There's something uniquely misery-making as a parent about seeing your teenager (or even younger child) experiencing depression or anxiety. You can't make it all better as you did when they were little and it's painful to feel so powerless.
The stereoptypical view of teenagers is that they're moody and uncommunicative, and spend the whole time slamming in and out of rooms or sulking in their bedroom. (To be fair, this is only true some of the time.)
So as parents, the challenge is working out which of your teen's moods and behaviour are part and parcel of growing up, and which could be warning signs of teenage depression or other more serious mental health problems.
"She has been unhappy at school for some time but is in the last month before she does GCSEs and leaves to go to college - she seems to be almost holding her breath until it's over. I'm most worried that she rarely leaves her room. She will come out for meals and for her part-time job but would prefer to stay in bed all day. We've always been really close and I accept that she needs to separate from me, but I desperately want to help."
Causes of teenage depression
Most of can recall, at least dimly, the turbulence of teenage-hood and can relate to our teenager if they're feeling sad and a bit lost. As this Mumsnetter illustrates:
"She's had a haircut she can't manage, she's fallen out with a friend, she got a particularly bad flurry of red-haired glasses-wearing 'jokes' from the boys on the bus and she just feels dowdy and ugly. Last night she was completely cheered up by a cuddle from her little brother, macaroni cheese for supper and The Life of Brian. So it doesn't go very deep. But don't you wish you could help them through it!"
We're all, whatever our age, more at risk of experiencing depression when things in life go awry: the Mumsnet Talk boards are eloquent testimony to this. But certain circumstances increase the likelihood of teenage depression, including:
- Parents constantly arguing
- Witnessing domestic violence
- Feeling rejected or left out within the family
- Parents separating, divorcing or dying
- Anyone close to them dying
- Changing school or moving house
- Problems with school work or exam pressure
- Friendship problems
- Physical illness in themselves or a family member
- Poverty or homelessness
And if your teenager is a perfectionist with very high self-expectations, they may be more at risk of depression when life doesn't go according to plan.
"When people are clinically depressed, they can't cope with the world around them and crave being left alone. Also, friends of that age can't be doing with the 'flatness' of a person who isn't 'jolly' and will drift away. She will find her way through this but may need clinical support either with counselling and/or medication." allbie
Mental health experts say you should be alert to the following signals in teenage behaviour:
- Shunning social contact and not enjoying the things they used to
- Losing their appetite
- Finding it hard to concentrate
- Complaining of stomach aches
- Feeling exhausted and having difficulty sleeping or sleeping too much
- Low self-esteem and lack of self-confidence
- Gaining or losing a significant amount of weight
- Refusing to go to school or college, or playing truant
- Tearfulness and extreme moodiness
- Defiant, violent or disruptive behaviour at home or school
- Self-harm or drinking / taking drugs to excess
What you should do if you think your teenager is depressed
For all the reasons outlined above, it can be difficult (and stressful) trying to decide if your teen's behaviour and mood are all part of their hormonal rollercoaster or something more serious.
If your teenager is exhibiting symptoms of depression, lasting for several weeks, your first port of call should be your GP.
"All suspicions of depression in teenagers should be taken very seriously. It is important to get treatment before they fall below the line at which they will accept help." maryz
Your child may well be resistant to seeing their GP, but try to persist in getting them there because your GP is the person who can refer them to the appropriate service via NHS Child and Adolescent Mental Health Services (CAMHS).
"Go and see your GP and get your son referred to the mental health team, they should have a department for young people. He may simple be a male teenager: a fair number of boys turn quite suddenly into sullen, grunting, unhappy beings, but then again there may be more to it. Getting him assessed by a stranger who is not as emotionally close as you are can be very helpful." PacificDogwood
If your GP thinks your teenager is depressed or anxious they may refer him or her for counselling, and this may involve you and the rest of the family to some extent.
"Many psychiatric units help the whole family, so take advantage of everything you are offered. And don't blame yourself. He is where he is now, don't waste energy wishing things were different or trying to change the past." maryz
According to BMJ patient advice about child and adolescent depression, a bout of depression lasts on average seven months. Some children recover without treatment, but at least half who don't have treatment will still be depressed after a year.
"For us it is a slow process. He sees a psychologist weekly and a psychiatrist every now and then. The talking therapy/CBT seems to be helping but there is a long way to go." lazymumofteenagesons
Others tactics for helping your teenager
In addition to seeking professional medical help, there are other ways you can try to provide the best care for your teenager.
Try, gently, to get your child to think about how they're feeling and why they may be feeling that way. This is easier said than done and may provoke an angry or hurtful reaction.
"I would see this as a positive - at least he is reacting, not lying in his room not caring!" maryz
If they can't, or won't, talk to you, try to find another family member, eg an older sibling or aunt/uncle/grandparent, or a trusted teacher or family friend in whom they can confide.
Try - despite the provocation - to demonstrate consistently to your teenager that you love them and are rooting for them.
"I try to boost him whenever I can verbally, I tell him I love him, I'm proud of him etc. Even if you think it's not going in or having an effect, it definitely will be." barefootinthepark
"Get her to look beyond today, tomorrow... do everything you can to give her confidence and something to look forward to. And remember confidence (self-esteem) doesn't only come from your parents telling you how great you are, it comes from new challenges that excite you. If you can find some of those for her you might just help her turn the corner." mumonthenet
- Talk to the school
Are they being bullied or having problems coping with school work that you're not aware of? You need to find out. And see if there's a school counsellor or psychologist they can talk to if school is part of the problem.
"Do not worry about the teachers knowing, we are in the 21st century! Most of his teachers have offered extra sessions to help him catch up and have waived deadlines for coursework. People do understand." lazymumofteenagesons
- Get them to write it down
If your teenager can't express how they're feeling verbally, encourage them to release their emotions by writing or typing them down.
- Encourage them to exercise
Regular exercise, even just a walk, reduces stress and releases mood-enhancing chemicals into the brain. If exercise is too much, see if you can get them to do some relaxation techniques.
- Impose a routine
If your child is refusing to go to school, or shunning out-of-school activities, try to come up with some sort of daily routine so they don't lose the habit of engaging with the wider world.
"I try to do a couple of things with my son. He hardly ever has social arrangements so I try to take him out to family stuff, make him go out, even with people he doesn't know, even if I need to bribe him with, whatever, Pizza Hut, a stop at the one particular shop he likes. Just to stop that feeling of the world closing in on him." barefootinthepark
- Encourage healthy eating
That old parenting stalwart: try to provide them with a healthy, balanced diet, including plenty of fruit and vegetables, and if they're not eating much - or eating rubbish - try to ensure they're getting important minerals, such as Vitamin B12, even if it's in supplement form.
It's terrifying to confront the possibility that your child could take their own life, but suicide is the second biggest cause of death for 15-24 year olds after road accidents, according to Great Ormond Street Hospital. Girls aged 15-19 are more likely to try to kill themselves, but boys are more likely than girls to succeed.
If your teenager talks about suicidal feelings, they need help. Call your doctor immediately.
If your child has a history of depression, make an emergency plan with their doctor in case you become worried they are suicidal.
Look after yourself
You're no use to your depressed child - or any other children you have - if you're compounding the situation with your own stress or guilt. Unburden yourself on Mumsnet Talk or with friends to get some sympathy and perspective.
And the charity YoungMinds has a free telephone helpline for parents, on 0808 802 5544, 9.30am to 4pm, Mon-Fri, if you're worried about your teenager's emotional state or behaviour.