Depression in Adolescent Males

Depression is soaring among adolescent males. However, these young men frequently go undiagnosed and untreated, often because they don’t exhibit standard diagnostic criteria for depression. Instead — after a lifetime being told boys don’t cry — they appear angry, oppositional, self-destructive, or maybe even violent.

Depressed adolescent males hide behind these masks, doing their best to push away the world and hoping nobody notices they’re actually sad, lonely, vulnerable boys. In counseling I strive to help them remove their masks, explore the Guy Code, and resolve the stuckness that often results from depression.

Stuckness is a recurring theme in much of my work. It can be especially relevant with depressed adolescent guys. I define stuckness as an unwillingness or inability to do anything differently. In other words, the teen can’t or won’t change.

Teens who can’t change lack the skills to do so. Teens who won’t change lack the motivation. In my experience, most depressed adolescents fall somewhere between these two extremes.

Additionally, can’t and won’t are likely to perpetuate each other. Teens who believe they can’t make change are unlikely to be motivated to try. Teens who are unmotivated to change probably won’t be receptive to new skills.

Sometimes, this stuckness includes distress about Big Questions related to death, isolation meaninglessness, and choice. In fact, this is quite common. Abstract thinking skills develop during the early teen years. Combine depression with this new thinking skill and existential angst is, perhaps,  inevitable.

Therapists and other professional helpers often shy away from these existential themes when meeting with teens. It seems to me there are two reasons for this.

First, these themes just don’t fit into the solution-focused, goal-driven treatment approaches most commonly utilized when counseling adolescents. There’s nothing wrong with being solution-focused, but not everything can be fixed.

It seems to me that when we push away or ignore “unfixable” issues,  we end up reinforcing the stuckness. With that in mind, instead of pushing these topics away, I believe we should embrace them.

Second, some therapists seem to think depressed teens, especially trauma survivors or those with suicidal thoughts, are simply too fragile or damaged to explore these themes. This thinking suggests that acknowledging teens are  stuck will somehow make things worse. That’s just not true.

Its important to be thoughtful, of course. I firmly believe that establishing rapport and addressing critical presenting concerns must come first. However, it’s also important to hold teens capable of exploring existential themes and other unfixable issues. Doing so emphasizes their resilience, suggests the possibility of a life beyond stuckness, and helps them move forward.