Adolescents, Teens, Depression & The Warning Signs

By Concentric Counselor Katie Ho, LPC, NCC

At a time in life when the only thing certain is constant change, recognizing and being aware of depression during adolescence can be a challenging feat without the knowledge of warning signs and risk factors. Mental health and the seriousness of depression continue to be topics of conversation following the headlines of national news and tragedies - but an equally, if not more urgent conversation is the one that needs to be started at home. The pressures of adolescence and impact of today’s culture of social media appearances and limited interpersonal connection only reinforce the need for education and awareness on depression. Parents and caregivers can provide their support and intervention through having the skills and knowledge to address their young person’s greatest mental health needs.

The answer to why we should talk about depression with teenagers is becoming more clear as the topic continues to be normalized, de-stigmatized and commonplace in the discussion of healthy emotional development; but the answer of how is where the light could shine a little brighter. How do you initiate a conversation around feelings, emotions and concerns of your child or loved one’s changes in mood and psychological health? How do you create a safe environment that fosters and promotes honest, sometimes uncomfortable dialogue about profound sadness or even thoughts of self-harm or suicide? Many of those answers involve one important action: listening.

In order to fully understand and be prepared for a conversation around your young person’s mental health, it’s vital to know the warning signs and symptoms involved with depression during adolescence. These characteristics can be different than how they typically manifest in adults, and can oftentimes be mislabeled as expected changes during a new phase of life. It’s important to distinguish between depression and normal sadness. Depression can consume their day-to-day life; interfering with the ability to work, eat, sleep, study and have joy. It can involve feelings of helplessness, hopelessness and worthlessness with little to no relief.

Here are some signs and symptoms of adolescent depression:

● While some individuals may appear sad - many and most appear irritable (unrelenting)
● Negative view of self and/or the world and future
● Withdrawal from family and friends (isolation)
● Anger/Rage
● Overreaction to criticism
● Excessive sleeping
● Significant change in appetite
● Increased reckless or impulsive behaviors
● Substance use or acting out in an attempt to avoid feelings
● Violence
● Running away

If you suspect your teenager is struggling with depression or begins showing signs of concerning behavior, finding the time, the patience and the space is the first step in creating an environment for an honest discussion.

❖ Remember the value in listening over lecturing: initiating a conversation about emotional pain or hardships means being willing to hear their truth without judgment or criticism.
❖ With unconditional love will need to come unconditional support; let them know you’re committed to helping them fully and in a way that respects their experience, choice and voice.
❖ Be gentle, but persistent - if your teenager claims nothing is wrong, but is otherwise unable to explain the concerning observations and behaviors, trust your intuition and consider options for getting them to open up. The most important goal is to get them talking - whether it’s to you or to a reputable third party, give them the resources and options to share with someone they can trust.
❖ Validate their feelings - always. Try to avoid talking them out of their feelings or giving them an alternative perspective in which to view their experience. Acknowledging and communicating that you believe and hear them will foster trust and empathy. In combating adolescent depression, it can be effective to take a holistic approach - making their physical health as much of a priority as their social and emotional health. Encourage movement!

Physical activity can be incorporated in a number of ways, whether it’s a sports team, individual activity, dance class, walking the dog or riding their bike - all movement is good movement! Healthy, balanced eating and limited screen time are essential requirements for anyone’s lifestyle, but particularly those in adolescence. These items can also be partnered with the important aspect of positive interactions with family or loved ones. Sharing a meal or spending quality time can help that young person feel connected and valued.

Should the need for professional help and intervention be determined, be sure to involve your teen in those decisions. Respect their thoughts and opinions, and talk openly about their options for treatment. It may be a struggle for them to feel connected or comfortable talking with a professional, and collaborating with them on identifying someone who could meet their needs may help to bridge that gap. Depression and recovery can feel scary to both parent and child, but having open conversations with clear understandings of love, validation and support can make helping them more manageable so that they can live their most meaningful life.

