This past week reminded the world that mental health issues don’t discriminate. Depression and anxiety can affect anyone, over 16 million people are diagnosed with depression and nearly half are also diagnosed with an anxiety disorder. Depression in children and teens looks a bit different than it does in adults so this week I decided to focus on a case where we addressed depression in a teen and their parents learned the signs, symptoms and treatment options.
About two years ago, I returned the call of a mother who was concerned that her 15-year-old daughter was irritable, moody, often tired, and angry at times. She was added that her daughter’s friend group at school was changing and that she thought she was making poor choices like skipping soccer practice, staying out past curfew and coming home smelling like cigarettes. What prompted the call that day was that the mother checked the parent portal and her daughter had several missing assignments and her grades had dropped dramatically. This mom was confused, she wondered is her daughter was really stressed out and every time she asked her she said she was fine and wanted to be left alone. The mom warned me that her daughter would likely not want to come in and that she may be shut down or rude to me. I assured her that I was used to this and not to worry, I would see her the following week.
When Carrie walked into my office she was clearly nervous and not too thrilled to be there. However, she was talkative and agreed to have her mom join for the first part of the session. I asked Carrie why she thought her mom wanted her to come in. She responded with something like, “I don’t know, it’s dumb, she thinks there is something wrong with me but there’s not.” Okay, here we go, a typical teenage response, I love working with them.
Her mom reiterated many of the things she was worried about and after we reviewed the process and confidentiality she left the room. With just Carrie and I there she started to settle in. She told me how tough the transition into high school had been freshman year and that she was trying to make friends. She said that she liked this newer group because they accepted her as she was. She eventually admitted to having tried smoking marijuana and reported that it made her feel more relaxed. When I questioned several other areas Carrie admitted to drinking alcohol at parties, having a poor body image, a decrease in appetite, trouble sleeping, difficulty with maintaining attention at school, fatigue, and a general loss of interest in things she used to enjoy. While Carrie denied being suicidal she did admit to having thoughts of worthlessness and said things like it would easier if she were never born. She was emotional throughout the session and talked about how much things had changed for her the past year. She had been feeling this way for almost a year.
I continued to see Carrie for over a year. Throughout that time she was diagnosed with Major Depressive Disorder and we tried several modalities of treatment. We had weekly individual therapy sessions and monthly family therapy session. Initially, we started off reviewing her cognitions (thoughts) about herself, what she believed others thought about her, and her negative view of her future. She had a mindset that she was not smart, no one liked her, she was fat and ugly, she was weird, and that her future would be a disappointment to her parents. We slowly challenged her negative thoughts, replaced them with more positive ones, got her exercising, going outside more, attending sports practices, re-engaging with some old friends and some different new friends. Carrie also got involved in a club that had kids in it that shared similar interests and she began going to bed earlier. Carrie eventually got caught up on school work and improved her grades. This all took stead work on her part and with her family’s support.
However, once the first winter came around we all noticed a downturn in Carrie’s mood. Some of the negative thinking and behaviors returned. After much discussion, Carrie went to a psychiatrist and was prescribed an antidepressant. The combination of therapy and the medication helped to elevate her mood and dysfunctional thinking. She was on the medication for about 8 months and then slowly discontinued use.
Carrie and her family understand that medication may be something that she needs again to help with particularly stressful times or even with the change of seasons. They also learned that depression in childhood looks different than it does for adults. The anger, irritability and co-morbidity of either anxiety, an eating disorder or substance abuse are hallmarks of depression in childhood. Crying and sadness can certainly be symptoms but it is not always as evident as it is in adulthood. Further, signs of stress can include trouble sleeping, feeling overwhelmed and having overall trouble functioning in life. With depression, those symptoms turn chronic and more severe with time.
If you or another biological family member suffer from depression it’s good to know the signs and symptoms in children. There is a genetic family link so knowing your family history can be helpful in the early stages of identifying what may be going on with your child.
Talking to Kids
This past week I was interviewed on how to talk to kids about suicide. While this is not an easy topic to discuss it’s important that kids get information from you first so you can provide facts and safety around it. In order to truly address the stigma that exists around receiving mental health treatment, we have to talk about it. Watch here for some ideas on how to start the conversation.