More Than Moody

"I hate you," she stated matter-of-factly, staring stone-faced at the floor. Those were the last words I'd ever expected to hear from my daughter, Jaclyn*. She'd been a delightful child—seemingly carefree, with a sense of humor that always brought a smile. But over the past two years, she'd been seething with anger. As I sat across from her bed, beneath the harsh fluorescent glare of a high-security psychiatric unit, no one was smiling.

Jaclyn, 16, had been admitted to the hospital a few days earlier when her behavior became so bizarre we feared for her safety. She'd been receiving treatment for depression. But while the medication initially helped, she'd become increasingly despondent, highly agitated, and unable to sleep or attend school. When I found the word "die" scrawled on Jacyln's bedroom wall in her blood, I knew my husband and I needed help to protect her. Jaclyn was placed in the hospital's new pediatric psych ward, where she was diagnosed with major clinical depression and social anxiety disorder.

By the third day, my daughter demanded we release her from the hospital. "Jaclyn, I can't take you home until the doctor believes you're well enough," I explained, afraid for her safety.

"Fine. Then I never want to see you again." Her icy response sent a shiver through my soul.

It's the illness talking, I attempted to assure myself. But I was heartbroken. I longed to be reunited with the happy little girl I hadn't seen in years.

Unfortunately, my family's experience isn't uncommon. According to the National Institute of Mental Health, up to 8.3 percent of adolescents in the U.S. suffer from some form of depression. Adolescence is noted for mood swings and unpredictable behavior, and the symptoms of depression often are attributed to normal teenage angst. For many, moodiness is a passing phase—but when it persists longer than a few weeks and interferes with a teen's ability to function, it's categorized as a biological disease called major depressive disorder (or major clinical depression), a serious but treatable mental illness that changes how a person thinks, feels, and acts. Depression impairs concentration, decreases motivation, and hampers a young person's ability to succeed. If you suspect, or know, that your teen is depressed, help is available. And while you can't cure your teenager's illness, there are steps you can take to help your adolescent cope with it.

1. Be aware.

Depression manifests in a variety of ways in adolescence. Dr. Harold Koplewicz, founder and director of the New York University Child Study Center and author of More Than Moody: Recognizing and Treating Adolescent Depression, states that two-thirds of young people with major depressive disorder have coexisting mental disorders, anxiety being one of the most common. Others include post-traumatic stress disorder and substance abuse. Because the symptoms of depression in teens sometimes differ from those experienced by depressed adults, it's essential parents be aware of the warning signs (see sidebar) and look past stereotypes.

For example, previously an excellent student and "model" child, Emma's behavior began to change at age 15. Though dismayed, her parents didn't initially suspect their daughter was depressed. "I assumed she was behaving like a typical teenager, rebelling against the restrictions of childhood," says her mother, Gayle. "She snuck out of the house at night, skipped school nearly every day, and became sexually active." Later, Gayle discovered Emma was corresponding with men she met on the Internet, including several jail inmates—one convicted of sexual assault.

Emma's depression was masked by her problematic behavior—not an uncommon occurrence in adolescents. Dr. Lisa Machoian, child and adolescent psychologist and author of The Disappearing Girl: Learning the Language of Teenage Depression, explains, "Scheming provides a respite from negative thinking. Pain can be kept at bay if she's running, sneaking, partying, dancing all night, and sleeping all day."

2. Seek professional help.

Obtaining a medical diagnosis is the first step toward helping your teen. Treatment may include antidepressant medication, individual therapy, group therapy, and/or family counseling. Ask your physician to refer you to a professional who specializes in the diagnosis and treatment of adolescent depression.

A comprehensive treatment plan is one that addresses the biological, emotional, and spiritual factors that contribute to depression, so don't overlook the role Christian counseling may play in your teenager's treatment. Acutely depressed adolescents may require hospitalization, particularly if they're at risk of harming themselves or others.

Tragically, between 70 and 80 percent of teens with mental health problems don't get the help they need. Although depression can vary from mild to severe, left untreated, it can have serious, ongoing consequences: school failure, social isolation, family breakdown, unsafe sexual behavior, substance abuse, increased incidence of depression as adults, involvement in the criminal justice system, psychosis, and even suicide.

