How Can I Help My Depressed Teen?

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The following transcript has been automatically generated by an AI system and should be used for informational purposes only. We cannot guarantee the accuracy, completeness, or timeliness of the information provided.

Reena Ninan:

Episode 190: How can I help my depressed teen? You always say the beginning of the school year, you kind of like, because people get into routines. I feel like October is the time of year when sometimes those routines very quickly start to unravel. What’s your advice for that? Or there’s resistance. People don’t want to get up and go to school all of a sudden.

Lisa Damour:

No, it’s so true. It’s so true. I mean, I say this all the time and it is a hundred percent true. I love routines and then I quickly start to feel oppressed by routines and this is the time of the year where I’m like, when is the next break? And I will also tell you, having been someone who works with schools, has worked in schools for so long, this stretch from the start of the school year to Thanksgiving break is the longest schools go in the year without a meaningful break. And it gets tedious at this time.

Reena Ninan:

So that is whay we all ind of feel this way sometimes, like I’m ready for that break already. I think that’s right. I think that’s right. Well, we got letter about depression and it just got me thinking about sort of where we are in the school year and how so many people can feel like this. I’m going to read this to you, Lisa. It says, hi Lisa. I’m writing to ask you to address the topic of teens dealing with depression and intrusive thoughts. My 16-year-old daughter has struggled with depression and most recently it seems the worst part of it is negative, intrusive thoughts including ones of seeing herself dead. Her psychiatrist has said that this is a common theme for teens with major depression to experience and has recently changed my daughter’s antidepressant to a different one. My daughter is also in DBT therapy to address her depression. We encourage exercise and having outlets for stress and other things to focus on, but she doesn’t listen and doesn’t have the motivation to do much besides hang out with friends and work part-time, which we see as great engagement. But outside of that, she’s on her phone laying around, is there more we can be doing to help her manage her depression and intrusive thoughts? I appreciate your input on this. Thank you. Alright, I know I was talking about this time of year, but it also feels you forget about parents who might be struggling with kids who are dealing with this type of really intense depression.

Lisa Damour:

Absolutely. Right. I mean there’s the normal stresses and strains of family life and getting into the thick of the school year. And then there are families and kids who are struggling with really painful and persistent and sometimes hard to treat mental health concerns.

Reena Ninan:

Painful and consistent. You’re absolutely right. What exactly is intrusive thought?

Lisa Damour:

So this is interesting. This is a very interesting letter because what you’re seeing in this letter is actually the combination of a symptom pattern that isn’t that common. I am interested in the psychiatrist’s take that it’s not rare to have these intrusive thoughts. I think it’s not rare, but it’s not particularly common either. So intrusive thoughts when we think about them technically as clinicians, these are thoughts that come into a person’s mind that make them very uncomfortable, that they’re unwanted, they make the person very uneasy and they often have to do with things like worrying about harming other people or worrying about having done the wrong thing. There’s often a conscientiousness piece to it. And when we look at intrusive thoughts and sort of the diagnostic kind of panoply of things, they’re much more closely associated with obsessive compulsive disorder than they are with depression.

They’re, in fact, one of the key hallmarks of obsessive compulsive disorder is that you have these obsessions, these thoughts that are uncomfortable and unwanted and then it gives rise to compulsive behaviors that are trying to counter those thoughts. So it might be like, I’m worried that I touched something contaminated. That’s the intrusive thought. And then the compulsive behavior is I’m going to go wash my hands. So what this letter captures is that symptoms can show up all over the place. You can have someone who suffers from depression, does not suffer from full blown OCD is what it sounds like in this letter, but has elements of another disorder that are popping up or a symptom from another disorder that we associate more closely with another disorder that is showing up in the diagnostic profile that we’re looking at. So

Reena Ninan:

Teens that fall into this category, are they vocal about, it sounds like self-harm is a big piece of the intrusive thoughts. Am I right on that or are there other things as well?

