Your Teenager Is Not Crazy

by Jerusha Clark

  Since his breakup with Julia, though, Harrison was angry inside. He tried to ignore it, but the rage was getting harder to contain. The restlessness Harrison felt from the minute he woke up only intensified throughout the day, and pounding, daily headaches made it almost impossible to concentrate on school. His third-quarter grades slipped, big-time.

  Harrison told his parents it was just the stress of working and trying to keep up with homework after practice, but he knew it wasn’t just that. He couldn’t remember things, even things he’d known for a long time. He’d lost weight, but apparently not enough for anyone else to notice.

  Thursday afternoon during sixth period, the dam finally broke. Mr. Gregson was a nice enough guy; Harrison felt bad that he’d done it, but even now, sitting in the vice principal’s office, he didn’t truly regret punching a hole in the drywall of Mr. Gregson’s room. Maybe now they’d see that something was wrong.

  Bio 101

  Though both Avery and Harrison were battling depression, their struggles were unique. Dealing with similar situations, trying to identify “what’s wrong” and “what caused it” leaves many parents bereft. Some would rather chalk concerns up to “teenage nonsense” or dismiss warning signs as a “phase they’ll outgrow,” but we simply cannot ignore the heartbreaking statistics about adolescent mental health.

  According to the National Alliance of Mental Health (NAMH), four million American children and adolescents suffer from a mental health condition that significantly impacts daily life at home, at school, and with peers. Millions more go undiagnosed, suffering yet getting no help.

  The NAMH also reports that half of all mental disorders begin by age fourteen. Sadly, despite the presence of effective treatments, only one in three people receives help of any kind. Furthermore, long delays between the onset of symptoms in the adolescent years and when (if) treatment begins make conditions more severe and difficult to address.

  This is the reality of what teenagers face, but what are the causes?

  Recent research connects neural remodeling during adolescence to the revelation of underlying neurochemical or structural weakness. Dr. Daniel Siegel observes, “Such vulnerability may have a wide array of causes, from genetics to toxic exposures to adverse childhood experiences such as abuse and neglect. . . . The pruning of childhood circuits that may have been ‘at risk’ leads to the unmasking of those deficiencies. . . . Even if average pruning occurs, what remains may be insufficient to enable mood to be kept in balance or for thought to be coordinated with reality.”1 Siegel also notes the role of stress in exacerbating the pruning process. When pressure is high, a greater number of “at-risk circuits” may be pruned, diminishing neural effectiveness. Brain functioning suffers and mental health conditions manifest.

  Even in otherwise well-functioning people, the adolescent years—full of intense personal change—can introduce challenges with mental health. Transitions in school, friendships, activities, and familial relationships, coupled with the experience of confusing feelings about identity, future plans, and major decisions contribute to adolescent struggles as well.

  Avery’s and Harrison’s stories reveal the complex nature of mental health concerns. Depression doesn’t always look one way. Parents sometimes ask us to help them discern whether their teen is really depressed or just experiencing the natural, perhaps even unavoidable, ups and downs of adolescence. This is a difficult question to answer and should be directed to a trusted health care practitioner.

  A period of temporarily impaired mood may result from the process of neural remodeling, and neurochemical chaos may correct with age, so the advent of symptoms is “not an ‘all-or-none’ proposition in which a genetic vulnerability always becomes a psychiatric disorder.”2

  Symptoms of Depression

  Symptoms of depression vary widely and may include:

  feelings of sadness, emptiness, helplessness, hopelessness, and/or worthlessness

  anxiety (more details in chapter 26)

  a pervasive sense of guilt and shame

  irritability, bursts of anger or rage

  restlessness

  rigid, inflexible thinking

  uncharacteristic behaviors (lying, sneaking, manipulation, etc.)

  loss of interest in activities once enjoyed

  lack of energy or lethargy

  problems concentrating, remembering information, or making decisions

  insomnia

  hypersomnia (sleeping too much)

  loss of appetite or overeating, leading to weight loss or gain

  talking about death, thoughts of suicide, or suicide attempts

  hallucinations or delusions

  aches, pains, headaches, cramps, or digestive problems that do not go away

  Note: Bipolar disorder often develops in adolescence. At least half of all cases start before age twenty-five. With bipolar disorder, symptoms of depression are accompanied by manic behaviors, which may include dramatic mood swings, reckless behaviors, impulsivity, rapid speech, and trouble sleeping. Instead of appearing tired, a person struggling with bipolar may seem hyper or oddly silly. About 10–15 percent of adolescents who battle deep, reoccurring depression develop bipolar disorder,3 so it’s essential to get your teen help. Adolescents at risk for bipolar disorder need a thorough medical examination conducted by a specialist to ensure appropriate treatment is administered.

  Other times, however, the onset of symptoms signals the appearance of a serious condition. A medical doctor, qualified counselor, or both should evaluate any teenager consistently and concurrently exhibiting four or more symptoms of depression. Your moody teen might be down for a couple days, but if he or she doesn’t bounce back after two weeks, seeking help is extremely important. Remember, the longer the delay between the onset of symptoms and treatment, the more difficult it can be to overcome. As toxic thinking increases, the possibility of feeling better seems more and more remote, which creates a vicious cycle of ever-increasing negativity. Don’t leave your teen here!

