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Teens And Depression

Teens And Depression
Is your teenager depressed or just moody? How can you tell? Local experts discuss the differences.

MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh. You're listening to These Days on KPBS. Suppose you observe that your teenage son seems irritable and tired and lost in his own world. Or your 14-year old daughter seems to burst into tears at any excuse. Is that normal? Or is it a sign of a deeper problem? The difficulty of spotting mental health issues like depression in teenagers, whose emotions are volatile to begin with, is a real challenge for parents, and sometimes doctors. That could be one reason only about 20% of teenagers who are suffering from depression are ever treated for it. This morning we'll be talking about some of the signs of teen depression and how widespread the illness has become. I’d like to welcome my guests. Lisa Boesky, Ph.D., is an adolescent psychologist and author of "When to Worry: How to Tell If Your Teen Needs Help—And What to Do About It." Lisa, welcome to These Days.

LISA BOESKY (Adolescent Psychologist/Author): Thank you very much.

CAVANAUGH: And, on the line, Dr. John Kelsoe is professor of Psychiatry at UC San Diego. Dr. Kelsoe, good morning.


DR. JOHN KELSOE (Professor of Psychiatry, University of California San Diego): Good morning.

CAVANAUGH: We invite our listeners to join the conversation. Do you watch your kids for signs of depression? Why do you think more teenagers are experiencing depression? Give us a call with your questions and your comments. Our number is 1-888-895-5727, that’s 1-888-895-KPBS. To start off with, Dr. Kelsoe, tell us, if you would, what’s going on in a teenager’s brain and body as far as hormones go that really make them so moody.

DR. KELSOE: Well, I’m not sure we have a full understanding of why teenagers are so moody but I think it’s important to keep in mind that modern neuroscience has shown us that the teenagers’ brain is not mature yet. There are the more sophisticated regions of the brain involved in reasoning, abstraction, judgment, social judgment, really the sort of wiring to that part of the brain continues to be wired and to come online well into your twenties. You probably – your brain isn’t probably close to mature until age 30. So we know that their brains are changing, aren’t fully mature, and that probably explains a lot of the variety of things we experience with teenagers.

CAVANAUGH: So, Lisa, then a lot of that change, that moodiness, that brain development that we’re witnessing in the teenage years can sort of mirror depression at times, can’t it?

BOESKY: Well, that’s what’s confusing for parents is that during adolescence we know that teens experience more intense moods than childhood or adulthood and more frequent changes of moods, and that’s good moods and bad moods. So when you see someone being – a teenager being sad, they’re more sad than you would be as an adult. So it can be confusing and it’s hard to tell what’s the difference between teenage moodiness and a true mental health disorder. And I think for a lot of parents, that’s the difficulty. Is this a phase? Or is this something to worry about? And I think often times we think, well, that’s just a teen being a teen, and left untreated, it can actually get worse and that’s the problem because we want to intervene early but parents often don’t know how to recognize it.


CAVANAUGH: And, Lisa, is there also a feeling among some parents that a condition like depression really can’t affect someone as young as 14 or 15?

BOESKY: Absolutely. One of the biggest misconceptions is things that happen during the teenage years aren’t big enough to cause true depression. So we all think, as adults, of course you broke up with your boyfriend, everybody breaks up with a boyfriend, you’ll have many, many more, or, yes, you got a bad grade, or, yes, you have a big pimple and you’ve got the prom. It’s not that big of a deal. But for some teenagers, particularly those who have a genetic predisposition that those things can actually be a big enough deal to make someone not only depressed but actually can trigger suicidal feelings. And so it can absolutely occur in children, absolutely during the teenage years, and we know if they do have it in the teenage years, it’s likely to continue, if left untreated, throughout adolescence and possibly into adulthood.

CAVANAUGH: And, Dr. Kelsoe, I’d like to get your take on that as well. Is this idea that really young teenagers and teenagers can develop a fullblown depression, is that sort of new in the – in psychiatry?

