Talking to Your Teen About Mental Health and Depression (Without Saying ‘Mental’ or ‘Depression’)

Day to day ups and downs are a normal part of adolescence, making it difficult to distinguish between normal teenage moodiness and depression. Teens might not always be able to articulate what they’re going through, and they might not want to talk about it to you, but starting the conversation will help to protect their mental well-being.

Rates of teen depression increase sharply during adolescence, peaking around 16 years old. The exact reasons for the rise in depression during this time is unknown but it’s widely accepted that a number of factors contribute, including school transitions, academic and social stress and hormonal changes. Add to this their developmental goals of figuring out who they are, where they fit in and establishing their independence and it’s clear that teens have a lot going on. 

The Conversation That Will Help Protect Your Teen

One of the best things you can do for your teen in your life is to let them him or her know that you’re available to talk on their terms.  Here are some ideas for how to make that happen:

1. Let them see you.

   Let them know you’re there for them unconditionally and whenever they want – no limits. Be careful not to ask too many questions. You don’t want them to feel crowded or patronised.

2. Put the invite out there.

   Sometimes starting the conversation is the hardest part. Here are a few ideas to get things started:

   • ‘Are you okay? I’m here if you ever want to talk.’
   • ‘It’s really normal to feel stressed/ cranky/ sad/ tired sometimes but if it gets to the point where you’re feeling like that all the time we should talk about it. You don’t have to feel like that and there are ways to feel better.’
   • ‘You seem a bit down/ stressed/ tired/ sad lately. Is that how you’re feeling at the moment?’ Then, depending on the answer, ‘Would you like to talk about it?’ or ‘Well I’m here if you ever need to talk.’ 

3. Validate them.

   Casually acknowledge that high school can be tough and that it’s all part of the gig. Acknowledge the things that might be going on – ‘I know that you want to do well so it’s not surprising that you might feel the pressure of school/ staying on the team/ staying with the crowd. Everyone’s going through the same thing so there might be some crazy stuff that happens with your friends. It’s pretty normal. I’m here if you ever want to talk.

4. Give them an easy out.

   Have the duration of a car trip as the time limit so they know there is an easy end to any difficult conversation and that they have control. Let them know that you will only talk until you pull into the driveway and then they can decide whether or not to keep the conversation going. It’s completely up to them – no questions or argument from you. ‘Do you think we can talk about how you’re travelling. Let’s do it like this. Let’s chat until we pull into the driveway and then I promise we’ll talk about something else if you want to. Totally up to you.’

5. Your physical presence can make a difference.

   This can depend on the teen and the situation. Sometimes your teen might respond better if you avoid eye contact. Try starting the conversation in the car (this is a favourite of mine) or while you’re doing something else (like cooking dinner) rather than when sitting down and facing them. Then there might be other times when they’ll appreciate the one on one close attention from you. I’ve found that my kids tend to open up when I go in and sit on the edge of the bed just before they go to sleep. When it’s late and dark outside, the rest of the world seems a bit more removed – no distractions, no expectations. They won’t always talk of course – sometimes they’ll have nothing to say, or they might not feel like talking – but if they’re going to talk, this seems to be the time they do. 

6. Be gentle but persistent and available but not intrusive.

   Your teen might not open up straight away – and that’s okay. Keep trying but be mindful of pushing too hard. It’s a tricky line this one. The main thing is to keep making yourself available for when they’re ready.

7. Don’t try to talk them out of their depression.

   Even if their thinking seems irrational or their thoughts trivial, it isn’t that way to them. Validate them, ‘It’s bothering you isn’t it,’ or ‘I can see how upset you are,’ so they know they can come to you again.

Teenage Depression: The Warning Signs

Knowing the warning signs is important because with early detection plenty can be done.

If you’re not sure whether the teen in your life is depressed or just going through the usual growing pains that come with adolescence, consider the duration and severity of the symptoms and how different your teen is acting from his or her usual self.

Teenage depression can look similar or very different to depression in adults. The usual signs of depression are: 

• mood changes – sadness or irritability
• a sense of hopelessness
• tearfulness or crying
• withdrawal from social and family relationships
• loss of interest in activities
• changes in sleep habits – sleeping more or less, change in waking times (later, earlier, during the night)
• changes in appetite and eating habits
• restlessness
• feelings of worthlessness and guilt
• lack of enthusiasm or motivation
• tiredness and fatigue
• difficulty concentrating
• suicidal thoughts

For teens the warning signs can look different to this:

• They may be negative, cranky, irritable, angry, easily frustrated or prone to outbursts. Often, depressed teens come across primarily as irritable and cranky, more than sad.