Men, Loneliness, and the Substance Substitute

By Concentric Counselor Myron Nelson, LCPC

We know it is true when we take stock of our lives, although it is easier to simply ignore. We do not have the same number of friends that we used to. We definitely do not have the same number of close friends, friends we could call in an emergency. Whether it is technology taking up more of our time, a culture that promotes handling problems on your own, or some other reason, it is clear we do not connect in the same way.

Due to factors that will be explored in this blog post, half of the population is more vulnerable to the Great Friend Migration. Men, myself included, are bombarded with societal forces that encourage segregation. We are instructed to cope with problems silently, internally. Isolate yourself or be shamed. We are taught to detest emotions, push them down or aside but do not let them grow. Best to not spend time with other people if we are in an emotional state.

Consequently, our problems grow bigger, the stress becomes heavier, and the emotions continue to build up until we are neck deep. Keeping quiet and keeping it to ourselves, we fall deeper into our own thoughts. Expecting that other people do not want to be burdened with our issues. We drift apart from friends because we do not know how our problems could possibly fit into their lives.

What’s next? We turn to something that can help. Something that makes us feel better, it’s reliable, it’s dependable, it does not judge us, and it does not share our secrets. Alcohol and other drugs can become a refuge for emotional pain. They can buffer feelings of anxiety or depression and temporarily give us the mask we want to keep the facade going.

Alcohol and drugs can slowly become something we depend on but that dependency is dangerous. What starts as a solution to the problem becomes its own problem. Substances attempt to fill the void that other people used to, but they will never be enough. Substances can never talk back to us and make us feel cared for and understood. They cannot debate options with us and challenge us to be better. Substances offer complacency but relationships give us acceptance and growth. It takes courage and a leap of faith to connect with another man and share your problems but it is truest the solution.

The irony is, that we all want to lean on each other but are scared to lean first. It is society’s expectation about men and men’s expectations about society that propel this problem into an epidemic. When we let our predictions go and venture into reality, it’s clear that other men feel the same way we do and we can meet each other with compassion and caring.

Men are not inherently isolating and society is not inherently cold. Expect that other people feel the way you feel. Expect that as a man you will experience things that other men experience. Expect that others want to know about your struggles because they want to be able to lean on you too.

If you find yourself experiencing The Great Friend Migration, convincing yourself that filling your loneliness with substances is better than the alternative - opening up, reaching out, and relying on a male friend, I encourage you to stand up to your shame, choose connection, and lean it to a friend.

Is Your Saw Dull? A Self-Care Mandate Is Your Sharpening Tool→

By Concentric Counselor Stacey Kiran, LSW

This blog post goes out to anyone who has said to themselves recently, “I really need a break.” or “I have no time to relax!” I am here to tell you – Your time has come! Huzzah! I am going to provide all readers with a Relax and Self-Care Mandate.  My purpose for this mandate stems from learning the importance of self-care in graduate school. During grad school, students are told to 'take care of yourself' so often, it felt like a mandate.  And I often found myself thinking, “I wish someone would have forced me to take care of myself before grad school, I could’ve used it then, too!”

Are you feeling burnt out from the grind of work and life?  Noticing negative effects of this routine in your personal or even work relationships? Do you feel you are missing out on some understanding of your your family or friends' experiences? If you answered yes, you may be experiencing empathy-deficit for others.  Also known as compassion fatigue in the field of counseling and therapy.  

Maybe you will need to first ask yourself “Is empathy important to my relationships?” If that is a question that is hard for you to answer, I am going to point you to the Queen of Empathy, Dr. Brene Brown. She has a short, fun cartoon for you to watch on the importance of empathy, check it out here. 

The article Self Care as an Ethical Imperative offers the story of a person sawing down a tree with a dull saw. Try to tell that person to take a moment to sharpen their knife and they say “I don’t have time to sharpen it! I am too busy sawing!” Well, you can easily imagine using a dull saw will wear on that person, making that person feel depleted and disconnected. This same story applies to many people.  I am sure you may feel like you are a personal or professional lumberjack in your life.  For example, caregivers (including therapists) are in the role of taking care of others, but may feel too busy to take of oneself.  Or people who are not necessarily in the helping role, but who go through the daily grind may feel there is not enough time to nourish oneself. 

