Identifying Teenage Depression

Teenage depression is a complex, subtle and dangerous phenomenon. It is complex because of its many complicated causes and effects. It is subtle because it almost always goes undetected, even by the teenager, until a tragedy occurs. It is dangerous because depression can result in the worst of happenings -- from school failure to suicide, even murder.

Teenage depression is difficult to identify because its symptoms are different from the symptoms of adult depression. For example, a depressed teenager may act and talk normally. There are no outward signs of depression. It is manifested in fantasies, in daydreams, or in dreams during sleep. It is detectable only by somehow knowing the child's thought pattern and thought content. Few professionals can even pick up teenage depression.

Again, the teenager may act and talk normally. However, the content of the teenager's speech is affected, dwelling primarily on depressing subjects such as death, morbid problems and crises. Since many adults today seem to dwell on pessimistic trains of thought, the teenager's depression may go unnoticed.

Teenage depression is just as profound and serious as in adults, but the manifestations and symptoms are different. A depressed adult looks terrible, feels miserable and is severely affected in his ability to function. But the teenager? In a vast majority of cases, only in severe depression does the teenager appear depressed. When we can say, "Boy, does that kid looks depressed!", we should assume that the teenager is profoundly depressed and probably suicidal.

There is an exception to this, however. Teenage depression is difficult to identify because teens are good at "masking" it. That is, they can cover it by appearing okay even when they are absolutely miserable. This is often called smiling depression. This is a front which teenagers employ unconsciously. This masking of depression is done primarily when other people are around. When depressed teenagers are alone, they let down or relax the mask somewhat.

This is helpful to parents. If we are able to see our teenagers when they believe no one is looking at them, we may be able to identify depression. It is an amazing thing to see the transformation in the face. Alone they will feel terribly sad and miserable. As soon as they think someone is watching, the smiling mask of depression appears as though nothing is wrong. This is one way of identifying depression, although it is not the best way.

Discovering Depression

How then can we discover depression in our teenagers so that they can do something about it before tragedy occurs? It is imperative that we be able to identify it early, since there are numerous ways today in which depression can be a harm to our children. A depressed teenager is quite susceptible to unhealthy peer pressure, is prone to fall victim to drugs, alcohol, criminal activity, inappropriate sexual experiences and other behaviors, including suicide.

The best way to identify depression in a teenager is to understand the various symptoms manifested in teenage depression and how they develop. It is crucial to understand the total constellation of symptoms in detail, because one or two symptoms may or may not signify true depression. True depression is a biochemical and neurohormonal process that in teenagers usually develops slowly over a period of weeks or months.

Before we study the specific symptoms of teenage depression, we should understand that a depressed teenager may also have one or more of the classic symptoms of adult depression, including feelings of helplessness, hopelessness, despondency and despair; problems with sleep (either too much or too little); problems with eating (too much or too little with weight loss); lack of energy; feelings of low self-worth; problems handling anger.

Specific Teenage Symptoms

1. Shortened attention span. In teenage depression, the first symptom generally seen is a shortening of attention span. Depressed teenagers are not able to keep their mind focused on a subject as long as they once could. Their mind drifts from what they want to focus on and they become increasingly distractible. This shortening of attention span usually becomes obvious when teens attempt to do their homework. They find it harder and harder to keep their mind on it. And it seems the harder they try, the less they accomplish. Of course, this leads to frustration, as they blame themselves for being "stupid" or "dumb". They assume that they don't have the intellectual ability to do the work. Imagine what this does to their self-worth, which can lead to insecurity, fear and anger.

2. Daydreaming. The shortened attention span affects teenagers in the classroom. At first, they may be able to pay attention to the class work for most of the period and then daydream the remaining minutes. As the depression deepens and the attention span becomes shorter, teenagers pay attention less and daydream more. At this point, their teacher is in the best position to identify depression. Unfortunately, daydreaming is usually interpreted as laziness or poor attitude. However, just one or two symptoms alone, such as daydreaming and short attention span, do not allow a person to make a diagnosis of true teenage depression. We must see a gradual development of a constellation of symptoms.

3. Poor grades. As a teenager's attention span shortens and their daydreaming increases, the natural result is lower grades, even cheating. Unfortunately, this falling of grades is so gradual that it is difficult to notice. For this reason, it is seldom associated with depression. In fact, teenagers, their parents and their teachers usually assume that the work is too difficult or that they are becoming more interested in other things. It would be quite helpful if the grades took a drastic plunge, an A to D in one grading period. However, the grades usually go something like this: A, A-, B-, B. Depression is seldom considered.

