How Do I Decide How Much Mental Health Support My Teen Needs?

When your teenager receives a diagnosis for clinical depression, you have several important decisions to make.

After you come to terms with the emotions you feel related to the diagnosis, that is. At first, you may wrestle with a range of feelings: fear, anger, shock, disbelief, confusion, grief, and sadness are all common reactions. And they’re all acceptable, whether they feel acceptable or not. You may not want to believe your teenager is clinically depressed. You may want to find someone or something to blame. It’s not at all unusual to blame yourself, your spouse, your relative who had depression, one or more of your spouse or partner’s relatives because they had depression, or some event in the past over which you had no control.

It’s not at all unusual to look for someone or something to blame, but you should know something right away. There’s no one person and no one thing or event to blame. It’s true that looking back to find a reason for or the origin of the presence of a depressive disorder in your teen can help you unlock the particulars of your teenager’s mental health diagnosis. But looking back to find someone or something to blame won’t help you or your tee accept your current reality. Nor will it help your teen, you, and your family heal and move forward.

Which is exactly what the decisions you need to make now revolve around. Your priority right now is how to find the best way for your teen and your family to heal and move forward.

In order to do that, you need to learn more about depression – known by clinicians as major depressive disorder (MDD) – and how mental health professionals determine the nature of your teen’s depressive disorder and decide which type of treatment program gives your teen the greatest chances of treatment success.

We’ll start by defining depression, so you understand exactly what’s going on with your teen.

How Do I Tell Whether It’s Depression or Typical Teen Behavior?

One of the many challenging aspects of parenting a teenager is deciphering their moods. We all know adolescence is a time of radical change. Teens transform on physical, psychological, emotional, and cognitive levels. They may change their interests, their passions, their hobbies, and their friends. They may change the way they dress and the way they behave. Some become moodier. Others become less moody and more stable – yes, that can happen. Some may drop sports for the arts, the arts for sports, or drop all their hobbies altogether and focus on their peers and their social lives.

Some lose interest in academics. Others might discover a new enthusiasm for their schoolwork: it all depends on your teen.

They may go from loud and outgoing to quiet and reserved, or vice-versa. Your teen may handle stress and challenges in new ways as they develop new ways of understanding and seeing the world. And that’s where recognizing depression can become challenging for both parents and mental health professionals alike.

What the reference manuals and diagnostic guides – and articles like this – tell everyone is to watch closely for behavioral change – in every area we just mentioned. They tell us to watch for changes with regards to friends, dress, behavior, activities, emotions, academics, everything.

The problem is this: since all those things change – sometimes by the hour or minute – during adolescence, how do you know what’s typical teen behavior and what’s the sign of clinical mental health disorder such as depression?

That’s where the manuals, diagnostic guides, and articles like this can help. All three give you a list of signs to watch for, a list of risk factors to watch for, and a way to determine how severe the symptoms you see might be – which are the things you need right now.

Clinical Depression: Definition, Warning Signs, Risk Factors, and Severity

That’s what we’ll do now – starting with a simple definition of major depressive disorder (MDD). Then we’ll offer a list of symptoms to watch for, a list of warning signs, and a guide to determine the level of severity of any possible depressive disorder.

Here’s the go-to clinical definition of major depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V):

“[Depression is] …an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

If you suspect your teen has depression, the most important part of that definition is the last phrase. We’ll paraphrase:

Depressive symptoms present every day for two weeks or more are a warning sign of major depressive disorder.

To clarify: a teen who has a social or romantic disappointment on Monday, spends Tuesday sad and moping, and bounces back by Wednesday or Thursday probably does not have clinical depression. However, a teen who loses a friend or loved one to an illness and becomes sad, withdrawn, and irritable for a month may indeed have clinical depression.

That’s a rather facile oversimplification, but we think you get the idea.

With those points in mind, please take the time to read the following signs and symptoms of depression.