DR. KELSOE: Well, I agree with what was just said. I think that recognizing it and this idea that teens and children can’t become depressed, it has sort of the common sensical roots that were just described but also has some older theoretical roots that go back to older theories about brain and mind function. But they certainly do get depressed and the symptoms, although a little different in presentation, fundamentally they’re the same as in adulthood.

CAVANAUGH: And, well, we see movies and TV shows that portray depression as someone who’s always crying, always sad, and, Dr. Kelsoe, is that really what depression looks like?

DR. KELSOE: I think depression can have many faces and, of course, the most prominent is sadness and crying but not necessarily everyone experiences that as the main thing. Some people may present with problems with energy or sleep problems as being the primary symptom of depression. In older people it can be forgetfulness. And teens are – may have a limited ability to describe what they’re feeling and it may be difficult to get out of a teen exactly what’s going on in their brain and what they’re experiencing so I think that those sad – you know, the excessive sadness is sort of the primary presentation. I think we all need to be open to the prospect that it could appear otherwise as well.


BOESKY: Yeah, one of the things I think is the most difficult and, I think, confusing for family members and parents and doctors alike is oftentimes during adolescence, with teenagers, they show an irritable mood so they’re agitated, they’re irritable, they might even get aggressive. So they’re often seen as bad kids when they’re really sad kids. Parents might respond by having them be arrested, they may send them off to a boot camp, which, if you’re depressed, one of the worst places you can be is juvenile hall or a really strict boot camp. And so I think that’s another thing that’s hard to recognize is irritability is often one of the most presenting factors in depression during the teenage years but parents don’t realize that.

CAVANAUGH: I’m speaking with adolescent psychologist Lisa Boesky. Her book is "When to Worry: How to Tell If Your Teen Needs Help—And What to Do About It." And Dr. John Kelsoe, professor of Psychiatry at UC San Diego. And we are taking your phone calls about teen depression. We’re asking you if you think there are signs of depression or maybe if you watch your children for signs of depression. Give us a call at 1-888-895-5727, that’s 1-888-895-KPBS. Lisa, have there been studies done that show how many teens are depressed?

BOESKY: There have not been great studies that can be extrapolated throughout the country. They’ve done it in certain places and what – the Surgeon General came out with a report and said about 20% of teenagers, children and teenagers, have a mental health disorder that impacts their functioning, either at school, with friends or at home, about 20%. And of those 20% only 20% are actually getting treatment for that mental health disorder. So when it comes to depression specifically we’re not exactly sure because, as was mentioned by Dr. Kelsoe, a lot of teens don’t know when they’re depressed and so even if you ask them straight out, are you depressed?, they don’t recognize it even in themselves. And a lot of parents don’t recognize it. So it’s very difficult to do good studies. You’d have to look at millions of kids to really understand it. And so we know that it’s growing and we also know that the teenage years are one of the most common times that you’re going to see depression and it’s twice as common in girls versus boys during adolescence.

CAVANAUGH: That’s interesting. So if the teens themselves don’t know that they’re depressed, their parents can’t spot it, Dr. Kelsoe, how do psychiatrists and psychologists spot this in teenagers?

DR. KELSOE: Well, I think a lot of it is more from changes in behavior that may reflect the depression. The student’s grades may drop, they may have problems with sleep or insomnia, and this has to be considered in the context of the adolescent’s normally sort of shifted sleep pattern. They naturally, during adolescence, will go to sleep late and wake up late but they may have difficulty sleeping. They may lose weight. There may be changes in their friends, or use of drugs may be another aspect of this. Or, alternatively, they may act out and may get into trouble with police or at school. All of these things may reflect behaviors that should at least raise a suspicion of depression.

CAVANAUGH: And, right, Lisa, if, indeed, your child had some confrontation with the police or was getting into trouble, depression would not be the first thing you’d think about.

