How to Know When Your Teen Needs Inpatient Treatment for Depression
When your teen first started showing signs of depression, you probably thought what most parents think. Here are some things we bet you told yourself:
It’s a phase.
It’s typical teen moodiness.
Teens’ mood swings are impossible to decipher.
I was up and down as a teen, myself.
They’ll bounce back.
Then, when they didn’t bounce back, you took action. You talked to people and got advice. You found your teen a therapist. Therapy helps – but not as much as you thought. Your teen is still depressed more days than they’re not depressed. And now – after over a year of the coronavirus pandemic – their symptoms are worse.
Your teen’s therapist recommends taking them to an inpatient treatment center for a full biological, psychological, and social evaluation – what mental health professionals call a biopsychosocial evaluation. Since your teen has already attempted outpatient therapy – if your situation is like the one we describe above – their current therapist thinks they may need more immersive treatment.
They mention three additional levels of treatment, known as levels of care:
In a nutshell, IOP is when your teen goes to treatment 3-5 days a week for 2-3 hours per day, PHP is when they go 5 days a week for 5-6 hours a day, and RTC is when they live at the treatment center and get treatment and support 24/7. Teens in IOP typically go to school and live at home. Teens in PHP typically do not go to school but do live at home. And teens in RTC neither go to school nor live at home: RTC is immersive and qualifies as a form of inpatient treatment.
Your teen’s therapist thinks an inpatient, residential program would help the most.
Now you have another decision to make.
What To Do Depression Gets Worse
When your teen’s therapist recommends inpatient treatment for depression – such as a teen RTC – how do you know if that’s what they need?
The first thing to do is check in with what you already know. Not about depression, mental health treatment, or the details of the different levels of care, but what you know, as an adult raising a teenager, about life itself.
We’re sure you’ve learned that if your approach to a problem or a situation doesn’t work, you need to try something else.
That’s one thing you know. Therefore, if your teen has a depressive disorder and your current approach to treatment is ineffective, or less effective than you or your teen would like, then it’s time to try something else.
That’s logical.
The second thing – or person – you know is your teen’s therapist. If you trust them, then listen to them. They’re professionals, and you didn’t choose them by accident. The chances are you chose them because of a word-of-mouth recommendation from a trusted friend or family member. That doesn’t mean you should believe everything they say or take every piece of advice they offer as beyond reproach, but it does count for something.
Especially if they help your tee but think someone else – or a different approach to treatment – is what your teen needs in order to heal.
That’s logical, too.
And it shows they put your teen’s wellbeing above the length of their client list – which means you should probably listen.
At this point, as with any medical decision that requires significant commitment and life changes, the most logical thing for you to do is get a second opinion, in the form of a full biopsychosocial evaluation at a licensed inpatient treatment center for teen depression.
That’s exactly what a good therapist would recommend.
Inpatient Treatment for Teen Depression: What are the Criteria?
If your teen has depression, tried outpatient treatment, hasn’t made significant progress, and their therapist recommended a full evaluation and a more immersive level of care, then you know you chose a good therapist.
Let’s go over the symptoms of depression and distinguish between what types of symptoms require inpatient treatment and what types of symptoms don’t. As you read through these lists, keep in mind that depressive disorders can be mild, moderate, or severe. Clinicians make diagnoses based on a set of common symptoms. The threshold between mild, moderate, and severe does not necessarily mean some are present in mild depression and others are present in severe depression. Rather, the intensity, duration, and severity of the common symptoms are what clinicians analyze to determine what level of treatment may work best for your teen.
A rule of thumb: the more disruptive the symptoms are, the more immersive the treatment should be. Symptoms that prevent a teen from participating in any form of family, school, or social life are significantly disruptive, and may warrant inpatient treatment. On the other hand, symptoms that are intense and persistent but not significantly disruptive may warrant a less immersive level of treatment, such as intensive outpatient (IOP) or partial hospitalization (PHP).
Keep that in mind as you read through these lists. We’ll start with the most common symptoms of depression in teens. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) refers to depression as major depressive disorder and defines it as “…an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”
Depression in Teens: Common Symptoms
- Persistent sadness and low mood
- Crying frequently and/or every day
- Feeling hopeless or pessimistic every day
- Daily anger, hostility, and/or irritability
- Feelings of guilt, worthlessness, or helplessness that don’t go away
- Withdrawal from/loss of interest in/impaired inability to participate in or enjoy formerly favorite/loved hobbies, sports, and activities
- Low energy
- Daily fatigue
- Social isolation
- Disrupted communication/problems talking about things with family or friends
- Persistent boredom
- Extreme restlessness and agitation
- Problems concentrating
- Memory problem
- Difficulty making decisions
- Extreme changes in sleeping patterns – too much or too little sleep
- Extreme changes in eating patterns – including uncharacteristic or new loss or gain of weight
- Physical symptoms such as headaches or stomach aches without a clear physical cause, which don’t respond to typical treatment
- Suicidal ideation: thinking about, talking about, or attempting suicide*
* If you think your teen is in immediate danger or poses an imminent threat to themselves or someone else, call 911 immediately or take them to an emergency room at a regular hospital or a psychiatric hospital.
Most adolescents display many symptoms of depression at some point during their teen years. Up and down emotions, overwhelming days, and some degree of restlessness, irritability, and agitation are par for the course. However, in a teenager that does not have clinical major depressive disorder as defined by the DSM-V, the symptoms don’t appear every day and don’t last for long. The DSM-V criteria require an individual to display any five of the symptoms above every day for two weeks or more.
