table, he picked at his food and seemed irritable. Andrea was concerned because she knew the signs of depression.

“What’s going on?” she asked him when they sat down to talk about his low mood.

“I don’t know,” Brandon said. “I just feel bad all the time. Even doing nice things for my friends doesn’t make me feel good anymore.”

Andrea decided to take him to the doctor—right away.

When the doctor asked Brandon if he ever thought about suicide, Andrea was shocked when her son said yes.

Then the doctor asked Brandon if had a suicide plan. And Andrea was even more shocked by Brandon’s answer: “Yes, I was going to use the guns at my friend’s house.”

***

Depression is by far the most common mental and emotional health problem in the western world today. As a matter of fact, it can be compared with the common cold in terms of the frequency with which it occurs in the general population. And it’s much more common in teenagers then we’d like to think. For obvious reasons, depression among young people carries with it a heightened risk of suicidal thoughts. This is clearly a serious issue for us as parents who have preteens, teens, or young adults. Maybe you already know enough about depression, but for those who don’t, it’s worth a closer look at the connection between depression and suicide.

Varieties of Depression

Let’s begin with a basic definition:

Clinical depression (also known as major depression or major depressive disorder) is usually accompanied by several of these identifiable signs that persist for at least two weeks:

• Persistent low mood or sadness
• Fatigue or low energy levels
• Feelings of dejection, despondency, apathy, and hopelessness
• Lack of energy
• Trouble sleeping, or sleeping a lot more than usual
• Significant weight loss or weight gain
• Loss of interest in work, recreational activities, interests
• Neglect of personal hygiene
• Cognitive abilities are slowed or difficult
• Anger
• Inability to function in normal tasks
• Suicidal thoughts

Subcategories of clinical depression can be grouped under two major headings: the situational or environmental and the organic or biological.

Situational or environmental depression, which may also be diagnosed as adjustment disorder with depressive features, is a type of major depression that can be brought on by experiencing the breakup of your family; the loss of a parent, family member, or close friend; witnessing a shooting at school; the breakup with a boyfriend or girlfriend; or surviving a natural disaster. Any major circumstance can bring on depression. The symptoms of this type of depression may be fewer, less intense, and the recovery time may also be shorter (usually six months or less). This type of depression often goes unnoticed because your child is still able to function—at least at some level—and can get lost in all the changes happening because of the circumstance.

Organically or biologically generated depression is major depression associated with brain and body chemistry and may be genetically transmitted, although that’s not always the case. If your teenager is suffering from clinical depression, she will usually experience many of the symptoms listed in the definition and will likely experience them with a high degree of intensity. As a result, the condition generally has a significant impact on her ability to function in everyday life; hence the term dys (meaning not function). Recovery may take a year or longer.

This type of depression can be further subdivided as unipolar depression or biopolar disorder. Unipolar depression is characterized by persistent and recurring episodes of extreme low mood; think down mood only. If a normal person’s emotional state fits this pattern . . .

. . . then the emotional-state pattern of a person suffering from unipolar clinical depression would look something like this:

Bipolar disorder is a lifelong, chronic condition characterized by extreme mood swings or episodes of depression and mania that often lead to impulsive and risky behaviors; think down and up both. Bipolar disorder might be diagrammed as follows:

Bipolar is further subdivided and can look the exact opposite of the diagram above as well—mostly above the normal with an occasional below-the-normal spike. The general idea is there’s both down and up in some configuration and duration.

That’s a very brief overview of what depression is. It’s also important to know what it’s not. Being seriously depressed is not the same thing as your teenager being moody.

Normal Adolescent Behavior

The Herberts took their seventeen-year-old daughter, Kathrine, to see Terri, a Licensed Clinical Social Worker who specialized in working with teens and depression.

“She’s sleeping way too much, isn’t eating, isn’t interested in things she always enjoys doing, and is sad and lethargic all the time,” the parents told Terri. “There’s a history of depression on both sides of the family, and we’re worried that Kathrine may be depressed.”

After the initial interview, Terri asked the Herberts when Kathrine had last had a medical checkup. She encouraged them to make an appointment with her primary care physician to make sure nothing medically was going on with her.

After the doctor appointment, Kathrine’s mom left a voice mail for Terri. With relief in her voice, the mom said, “Kathrine isn’t clinically depressed; she has mononucleosis.”

***

There can be any number of issues that at first glance have similar symptoms to that of clinical depression. It was Terri’s professional training and years of experience that kept her from jumping to a hasty conclusion and helped her steer the Herberts in the direction of their physician. The Herberts did the right thing by noticing Kathrine’s symptoms. But especially with teenagers, it’s not always easy for us to notice what’s normal behavior and what’s not.

Here’s at least a starter list of what’s normal (whether you call it moody or stressed, it’s all within the normal range of behavior). Comparing these behaviors to the signs of depression on page 118 can give you a basic understanding of the difference between normal and abnormal.

