#44 | How LGBTQ Teens Are Coping with Anxiety & Depression—And What Parents Need to Know

Welcome to Just Breathe: Parenting Your LGBTQ Teen, the podcast transforming the conversation around loving and raising an LGBTQ child. Filled with awesome guests, practical strategies, and moving stories, host Heather Hester always makes you feel like you're having a cozy chat. Wherever you are on this journey right now, in this moment in time, you are not alone. And here is Heather for this week's amazing episode.

Welcome to Just Breathe. I am so happy you are here today. I've had several conversations recently that sparked my desire to do an episode on mental health awareness for everyone. The uncertainty and isolation resulting from COVID have had a widespread effect on the mental health of most people. And for better or worse, this is helping to shake the stigma that struggling with depression, anxiety, or any other mental health issue means you are broken or weak. So what I would like to do today is to continue this conversation in our space, to share what signs, behaviors, and symptoms to look for, as well as how to manage these with specific coping tools. To understand what mental health and mental illness are and how to take good care of yourself, how to teach your child how to take good care of themselves, and who to call or where to look for resources when you need more intensive support for yourself or for your child. The most recent conversation I had was with a parent who is a friend of a friend. She reached out to me because her son is struggling with depression, and she wanted to ask questions about some of our experiences and places we turn to for support. There were several times during our conversation where each of us commented how naïve we had been, or reflected on our frustration at not knowing more about mental health, about not realizing that supporting your child through a mental health crisis is vastly different than most physical health crises we face as parents with our kids. How many of you out there felt ridiculously underprepared when your child started struggling? Did you think, "Okay, we'll see this doctor," or "We'll try this program," or "Take this med," and in a few weeks everything will be just fine? I know I did. 4 years ago, I couldn't even begin to understand the intricate layers of mental health. From the day we find out we are bringing a little one into the world, we begin our education on handling every possible physical ailment that could pop up, right? Fast forward through many trips to the pediatrician, and it is not until our children are near puberty that mental health education becomes more than an occasional mention. I do believe this is now shifting. Kids around the world are struggling. Parents are searching for support. You see more and more articles being written every day, and research is being published at an unprecedented rate. And perhaps most importantly, more and more people are courageously sharing their stories. We can do our part in eliminating mental health stigmas by having open conversations like this, by sharing educational and factual information, and by advocating for our children and for ourselves. The most important thing we can do, though, is to let our kids know that it's okay to not be okay. Why does it seem like mental health disorders are so much more common now? I think the main reason, and the reason most other reasons point back to, is people feel safe talking about their struggles and experiences. One of the most common questions or concerns is, how do we know if our child is struggling with a mental health disorder or if their behavior or symptoms are just typical adolescent or teenage development. Mood swings and rule-breaking behaviors are part of this awesome stage of life, making it that much more tricky to discern when there is a problem. Know that it is completely normal for our teens to feel depressed from time to time. It is also completely normal for them to push the boundaries and break the rules. This is part of their identity exploration. Here are 3 criteria, though, to help you distinguish between typical teenage development and signs of more serious issues. 1. Duration. If any behaviors or symptoms last more than a few weeks, it is time to seek professional help. 2, the severity of the behaviors and/or the symptoms. Ups and downs are normal in mood and behavior, but take note of how these fluctuations change. Do they become really level, or are they all over the place and really, really hard to predict or to know what's coming next? And 3, the impact on daily life. Are the behaviors or symptoms affecting schoolwork or willingness to go to school? Are they affecting your child's social life or their activities? If you're like me, it is helpful to have a list of behaviors and symptoms to watch for. So here you go. You want to look for moodiness, and this can be anything from low mood, tearfulness, or lack of interest. Physical complaints like headaches, stomachaches, difficulty sleeping. Self-harm, and this is a big one. But it is important to keep an eye out for. And self-harm can be