  Neurotransmitters, including serotonin, play a significant role in depression. In healthy brains, serotonin helps people feel relaxed, working in a check-and-balance manner with the emotionally charged amygdala. Certain studies indicate serotonin levels dip during adolescence. For many teenagers, this is no problem; for others, it leads to depression. Clinicians propose that these teens either can’t use the serotonin they have effectively or their levels of serotonin are too diminished to be effectual.4

  Neurotransmitters don’t tell us the whole story, however. Most professionals understand that depression results from a complex interplay of genetics, environment, and experience. Be aware of the risks of adolescent depression and intervene quickly. Depression is highly treatable, but help won’t come to you. Seek it!

  A depressed teen may express, “I’ve never been happy” or “I don’t know why I feel this way,” but don’t react to these statements. Understand what’s behind them. With chronic depression, the hippocampus—which plays an essential role in memory and emotional integration—decreases in size, making it more difficult to recall being happy, process feelings (they really don’t understand what they’re going through), or learn new things.5 Imagine if a part of your own brain was progressively shrinking. Wouldn’t you hope other people would respond with empathy? Depressed adolescents need compassion first and foremost. Of course, troubling behaviors must also be addressed. But keep in mind: modifying behavior is only effective once we address core issues.

  Risk Factors

  Your teen is at greater risk for depression if he or she:

  has experienced a stressful life event such as a family death, divorce, bullying, a breakup, or failure in school or in an activity considered personally significant.

  is the victim of abuse or abandonment.

  expresses self-condemnation, perfectionism, or excessive self-criticism.

  is female. Teen girls are twice as likely as boys to develop depression.

  struggles socia
lly.

  suffers from learning disabilities or chronic illness. Both can contribute to the imbalance of neurotransmitters.

  abuses alcohol or drugs. Some recreational drugs, including marijuana, can lead to psychosis, hallucinations, or delusions.

  can trace a family history of mood disorders (remember, however, this is not an “all or nothing” proposition).6

  Psych 101

  Behind the hard realities about depression lies some really good news: with treatment, most adolescents get better, especially if they receive good care early on.

  Given the impressionability of teenage brains, early intervention is essential. Your teen’s high neuroplasticity can work for or against his or her mental health. Preventing exposure to stresses and substances that cause psychological problems as well as addressing problems quickly and courageously are equally important.

  Some parents fear treating teens for depression because “overmedicating is such a big problem.” This position is certainly understandable, but please don’t make a decision about your adolescent’s health based on fear of what “could be.” Equip yourself with information, pray earnestly, and follow the counsel of trained practitioners you trust.

  The human brain, arguably the most complex structure in the known universe, is the one organ that medical professionals rarely look at when considering treatment options. Despite the brain’s intricacies, when we think about depression, we tend to view it as a single disorder. Health care practitioners, even well-intentioned ones, often administer a questionnaire, diagnose a problem in twenty minutes, and prescribe the same psychotropic drug for every depressed patient. In some cases, this leads to repercussions that worsen an adolescent’s condition or delay healing interminably. Finding a skilled doctor who listens and whom you can trust is nonnegotiable.

  Reading about potential problems with treatment increases apprehension in some parents. We like how Dr. Michael Bradley approaches these concerns: “There is no clear bottom line with medication. There are only risks and benefits, which you must weigh. The only truly wrong decision you can make is one based on fear or prejudice. The experts can only offer you their views. The ultimate call must be yours. Wade into the complexity.”7

  Treating depression is complex, and medication doesn’t take the struggle away. In our experience, both personal and pastoral, medicine simply keeps a person’s head above water, enabling him or her to do the hard work of counseling. Sometimes the issues to wade through in therapy are agonizing and specific—abuse, for instance. Other times they are nagging and nebulous: a feeling of never measuring up.

  Ultimately, what teens do with the complexity is up to them, not you, not a drug. No antidepressant or therapist can make your teen do, feel, or be anything. They may help a struggler start “getting back to life,” however, a simple but profound component in counteracting depression. Treatment gives your adolescent tools to do what he or she needs to do.

  While your teen gets treatment, you can focus on the following:

  Talk less, listen more.

  Express love, empathy, and compassion whenever possible.

  Be appropriately affectionate.

  Remind your teen that symptoms aren’t a sign of personal weakness.

  Encourage your teenager that with time and treatment, they can get better. Patience is important!

  Engage with your adolescent in physical activity of some kind. Exercise is an essential mood improver.

  Help depressed adolescents break large tasks into small chunks. Taking too much on at one time can be exhausting and frustrating.

  Avoid dismissing or minimizing feelings. Don’t promise everything will be okay or point out everything that’s “right” with life.

  As much as possible, delay making major decisions during seasons of depression.