BOESKY: That’s exactly right. And I think what’s – The same thing with drugs and alcohol, when someone sees that, when a parent sees that their child is on drugs and alcohol, the number one thought isn’t, oh, I wonder if my child is depressed, it’s why are they using drugs? How are we going to intervene? And I would say there’s a lot of treatment programs that a lot of parents have spent a lot of money on substance abuse treatment programs that never even looked at a co-occurring mental health disorder. And we know for teenagers, if they have a substance abuse problem or if they have a mental health issue, they often have a co-occurring substance abuse problem and mental health disorder together. And so it’s very difficult and, as Dr. Kelsoe mentioned, the sleep issue, it’s hard to tell what’s normal and what’s not during the teenage years. The same thing is true with weight gain and weight losses. We always say appetite and sleep disturbances but appetites can change. You’ve got a girl on a diet, you’ve got a boy who wants to bulk up. It’s very hard to tease apart, and I think it’s hard for professionals as well as for parents.

CAVANAUGH: We are taking your phone calls at 1-888-895-5727. Let’s hear from Rachel calling us from Chula Vista. Good morning, Rachel, and welcome to These Days.

RACHEL (Caller, Chula Vista): Hi. Good morning. I really appreciate the topic and the time being spent on it. I’m a young 30-year-old and I’ve struggled all my life with issues and what’s interesting is of what I’m hearing from the discussion is I had parents who were both social workers, both supposedly quite trained in recognizing these kinds of things and it flew right past them, everything that I was going through in my teen years. And it took until I was a young adult basically dealing with some very serious issues in my own life and my own behavior to have to seek treatment. And so listening to this conversation it strikes me, why don’t we have something like regular mental health physicals because we have physical physicals for our teenagers and children. It seems like it’s too late when we wait for things like eating disorders, suicide attempts, substance abuse. Like what can we do preventatively to help people like myself that are struggling?

CAVANAUGH: Thank you for that, and I’ll pose that question to both my guests. First you, Dr. Kelsoe.

DR. KELSOE: Well, I think recognition, just as you’re saying, is the most important thing. I think oftentimes parents, even parents in the business may not know exactly what to look for or may not recognize it. So I think recognition and an early treatment is the most important thing. I think as a society, it’s important for us to educate people about this and reduce the thresholds of stigma that prevent people from getting treatment, the things that tell the depressed person it’s not real, it’s just in your head, pull yourself up by your bootstraps, none of which are helpful in really getting over the depression and prevent people from getting in to seek adequate treatment. And I think it’s also important to just point out, of course, the most serious aspect of this is suicidality and how important it is to recognize signs that might suggest depression and to ask about suicidality. I guess the one thing I wanted to be sure was said here is that I think it’s very important when you see these kinds of things to ask your teen about suicide. Are they having these thoughts? People often become afraid to ask that for fear they’re going to put the idea in their child’s head or something like this or they’ll be embarrassed, but the reality is, is most of the time, if there’s – if you think someone might be depressed, probably they’re already have had thoughts about suicide and their primary reaction is going to be relief on being allowed to talk about it. So I’m sorry to kind of turn the question a little bit here but I think it is very important that we raise this issue in the context of early detection to really being very sensitive in detecting teens who are thinking about suicide.

CAVANAUGH: Dr. Kelsoe, that’s an essential point. I’m glad that you were able to get that in. I’m wondering, Lisa, is it important, considering how complicated it is to make any kind of diagnosis of depression in young kids, to find a therapist that specializes in adolescents or teenagers?

BOESKY: Absolutely. There’s no doubt about that because a lot of professionals who specialize in adults may not recognize what depression looks like. As was said, the symptoms are similar but not exactly the same. You have to be aware of teenage issues and, more importantly, you have to be able to engage a teenager so it’s typically not the teenager’s idea to go to the local mental health professional. Their parents are trying to bring them, they don’t want to be there, they don’t trust this person. They may be afraid they’ll get in trouble if they spill what’s really going on and what kind of thoughts they’re really having. So you really need someone who can engage with the teenager and make them feel comfortable, and knows how to recognize the symptoms specifically. Because the thing about depression, it’s not looking at a checklist of symptoms, it’s ruling out. It’s not due to stress, it’s not due to family conflict, it’s not substance abuse, it’s not this, it’s not that, it’s not that, it’s not a medical condition. And someone really needs to be well versed in the typical teenage behavior so that they don’t over diagnose depression or miss it when it’s there.

