Adolescence can be an especially challenging phase of life, often accompanied by emotional ups and downs – as any parent of teens can attest. The combination of rapidly changing bodies, identity issues, raging hormones, and myriad social pressures can trigger occasional “blue” days for even the most well-adjusted adolescent. Unfortunately, for some adolescents those blue days are actually a sign of something more serious – clinical depression.
As a parent, one of the most difficult tasks can be determining what’s normal and what’s not when it comes to your adolescent’s emotional health. This brief guide is designed to help you know what to look for and what to do if you suspect your child may be suffering from depression.
Adolescent Depression Statistics
Many parents make the mistake of attributing signs of depression to typical teenage moodiness. This can be a deadly error, considering suicide is the third leading cause of death for pre-teens through young adults (10 to 24 years of age). According to a recent CDC survey, 16% of high school students (grades 9 through 12) seriously thought about killing themselves at some point during the year prior to the survey, with 8% actually making a suicide attempt.
A few other statistics:
- In the U.S., the leading mental health disorder in adolescents is depression
- Approximately 1 in 20 teens is currently experiencing a bout of major depression
- Adolescent females are over three times more likely to develop depression than adolescent males
- Approximately 80% of deaths by suicide (ages 10 to 24) occur in males
- As many as 15% of adolescents are suffering from at least some symptoms of depression at any given time
- For adolescents who battle depression, an estimated 15% will go on to develop bipolar disorder
Looking for and Recognizing the Signs of Depression
Knowing what to look for and how to recognize symptoms of depression in your teen are the first – and perhaps the most crucial – steps you can take as a parent. While this may seem like a daunting task if you’re not a trained mental health professional, it’s more doable than you may think. There are two key things to remember:
1. Look for and pay close attention to any changes from your teen’s normal mood and behavior.
For example, if your normally energetic and outgoing adolescent starts spending more time sleeping or laying around the house and avoiding friends and social activities, these could be possible indicators of depression.
2. Symptoms of depression in teens often don’t look the same as they do in adults. Additionally, gender can make a difference in how depressive symptoms manifest.
For example, teenage girls struggling with depression are often moody, easily upset or distressed, tearful, and sad. Depressed teenage boys, on the other hand, may be more irritable, oppositional or even hostile, restless, and withdrawn.
Signs to watch for may include the following:
- Frequent or persistent sadness or “blue” mood
- Frequent tearfulness
- Anger outbursts
- Apathy / an “I don’t care” attitude
- Agitation or restlessness
- Low energy levels or frequent fatigue
- Slowed speech
- Lack of motivation (which may present as laziness)
- Loss of interest in activities they once enjoyed
- Isolating or withdrawing from family and friends
- Changes in appetite (increase or decrease)
- Changes in sleep, including sleeping excessively (hypersomnia), difficulties falling asleep or staying asleep, or early morning awakening
- Difficulties concentrating or making decisions
- Low frustration tolerance / easily annoyed
- Oppositional or hostile attitude
- Feelings of worthlessness
- Feeling hopeless about the future
- Struggles with excessive guilt or self-blame
- Unexplainable drop in academic performance
- Frequent absences from school or work
- Somatic complaints (e.g. stomachaches
- Decline in personal hygiene
- Use of alcohol or drugs (particularly intravenous drug use)
- High risk behavior (e.g. sexual promiscuity)
- Talking and / or writing about death or suicide*
- Giving away prized possessions*
- Suicide attempts*
*Even if there are no other signs (although there almost always are), suicidal thoughts or behaviors should always be taken very seriously and never ignored.
Many, if not most, adolescents exhibit one or even a few of the above symptoms at one time or another. This is particularly true during times of stress, such as right after a breakup or a major disappointment. As a parent, your task, again, is to pay attention and not be quick to assume it’s “just a phase” that will pass. That might very well be the case. However, any significant loss or disappointment – in the eyes of your teen (even if it seems trivial from your adult perspective) – can be a trigger for depression, particularly for teens who are predisposed.
If your child doesn’t have a solid support system, has experienced multiple losses or disappointments in close succession, and / or seems to have an especially hard time coping with a painful event, the risk of developing depression is even greater.
Knowing the First Steps to Take
If your observations and instincts lead you to suspect your adolescent is battling depression, the first two steps to take towards handling the situation are:
1. Talk to your teen. Let your child know that you’re concerned about the things you’ve noticed, that you want to help in any way you can, and that you’re there if he or she needs to talk – about anything.
Ask your teen if there’s something going on that’s troubling him. Keep in mind, if your teen rarely opens up to you he or she may blow you off or tell you “everything’s fine” – and even accuse you of over-reacting.
2. Set up an appointment for an evaluation. Your child’s pediatrician or your family doctor may seem like a good place to start, but keep in mind he or she isn’t a mental health professional. That being said, he or she can do a physical examination, make an initial diagnosis, and rule out an underlying medical cause for your teen’s depressive symptoms.
If possible, have your teen evaluated by a psychologist or psychiatrist instead, preferably one who specializes in treating children and adolescents. The advantage here is that these individuals have the specialized training and experience to identify and understand the more subtle nuances of adolescent depression. Your family doctor may be able to give you a referral or recommendation.