Depression in Teens: Risk Factors
The symptoms above are all warning signs that your teen may be depressed – if they persist for two weeks or more. In addition to the symptoms and warning signs, there are also risk factors to think about. These are important because when warning signs and risk factors are present simultaneously, then it’s important for you to the entire situation seriously – if you aren’t already.
Here are the common risk factors for depression in teens:
- Personal or family history of depression
- Previous history of mental health disorder
- Major life changes, trauma, or stress
- Major physical illnesses
Let’s talk about something everyone has had to deal with for the past year: the coronavirus pandemic. For most teens across the country, everything about the pandemic falls under the category of major life changes, trauma, or stress. During 2020 and the first half of 2021, teens experienced major disruption, trauma, and stress – all related to the pandemic.
Therefore, if your teen was diagnosed with depression before the pandemic, that means there’s a real risk that it escalated – meaning got worse – during the stress of the pandemic. And if your teen developed depression during the pandemic, there’s a real risk that the ongoing stress and other related factors, such as the absence of regular social contact, extracurricular activities, and the opportunity to simply be a teen, cause their newly developed depression to escalate to severe depression more quickly than it may have otherwise.
A study called “Kids Under Pressure: A Look at Student Well-Being and Engagement During the Pandemic” published this year by Stanford University, in collaboration with NBC news, offers a valuable perspective on the mental health of teens in the U.S. with regards to the coronavirus pandemic.
Here’s what they found:
Kids Under Pressure in 2020: Stress and Connection Among High School Students
- 56% of students reported increased levels of stress, compared to their pre-pandemic stress levels in 2019.
- 65% of students said they were not very confident in their ability to handle stress productively.
- 47.1% of students reported a decrease in the strength of their relationships with their friends, compared to 2019.
- 32% of students reported a decrease in their sense of belonging in school, compared to 2019.
- 31.5% of students reported increased worry/concern over their mental health, compared to their pre-pandemic levels of worry/concern in 2019.
The findings from the Kids Under Pressure give us critical information. Students reported increases in all areas that overlap with depression risk factors: stress, coping with stress, the strength of friend and peer relationships, and their sense of connection to their friends and school. A third of teens are also more worried about their mental health now than before the pandemic.
All this means that if your teen’s depression escalated over the past year, you don’t have to look far for an explanation. It’s been a tough year for everyone – especially for teens with a mental health disorder like depression.
Is Inpatient Treatment Right for My Teen?
If the symptoms of your teen’s depression impair their typical function in the following areas, inpatient treatment may be appropriate:
Home Life.
This includes their ability to carry participate in the activities associated with family life, such as eating meals, going on family outings, and meeting the minimum responsibilities associated with family chores, such as yard work, helping with dishes, or cleaning common areas. This also includes managing their personal space (keeping their room somewhat clean) and maintaining personal hygiene.
Relationships.
This includes their ability to maintain smooth, productive, and fulfilling relationships with you (parents), their peers, and their friends. Interpersonal relationships that are characterized by conflict, anger, and misunderstanding are not smooth, productive, and fulfilling.
Academics.
This includes their ability to attend, participate, and achieve some level of success at school. We’re talking about relative levels of success, as defined by you and your teenager. If your teen was a straight-A student and now gets all Cs and Ds, that’s a red flag. Not because of the grades themselves, but because of the drop. A mid-C student who drops down to Ds and Fs is also a red flag – again, not because of the letter grades themselves, but because of the drop.
Extracurriculars.
This includes their ability to participate in things like sports, music, and any special interest clubs at school. Clubs include anything that interests or used to interest them, from volunteering in the community to robotics to computers to chess. If they used to do it voluntarily and with enthusiasm, but their depressive symptoms prevent them from doing it at all, then their ability to participate is considered impaired.
We think you understand what impaired ability means now: it means their depression prevents them from doing the activity in question. A teen who doesn’t clean their room because they don’t want to does not meet the criteria. A teen who can’t clean their room because their feelings of sadness and hopelessness keep them from getting out of bed does meet the criteria. You can extrapolate to the other areas: a teen who quits playing soccer because they lost their passion for the game does not meet their criteria, whereas a teen who won’t go to practice because they get mystery stomachaches or headaches every day might meet the criteria for impaired ability.
If your teen’s depressive symptoms are so severe they meet the criteria for impaired function listed above, then your teen may need inpatient treatment for their depression.
How Can Inpatient Treatment for Depression Help My Teen?
The main thing inpatient treatment does for teens with severe depression is minimize distractions so they can focus on healing. A teen with severe depression may find themselves in a chicken/egg situation: they know they need to get out of bed and do things that are productive and healing, but they can’t. That very fact can foreground their depression and make them feel worse.
At a depression treatment center, a teenager can learn to:
- Identify, learn about, talk about, and build the skills required to process their emotions in healthy and productive ways.
- Validate their emotions and learn to value their experience and insight, which, in turn, empowers them on their road to recovery
- Understand the relationship between emotions and thoughts.
- Realize how their thoughts affect their behavior.
- Use their knowledge about emotions, thoughts, and behavior to process the emotions, thoughts, and behaviors that impair their daily function
- Empower themselves and develop the tools they need to manage their depression
The best inpatient treatment for teen depression gives teens everything they need to be themselves. In an inpatient depression treatment center, free from the distractions of home, school, and friends, teens with severe depression can take time to focus on their primary issues. Therapists and recovery peers help them stabilize their moods, cope with their emotions, and help them reach a place where they’re willing and able – and most of the time, eager – to return to home, school, and typical teen life.
What You Can Do
If you’re seeking inpatient depression treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.
In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.