Teen Depression: Warning Signs

• Persistent sad/low mood
• Persistent crying
• Daily feelings of hopelessness or pessimism
• Uncharacteristic or increasing irritability
• Uncharacteristic or increasing anger or hostility
• Powerful feelings of hopelessness or worthlessness
• Withdrawal from friends, family, and favorite pastimes or passions
• Withdrawal from extracurricular activities, including sports, band, or academic clubs
• Persistent fatigue
• Problems communicating with family, friends, or teachers
• Constant restlessness/agitation
• Cognitive issues: concentration, decision-making, memory
• Problems completing tasks or responsibilities at school or at home
• Difficulty following through on tasks at home or at school
• Extreme changes in eating or sleeping: too much or too little of either
• Extreme gain or loss of weight
• Phantom ailments that do not improve with typical remedies
• Thinking about, talking about, or attempting suicide*

* If 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.

Remember: in isolation, or for small or short periods of time, all of the things on the list above could be typical teen behavior. But not the suicide part: never ignore any talk of suicide, no matter how sure you are that your teen is doing it to be dramatic or to get attention. We’ll say it again:

DO NOT DOWNPLAY TALK OF SUICIDE: GET REAL HELP NOW

Now it’s time to talk about risk factors. The following factors can increase the chance your teenager will develop clinical depression.

Teen Depression: Risk Factors

• Family history of mental illness
• Personal history of depression
• Significant events such as moving or changing schools
• Traumatic life events, such as a death in the family, major accidents, significant illness
• Significant trauma such as physical, sexual, and/or emotional abuse
• Significant traumas, such as physical or emotional neglect
• Adverse childhood experiences
• Extreme stress related to family, school, friends, or current events

Please understand the presence of one or more risk factors does not mean your teen will develop depression. Also, the presence of symptoms and risk factors simultaneously does not mean your teen has or will develop depression.

Here’s how to understand and contextualize the information in the two bullet lists above:

When signs and symptoms of depression appear every day for two weeks or more and risk factors are also present, then it’s time to consider the very real possibility your teen may have clinical depression.

Understanding Depression: Mild, Moderate, and Severe

Mental health professionals identify three levels of depression. They determine the level of the disorder by considering two things: how long your teen displays depressive symptoms and the level of disruption the symptoms cause. Here are the three levels, with descriptions of each:

Mild

Mild depressive symptoms typically will not prevent them from meeting the daily responsibilities of school, social, or family life. Your teen has low moods, persistent sadness, and perhaps more symptoms from the list, but the symptoms do not cause severe disruption to their daily life. If your teen has mild depression, they’ll likely receive a referral for outpatient treatment.

Moderate

Moderate depressive symptoms may prevent your teen from going to school and engaging in some social and/or extracurricular activities. However – while they’re difficult and sometimes painful and disruptive – they don’t prevent your teen from living at home. If your teen has moderate depression, they’ll likely receive a referral for an intensive outpatient program (IOP) or a partial hospitalization program (PHP). If your teen has moderate MDD, it’s unlikely they’ll referral for inpatient treatment.

Severe

Severe depressive symptoms prevent your teen from participating in family, school, extracurricular, and social activities. Untreated severe depression can be dangerous, and lead to suicidal ideation, non-suicidal self-injury, and suicide attempts. If your teen has severe MDD, it’s likely they’ll receive a referral for inpatient treatment at a residential treatment center (RTC) for teens.

We just used phrases we haven’t fully explained: outpatient treatment, intensive outpatient programs (IOP), partial hospitalization programs (PHP), and residential treatment centers (RTC). Mental health professionals call these levels of care, which we’ll define in a moment.

First, we need to discuss one more thing: level of acuity.

What Does Level of Acuity Mean?

Acuity means how immediately serious the disorder is at the time of assessment. To determine whether your teen needs outpatient treatment for depression or inpatient treatment for depression, they consider the level of acuity alongside the presence of symptoms, the presence of risk factors, and whether the disorder is mild, moderate, or severe. The level of acuity and level of severity may seem like the same thing, but they’re not.