cutting, scratching, pulling hair out. Kids are really, really good at hiding marks if they are self-harming. So if you are concerned that your child is self-harming, reach out to me and I will walk you through what to do and what to look for. Another behavior to look for is aggression. Another symptom to look for is isolation, escalating of breaking the rules or boundaries, changes in school performance or behavior, substance use or substance abuse, and weight loss or failure to gain weight. So let's start with the basics. The 5 most common mental health disorders for adolescents, teenagers, and young adults are depression, anxiety, ADHD, disordered eating, and behavior disorder. In this episode, we are going to talk about depression and anxiety. Depression is the most common mental health disorder our kids struggle with. Between the natural development of the teenage brain and the effect of external influences such as school environment, social media, and factors that are really out of their control like COVID, the weather, politics, it's really easy to see why. Here are some of the symptoms and behaviors that are specific to depression to keep your eye out for. Consistent sadness, irritability or snippiness, loss of interest in activities or sports or social life, sustained change in appetite or weight, too much sleep or, conversely, difficulty sleeping, just feeling blah, not wanting to do anything, low self-worth or low self-esteem, difficulty concentrating, and fixation on death or suicidal thoughts. It is okay to ask your child if they think about suicide. Asking actually reduces the likelihood rather than increases it. I know it is uncomfortable and it is scary, But the more you ask and the more you leave that door open for conversation, the easier it will become and the more information you will get. Remember, you know your kid. Trust your gut on this one. If you feel something is off, it probably is. So while you and your child are trying to assess the severity of their depression, Try the following coping tools. Even if more intensive help is needed down the road, empowering them now with positive ways to manage their depression helps take away that helpless feeling and teaches them really valuable life skills. So first, try to encourage them to hang out with a good friend. Being with someone they can laugh with or just be themselves with helps pull them out of the darkness that they are feeling. Our goal as parents is to minimize the time they spend in literal darkness alone in their rooms. We've all been there. 2. Encourage them to do any type of physical activity they enjoy. Exercise of any kind increases endorphins in the brain, which are literal chemical depression busters.

3.

Encourage them to do something that seems scary or intimidating. Doing something hard gives a huge sense of accomplishment, and it also helps build resilience. This one doesn't work for every kid, though. For example, it works great for Isabel, not so much for Connor or Grace. 4. Encourage them to tap into their creativity. It can be very therapeutic to have a space where they can funnel all of those emotions into a creative project. All four of my kids love this tool, and over the past few years, they have painted multiple murals in our house, taught themselves to play new instruments, written music and poetry, and used makeup to create incredible transformations. The possibilities are truly limitless. And five, Encourage them to build healthy eating habits and more importantly, really understand how certain foods can affect them both positively and negatively. For example, foods that are high in vitamins B and D, as well as in magnesium and omega-3 fatty acids, are so good for energy and for the brain, as well as a plethora of other benefits. Conversely, foods that are high in carbs, sugar, and caffeine cause inflammation in the body, which directly affects our ability to maintain our mood or keep our mood stable. Not every one of these tools will help every person, but encourage your child to try one each day or help them try one every few days. So now we're going to move on to anxiety. Anxiety is the second most common mental health disorder our kids are likely to deal with. In many cases, anxiety and depression work in tandem, taking turns with levels of intensity and one triggering the other. Anxiety disorder is different from feeling anxious from time to time. Like depression, anxiety can present in multiple ways. Acute anxiety can come on suddenly, feel intense for a few minutes, and then go away. Generalized anxiety affects daily life, and social anxiety affects one's ability to participate in any social situation. So here are a few symptoms and behaviors that are associated with each form of anxiety. Acute anxiety can come on unexpectedly or be triggered by something. You want to look for pounding or rapid heart rate, excessive sweating, trembling or shaking, shortness of breath or feeling like you can't catch your breath, and feeling out of control. People who struggle with generalized anxiety feel intense anxiety or worry every day about multiple areas of their life to the point