4. Boredom. As teenagers daydream more and more, they gradually fall into a state of boredom. Boredom is normal in teenagers, especially in early adolescence, but only for relatively short periods of time. Normal boredom is frequently seen for an hour or two, sometimes for an entire evening or day, or occasionally even two days. But prolonged boredom, several days or more, is not normal, and should be a warning to us that something is not right. Few things worry me as much as prolonged boredom in an adolescent, especially an early adolescent. Boredom usually manifests itself in teenagers wanting to stay by themselves in their room for increasingly longer periods of time. They spend their time just lying on their bed, daydreaming, listening to music or on social media. Bored teenagers lose all interest in things that they once enjoyed, for example, sports, clothes, cars, clubs, church, social activities and dating.

5. Psychosomatic depression. As the boredom continues and deepens, some teenagers gradually slip into a greater depression. At this point, they begin to suffer from what I [Charles] call psychosomatic depression [Psuche (Gk) = soul (mind, will and emotions) & Soma (Gk.) = Body]. I use this term because, even though depression is physiological or has a biochemical-neurohormonal basis, at this point, the symptoms begin to affect teenagers mentally, emotionally and physically, even the choices they make. For example, in psychosomatic depression, teenagers begin to experience mental, emotional and physical pain. This pain may occur in many places, but is most often felt in the lower mid-chest region or as headaches. Many teenagers suffer pain in the lower chest and/or head, secondary to depression.

6. Withdrawal. In this state, teenagers may withdraw from peers. And to make matters worse, they don't simply avoid their peers, but may disengage themselves from them with such hostility, belligerence and unpleasantness that they alienate them. As a results, teenagers become very lonely. And since they have so thoroughly antagonized their good friends, they find themselves associating with rather unwholesome peers who may drink and use drugs to medicate their pain and/or frequently cause trouble. This situation becomes more frightening.

Once prolonged boredom has set in, many things can develop. The mental, emotional and physical pain at this stage may be excruciating and at times unbearable. Teenagers in this state cannot tolerate their misery indefinitely. Eventually, they become desperate enough to do something about their misery. Most amazingly, even at this point teenagers are hardly ever aware that they are depressed. The teenager's ability to hide behind denial is truly incredible. This is why depression is seldom suspected until tragedy occurs.

Acting Out Depression

When teenagers have been moderately to severely depressed to the extent that they can endure it no longer, they will take action in an attempt to alleviate their misery and distress. The teenager's action resulting from depression is termed "acting out their depression". There are many ways for teenagers to act out their depression.

BOYS tend to be more violent than girls. They attempt to relieve their depressive symptoms by stealing, lying, fighting, driving fast, leaving home or through other types of behavior. One of the most common kinds of criminal behavior seen today among boys is breaking and entering or flash mob stealing. Doing something that has an air of excitement and danger to it seems to somewhat relieve the pain of depression. Breaking into homes provides this air, and is therefore commonly resorted to by depressed boys. I believe that overlooking the depression in these young people is totally negligent. And unfortunately, most agencies dealing with teens focus on behavior and are unaware of the depressive component in the child's problem.

GIRLS tend to act out their depression in less violent ways. However, because of unhealthy, violence-oriented models in the media, this trend is changing. Girls frequently act out their depression by sexual promiscuity. Their depressive pain tends to be alleviated during the close physical relationship of intercourse. However, when the act is over, these unfortunate girls feel worse -- more depressed -- than before because of the self-degradation involved. Depression and low self-worth are almost always the basis of a girl's promiscuity. It is amazing how much we can help a girl with this type of problem by ministering to her depression. It is equally true how little we can do if we neglect her depression.

Drug Taking

Depressed teenagers can also act out their depression by taking drugs. Marijuana and depression are a very dangerous combination because marijuana actually makes a depressed teenager feel better, without getting to the root of the problem. Marijuana does not cure or heal the pain. Rather, it blocks the pain of depression. Unfortunately, teenagers feel better simply because they do not hurt as much. Of course, when the marijuana is out of their system, the depression returns. Then, in order to obtain the same degree of relief from the pain, the teenager must use a greater quantity. This is a common way for a teenager to become habituated to marijuana, to become a "pothead". Other drugs can affect a depressed teenager in the same way. So naturally, when we attempt to help teenagers on drugs, we must determine how great a role depression is playing in their drug usage. I am genuinely alarmed how depression is overlooked or discounted by many professionals and agencies involved in treating teenage drug problems.

Attempting Suicide

Another way depressed teenagers may act out their depression is by attempting suicide. Sometimes, the attempt is a gesture in which the teenager does not wish death but attention. At other times, there is a genuine attempt to die. Girls make many more suicide attempts than boys, but boys are more often successful in killing themselves. Girls generally use less violent means of attempting suicide, such as pills. Boys, on the other hand, use more violent means, such as guns not only to commit suicide, but mass killings at their schools. Of course, this makes it easier to save girls from their own attempts. However, many girls come extremely close to death or actually die. What a tragedy!