• They may complain of aches and pains (such as headaches or tummy aches) for which there is no medical explanation. 

• They may feel misunderstood or highly sensitive to criticism. Because of their feelings of worthlessness, depressed teens can be extremely sensitive to failure, rejection or criticism. Overachievers are particularly vulnerable.

• They might withdraw from some, but not all, of their relationships. Depressed adults tend with pull away from relationships generally but the withdrawal is not as clear in teens. They might pull away from some and keep others, start mixing with a different crowd or just pull away from their parents.

• There may be problems at school. Difficulty concentrating and low energy may lead to attendance problems, poorer grades and frustration with school work in previously good students.
• Drug and alcohol abuse.

• Low self-esteem that might play out as expressions of ugliness, shame, unworthiness and failure.

• They may spend excessive time on the computer.

• They may engage in risky behaviour – recklessness, drinking, unsafe sex.

Remember that these warning signs can look like a normal part of adolescence and in many cases that’s exactly what it will be. The symptoms exist on a spectrum and the main thing is to be alive to the duration and severity of the symptoms and the departure from whatever is ‘normal’ for your teen.

If You Suspect Your Teen is Depressed

• The most important thing is to let them know that depression and anxiety is treatable. The sense of helplessness that comes with depression doesn’t only touch those who are struggling with depression, but also those who love them. Know that even if it doesn’t seem as though the things you are doing are making a difference – they are. See here for ways to support your teen if he or she is struggling with depression. 
• Things can change and they won’t always feel the way they do today. Let them know this. It’s critical and will make a difference.
• If there’s any chance your teen might be suicidal, ask them directly if they are having thoughts of suicide. Many people avoid asking the question for fear it will put the idea into their head, but it won’t. It might be the most important question you ask them. If they are suicidal, help them seek professional help straight away through a counsellor, doctor or hospital. To find a suicide helpline in your country, see suicide.org or IASP (International Association for Suicide Prevention).
• Help them to challenge the negative thinking that contributes to depression. See here for effective ways to do this.
• Exercise can protect against depression and for mild to moderate depression, exercise causes the same changes in the brain as antidepressants. A 20-30 minute walk five times a week will make a difference.
• Have your teen assessed by a doctor to determine whether or not medication is appropriate. Medication can be very effective but the effects of antidepressants on the adolescent brain aren’t fully known. Close monitoring is important particularly in the first two months of treatment to pick up any worsening of symptoms, suicidal thinking or further changes in mood or behaviour. If medication is recommended, it should always be used as part of wider treatment plan that includes counselling (to equip them with the skills to protect themselves from depression) and lifestyle factors (such as diet, exercise, mindfulness). Medication isn’t a magic bullet and changes generally won’t be seen for at least a few of weeks. 
• Understand that depression is physiological. It’s NOT a deficiency in personality or character. Living with a depressed teen might expose you to rejection, conflict, despair and extreme sadness yourself. Living with someone who is depressed requires a heroic effort from those who love them. Understand that your teen is still the child you’ve always known and they aren’t pushing you away or hurting you on purpose. They’re hurting. It’s just what depression does.
• Do whatever you can to accommodate your teen socially. One of the symptoms of depression is withdrawal from relationships, but isolation will make their depression worse. Anything you can do to support them in maintaining friends or getting out will be important. 
• Be patient and don’t compare. Depression can take aim at anybody. It is not a reflection on parenting or personality. The most loving, involved parents can have a teen with depression. It’s chemical. It’s important for your own sake that you don’t compare yourself or your family to others. Your teen will come back. Be patient and don’t be disheartened by temporary setbacks – it’s a normal part of the recovery.

And finally …

I’ve yet to meet a parent who isn’t racked with self-doubt now and then, wondering if they’re getting it right. I do it regularly. As in often. Adolescence seems particularly adept at taking any self-doubts we have and flourishing them to spectacular proportions.

Whether your teen is depressed or not, if you are arming yourself with information and making yourself available, know that you’re doing what they need you to do. They’re lucky to have you. Deep down inside them, whether they show you or not, they know it too.