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When Does a Teen Need Rehab for Depression?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT

Meet The Team >

Teen Depression Treatment: My Bay Area Options

We can answer the question posed in the title of this article immediately:

A teen needs rehab for depression when the symptoms of their depression persist for more than two weeks and prevent them from participating successfully in the day-to-day activities of school life, family life, social life, or work.

Let’s unpack that statement.

We’ll start with this critical disclaimer:

Only a mental health professional can diagnose your teen with a depressive disorder.

If you read this article, understand the symptoms and risk factors we discuss, and think your teen may have developed a depressive disorder that meets clinical criteria, then the best thing to do is arrange a full psychiatric/psychological evaluation with a licensed psychiatrist, therapist, or counselor.

They’ll recommend a course of treatment, which may or may not include rehab.

Next, we need to define the word we just used: rehab. In this case, rehab is a stand-in for the phrase residential treatment. When people think of rehab for depression, they think of immersive depression treatment programs where people – in this case, teenagers with depression – live in the treatment facility 24/7, including evenings and weekends.

There are other types of teen depression treatment programs that are immersive, such as intensive outpatient programs (IOP) and partial hospitalization programs (PHP), but in IOP and PHP programs, teens with depression live at home, rather than at the treatment facility.

Now let’s address the phrase participating successfully in day-to-day activities. By success, we do not mean win as in coming in first in a contest or game. What we mean is they can do life as usual without any significant problems. Teens may be moody. They may resist responsibilities. Moody, obstinate, responsibility-averse teens are not who we’re talking about. What we mean by success, in this context, is that whatever is on their plate – school, summer camp, summer job, chores – their depressive symptoms do not prevent them from showing up every day and doing it.

Now that you know what we mean by that opening statement, we’ll define depression, share the warning signs and risk factors, and address the state of teen mental health in the U.S. in 2021. We’ll close this article by talking about options for rehab for depression in the Bay Area.

What is Depression? Signs and Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the go-to diagnostic reference for teen depression experts, refers to depression as major depressive disorder and offers a basic, general definition. Depression is:

an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

The most common symptoms of depression in teens include:

  • Constant sadness and low mood
  • Frequent or daily crying
  • Constant and/or daily feelings of hopelessness or pessimism
  • Anger, hostile, and/or irritable mood every day or most days
  • Persistent feelings of guilt, worthlessness, or helplessness
  • Loss of interest in favorite hobbies, sports, and activities
  • Withdrawal from family and friends
  • Difficulty communicating with family and friends
  • Low energy
  • Daily fatigue
  • Constant boredom
  • Excessive restlessness and agitation
  • Difficulty concentrating
  • Problems remembering things
  • Problems making decisions
  • Radical changes in sleep: too much or not enough
  • Radical changes in eating: uncharacteristic loss or gain of weight
  • Headaches, stomach aches, or other maladies that don’t respond to typical remedies and have no easily identifiable physical cause
  • 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.

The signs listed above – if they persist for two weeks or more – may indicate that your teen has depression – if they persist for two weeks or more. Please keep in mind the specificity of the language we use. Persistent low mood, excessive restlessness, constant sadness, anger every day – a teen without depression may well show most of these symptoms sometimes ­– that’s the adolescent rollercoaster. What separates typical adolescent ups and downs is the frequency and duration of symptoms, rather than their occasional presence.

Teen Depression: Risk Factors

In addition to knowing what to look for, there are also risk factors to consider. Risk factors are things that increase the likelihood your teen may develop depression. They’re important to understand because warning signs and risk factors – when combined – mean you need to take the situation seriously: your teen’s mental health may be in jeopardy.

Teen mental health experts identify the following risk factors for depression in teens:

  • Personal or family history of depression
    • Family history of depression is a genetic risk factor associated with childhood onset of depression and early-adult/adolescent onset of depression
  • Previous history of mental health disorder
    • Previous diagnosis of a mental health disorder such as anxiety or the presence of an alcohol or substance use disorder increases the risk of depression
  • Major life changes, trauma, stress
  • Major physical illnesses

We need to drill down on those last two bullet points, because they involve trauma. Experts in teen mental health place both those risk factors are in a category called adverse childhood experiences, or ACEs. Major life events such as moving, changing schools, and a death in the family increase risk of depression in teens, as well as adverse childhood experiences (ACEs).