CAVANAUGH: And I just want to follow up on our caller’s point. She was saying why don’t we basically have a mental health screening for our young people the way we do with their physical health. And do you know much about that, Lisa? Do schools actually have mental health screenings?

BOESKY: You know, I thought the caller was right on target. Two things: one, why don’t we do a mental health screen? There actually is something called Teen Screen that is done in some schools around the country where they basically screen every single student at a certain point in the year, and there are some questions on there about depression and some other issues. And kids who, quote, unquote, red flag, not necessarily have depression but need to be followed up on, then get a more in-depth evaluation. As you can imagine, there are some parents and professionals that are adamantly opposed to this. They feel that people are going to over-diagnose children. Some people feel they’re only doing this, it’s part of the pharmaceutical, you know, companies trying to get kids on medication. But my experience with it in the schools that have used it, have found it incredibly helpful and have really identified kids who really were slipping through the cracks and would not have been identified, and that may have been the caller. What she describes is very, very common and one of the reasons that I wrote the book. I work, as she said, perfectly. I used to work in jails and prisons with kids, in psychiatric hospitals when things got really bad, and then it struck me I talk so much about prevention, why haven’t I written a book for parents, because they really are the first stop. But you can’t blame them to not know what to look for. There’s not a manual on teenagers in general and there’s certainly not one on how to recognize depression in them.

CAVANAUGH: We are taking your calls at 1-888-895-5727. Let’s take another call. Kris is calling from San Clemente. Good morning, Kris. Welcome to These Days.

KRIS (Caller, San Clemente): Oh, thank you and thanks so much for taking my call. You know, it was interesting, I was just driving to work and your – Lisa, you really struck me. I’ve been really, really worried about my daughter and I’ve been kind of toying with the idea that it could be depression even though she doesn’t act, you know, quote, unquote, depressed. But she’s been going through a lot and I wanted to see – I’m so afraid of getting the wrong therapist or somebody that really doesn’t know a lot about adolescents, especially here in Orange County. What should I be looking for? First of all, should I go to a psychiatrist? A psychotherapist? You know, what credentials, what, you know, should I be looking for in a therapist?

CAVANAUGH: Thank you, Kris.

BOESKY: That’s a great question, and I think as a parent it’s a hard thing to think I actually may need to seek out professional help but I think it’s one of the best things you can do because what may happen is the professional might say don’t worry about it, it’s nothing, it’s nothing to worry about. But if there is something, you want to know now. You know, keep in mind, I’m a psychologist so take it with a grain of salt. What I like about taking someone to a psychologist is particularly with teenagers who are not always the most verbal when it comes to this type of information, is a lot of psychologists can run tests, not school type tests but things that get underneath the surface to really look at what’s going on that the teen may not even be aware of and what’s going on that the teen doesn’t feel like they’re ratting out their parents or saying something bad about someone else, and so a psychologist can run tests and find out what’s underneath because although it may or may not be depression, depression often coexists with other issues, learning issues, ADHD, social issues, and they can find that stuff out as well. So I’m a big believer to – I think psychologists are very helpful. Orange County has the Orange County Psychological Association. San Diego has the San Diego Psychological Association. LA has one as well. And you could call and say I’m looking for someone who specifically works with teenagers, and they can recommend someone. Because here’s the bad news: You really only get one, maybe two, chances of taking them to a professional. With an adult, they may give it a couple tries but if it doesn’t go well the first time with a teen, it’s really hard to get them back there again. So you want that first time to really be well thought out and strategic.

CAVANAUGH: We have to take a short break and when we return, we’ll continue the discussion with my guests, Lisa Boesky and Dr. John Kelsoe. And we’re talking about teens and depression. We’re also going to talk a bit about the controvery regarding antidepressants and teenagers. And we’ll continue to take your phone calls at 1-888-895-5727. You’re listening to These Days on KPBS.

CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. My guests are Lisa Boesky. She’s an adolescent psychologist and author of "When to Worry: How to Tell If Your Teen Needs Help—And What to Do About It." And Dr. John Kelsoe is professor of Psychol – Psychiatry, that is, at UC San Diego. We’re taking your calls about teen depression. The number is 1-888-895-5727. A lot people want to join the conversation but before we take a call, Dr. Kelsoe, I do want to talk just a minute or so about antidepressants and teenagers. I think we all know that there was a controversy and continues to be a controversy about how effective antidepressants are with teenage brains. I’d like to get your expertise on this.

DR. KELSOE: Well, I think it’s clear from many studies that antidepressants do work for teenage depression. The presentation, as Dr. Boesky indicated, is – can be somewhat different but the medications are quite effective. I think the concern – of course, there’s always a concern in a child or adolescent giving them any kind of medication and I think that always should be thought about carefully. But at the same time, I think it’s a mistake to neglect the use of medication when some of the teen’s suffering might be alleviated. A lot of the concern about antidepressants has been the reports of an increase in suicidal thinking in some teens and adults taking the kinds of antidepressant medications referred to as SSRIs and it’s – and this has led the FDA to put a formal warning on the package inserts from some of these drugs and has caused a lot of doctors to, I think, prescribe these medications less commonly for teens and children in particular. So I think that it’s unclear exactly what this means. The studies are a little bit mixed. It’s always been known that there were a subset of patients who had suicidal thinking just as they were starting to get better in response to antidepressant treatment. I think many people now believe this is probably some specific subset of individuals and there’s a lot of work to try and identify those who may be vulnerable. So – But though there may be a subset who are vulnerable to this increase in risk, the majority of adolescents are going to experience a decrease in suicidal thinking as their depression gets better. And I think it’s important, though, we need to be concerned about the risk in this small group of individuals, we also need – I think it’s important to not avoid these medications unnecessarily and thereby leave teens continuing to suffer and develop suicidal ideation without appropriate treatment. I think in many – in almost all cases, medication treatment is best combined with psychotherapy, so I’d answer your earlier question with both. They really should be getting therapy and, if indicated, at least seen by a psychiatrist to consider the prospect of medication.

CAVANAUGH: We are taking your calls at 1-888-895-5727. We’ve got a lot of people on the line. If you’d like to go online and post your comment, please do. That’s Let’s take a call now from Doug in Carmel Valley. Good morning, Doug. Welcome to These Days.

DOUG (Caller, Carmel Valley): Thank you and thank you for the topic. I have a nephew who’s a young adult, no insurance, depressed and has expressed suicidal thoughts. There are some bipolar history in the family. And I had two quick questions, one of which I think you touched on a bit already. The first is, is any known resources for those without insurance, you know, to deal with these kinds of situations? And the second is, you know, what are sort of the first steps, best first steps to take to stabilize someone in relation to sort of medicine versus therapy or some combination thereof?

CAVANAUGH: Thank you, Doug. Let me ask you first, Lisa, specifically about what people can do if they don’t have health insurance.

BOESKY: Well, we have Community Mental Health centers that are specifically designed to help people who don’t have the resources. And I think here in San Diego County, I think it’s 2-1-1. If you dial 2-1-1, they – you can call and they have a variety of resources that may be available for someone who doesn’t have any type of financial resources. Number two, the second question, how to stabilize, well, I think as we talked about medication and I think Dr. Kelsoe is exactly right about a combination is necessary, and I think sometimes, particularly you mentioned your nephew is a young adult, and this happens with teenagers sometimes as well, where they’ll go to their primary care physician or their internist and after a quick interview they’ll prescribe some antidepressant medication or medication – a mood stabilizer if it’s bipolar disorder. I would say that is absolutely not the way to go. You want to go to someone like Dr. Kelsoe who is a psychiatrist, someone who will spend a lengthy amount of time evaluating it, who will closely watch the medication. It’s really challenging these days. Most people are getting their antidepressant medication from family practice and primary care physicians who obviously are very limited on the amount of time that they can spend, and are much more limited in their training in these types of areas compared to a psychiatrist. And, as we said, it’s very difficult to diagnose. So I would recommend if someone is going to look for medication that they find a psychiatrist. If it’s for a teenager, find someone who definitely deals with teens, if it’s a young adult, someone who definitely deals with young adults.