where their fear and anxiety disrupt how they function at home, at school or work, and socially. So for generalized anxiety, you want to look for feeling on edge or irritability. For our teenagers, this looks like snippiness or biting comments that are seemingly out of the blue that come on a regular basis. Unusual fatigue occurs because it takes a lot of mental effort to constantly try to regulate how you are feeling or how you are experiencing the world around you. The third is difficulty concentrating. Again, when our kids are working so hard to regulate internally, it becomes difficult to focus on schoolwork or anything else that may need to be accomplished. Procrastination is a huge side effect of both anxiety and depression. And finally, sleep problems. Anxiety can wreak havoc on sleep. Difficulty falling asleep or staying asleep. Restlessness or inability to get restful sleep are all common symptoms here. Finally, I want to mention social anxiety specifically because it is many times dismissed as shyness. Isabel has struggled with social anxiety her entire life, but we didn't realize that that is what it was until just a few years ago. What externally looks like a child who is quiet and hesitant to engage internally feels like intense fear or anxiety toward social situations or any type of performance, even and perhaps especially class presentations that are becoming more and more the norm, right? What really separates social anxiety from shyness is the child's worry that their actions or behaviors associated with their anxiety will be judged by others—peers and adults alike—and they feel scrutinized and embarrassed. This worry causes them to avoid social situations, including wanting to attend school, and it causes them to work really hard internally to overcome or to push through these feelings so that they can make it through the day. This is a sneaky one, but it's definitely good to have on your radar. So what can you do to help your child cope with or manage their anxiety? Well, thankfully there are several very actionable options here. It shouldn't surprise you that breathing techniques are at the very top of my list. They are so helpful in a variety of situations, and all you need is your breath. For anxiety, either acute or general, try the 4-7-8 breathing pattern. As long as you or your child are somewhere where you can be still and close your eyes for a few minutes, you can do this one. What you want to do is breathe in for 4 counts, hold for 7 counts, exhale for 8 counts. Silently counting helps settle the mind, and the breathing pattern helps settle the fight-or-flight response. The second tool that you can use is to encourage them to journal or doodle or draw, to just get a notebook and get all of their thoughts out on paper in whatever form gives them the most relief. Taking all of those swirling thoughts and putting them down on paper frees up mental space and it helps bring feelings of calm and groundedness. The third thing you can do is begin to track their triggers. This is something that you and your child can actually do together. Triggers can be anything from a specific class in school to a trauma to depression to a specific person or even scents or sounds. Knowing triggers allows you and your child to create a plan to either avoid that trigger or take action to change it. And finally, try establishing a daily routine. Knowing what to expect each day can significantly reduce anxiety. Think back to when our kids were little. They always behaved better, slept better, played better, right, when they had a routine. So you may be asking what the options are for more intensive help. How do you know if your child needs it? Where do you even begin to look? Before I answer these questions, I want you to know it is totally okay to feel overwhelmed and even a little scared by all of this. In so many ways, this is uncharted territory. As parents, we are so used to the routine of handling physical illnesses that it can be shocking at first to realize that diagnosing, treating, and managing any mental illness is an entirely different ballgame. This was a massive eye-opener for both the mom I talked to the other night and for me, and I'm guessing it was or is for many of you as well. For us, we didn't even know to look for or seek coping skills for Connor. Even though he did have multiple therapists that first year, it wasn't until about 8 months in that we were even educated on that option. Furthermore, we had no idea how interconnected depression, anxiety, and for Connor, the coming out process were. We truly naively thought that we would get him support to whatever degree he needed it, and then he would feel better. Check. Done. Right? We had no idea the complexity of mental health disorders mixed with adolescent brain development mixed with coming out. Honestly, this is one of the biggest reasons I do what I do. If your child has been experiencing multiple symptoms or behaviors from the above list consistently for 2 to 3 months, then you may want to consider looking for more intensive help. This can look like one-on-one therapy and/or family therapy. Medication