- Clinical Psychologists have a doctorate degree (usually a PhD or PsyD) and are trained to evaluate and mental health disorders and other psychological or emotional issues with various types of psychotherapy.
- Psychiatrists are medical doctors (MD) who specialize in treating mental health disorders. Psychiatrists are licensed to prescribe medication and may also provide psychotherapy.
- Other mental health professionals who can provide therapy include licensed clinical social workers (LCSW), marriage and family therapists (MFT), and licensed professional counselors (LPC). These individuals typically have a master’s degree in psychology or a related field.
3. Treatment. The third step to take is to get your child into treatment. The two primary types of treatment for adolescent depression (sometimes used in combination) are:
- Psychotherapy or “talk therapy”
One of the most effective and common forms of talk therapy used in the treatment of depression is cognitive behavioral therapy (CBT). CBT is a relatively short term therapy that focuses on helping your teen identify and change negative thought patterns, behaviors, self-talk, and beliefs that are contributing to and reinforcing his or her depression.
Two other types of therapy that can be particularly effective for adolescent depression are family therapy and interpersonal therapy.
Medication may be prescribed to help alleviate your child’s depression. Since your teen’s brain is still developing, caution must always be used with antidepressant medications. However, in moderate to severe depression, the benefits often significantly outweigh the risks when taking medications that have been FDA-approved to treat adolescent depression.
The best course of treatment will be determined by whoever evaluates your child and discussed (usually) with both you and your teen.
Supporting and Encouraging Your Child
There are many things you can do to support and encourage your child through this difficult time. Two of the most important things to remember are that 1) depression isn’t a sign of weakness and 2) it isn’t something your child can simply “overcome” by sheer willpower and determination. Think of it as you would any other serious health condition.
Things you can do include:
- Make yourself available (and willing) to listen and let your child know you’re there for him or her
- Don’t minimize or ridicule what your child is experiencing
- Don’t pressure your child to talk or open up
- Understand that your child didn’t choose or cause his or her depression
- Refrain from nagging or lecturing
- Be hopeful and reassuring, but avoid over-the-top “Pollyanna-ish” optimism – your teen will see through it and may feel insulted by it
- Be genuinely supportive in both your words and actions
- Stay calm, even if you feel scared or frustrated
- Don’t tell everyone you know about your child’s depression, which can exacerbate feelings of shame, guilt, and embarrassment
- Frequently check-in with your child to see how he or she is doing, whether or not treatment is helping, and to see if there is anything you can do that would be helpful
- Follow through on any promises you make to your child
- Respect your child’s experience, even though you may not be able to understand it
- Educate yourself about depression (don’t assume you understand your teen’s experience, even if you’ve dealt with depression) so you can have greater empathy for and understanding about what your teen is going through
What to Do When Things Escalate
Unfortunately, the course of adolescent depression can vary greatly and be unpredictable. While some teens will respond well to treatment and quickly show signs of improvement, others may get worse as time goes on. If medication is part of the treatment, it often involves some trial and error. This can be frustrating for both you and your teen.
It’s not uncommon for a severely depressed individual to become actively suicidal after they start to feel a little better. This is often because they now have the energy to plan and / or act upon suicidal thoughts that have been lurking for some time.
If things do escalate – for example, your child’s depression gets worse, he or she becomes manic or becomes increasingly or actively suicidal – don’t delay in reaching out for help.
- Contact your child’s provider asap
Or, if after hours:
- Enlist the help of a close family member or friend
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
Sometimes individual therapy and / or medication simply isn’t enough to adequately treat your child’s depression. If your child is:
- Threatening or actively planning suicide
- Making suicide gestures or attempts
- Unable to function at all or without frequent assistance
then it’s time to consider a more intensive level of treatment. This may involve:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Residential treatment
- Inpatient psychiatric treatment
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how often (e.g. twice a week, 5 days a week) your child is required to go. These programs are the next step up from regular outpatient treatment (i.e. an hour of therapy once or twice a week).
Residential treatment involves having your child stay at a non-hospital treatment facility that specializes in treating adolescents with mental health disorders. Residential treatment often lasts between 30 to 180 days, depending on the disorder and its severity.
Inpatient psychiatric treatment is the highest and most intensive level of treatment for depressed adolescents. It involves admitting your child to an adolescent psychiatric hospital unit where medical staff is on hand to monitor patients 24/7. This level of treatment may last for a few days to a few weeks, and is particularly beneficial for adolescents who are an imminent danger to themselves or others, usually due to severe depression, psychosis, or mania.
Each of these intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and daily therapy (often both group and individual, and a combination of different types, such as psychotherapy, art therapy, music therapy, etc.).
Depression is one of the most common – and also one of the most treatable – mental health disorders your child can develop. However, the success of treatment and course of the disorder (even with treatment) can vary significantly from one individual to the next.
In addition to doing all of the above to help your child, it’s vitally important that you also take care of yourself throughout this process. This can include getting therapy for yourself, taking proactive steps to manage your stress and anxiety (if relevant), reaching out for support to family, friends, support groups, and organizations such as NAMI (National Alliance on Mental Illness, with local chapters all over the U.S.)
Your depressed teen will be looking to you for hope, encouragement, and guidance, so be sure you don’t neglect your own emotional and physical well-being as you strive to do everything you can to help him or her.