3. Be vigilant.

Pay attention to changes in your teen's mood and behavior. If he's being treated with antidepressant medication, realize there may be serious side effects. Although medication offers substantial benefits, some studies link the use of certain antidepressants with increased suicidal thoughts in depressed youth. Alert your teen's physician or counselor to anything that concerns you. If he seems preoccupied with death or talks about suicide, seek immediate help.

4. Commit yourself to love.

Make sure your teen knows you love her unconditionally; be certain your words and actions convey love and support. Assure her you'll see her through this difficult time and do whatever you can to help her get well.

Sophie's depression and accompanying rebellious behavior caused her to fall behind in college. For a while, she wanted nothing to do with her parents. Her mother, Brenda, responded by letting Sophie know she was thinking of her. Brenda says, "Even when Sophie wouldn't answer my e-mails or the telephone, I left a message that I loved her."

5. Don't Take it personally.

You may be confounded because your teen seems happy and pleasant with others but is critical, sarcastic, or even abusive to you. Dr. Machoian says, "Some kids are just so sad they can't let themselves know or feel it, so they cover it over with anger." Deep anger is one of the most common symptoms of adolescent depression, and teenagers often reserve the worst of their moods for those they know they can trust.

6. Readjust your expectations.

Previously an honor student, our daughter, Jaclyn, is now struggling in school. Her depression, accompanying exhaustion, and social anxiety have caused her to miss weeks at a time, and it's been impossible for her to keep up in some courses. Initially, I tried to compel Jaclyn to attend school regularly, but now realize she's doing all she can. Pushing her increases her feelings of guilt and inadequacy. She recently stated, "It's hard not to feel stupid when you can't accomplish anything." Our daughter's guidance counselor and teachers have been accommodating. Jaclyn now tries to attend school half-days and takes one course at home through the Internet.

Our daughter's therapist also helped us understand her limitations and form realistic expectations. Rather than focusing on all the things Jaclyn's no longer able to do, I try to appreciate the accomplishments she does make, whether it's washing the dishes, going shopping in public, or taking a walk after dinner.

Progress can be slow, but it's important to have patience and celebrate any advances your teen's able to make, no matter how small they may seem. Janet's daughter, Brianna, was diagnosed with depression as a ten-year-old and continued to struggle with it through adolescence. Janet says, "It helps me to remember that depression is an illness, not a choice."

7. Lean on the Lord.

Brenda, Gayle, and Janet all agree that the best advice they could give other parents of teens with depression is "Pray!" Not only did prayer help Brenda survive, but it benefited her daughter, Sophie, as well. She says, "Sometimes I drove an hour and a half to sit in the parking lot of her apartment and pray for her." Gayle points out that "prayer will keep your focus on the One who can help your child most of all."

No teen is immune to clinical depression—it strikes even those who seem to have the most going for them. But depression is treatable, and treatment is imperative if we are to see our children enjoy life and live up to their God-given potential.

Realize that healing is a process. For some, progress can be seen within weeks of beginning treatment. For others, relapses may occur and progress may seem slow. Pray for patience and try to remain optimistic.

Brianna and Sophie (now a newlywed in graduate school) are in their twenties and are both doing well and managing their depression. Emma, also in her twenties, is now "one of the most responsible people you would ever meet," declares Gayle.

Though still struggling with depression, Jaclyn's in counseling, taking antidepressant medication, and making progress toward healing. She's no longer an angry teen unable to express her feelings, but has found her voice and is able to say whatever's on her mind! I'm blessed to hear Jaclyn affirm her love for me every day.

Although I grieve all my daughter has lost, I know God can use all things for good. Jaclyn will emerge with a keener awareness of our love for her and recognition of God's provision and her strength, having persevered and overcome great obstacles.

Remember that although your child's difficulties may seem insurmountable at times, nothing is impossible with God.

Leigh Fenton is a pseudonym for a writer who lives with her family in Canada.

*Names have been changed.

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