7 Red Flags of Teen Depression to Look for Today

Adolescence is not an easy time for most. My wife – the bright, outgoing cheerleader daughter of a 60’s rock legend – often says she breezed through it. Me – the geeky, gangly marching band punk son of a minister – not so much! 

No matter who you are, the journey into adulthood from dependence is a moral, physical and mental juggernaut. As children advance through the various tumultuous transitions that accompany adolescence — body changes, emotional upheaval, hormonal overdrive, sexual awareness, social norms, intellectual development, increased access to just about anything, and the complex ways these all intertwine — the pressures and problems encountered can all too often seem overwhelming. For many, these and other challenges lead to one or more of a variety of mental health disorders; all matters of concern, and some truly life-threatening. 

Adolescence is tough on parents, as well. Any who have braved the task (and blessing) of nurturing a young life and directing another human into independence know Well the bouts of grumpiness, solemness and silent brooding interlaced with joy and downright giddiness. Some of the darker, “I’m going to withdraw inside my headphone silenced digital world and be a sad rock” sulking is normal, yet how do you know?

As May is Mental Health Awareness Month, and today is Childhood Depression Awareness Day, it is important to take note of this shocking statistic: as of this writing, teen suicide is the second leading cause of death among teenagers in the United States and the leading cause of death among young women worldwide, surpassing accidental injury. Thankfully, in our home, as the threat of self harm became all too real, we already had a sense the normal teenage angst of our youngest had gone way too deep and was consuming her. We are among the lucky ones who still had a chance to intervene and surround her with a team of professionals and a lot of focused attention that helped restore healthy thinking. I mourn for and with those who were not.

There are a multitude of signs we can all be looking for, whether it is as parents, medical professionals, teachers or friends. And, there are a multitude of resources for finding help. Here are just a few of the ways you might get engaged, understand what warnings to watch for and find the places you can go when you know you need a hand.

If you read no further, at least checkout these Top Tips for Parents:

• Keep communication constant, open, and honest: Your children should not only know they can talk to you about anything, you must be committed to broaching topics of concern with great transparency. Talk about your own experiences and fears when you were an adolescent. Be prepared to push through certain push-back and denial. Even today, my mostly happy recovering teen reminds of the time I first asked if she was depressed but failed to go deeper when she silenced me with supreme “stink-eye”. Let them know that they are not alone; nor are their anxieties unique.
• Understand mental health disorders are treatable: Arm yourself with information about the most common mental health disorders among adolescents; speak with your child’s physician, your local health department, religious leaders, and your child’s school representatives about what sorts of information are available from them.
• Be attentive to your teen’s behavior: Adolescence is, indeed, a time of transition and change. Still, some severe, dramatic, or abrupt changes in behavior might be strong indicators of serious mental health issues and not just pure rebellion.

Going Deeper, Watch for these Mental Health “Red Flags”:

• Excessive sleeping, beyond usual teenage fatigue, which could indicate depression or substance abuse
• Difficulty sleeping, insomnia, and other sleep disorders
• Loss of self-esteem
• Abandonment or loss of interest in favorite pastimes
• Unexpected and dramatic decline in academic performance
• Weight loss and loss of appetite, which could indicate an eating disorder
• Personality shifts and changes – such as aggressiveness and excess anger sharply out of character – could indicate psychological, drug, or sexual problems

Possible Mental Health Issues (Just a few)

Depression – While most of us are subject to an occasional bout of “the blues,” clinical depression is a serious medical condition requiring immediate treatment. Watch for:

• Unexpected weeping or excessive moodiness. A sad or irritable temperament for most of the day. Your teen may say they feel sad or angry or may appear more tearful or cranky.
• Eating habits that result in noticeable weight loss or gain
• Expressions of hopelessness or worthlessness
• Self-mutilation, or mention of self harm
• Obsessive body-image concerns
• Paranoia or excessive secrecy
• Changes in sleep patterns
• Excessive isolation
• No longer wanting to be with family.
• Abandonment of friends and social groups.
• Not caring about what happens in the future.
• Aches and pains when nothing is really wrong.
• A lack of energy or feeling unable to do simple tasks.

Note: Any of these signs can occur in children who are not depressed, but when seen together, nearly every day, they are definite red flags for depression.

Eating disorders – Body image concerns can become obsessions, resulting in startling weight loss, severely affecting the adolescent’s health:

•  Anorexia: Avoidance of food and noticeable restrictions in eating habits should trigger concern. NOTE: This is the deadliest of all mental disorders.
• Bulimia: Purging (forced vomiting) after eating. Be alert for both dramatic weight loss without changes in eating habits (which could, of course, indicate other health issues that require a doctor’s attention). Also, be alert for immediate trips to the bathroom or other private spot after a meal.

Drug abuse – In addition to peer pressure, mental health issues can lead adolescents beyond experimentation with alcohol and drugs to use of substances for “self-medication.” In addition to being alert to the behavioral and physical signs of alcohol and drug abuse — drug and alcohol paraphernalia or evidence, hangovers, slurred speech, etc. — parents should also:

•  Watch for prescription drug misuse and abuse: According to the AAP, prescription drug misuse by adolescents is second only to marijuana and alcohol misuse. The most commonly abused prescription drugs include Vicodin and Xanax, with a sharp rise in opioids.
• Know that over-the-counter-medications can be abused as well: Teenagers also frequently abuse OTC cough and cold medications. Heck, there are popular songs about it.