CAVANAUGH: Let’s take another call. Wendy’s calling from San Marcos. Good morning, Wendy. Welcome to These Days.

WENDY (Caller, San Marcos): Good morning. I was wondering, I have heard some studies that connect video game playing and media use with teen suicide or depression. Not teen suicide but depression. And I wondered what you would think about that?

CAVANAUGH: Sure. Dr. Kelsoe, have you heard anything about that?

DR. KELSOE: Yes, this is a study, I guess maybe a year ago, that indicated that teens who watched, I think, greater than 8 hours of television a day or any kind of video had an increased risk for depression in their twenties. So I think that one thing that’s important there is there’s no – from a study like this, you can’t imply causality.


DR. KELSOE: It could be that the television makes them depressed when they’re in their twenties but it also could be that they are – have some predisposition to depression that both makes them more lethargic and sit around and watch TV all the time and later leads to the development of depression in their twenties. And also, I think that the, you know, how many kids are watching 8 hours or more of TV a day. That’s a lot of TV before they found a significant effect. And I think any kid who’s watching that much TV a day, that’s a sign in and of itself.

CAVANAUGH: Gotcha. You can’t from a study like that say, though, that video games cause depression.

DR. KELSOE: No. It was widely – when it came out, it was widely discussed but you really can’t reach that conclusion.

CAVANAUGH: Let’s take another call. Greg is calling us from Escondido. Good morning, Greg. Welcome to These Days.

GREG (Caller, Escondido): Hi.


GREG: Thank you for taking my call. I had depression all throughout my teenage years and it wasn’t diagnosed until I was an adult. I was wondering what the genetic predisposition was for having to watch my own children.

CAVANAUGH: Thank you, Greg. Excellent question. What do we know about that, Lisa?

BOESKY: Oh, God, that is so great. I wish more people would ask that question. Well, the good news is, just because you suffered—and I’m sorry that you did suffer from depression—does not – absolutely does not mean that your children will have depression in their teen years. What we think—and we don’t exactly know—but what we think is that depression is a combination of genetic factors, just like heart disease or diabetes. If it runs in your family, you’re more likely to get it, doesn’t mean you necessarily will. So it’s partly genetics from your parents or close relatives. It’s also partly environmental responses. So how you were parented, what your family life is like when you’re growing up. Is there a lot of conflict, a lot of chaos versus a more stable childhood and a lot of love and nurturance. But also traumas that may happen or stressful events. So it’s genetics, stressful events in the environment and then also an individual child or teenager’s coping skills. As we all know, some kids just cope better than others. You can see siblings who both go through a divorce. One completely falls apart and the other one comes through like a trooper. It’s really very difficult to know which one. The best thing you can do is keep your eye on it, look for the early signs and provide a very structured, loving, warm, supportive home without a lot of stress, and the chances that your children will suffer from depression are much, much lower if at all.

CAVANAUGH: Another call now. Stan calling from San Diego. Good morning, Stan. Welcome to These Days.

STAN (Caller, San Diego): Good morning. How are you?

CAVANAUGH: Fine, thank you.

STAN: Thanks for having me. Hello, Lisa. My name is Stan Collins. I’m the youth and program coordinator for the Yellow Ribbon Suicide Prevention Program here in San Diego. I just wanted to call and make the point that I think it’s also important in this process that we give the information directly to the teens, we educate them about warning signs of suicide as well as the depression, how to recognize those symptoms in a friend because, ultimately, they spend more time with each other than anyone else does. And also when talking about the treatment end of it, the same way that you let a child touch a doctor’s stethoscope, it’s important to explain the steps of treatment to them of what is depression and letting them know that, you know, antidepressants aren’t always needed, that just sometimes eating right and sleeping right and taking care of yourself can get you through this, so…

CAVANAUGH: So, Stan, how do we get that word out to teenagers?

STAN: Well, that’s what we’re trying to do, hopefully, but in the public’s view, you know, more encouraging the people to invite programs like Yellow Ribbon or invite speakers into the schools or to have that conversation happen in school. A lot of schools are timid because of parents’ resistance to have information, you know, given out to their children. And in the void of a lack of information that these kids will have, you know, they’ll turn to anything. They’ll turn to the internet. They’ll turn to television. And it’s important for us to give them the correct information.