Lisa Damour:

No, you’re asking exactly the right question, which is okay, so if we think about this as a clinician, and I have cared for a teenager who suffered from depression and had thoughts, she call ’em almost like visions where she could see herself dead. That’s sort of that same sort of in this neighborhood. As soon as you have a teenager who’s depressed and especially one who’s voicing thoughts about death, the key question, the do not pass go do not collect $200 question is this kid at risk of being unsafe with themselves? So this is what would need to be assessed. And it sounds like this family’s put together a really good team, they’ve got a psychiatrist, they’ve got a DBT therapist. But as soon as we get towards depression at all, we do want to rule out suicidality and especially if a kid’s mentioning upsetting thoughts about dying and the way that we do it, I just want to do quickly, let’s not even rest on this for a minute.

Let’s go down to write how we do it. If your kid says something that makes you worried or if you’re worried that your kid’s depressed, go ahead and say to them, I need to ask you if you had any thoughts of harming yourself or ending your life. Or if they tell you about, I was thinking about dying like this kid said. In a way you can say that’s a really upsetting thought to have. Is it something that you feel like you would act on? Do you worry about your own safety? And so just go right to it. Don’t beat around the bush. Your kid won’t be surprised, especially if they’ve brought up the question of thinking about death or dying and you’re going to get an answer from your kid. A lot of kids are going to say, oh, no, no, the thought crossed my mind, but I wouldn’t do it. And you know your kid, if you feel that that is reassuring to you, go with it. If they’re like, I don’t know, I don’t know, then you call your pediatrician, you call a mental health professional, you get that child evaluated as quickly as required to make sure that they, they’re a hundred percent safe.

It’s not that thoughts or intrusive thoughts about violent, I don’t even know if that it’s violent, right? This kid’s just saying she’s imagining herself dead. They’re not always associated with actual risk for suicidality. But you check that risk yesterday,

Reena Ninan:

You don’t wait on that. No. What is DBT

Lisa Damour:

Therapy? So DBT therapy is dialectical behavioral therapy and in the universe of technical approaches to caring for people, it’s relatively young, but it’s not that young anymore. It’s well more than 20 years old. And it’s a very, very effective therapy for helping people manage overwhelming uncomfortable feelings. That’s sort of the heart of it, is that we care for people who when they become upset, really struggle to cope effectively. They either do harm themselves or they engage in eating disorder behavior or they turn to substances or they stop managing their own care in any meaningfully useful way. And dialectical behavior therapy is a set of approaches, a set of techniques that helps people manage uncomfortable feelings well, right. You know that that’s the end all be all is managing uncomfortable feelings. Well, and when we look at the research on approaches to treating depression, dialectical behavioral therapy is absolutely one of the accepted and recommended approaches.

Reena Ninan:

If your child has these thoughts, can you help correct that or is there hope that you can get that to turn around?

Lisa Damour:

It’s so interesting because the take on this, you can go so many directions and there’s not one right answer. So let me give you three answers because, and this is what I love about caring for families and getting to do individualized work, is that different kids in different families are going to need different solutions.

Reena Ninan:

There’s not a one size fits

Lisa Damour:

All. There’s not a one size fits all. And what’s really some of my favorite clinical work is when I can actually share the options with people

And sometimes I know the path. I think that’s most going to be most useful. And I’ll often say, here are your options. Here’s what I recommend, but I want you to know your choices. So in this situation, out of the gate, I see three options. So interestingly, one of the details in the letter is that the psychiatrist is changing the kid’s antidepressants. So for reasons that we do not entirely understand, there is a class of antidepressants. It’s the SSRIs, it’s what Prozac is in. It’s the selective serotonin reuptake inhibitors. I’m not a psychiatrist, but I do know this stuff that seem to quiet, intrusive thoughts. We don’t know how or why, but when people are suffering from intrusive thoughts, getting on an SSRI can help. And so one of the things I wonder is I hear this letter is, oh, was this kid on a different class of antidepressants? And then the news of the intrusive thoughts came up and the psychiatrist was like, oh, if we switch you over to an SSRI, there’s a good chance that on its own is just going to make those thoughts go away or quiet them way down.

Reena Ninan:

Lisa, you tell us and remind us often about how, and maybe you should remind us again about how the teenage brain is still forming well into your twenties. I don’t remember what that age was, but is there a chance that you could be on these meds now and your child might just fully grow out of it? Or do you think that often you’ve just got to stick on this path of these special cocktail drugs or certain drug?