So, I ask you, "How's your saw?" Finding yourself too busy or depleted to pause and sharpen your saw?  In graduate school, I was taught the role of a therapist needs to take time for self-nourishment. If you don't take care of yourself, you can't responsibly help others.  Relax and Self-Care Mandate. 

Then from Mandate to Practice.  Let me get to the point here - I am talking about moving away from a Mandate to a Practice. It’s not like I never heard the term Self-Care before grad school. But, in grad school, the phrase Self-Care began to mean something much more to me than “Go to an exercise class.” It meant ask yourself, "Am I feeling okay?"  "What is my body telling me I need?" And, be honest. Because if you are not feeling okay and you ignore it, you could burn out at work or at home or burn the candle at both ends. What is the cost of you continuing your life while still burnt out? The cost is the energy you could be curating and nurturing that can go in to a better tomorrow, a better you, and better relationships.

Many people reach out to therapy to improve themselves and their relationships.  If you want to better your relationships– start by relaxing. Sounds counterintuitive? Well, like non-nourished therapists who cannot responsibly help their clients, can you take care of your loved ones if you are depleted?  Be fully present?  Can you be empathetic towards the people you care about? 

In grad school, I kept finding myself think I want empathy in my personal life, not just my professional. I want to be present in my personal relationships.  I want my loved ones to present to me!  Why should this only be taught to grad students in the field of social work or counseling?  Or to therapists? It shouldn't be reserved for a select few.

So, I want to pass along this important information by first giving you a Relax and Self-Care Mandate.  Followed by a simple, but yet effective step-by-step guide to help you move into Relax and Self-Care Practice.                                                                                                            

1. Ask yourself, “How do I feel?” – You can ask yourself this question at anytime: every morning, or when you notice yourself doing something you don’t particularly like (i.e. eating an entire large pizza), or when you are doing something or know you will soon be doing something that is stressful (visiting family, perhaps). And this is a good one, if you find yourself fighting against something that usually helps you (i.e. listening to music when sad or going to yoga after work – be aware of those feelings! Listen to them!)

2. Listen to yourself. Closely. Carefully. With compassion and non-judgment. Judging yourself will only prolong your path to feeling good or better. (Hint – You can tell that your Critic is speaking in this part of the Practice if you feel small. Your truest, most helpful answers here will always make you feel more open, not smaller.)

3. Ask yourself, “What do I need?” – non-judging is the name of the game. And dare to dream! You can also pose the question “What is standing in my way of feeling however you want to feel. (This is a concept from the book I recommend, Focusing by Eugene Gendlin, Ph.D.).

4. If you can’t hear the answer, then close your eyes. Often when I cannot hear an answer, I just need a break to think about it and to listen, carefully. Think about it. If you can’t hear an answer about what you need for yourself, then chances are that you can’t hear others’ needs. And, you can't be as present in life. So take a break until you can get an answer.

5. Follow through. Your answer appears to you, and now you need to connect, commit and follow through. For instance you find yourself wanting or needing a break or vacation. Let's say you have no PTO. Find a way to give yourself the break, even if it's taking an afternoon off.

And, in closing, I want to remind you – when things get shaken up (could be due to a stressful life event, positive transition, recurrent memories, trouble in relationships), our Relax and Self-Care Practice may need to begin to include the use of a professional therapist.  I invite you to utilize the tools and guide I have learned for my own Relax and Self-Care Practice. Following your internal instincts of what you need is not just good Self-Care, it is, ultimately, being true to yourself, which may feel foreign in a life of meeting others’ expectations.

It is possible to follow your own voice, meet your own needs, and be true to yourself in a life of others’ needs. And, if you have children, loved ones, or employees looking to you for example or direction, you may model to those little ones, loved ones, or employees that it is OK and appropriate for them, too, to take care of themselves. So, get out there and sharpen your knife.  Engage in your Relax and Self-Care Practice.  And, start enjoying your life!