Up from Adolescent Depression: What Parents Can Do to Help

No matter what is going on, concern about your adolescent’s mental health should first be addressed directly with your child. This fosters open dialogue and goes a long way toward building sound adolescent mental health habits. Talk to your child about his/her feelings and the things happening at home and at school that may be bothering them. For us, these talks quickly escalated from denial to cries for help. We had to move to professional intervention, FAST!

If your concerns are serious, discuss them with your physician. Because so many mental health issues display physical manifestations — weight loss being the most dramatic, but not the only one — your pediatrician can offer both initial medical assessment and also refer you to appropriate mental health organizations and professionals for counseling and treatment when called for.

Promote health

• The basics for good mental health include a healthy diet, enough sleep, exercise, and positive connections with other people at home and at school. 
• Limit screen time and encourage physical activity (depending on the disorder) and fun activities with friends or family to help develop positive connections with others.
• One-on-one time with you, catching them doing great things, encouragement for seeking care and pointing out strengths build the parent-child bond.

Provide safety and security

• Talk with your child about bullying. Being the victim of bullying is a major cause of mental health problems.
• Look for grief or loss issues. Seek help if problems with grief do not get better. If you as a parent are grieving a loss, get help and find additional support for your teen.
• Reduce stress, as most teens have low stress tolerance. Accommodations in schoolwork are critical as well as lowered expectations at home regarding chores and school achievements. 
• Guns, knives, long ropes/cables and medicines (including those you buy without a prescription), and alcohol should be locked away.

Educate others

• Your teen is not making the symptoms up….
• What looks like laziness or crankiness can be symptoms of depression.
• Talk about any family history of depression to increase understanding.
• Get the school involved. I have to say, while I expected the medical and mental health professionals to respond the way they did – after all, that’s their job – I was most impressed with how the School staff rallied around us. They surrounded her with supportive teachers and counselors and covered her with intense levels of understanding while making allowances for exceptions to work under a 504 plan. Get one!

Help your teen learn thinking and coping skills

• Help your teen relax with physical and creative activities. Focus on the his/her strengths.
• Talk to and listen to your child with love and support. Encourage teens to share their feelings, including thoughts of death or suicide. Reassure them this is very common with depression. 
• Help your teen look at problems in a different, more positive way.
• Break down problems or tasks into smaller steps so your teen can be successful.

Make a safety plan

• It is critical to remember you are a key element in your child’s recovery and an essential part, if not the real leader, of their care team. Stay deeply involved in every portion of their recovery.
• Follow the treatment plan. Make sure your teen attends therapy and takes any medicine as directed.
• Treatment works, but it may take a few weeks, months or even years. The depressed teen may not recognize changes in mood right away and may become discouraged with initial side effects of treatments (such as antidepressants).
• Develop a list of people to call when feelings get worse.
• Watch for risk factors of suicide. These include talking about suicide in person or on the internet, giving away belongings, increased thoughts about death, and substance abuse.
• Locate telephone numbers for your teen's doctor and therapist, and the local mental health crisis response team.
• The National Suicide Prevention Lifeline can be reached at 1 800-273-8255 or online at www.suicidepreventionlifeline.org.

DISCLAIMER: Look, I am just a half-a-brain helicopter pilot and mechanical engineer turned accidental sales person who became an occasionally adept commercial leader. I am not a medical professional, so what I am sharing here should be in no way misconstrued as health advice. This list is not exhaustive. It is only some of what we learned in facing the fearsome specter of mental health gone askew in our own home. 

There are plenty of great people and resources, beyond those cited as sources, ready to give you any assistance you need, especially when it comes to the real potential for self harm. Below are just a few:

• We Can All Prevent Suicide via the National Suicide Prevention Lifeline
• Risk Factors and Warning Signs of Suicide via the American Foundation for Suicide Prevention
• Preventing Suicide via The Trevor Project
• Why You Shouldn’t Say Committed Suicide via The Mighty
• 24 Real Ways to Help Someone Who’s Feeling Suicidal
• 7 Essential Tips for Helping a Suicidal Loved One
• 5 Things Not to Say to Someone Who’s Suicidal — and What to Say Instead

If you or someone you know needs help, go to The Mighty’s suicide prevention resources. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.

Sources I borrowed liberally from:

Posner, Kelly. "Preventing suicide: Teen deaths are on the rise, but we know how to fight back," Published 1:08 p.m. ET Feb. 7, 2018. https://philanthropynewyork.org/news/preventing-suicide-teen-deaths-are-rise-we-know-how-fight-back

“Mental Health and Teens: Watch for Danger Signs”, Adapted from Healthy Children Magazine, Winter 2007

 “Adolescent Depression: What Parents Can Do To Help”, Adapted from Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit (Copyright ? 2010 American Academy of Pediatrics)

Schuster, Sarah. " Here's What We Should Be Sharing Instead of the Latest Details About Avicii's Suicide”, The Mighty, https://www.yahoo.com/lifestyle/apos-sharing-instead-latest-details-185503533