Lisa Damour:

It’s a really important question because I think what you’re getting at is often why families are reluctant to consider medication is that they’re like, I don’t want my kid number one on drugs of any kind, prescription or otherwise, and I don’t want to start like this lifetime, can’t we work through it another way? Here’s how I think about this as a clinician. Development in adolescence is so precious, so much is shifting and changing at this time of life. Kids are making friends they are getting that are going to follow them. They are making choices about how active they’re going to be in the world, what activities they’re going to do. I don’t mess around with the very short window that we have for fruitful adolescent development. So if a kid is suffering from depression in a way that is interfering with progressive development, if they are suffering from depression in a way that is interfering with friendships, interfering with school, interfering with functioning in any meaningful way, for me, I’m like, let’s get this kid back on track developmentally, whatever it takes, and then we’ll sort it out later on. I don’t like losing time in adolescence. So if therapy can do it and for some kids, therapy can do it. For some kids who are depressed, some adults who are depressed, therapy alone is adequate,

Well then that’s terrific. But if therapy doesn’t cut it or if you have real concerns about the kid safety, you get that kid evaluated by a psychiatrist because in all likelihood the most effective approach will be a combination of psychotherapy and medication for more severe depressions or depressions that are not yielding to therapy alone. So that’s a very technical answer, but the bottom line is you don’t mess around with teenage time, you don’t mess around with teenage development.

Reena Ninan:

Lisa, I want to pause and take a quick break on the other side of this break. I want to ask you a little bit, I know we’ve talked about treatments for depression. How do you get down that path of is there a right one for depression? And also what about phones not exercising? How does that factor into all this? We’ll be right back. You’re listening to Ask Lisa, the Psychology of parenting. Welcome back to Ask Lisa, the psychology of parenting. We’ve got this great letter from a parent talking about needing help for dealing with their depressed teen. And Lisa, you kind of cracked open some of the options for this family in dealing with this and walking us through the therapies. We talked about medication before the break. You said there were two other options. What are they?

Lisa Damour:

So with regard to the intrusive thoughts, there’s a couple other things I just want us to think through out loud. So like I said, an SSRI can often address those if that isn’t working, doesn’t make sense, isn’t the right choice for any variety of reasons. There’s a couple other ways parents and caregivers can respond when a kid tells them, I’m having this upsetting thought. So the first one is to check, like I said, say that is an upsetting thought. Is that something you’re actually thinking about? Have you had thoughts about harming yourself or ending your life? Is this something that you’re really worried about? If the kid says yes, you go down the path of getting them care right away. If the kid says no, one of the things that’s really, really important and we can forget to do is to actually rest with them in how it felt to have that thought.

So rather than once you’ve dispatched the safety concern, which you have to do first, if you’re reassured that the kid is safe, I have found it to be so important to say to them, well then what was it like to think that? What was it like to have that thought? Because they often do have a reaction to it. It really freaked me out or I was really sad and upset about it. And so sometimes you can just go there and offer comfort and empathy and if the kids in therapy say, this is the kind of thing you’re talking about with your clinician, but I’ve

Reena Ninan:

Seen it happen, that scares me. Just having to have this conversation is very scary. I just want to pause for a second when you say to ask them about it, I’m scared about as a parent opening up that door even though I know I’ve got to do it and open up that door, but in that moment I want to make sure I have the right response. You’re saying compassion and just sympathizing with them is really your go-to what can make a difference in talking about these response. It’s okay,

Lisa Damour:

But what you’re articulating, Rina is exactly why it’s hard for adults sometimes to get this right. And I’ll tell you the version I’ve seen happen a lot that I feel for everybody in these scenarios. And I’ve cared for kids, lots of kids where this has happened where the kid is super frustrated about something super upset, who knows what just happened and they’re like, oh my gosh, I wish I were dead. Or Oh my gosh, I don’t want to be here tomorrow or something, or I want to kill myself. I mean sometimes they’ll just say those words and of course as the adult in the room, this is horrifying. And I

Reena Ninan:

Think it’s the worst thing my teen could say to me, quite frankly, I don’t know if there’s anything worse than this to me

Lisa Damour:

At this moment. I think you’re right. Absolutely. And so where I have seen adults misstep in this is either to ignore it, which I get. Sometimes people are so overwhelmed that they’re like, I’m just going to pretend like that didn’t happen. Or to haul that kid down to the emergency room without asking a couple questions first. Because sometimes I’ve seen those kids and they’ve then gone through the emergency process and they were like, I did not mean it came out of my mouth. I never would’ve done it. So to take that beat and say, is this something I heard? What you said is, are you worried about your safety? Do I need to be worried about your safety? I mean to just hit it directly.