Normal

• A day or even several days of feeling down, especially when coupled with a significant event (things your child would consider big deals)
• Typical teenage irritability (annoyed by parents, siblings, schoolwork, etc.)
• Prioritizing activities in a healthy manner, even if that means dropping out of some of them
• Skipping periodic meals or occasional overeating
• Naps several days of the week, staying up later than is beneficial (and still able to function normally)
• Occasional “off” days, restless after sitting in classes all day, overwhelmed by big decisions
• Some sleepiness, lack of energy, especially if not getting enough sleep
• Expressed frustrations, questioning self-worth (especially after a big-deal event)
• Questions about death or the meaning of life

Risks and Contributing Factors

How does a person become depressed? Remember, in some cases the sources of the condition are situational. In others, the sources are rooted in biology and genetics. Here are a few of the more common causes of a depressive episode:

1. Stress. Pressure to perform in school, neurotic tendencies, worries about money or anxieties about the future or the well-being of friends— all of these can become burdens that weigh the mind down and drive it into a depressed state.
2. Transition or change. A major move, a change in job or school, or the readjustment that follows the death of a family member all have the potential to trigger a depressive episode.
3. Social conflict. This might include painful arguments with a family member or coach, a falling out with a friend, being bullied, being left out at school, or a breakup with a boyfriend or girlfriend.
4. Unstable environment. Depression can also arise in response to turmoil in the home, strained family dynamics, and any of those difficult circumstances that are called adverse childhood experiences. (For more on this topic, see pages 14–20.)
5. Identity struggle. In addition to an unstable external environment, kids—and teens especially—can struggle internally with their sense of identity. For some kids, sorting out who they are can generate a whole lot of stress and anxiety. This is especially true for more enduring areas of concern, such as body image, sexuality, and friend groups.
6. Genetics. The neurochemical factors contributing to organic depression can be passed on from one generation to the next. If you or a first-degree relative suffer from clinical depression, your children’s chances of developing the condition are two to four times higher than the average.
7. Mental illness. Other forms of mental illness, such as severe anxiety, obsessive-compulsive disorder, eating disorders, substance abuse, schizophrenia, and psychosis can either cause depression or occur in conjunction with it.
8. Medical or physiological issues. Depression has also been linked to a wide variety of medical conditions, such as diabetes, heart disease, hypoglycemia, hypothyroidism, hypertension, mononucleosis, multiple sclerosis, arthritis, chronic pain, and kidney disease—just to name a few.

How Does Depression Lead to Suicide?

The precise relation between depression and suicide isn’t always easy to determine. Though the link may seem obvious on the surface, depressed people don’t always take their own lives. How exactly do the dots get connected between feelings of depression and serious suicidal thoughts? Here are some of the key factors:

1. Catastrophizing. A depressed person has a strong proclivity for making mountains out of molehills. He dwells on negative thoughts, views the slightest problem as a potential disaster, and finds reasons to abandon hope in the smallest details of life. The heavier this burden of fear and anxiety becomes, the greater is his inclination to escape by putting an end to it all.
2. Isolation. Depressed people tend to withdraw. When your daughter is left alone with her own morbid thoughts, she loses the capacity to think about anything but her own misery. Eventually her outlook narrows to the point where she can no longer imagine how a self-harming or self-destructive act on her part might impact the feelings of others.
3. Lowered resistance to negative input. People in groups—especially young people—have the tendency to encourage one another to take greater risks. There’s no denying that adolescent suicide is on the rise, and the idea that everybody’s doing it can play a significant role in motivating depressed teens to entertain suicidal thoughts.
4. Altered perception. When you’re down, the world looks different. You see everything through the lens of your own self-loathing. It becomes easy to perceive hostility and rejection at every turn. The idea that “Nobody loves me, and everybody hates me” is common in suicidal thinking.
5. Psychosis. When pushed to the limit, altered perception can precipitate a complete break with reality. This state of mind is what psychologists and psychiatrists refer to as psychosis. Once an individual crosses that line, there’s no telling what he might do.

Action Steps

If you see signs that your child may be sliding into serious depression, try the following strategies:

Connect with your child. Be empathetic and compassionately curious about what’s going on in her life. Ask open-ended questions designed to draw her out, such as, “How would you describe your feelings about school these days?” Encourage her to develop her natural gifts and passions. Be an active listener.

Contact other adults in your child’s life. Check in with teachers, coaches, school counselors, youth pastors, or leaders to see if they’ve observed anything unusual in his behavior or attitudes.

Get a medical evaluation. Make an appointment with your doctor as soon as possible to rule out potential medical and physiological factors.

Locate a therapist. Engage the services of a licensed professional Christian counselor, preferably one who specializes in working with adolescents. You may also want to look into the possibility of getting involved with some form of group therapy or a peer support program.

Examine yourself. Take a close look at your family history, acknowledge any personal issues that you’ve had with depression, and discuss these matters openly with your child. This will help to normalize his feelings. Any family history of depression is vital information to relay to the medical doctor and therapist.

Be directive. Don’t allow your teen to minimize the situation. If she doesn’t want to see a counselor, find out why. Provide options by saying, “You can see therapist X or therapist Y—the choice is yours.” But make sure the issue doesn’t go unaddressed.

Be a good model. Set a positive example for your child in terms of good nutrition, exercise, sleep, and healthy relationships with God and other people.

Explore appropriate medications. Today there are many different medications available for the treatment of depression. We’ll discuss some of these in greater detail later.

Final Thoughts

Depression is a common and potentially serious problem, especially for your kids, who are living in a culture increasingly marked by a deep sense of despair. The causes of the condition are many and varied, but the good news is that it is treatable, and its effects can be successfully counteracted—regardless of it