Mood Disorders in Teens: Depression

Most parents of teens agree that adolescence can be a challenging phase of life, often accompanied by emotional ups and downs. The combination of rapidly changing bodies, identity issues, raging hormones, and myriad social pressures can trigger occasional sad and blue days for even the most well-adjusted adolescent. Unfortunately, for some adolescents those blue days are a sign of something more serious: clinical depression.

As the parent of a teenager, one of your most difficult tasks is determining what’s typical 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 has a mood disorder such as clinical depression.

Adolescent Depression: Facts and Figures

Many parents make the mistake of attributing signs of depression to typical teenage moodiness – but this error can be deadly. According to the Centers for Disease Control (CDC), suicide is the second leading cause of death for people age 10-24 in the United States. The CDC also indicates that 16% of high school students (grades 9 through 12) seriously thought about killing themselves at some point during the year prior to the survey. The survey indicates that 8% of those teens end up attempting suicide.

Here are some additional facts about suicide that parents of teens should be aware of:

  • Along with anxiety, the leading mental health disorder in adolescents is depression
  • 13.3% of adolescents age 12-17 teens experienced a major depressive episode in 2017
  • Adolescent females are over three times more likely to develop depression than adolescent males
    • 20.0% of females age 12-17 experienced a major depressive episode in 2017
    • 6.8% of males age 12-17 experienced a major depressive episode in 2017
  • Approximately 80% of deaths by suicide (ages 10 to 24) occur in males
  • As many as 15% of adolescents are experiencing at least some symptoms of depression at any given time
  • For adolescents with depression, an estimated 15% will go on to develop bipolar disorder

Adolescent Depression: Signs and Symptoms

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 to help a teenager with depression. While this may seem like a daunting task if you’re not a trained mental health professional, you can do it. There are two key things to remember:

  1. Look for and pay close attention to any changes from your teen’s typical mood and behavior. For example, if you have a teenager who’s always been energetic and outgoing, but starts spending a significant amount of time sleeping, staying in the house, and avoiding friends and social activities, these may be possible indicators of depression.
  1. 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, hostile, restless, and withdrawn.

Signs to watch for may include the following:

  • Frequent or persistent sadness or blue mood
  • Frequent crying
  • Irritability
  • Moodiness
  • Angry outbursts/tantrums
  • Apathy
  • Agitation/restlessness
  • Low energy levels
  • Persistent fatigue
  • Slowed speech
  • Lack of motivation, often mistaken for laziness
  • Loss of interest in favorite activities
  • Isolating or withdrawing from family and friends
  • Drastic changes in appetite (increase or decrease)
  • Drastic changes in sleep, including sleeping excessively (hypersomnia), difficulties falling asleep or staying asleep(insomnia), or early morning awakening
  • Difficulty concentrating or making decisions
  • Easily frustrated or annoyed
  • Oppositional/hostile attitude
  • Feelings of worthlessness
  • Feeling hopeless about the future
  • Excessive guilt or self-blame
  • Unexplainable drop in grades
  • Frequent absences from school or work
  • Somatic complaints, such as unexplained stomachaches
  • Decline in personal hygiene
  • Use of alcohol or drugs
  • High risk behavior such as risky sexual behavior
  • Talking and/or writing about death or suicide*
  • Giving away prized possessions*
  • Suicide attempts*

*Even if there are no other signs of depression, suicidal thoughts or behaviors should never be ignored. Don’t assume this is just your teen being dramatic or manipulative. If your teen talks or writes about suicide, have them evaluated by a mental health professional as soon as possible. If you think your child is in immediate danger, call 911 or the National Suicide Prevention Lifeline: (800) 273-8255*

Many, if not most, adolescents exhibit one or even several of the symptoms above 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 – their sadness might be a phase, and it might pass sooner rather than later. However, any significant loss or disappointment – in the eyes of your teen – can be a trigger for depression.

The main thing to understand is that almost all teens will be moody at time: that seems to be an unavoidable aspect of adolescence. However, when any of the symptoms above persist for longer than two weeks, then that’s cause for concern. A teen who is sad on Tuesday over a breakup but back having fun with friends on Friday or Saturday is probably not clinically depressed. However, if that same teen retreats to their room and stays sad for weeks is at risk of developing clinical depression. That’s an oversimplified example, but it serves our purpose: one or two symptoms occasionally is not cause for concern. One or two symptoms that persist for two weeks or more are cause for concern and should not be ignored.

Also, if your child doesn’t have a solid support system, has experienced multiple losses or disappointments in rapid succession, and/or has a hard time coping with painful events, frustrations, or disappointments, they’re at greater risk of developing depression than teens who have a solid support system, have not experienced significant loss, and have robust distress tolerance skills.

Know the First Steps to Take

If your observations and instincts lead you to suspect your adolescent meets the criteria for clinical 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 them. Keep in mind, if your teen rarely opens up to you, they may tell you they’re fine, and may tell you that you’re over-reacting.