And then if the kid says, no, no, no, say, oh my gosh. Okay, well I’m glad. Right? Okay, that’s a relief. But you must be very upset. Or what does it feel like to have that thought cross your mind? So what we’re doing once we’ve addressed the safety concern is we’re making it clear we can talk about hard things. We can tolerate intense negative emotions. We don’t have to overreact. We can tolerate that. Our kid is sometimes going to feel a lot of pain. And for teenagers to watch us do that, to see that we can withstand it gives them a vote of confidence that they can withstand it too. There was one more thing. Oh yeah, one more thing. Sorry. Just about the intrusive thoughts. This is a totally different, totally different approach. And so I really mean it. There’s three choices I can think of all very different. So medication one, talking about the thoughts and what they mean to the kid is another. The third one, remember that wonderful psychiatrist Sue Varma we

Reena Ninan:

Had Oh yes, she talked about practical optimism.

Lisa Damour:

Yes. So great. And do you remember on our episode with her, she brought up this metaphor that I will tell you I now use clinically several times of setting thoughts, seeing them luggage on a conveyor belt and letting them just go by. And she’s like, you don’t have to take it home with you. You can just let it go by. It may even come around again. And so I think another approach which may work for some kids and some families under some conditions is once the safety concerns are addressed and the kid says, oh my God, I still had that thought about dying or seeing myself dead, it is within totally reasonable range for a parent or a caregiver to get to a place where they say, can it be like luggage on a conveyor belt? You have the thought and you acknowledge it, but you don’t pick it up, you don’t carry it, you don’t unpack it, you don’t drag it around all day. You just let your mind move on to other things. See

Reena Ninan:

Luggage on conveyor belt creates such anxiety for me. Like I got to get my bag, I got to get my bag, I got to deal with it, I got to take it off. I got to take it off. Is that the one? Is that the one? No, no, no. That’s not the one. I didn’t put the ribbon on mine. No, it’s like it’s a great metaphor though. It’s a great metaphor. You got to just learn to let it go

Lisa Damour:

And this will learn, let it go. And it’s funny, Rina, I struggle to meditate. I don’t know that I’ll ever pull it off, but I’ve also, I think if I ever am going to get good at meditation, it’s going to be using that metaphor because clouds in the sky letting the thoughts go by. It’s too soft for me. Luggage on a conveyor belt, watching the baggage go, not picking it up, not carrying it, not unpacking it. I can get into that.

Reena Ninan:

I love meditation. I tell you, I think it’s been a game changer for me. I really see such power, but you got to be patient with it. It’s not easy to stick

Lisa Damour:

With Rena. You’re going to have to help

Reena Ninan:

Me. I love it. I really, that’s what calms down the craziness at the conveyor belt for me. You don’t nearly need to get that bag right now. So I want to ask you a little bit though about exercise. I know personally I did not understand and become converted to the power of exercise, really helping my mental health until I was in my early thirties and now it’s like that is the one thing in my life I cannot live without. It could be as basic as a walk during basic as that, do you have concerns? Is there a reason for parents to be concerned if your child is sedentary? Could that lead to more of these type of thoughts? Is there a connection between exercise?

Lisa Damour:

I don’t know that we have a research connection between exercise and intrusive thoughts. I do know we have a research connection between exercise and depression.