ACEs include:

  • Physical, emotional, or sexual abuse
  • Physical or emotional neglect
  • Domestic violence
  • Living with a parent or caregiver with a substance use or mental health disorder
  • Living with an individual who was incarcerated or sentenced to be incarcerated
  • Experiencing racism and/or bullying
  • Living in foster homes
  • Living in an unsafe neighborhood
  • Witnessing violence
  • Experiencing economic hardship

An ACE does not mean a teenager will develop depression. It does, however, increase risk. In addition, a family history of depression or a previous mental health diagnosis does not mean a teenager will develop depression. Evidence shows, though, that both factors do increase risk.

Teen Mental Health in 2021: Stress and Depression

2020 was a challenging year all-around for just about everyone. The coronavirus pandemic meant disruption, change, and more stress, uncertainty, and worry than any year in recent memory. We don’t need to recapitulate everything we went through, since we’re still in the denouement of the pandemic and everything that happened is fresh in our minds.

What we will do is talk about teen mental health in the years leading up to the pandemic and during the pandemic. This will drive home the point out that now, in 2021, our teens need support for mental health issues more than ever. We’ll also include data on suicide, because teens with major depressive disorder are at increased risk of suicide.

First, the data trends leading up to the pandemic:

Trends in Depression and Suicide: Adolescents and Young People 2005-2017

  • Depression in girls 14-17 increased by over 4 percentage points from 2005-2014
  • Depression in boys 14-17 increased by 1.2 percentage points from 2005-2014
  • The overall suicide rate for people 10-24 increased 56% percent from 2007-2017
  • Suicide among girls 10-14 increased 300% from 1999 and 2017
  • In 2018, over 1400 girls 10-14 died by suicide and over 5,000 boys age 10-14 died by suicide.

Now, the data for 2019:

Prevalence of Teen Depression and Treatment: United States (2019)

  • 8 million adolescents had major depressive disorder (MDE)
  • 6 million adolescents got treatment for MDE
  • 601,000 adolescents got treatment for a MDE with severe impairment

Prevalence of Teen Depression: United States (2019) Percentages By Age/Gender

  • 13-14: 8.4%
  • 15-16: 12.6%
  • 17-18: 15.4%
  • Females 13-18: 15.9%
  • Males 13-18: 7.7%
  • With severe impairment:
    • Female and male, age 13-18: 8.7%

Finally, we have up-to-date data from a study called “Kids Under Pressure: A Look at Student Well-Being and Engagement During the Pandemic.” This study gives us reliable data on the effect of the coronavirus pandemic on the mental health and wellbeing of our teens. Researchers compared answers to questions about stress, worry, mental health, and feelings of belonging and connection from 2019 to answers to the same questions in 2020.

Here’s what they found:

Stress, Worry, and Mental Health 2020: High School Students

  • 56% of high school students reported increased stress, compared to their pre-pandemic stress levels in 2019.
  • 59.2% of high school students reported increased worry about college
  • 31.5% of high school students reported increased worry about mental health issues

Connection and Belonging 2020: High School Students

  • Sense of Belonging in School:
    • 32% reported a decreased sense of belonging compared to 2019
    • 59.4% reported no change from 2019
  • Strength of Peer Relationships:
    • 47.1% reported a decrease compared to 2019
    • 38.1% reported no change from 2019
  • Strength of Connection to Teachers:
    • 50.0% reported a decrease compared to 2019
    • 42.2% reported no change from 2019

That’s a lot of data, and it paints a clear picture: depression was on the rise leading up to the pandemic. Then, the coronavirus pandemic brought a level of stress and uncertainty we’d never experienced before. The last set of data shows dramatic decreases in factors that protect teens from depression: such as strong peer relationships, and a powerful sense of connection to school, teachers, and peers. The next to the last set shows dramatic increases in factors that increase the risk of teen depression: stress, worry, about the future, and worry about mental health issues. Taken as a whole, this data tells us that in 2021, it’s likely that more teens than ever need rehab for depression.