For instance, a teen with severe depression may not be in crisis, while a teen with moderate depression may be in crisis: each teen has a different level of acuity. That’s the operative word: crisis. If your teen is in crisis, which means one of two things:

1. They pose an imminent risk of harm to themselves or others
2. Their depressive symptoms render them unable to function at all: i.e. they can’t get out of bed, dress, eat, or maintain the most basic functions necessary for day-to-day life.

Now that you know all the terms involved, we can tell you that when a mental health professional decides which level of care is best for your teen, they consider four things:

1. Disorder severity
2. Disorder acuity
3. The level of disruption caused by the disorder
4. Previous treatment history

Now we’re ready to talk about whether your teen needs outpatient treatment or inpatient treatment for their depression. First, though, we have an important disclaimer:

This article cannot diagnose your teen or recommend a level of care. Diagnoses and referrals can and should only be made after your teen receives a full biopsychosocial assessment administered by a licensed mental health professional.

We should also clarify an important point: in mental health care, inpatient does not mean the same thing as in other areas of healthcare. In general, inpatient means the patient – in this case, your teen with depression – stays in a facility overnight. However, there’s a big difference between inpatient psychiatric hospitalization and residential treatment. You’ll learn about those – in addition to the other levels of care – in the following section of this article.

Levels of Care: What Are They?

We’ll describe the levels of care from the least intensive/immersive – outpatient treatment – to the most intensive/immersive – inpatient hospitalization:

Outpatient Programs

If your teen is diagnosed with mild depression and their symptoms do not prevent them from participating in school or significantly disrupt relationships with family or peers, they’ll likely receive a referral for outpatient treatment. Outpatient treatment involves office visits with a  mental health professional once or twice a week, and in some cases, once every other week. Outpatient treatment is the most common starting point for depression treatment in teens.

Intensive Outpatient Programs (IOP)

If your teen is diagnosed with moderate depression and their symptoms are disruptive but do not prevent them from living at home or going to school, they’ll likely receive a referral for an IOP program.  In an IOP program, your teen receives treatment for half a day, three to five days a week. Intensive outpatient treatment is often the second level of treatment for depression in teens.

Partial Hospitalization Programs (PHP)

If your teen has depressive symptoms that disrupt daily life and prevent them from functioning in or attending school, they’ll likely receive a referral for a PHP program. In a PHP program, your teen receives treatment all day, five days a week. While in a PHP program, your teen will probably live at home: they’re outpatient programs. Partial hospitalization is often the third level of treatment for depression in teens.

Residential Treatment Programs (RTC)

If your teen has depressive symptoms so severe they prevent them from participating in family life, social activities, or attending school at all, they’ll likely receive a referral for a residential treatment program at a teen residential treatment center (RTC). During treatment at a teen residential treatment center, your teens will live on-site at the treatment center. They’ll have the time and professional help they need to concentrate on what’s most important at the moment: recovery. Residential treatment is often the third level of treatment for depression in teens.

Inpatient Psychiatric Hospitalization

If your teen has clinical depression and is in crisis – meaning they pose an imminent risk to their own safety or the safety of others – they may receive a referral for inpatient psychiatric hospitalization. If your teen has attempted suicide or engaged in self-harming behaviors, this most immersive and intensive level of care may be the best. During inpatient psychiatric hospitalization, your teen lives on-site in the hospital and receives the highest possible level of support, monitoring, and medical/psychiatric care. Inpatient psychiatric hospitalization is the most immersive and intensive level of care and is generally only appropriate for teens in active crisis. It is neither entry level nor intermediate: it’s the most intensive level of care available.

The information above gives you a solid and reliable starting point for navigating the different levels of care available to your teen, from the least immersive to the most immersive.

We’ll end with this reminder:

Evidence-based treatment for teens works. Teens with depression – from mild to moderate to severe – can and do learn to live full and productive lives if they get professional treatment. Research shows that when a teen with depression gets the depression treatment they need sooner rather than later, outcomes improve dramatically.

Finding Help: Resources

If you’re seeking 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.