And for clinically, for teenagers who are depressed and especially if they’re not getting all the relief they need and want from therapy and or medication, exercise is a non-negotiable. So I think this letter writer should really take it under advisement, like is this kid better enough or thriving enough? And there’s some real thriving in this letter too, hanging out with friends, holding down a job. So there’s very good signs that even though this child may still be suffering from depression, things are a lot is going well. If it really feels like no, there just needs it better would be better. I would probably make a real issue about exercise. And it may be like, let’s go for a walk or is there a class that you could just go to a couple times a week? And we have some data showing that exercise is on par with medication for treating depression. It’s a very, very powerful effect. And my theory is that, well, this part isn’t a theory exercise improves the quality of sleep. And so my theory is that for some people who are suffering from depression, when they exercise, they start to sleep better and sleep and depression are very closely tied. And so first of all, you can’t go wrong by exercising

And you can almost always improve things. So I think on this one I would probably push a bit harder if I were a parent who didn’t feel like their kid’s depression was getting, the kid wasn’t getting the relief they deserved from their depression.

Reena Ninan:

I want to also ask you about the parents talking about most of the other hours are spent on the phone. So many of us with teens know much of their time is spent on their phone. Is this a problem? When should you be concerned?

Lisa Damour:

This is a really important point. So it’s not necessarily a problem. It’s not necessarily a problem because I think what it really comes down to is what is the kid looking at on their phone and are they spending so much time that it’s getting in the way of stuff that would be really good for them? So if your kid is looking at the darkest, driest, most depress genic memes possible, it’s a problem,

Right? And some of what we worry about when we look at the link between social media use and depression, we’re not convinced that social media use always causes depression. But we’re pretty convinced that kids who become depressed will sometimes start to spend a lot more time looking at social media just because they’re not doing much else and that it doesn’t help their mental health to have things narrow down to this digital environment. So I would put limits on it, but especially I would also like what are they looking at? But if it’s actually what it is for a lot of kids, which is it’s where they’re connecting, it’s where they’re having fun, it’s where they’re watching funny videos, it’s where they are learning stuff. They’re engaged in meaningful activities that are uplifting for them, then it’s less of an issue. So I think the questions I would ask is what are they looking at and are they looking at it so much that they’re not getting the sleep they need? They’re not getting the physical activity they need. They’re not hanging out with their friends, you just don’t want it crowding out healthy things.

Reena Ninan:

There is a lot here and one of the things we do these episodes, your child might not be going through it, but we always feel like you never know when you might come down that road. Having parents listen to these episodes and become aware of what other parents are dealing with. And sometimes I find solutions that you offer, I might not be going through that particular thing, but it’s still like the empathy piece of today. I was just thinking how often I’m just so short on patients and sometimes all they’re looking for is a little empathy on some stuff to feel comfortable.

Lisa Damour:

Totally. And sometimes kids, because they’re especially teenagers, they feel things intensely. They will sometimes use extreme language or talk in extreme terms or talk about extreme images and it’s very unsettling to adults. But we have to remember everything for teenagers is on steroids emotionally. And so checking for safety but not overreacting if the kid is safe and staying close and being curious goes a long, long way. Thank you, Lisa. So what do you

Reena Ninan:

Have for us

Lisa Damour:

For parenting to go Reina? I bet you could predict my parenting to go on this. It is something that anytime the topic of teenagers and depression comes up, I want to make sure we hit, which is sometimes depression in teenagers looks like depression in adults where they are low mood, low motivation, sad blue or blank in teenagers uniquely depression can also take the form of high irritability. They are prickly. They are like porcupines. No matter what anyone does. It rubs them the wrong way. Their parents bug them. Everybody at school bugs them. The adults at school bug them. This is not always often not a snarky teenager. This is often a kid suffering from depression and it’s the kind of depression in teenagers that we are likely to miss. So when we’re talking about depression in teenagers, this always has to be something that we make a point of remembering

Reena Ninan:

So much going on and it’s so easy to think your kid may or may not be depressed. But having this episode in particular to walk us through, really it was eye opening for me. Thank you so much Lisa. And next week we’re going to talk about using swear words. Should you just let your kid use swear words? My opinion is no. I’m curious what Lisa has to say next week. I’ll see you then, Lisa. I’ll see you next week. Thanks for joining us. Be sure to subscribe to the Ask Lisa podcast so you get the episodes just as soon as they drop and send us your questions to ask [email protected] and now a word from our lawyers. The advice provided on this podcast does not constitute or serve as a substitute for professional psychological treatment, therapy, or other types of professional advice or intervention. If you have concerns about your child’s wellbeing, consult a physician or mental health professional. If you’re looking for additional resources, check out Lisa’s [email protected].