CAVANAUGH: Thank you so much for the call, Stan, and Lisa?

BOESKY: Yeah, I’m very familiar with Yellow Ribbon. They do amazing work. And exactly what was said by the caller is we know that when a youth makes a suicide attempt almost always they have told a friend. Very rarely have they told a parent or an adult in their life. And so it’s important for us to get the word out for these kids to not only recog – or, to be able to tell because they feel like they’re betraying their friend even though to an adult it seems like, betraying your friend?, your friend’s going to die. But to them, they will hold that secret. And so to help them recognize the warning signs and then to give them permission just like we do – It’s no different than if you see someone with a gun at school or you hear someone talking about blowing up the school, schools are very good at having kids report that. We need to do the same thing with suicide, and we haven’t yet. There is a lot of resistance and a lot of misunderstanding but it would make a world of difference, and Yellow Ribbon does a great job with that.

CAVANAUGH: And Dr. Kelsoe, your – the point that you made earlier about talking to your teen – teenager about and asking them directly if perhaps they’ve had thoughts of suicide, do you find that parents are even resistant to even ask their teenagers if they’re depressed?

DR. KELSOE: I think there’s a wide range of attitudes about this and it depends a lot on education and knowledge of the parent but I think many parents are afraid to ask or first just don’t recognize it or are afraid to ask for fear it’ll be embarrassing or, again, that they somehow, you know, influence the teen to make them depressed. But I agree very much with the points that were just made. I think that education is key, and connecting with their friends is key because just as was said, that they will frequently talk to their friends far more readily than parents. And I think education of students in this regard and treating them as, really, partners in this is key.

CAVANAUGH: Lisa, is there anything a parent can do to help prevent depression in their teenagers?

BOESKY: Well, yes, there’s a lot they can do actually, and some of it was mentioned with – Eating and sleeping actually plays a much bigger role in depression than we give it credit for. So all of the fast food that kids are eating, all of the sugar that they’re eating, all of the caffeine that they’re drinking, not so good for a mood. Not good at all. So the healthier that they eat, the more exercise they do, the more active they are, we know that being active, for some people that actually helps in the treatment of depression. It changes their brain chemistry. So keeping kids active, keeping them eating healthy, and then sleep is a huge issue when it comes to mood disorders. They – Kids should really be going to bed at the same time every night, getting up at the same time. Pulling all-nighters, staying up all night texting or talking on the phone or on the computer and then catching up on the weekend is not good for the brain. And so for teenagers, those are just the basics. But bigger than that is listening. A lot of parents want to talk to their teens. It’s less about talking to them and more about listening to them, and not being judgmental. A lot of parents are afraid to ask the question because they don’t want to hear the answer. So they’ll sit down to communicate with their teen, they’ll ask their kid some really serious, you know, questions about issues, and their teen will open up and the parent will freak out. That is the absolute worst thing you can do. You can freak out in your bedroom later, but in front of the teen you need to listen non-judgmentally if you want them to come back again. And I think that’s one of the biggest things because it won’t necessarily prevent your teen from getting depressed but we know that being cut off and feeling like you have no support is a huge risk factor. Feeling hopeless is a risk factor. And what you want – the goal is whether your teen’s going to get depressed or not, you want them to feel comfortable enough to come to you and talk to you about it. And this doesn’t start when they’re a teenager. This starts much earlier on. You’re building the foundation for the teenage years.

CAVANAUGH: I want to thank you both so much for speaking with us. Lisa Boesky is the author of "When to Worry: How to Tell If Your Teen Needs Help—And What to Do About It." Thanks, Lisa. And Dr. John Kelsoe is professor of Psychiatry at UC San Diego. Dr. Kelsoe, thanks so much.

DR. KELSOE: You’re welcome.

CAVANAUGH: And if you’d like to comment on what you’ve heard about this – on this segment, go online, You’ve been listening to These Days. Stay with us for hour two coming up in just a few minutes here on KPBS.

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