  Help your adolescent give treatment a fair chance. If a counselor recommends activities between sessions (journaling, exercises, etc.), provide the resources, time, and space to make doing these “assignments” possible.

  Watch out for signs of illicit substance use. Chemical escapes are particularly tempting and dangerous for depressed adolescents.

  Ask teens who talk about death or dying direct questions, including whether they have plans to hurt themselves.

  Never offer to keep conversations about suicidal intentions secret.

  “Pray without ceasing” (1 Thess. 5:17 ESV).

  Important Facts about Meds

  Studies indicate that a combination treatment of medication and counseling works best for most teens with depression.8

  Research shows that teens who don’t respond to a first antidepressant medication are more likely to get better if they switch to a treatment that includes both medication and therapy.9

  Appropriately administered medication won’t “make your teen a different person,” “turn them into a zombie,” or “doom them to a life of taking drugs.” On the contrary, it should improve an adolescent’s ability to think, engage with life in meaningful ways, and journey toward healing.

  Unfortunately, many well-meaning parents try to play doctor. They may say, “I saw a depression commercial and I think my son needs Cymbalta” or “I read about Paxil online and that seems best for my daughter.” Of course it helps to have a basic understanding of a prescribed drug’s uses, benefits, and potential side effects. We want you to be discerning, and that involves arming yourself with information, but please leave diagnosis and prescription to trained and knowledgeable medical professionals.

  Getting treatment for your adolescent may be an issue of trust and obedience, not simply “an option.” In his book This Is Your Brain on Joy, Christian psychologist Dr. Earl Henslin describes this brilliantly: “In almost all cases of a severe depression, we need to use the best, targeted medicines available to get the person out of danger to themselves. There’s a point where medicine is simply God’s mercy to mankind. Once stabilized, we can look at other alternative therapies that support or perhaps someday will replace medication.”10 For the severely depressed, medication can be God’s mercy. Taking it may be a matter of obedience.

  Wherever you stand on the issue of taking psychotropic drugs, judging others will not help. If you believe medicine is a gift from God, arguing defensively with someone who holds a different perspective usually ends rather poorly. The same is true in reverse.

  Although antidepressants are generally safe, all carry a “black box” warning label. In a small percentage of the population, taking psychotropic drugs incites suicidal ideation. For this reason, adolescents should be closely monitored, especially during the initial weeks of treatment.

  Faith 101

  Sadly, a recent nationwide survey revealed that 54 percent of Americans still believe depression is a personal weakness. Despite hundreds of medical studies demonstrating the neurochemical reality of depression, more than half of adults still labor under serious misconceptions about depression. Many Christians assume depressed people just need to trust God more. After reading this chapter, you know that depression powerfully affects—and in many cases debilitates—the body. We can’t simply “pray it away.”

  That said, we cannot ignore that depression is also a spiritual issue. Depression, the physical manifestation of neurochemical chaos, is not a sin, but depression can be connected to bad decisions and toxic thinking in a variety of ways.

  Some claim that “thoughts come from your brain as though your brain is generating all aspects of your mental experience.” Dr. Caroline Leaf writes,

  People who hold this view are called the materialists. They believe that it is the chemicals and neurons that create the mind and that the relationships between your thoughts and what you do can just be ignored.

  So essentially, their perspective is that the brain creates what you are doing and what you are thinking. The mind is what the brain does, they believe, and the ramifications are significant. Take, for example, the treatment of depression. In this reductionist view depression is a chemical imba
lance problem of a machinelike brain; therefore, the treatment is to add in the missing chemicals [and nothing more].

  This view is biblically and scientifically incorrect.11

  In order to heal, the underlying toxic thinking that sparked, perpetuates, and/or exacerbates depression must be addressed. Depression is the result of blood flow and brain activity; it is also inextricably connected with everyday thinking and beliefs. Being depressed does not make your teenager a bad person any more than having to wear eyeglasses does. Depression can, however, lead to poor choices and the development of unhealthy thinking. Bad decisions and toxic thoughts can also lead to depression.

  The spiritual encouragement for this chapter is simple: don’t settle for a materialist approach to treatment. Medicine is not enough. Counseling, prayer, and fellowship can be part of the progressive transformation of the mind that God commands in Romans 12:2. Help your adolescent begin this process early. In doing so, you’ll equip them for a life of health and hope.

  Try It Today

  Observe and then write down the food your teens consume, the amount of caffeine they drink, and the number of hours they sleep over the next week. Start today! Ask your adolescents to help in this fact-finding mission if you’re unsure what they’re eating or whether they’re actually sleeping when you think they are. Use any information you gain to determine where changes can be made. Take what goes into your adolescent’s body (and your own) seriously! Eating from the rainbow (see chapter 21), establishing healthy sleep habits (see chapter 20), and limiting if not eliminating caffeine will make a huge difference in an adolescent’s struggle with depression.

  26

  What If . . . ?

  Jared hadn’t felt normal in a long time. He remembered being happy when he was little, but those memories were vague and generic, just a sense that there had been better times. Middle school had changed all that; those years had been marked with ever-increasing worry.