Rehab for Teen Depression in the Bay Area

The Bay Area extends from Silicon Valley to the wine country and is home to over seven million people. It includes towns like Danville, Walnut Creek, and Lafayette to the east and towns like Gilroy and San Jose to the south.

With a large, diverse population spread over hundreds of square miles, virtually every possible method and approach to treatment are available to you and your teen.

We can help narrow down your choices by sharing information about two things:

  1. The essential elements common to all high-quality treatment centers.
  2. The levels of care available in most high-quality treatment centers.

First, the essential elements.

A high-quality treatment center must:

  • Conduct a complete and comprehensive assessment of your teen upon entry
  • Create a custom treatment plan tailored to meet the needs of your teen
  • Be capable of offering integrated treatment, which means that if your teen is diagnosed with more than one mental health disorder, clinicians can treat both disorders simultaneously
  • Prioritize family engagement by including parents in the treatment process
  • Include programming specific to the adolescent population
  • Prioritize meeting teens where they are, with respect and compassion, to increase commitment and time-in-treatment
  • Be staffed by licensed, qualified professionals
  • Understand gender and cultural differences and tailor treatment to meet those needs
  • Form an aftercare plan that helps your teen transition from treatment to life back home
  • Engage in a continuous process of evaluation and improvement, in order to stay current and offer the latest, evidence

Now, the levels of care. Level of care, in a nutshell, refers to the level of immersion, intensity, and time per day your teen spends in treatment. There are four levels of care most often recommended for teen depression. We mention two levels above – intensive outpatient and partial hospitalization – and we’ll include two more here: general outpatient and residential treatment.

Again, the level of care that most people think of as rehab is residential treatment, but in reality, you can think of all four levels of care as rehab for depression.

Here are the levels of care, from least to most immersive:

Outpatient Programs

This is the entry level of treatment for depression. If your teen is diagnosed with MDD but their symptoms do not disrupt their ability to function in school, work, or at home, outpatient depression rehab may be appropriate.

Intensive Outpatient Programs (IOP)

IOP is the second level of rehab for depression. In IOP rehab programs, your teen goes to treatment for roughly half a day, three to five days a week. If your teen has depressive symptoms that are disruptive but they can still live at home and carry out their daily responsibilities, IOP rehab for depression may be appropriate.

Partial Hospitalization Programs (PHP)

PHP is the third level of rehab for depression. In PHP rehab programs, your teen goes to treatment for a full day, five days a week. If your teen has depressive symptoms that disrupt day-to-day life and prevent them from participating in typical daily life at home, PHP rehab for depression may be appropriate. During a PHP program, your teen will most likely continue living at home.

Residential Treatment Programs (RTC)

Residential treatment is what most people think of when they hear the word rehab. If your teen has symptoms so severe they can’t participate in any of their daily routines and need around-the-clock support and monitoring to manage their depressive symptoms, an RTC rehab program may be appropriate. When your teen goes to a residential depression treatment center, they receive treatment six to eight hours a day, with weekend schedules modified to meet their needs. In RTC depression rehab, your teen can focus on learning to manage the symptoms of their depression without distraction.

Depression Rehab for Teens: Objectives and Outcomes

The purpose of rehab for depression is to teach your teenager practical skills that allow them to manage their depressive symptoms and live a life of their choosing, rather than a life dictated by the presence or absence of their symptoms.

An integrated treatment plan at a teen rehab for depression should include the following:

  • Individual Therapy
  • Group Therapy
  • Family Therapy
  • Mindfulness Practices
  • Experiential Activities
  • Expressive Therapies
  • Community Support (i.e. Alcoholics Anonymous)
  • Medication (as needed)

An immersive depression rehab program can help your teen reach an emotional place where they’re able to return home and participate in all their typical daily activities related to family life, school, extracurricular activities, and socializing with friends. To put it simply, rehab helps them get back to being a teenager. They’ll use the skills they learn in rehab to weather the ups and downs of their teenage years. These skills will set them up for success in the future, and increase the likelihood they’ll move forward into adulthood with hope, confidence, and optimism.

Finding Help: Resources

If you’re seeking depression rehab 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.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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