A Teenager's Observation

I asked a 17 year old, who wrote me [Charles] about her depression, and this is what she had to say; "The big reason for depression among teenagers nowadays is related to social media, such as Instagram and TikTok. It is sad to see young people, like me, developing mental problems and becoming increasingly involved with harmful content on the internet, such as pornographic websites, anime and television series with promiscuous themes, among others.

"In addition, I see cell phones keeping my classmates from having better contact with family, friends and the community we live in. Instead, social networks contribute negatively, with 'influencers' who appear to have a perfect life, showing off sculptural bodies, impeccable appearance, dream homes and dream jobs in front of the cameras. It only takes one click for a young person my age to develop depression through such stimulation.

"Unfortunately, I see many young people with no direction in life. I believe that excess dopamine is keeping them from having a greater purpose, which can even be fatal. They have already developed insomnia, self-harm and eating disorders such as anorexia and bulimia, suicidal desires, isolation and discouragement due to media, bullying and cyber bullying. It is truly sad to have to deal with friends who, during classes, need to be hurriedly removed from the classroom due to anxiety attacks and panic attacks. I desire to help them, but it is difficult. Grazieli, Brazil."

Remedy For Depression

What can we do to help our depressed teenagers? First of all, we must identify depression early in order to prevent tragedy. This means we must be familiar with the symptoms of teenage depression. People who need this information most are parents and those who work with teenagers, such as teachers, school counselors and youth workers. When depression is identified early, that is when the depression is mild, it is relatively easy to halt its insidious progress and alleviate it.

Although most teenage depression is complex in its underlying causes, often, there is a specific factor or event that finally overwhelms the child and triggers the constellation of symptoms. For example, a death or illness, or departure of a person important to the teenager, a disappointment such as a divorce or conflict between parents, or a move to an undesired place. In such situations, teenagers feel lonely, abandoned and unloved. It is crucial, first of all, to show them we do care, love and accept them. Love and acceptance is the key! We show this by spending enough time with them to permit their defenses to come down in order for them to be able to communicate with us. Then, our love-giving, eye contact, physical contact, and focused attention will be meaningful to them.

If the problem is a conflict within the family, for example, a divorce, teenagers need help dealing mentally and emotionally with it. They especially need to realize that the divorce is not their fault -- that there was nothing they could do to prevent it. Hence, they are extremely sensitive to problems between their parents.

Teenage depression is not something you can consider a phase that will run its course. This insidious affliction tends to grow worse and worse unless the depression is identified and intervention is taken. I [Charles] can identify with depression as a teenager being a major part of my problem back then.

Though the problem seems physical and psychosomatic, the root cause is spiritual and can only be healed through God's amazing grace. The bottom line is that most depressed teenagers are separated from God. Only when they understand God's love and acceptance of them and receive Christ will they truly be healed and secure.

The ABCs of Salvation

A - ADMIT YOUR NEED - REPENT
Turn to God from sin (Acts 26:20). He is holy. We are not. Our sin separates us from Him. "All have sinned and fall short of the glory of God . . . the wages of sin is death, but the gift of God is eternal life" (Rom. 3:23; 6:23).

B - BELIEVE ON JESUS
God loves us so much that He sent Jesus to die for our sins. "God demonstrates His love toward us, in that while we were still sinners, Christ died for us" (Rom. 5:8). "Believe on the Lord Jesus Christ, and you shall be saved" (Acts 16:31).

C - CONFESS JESUS & CALL ON HIM
Receive JESUS by grace through faith today (Eph. 2:8,9). "If you confess with your mouth the Lord Jesus and believe with your heart that God raised Him from the dead, you will be saved . . . whoever calls on the name of the LORD shall be saved" (Rom. 10:9-13). Say: l confess Jesus as Lord & believe God raised Him from the dead for my salvation and righteousness. Amen!

The Christian's Toolbox

The Christian's toolbox is the place in our hearts where we have all our God-given tools for immediate use in our lives and ministry to build, renew and repair lives for the Kingdom of God.

As we come up with other tools, let's keep adding them to our toolbox. "By his divine power, God has given us everything we need for living a godly life. We have received all of this by coming to know him, the one who called us to himself by means of his marvelous glory and excellence" (2 Peter 1:3, NLT).

A large part of our Christian growth takes place by the renewal of the mind, creating emotional security through faith in the power of God's grace. We are given this warning by the apostle Peter, "Be on guard so you will not be carried away by the errors of these wicked people and lose your own secure footing. Rather, you must grow in the grace and knowledge of our Lord and Savior Jesus Christ" (2 Peter 3:17 ,18, NLT).

[Identifying Teenage Depression was edited by Charles D. Watson from an article not in print of the same name written in 1975, by the late Dr. Ross Campbell, M.D.].