prescribed by a psychiatrist, or a program such as intensive outpatient, partial hospitalization, or an intensive residential therapeutic program. We have experience with each of these types of support, and I can tell you that there is value in each one. It just depends on your child's needs. Start with one-on-one therapy or family therapy or both. It can be helpful, although completely not necessary, to work with a therapist who is trained in cognitive behavioral therapy, which has been proven to be effective for both depression and anxiety. What I like most about CBT for our kids is that it employs exercises within the session and then homework in between sessions that really helps empower our kids in taking ownership of their mental health. When we just say to them, "You have to do the work," that doesn't necessarily make sense to them if they don't understand how to develop the coping skills that help them manage their thoughts, emotions, and behaviors. A therapist will be able to advise you if they think you should consider medication for your child. In most cases, they will be able to recommend a psychiatrist who works with adolescents. Do not be afraid to ask questions. There are many natural options too, so make sure you add that to your list of questions if that is something that is important to you or is of interest to you. There is no such thing as a dumb question, particularly when you are advocating for your child. Intensive outpatient, partial hospitalization, and intensive residential come into play when your child's symptoms and/or behaviors are just too difficult to manage at home, or if there are more serious issues at hand, such as self-harm, suicidal ideation or attempt, disordered eating, school refusal, et cetera. Listen to your gut on this one. You know your kid. And please, please listen to me when I tell you this. You cannot love this away. I have been there thinking, if I just wrap Connor up in love and compassion and tenderness, he will feel better. I almost lost him with that thinking. Loving him enough meant getting him the intensive help he needed, letting go of him for a time, and trusting the process. Whew! So, who out there feels better when they're taking action? I know I do. Let's shift into how we can help transform this conversation and help fight mental health stigmas. One, get the facts. This is what we've been doing today. I will also list some of my favorite mental health websites in the show notes so you can add to your knowledge. Two, be conscious of your language. We've talked about this with regard to so many different areas. Words matter. Become aware of the meaning and implication behind the words you use. It truly does make a difference. 3. Check our own attitudes or prejudices. This is a big one. We all grew up with different ideas about mental health, many of which were probably not very accurate. Take some time to think about what you grew up hearing and learning and what you know to be true now. This exercise allows you the space to let go of the information that is no longer accurate, useful, or just doesn't serve you or your family. 4. Practice dignity and respect for everyone. We have no idea what another person's internal experience is or what they may be dealing with, unless of course they are a close friend or a family member. I find it really helpful to remember to intentionally allow space for respect, dignity, and compassion as I encounter others. 5. Support others in seeking help. Help them to let go of this stigma. Let them know that they are not broken and that it is okay to not be okay. 6. Talk openly about mental health and be honest about treatment. I talk about seeing my therapist like I talk about seeing my general practitioner. Over time, I have also found it particularly effective to talk about my personal struggle with depression and anxiety, just like I would talk about having a cold or a broken finger. It happens. It is part of life, and it is one way of many to help others see physical and mental health in the same light. And finally, choose empowerment over shame. The most significant effect of the mental health stigma is shame. By becoming empowered and empowering our kids, we directly affect the cycle. The more people we help inform and empower, the closer we get to eliminating this stigma. I really hope this episode was helpful and enlightening for you. While it wasn't specific to our LGBTQ+ kids, it is certainly something that tends to creep in at some point during the coming out process. As always, please reach out with questions or ideas for future topics. I love hearing from you. Until next time.

Thanks so much for joining Heather today. Remember to just breathe. Take a few minutes every day to calm and center yourself. Reach out anytime with ideas, questions, or feedback. Please rate and review Just Breathe on your favorite platform. Subscribe to Heather's website, www.chrysalismama.com, to receive her monthly newsletter and stay informed. Join the private Just Breathe Facebook community to chat with other parents and allies, and share with anyone who needs to know that they are not alone.