2. Set up an appointment for an evaluation.

Your pediatrician or family doctor may seem like a good place to start, but keep in mind they probably aren’t a psychiatrist or therapist as well as a general practitioner. That said, they can perform a physical examination, make an initial diagnosis, and rule out any possible underlying medical causes for your teen’s depressive symptoms.

The best choice is to have your teen evaluated by a psychologist or psychiatrist who specializes in treating children and adolescents. The advantage of a psychologist or psychiatrist is that they have the specialized training and experience to identify and understand the subtle details of adolescent depression. Your family doctor may be able to give you a referral or recommendation – but a psychiatrist or psychologist can give your teen an accurate diagnosis.

Here are some details about different types of mental health professionals you may encounter when you seek evaluation or treatment for your teen:

  • Clinical Psychologists have a doctorate degree (usually a PhD or PsyD) and are trained to evaluate and treat 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 are:

  • Psychotherapy or “talk therapy”
  • Medication

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.

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, for the treatment of moderate to severe depression, the benefits of FDA-approved medication often significantly outweigh the risks.

The mental health professional who evaluates your child will discuss treatment options with you. You’ll collaborate with them to determine the course of treatment that’s most appropriate for your teen and your family.

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:

1) Depression isn’t a sign of weakness

2) Depression isn’t something your child can simply overcome by willpower and determination.

Think of depression the same way you would think of any other chronic, relapsing medical condition: it takes time, effort, and treatment to make progress. Depression will not go away magically. It takes commitment on the part of the person with depression, their therapist/counselor/psychiatrist, and their family.

Things you can do to help the healing process include:

  • Make sure your child knows you love and support them unconditionally
  • Make yourself available to listen and let your child know you’re there for them
  • Don’t minimize or ridicule what your child experiences
  • Don’t pressure your child to talk or open up
  • Understand that your child didn’t choose or cause their depression
  • Be hopeful and reassuring, but avoid over-the-top, unrealistic 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 (especially 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
  • Check-in with your child to see how they’re doing, whether they’re making progress in treatment, and to see if there is anything more you can do to help
  • 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 they’re going through

What to Do If Things Escalate

The course of adolescent depression can be unpredictable. While some teens will respond well to treatment and show signs of improvement right away, others may not respond well to treatment, and their condition may get worse over time. 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 an individual with severe depression 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 and they become increasingly manic or becomes or actively suicidal – don’t delay in reaching out for help: contact your child’s mental health provider immediately.

If your child has a mental health crisis after working hours and you can’t get in touch with their psychiatrist or therapist, you can:

  • 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 isn’t enough to adequately treat adolescent depression. It’s time to consider a more intensive level of treatment if your child:

More intensive levels of treatment may involve:

Here are the details about these levels of care:

Intensive Outpatient Programs (IOP)

This level of treatment is a step above weekly therapy or counseling. The amount and timing of treatment depends on the program. Teens typically participate in treatment 3 times a week for 3 hours per session, live at home, and attend school during an intensive outpatient program.

Partial Hospitalization Programs (PHP)

This level of treatment is a step up from intensive outpatient treatment. As with IOP treatment, the amount and timing of treatment depends on the specific program. Adolescents go to treatment daily, usually for 4 hours per day, and attend school at least part time. Most teens in PHP programs for mental health disorders continue to live at home.

Residential Treatment Centers (RTC)

Residential psychiatric treatment, also often referred to as inpatient psychiatric treatment, involves having your teen live full time at a non-hospital treatment facility. This intensive level of treatment may last from 30 to 120 days. The length of stay depends on your child’s treatment needs and clinical progress. In addition to receiving full-time psychiatric treatment, one of the greatest advantages of residential psychiatric rehab is being in an environment that is designed specifically for teenagers with mental health disorders. This enables them to focus one hundred percent on recovery, without worrying about other factors in their life such as school, family, and peer relationships.

Inpatient Psychiatric Hospitalization

Hospitalization may be necessary if your teen is a danger to themself or others (e.g. suicidal or psychotic), or in need of 24/7 medical monitoring. Medical monitoring may be recommended for teens who are a danger to themselves or others due to suicidal ideation, suicidal behavior, or severe depression.

More About Levels of Care

These levels of care – excluding psychiatric hospitalization, during which immediate safety and psychiatric stability are the primary goals – typically involve some combination of the following therapeutic approaches:

  • Individual therapy and counseling
    • Once a week or more, depending on the treatment center and treatment plan
  • Group therapy and counseling
    • This typically happens every day
  • Family therapy and counseling
    • Family therapy commonly occurs once a month, and in some cases, once a week
  • Experiential activities such as exercise, mindfulness, music, or art
    • These activities often happen every day, with longer experiences on weekends
  • Community support

The exact combination of treatment depends on the treatment center and the level of care your teen needs.

What You Can Do for Yourself

Depression is one of the most common mental health disorders we know about. 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 take care of yourself throughout this process. This can include getting therapy for yourself, taking proactive steps to manage your stress and anxiety, reaching out for support to family, friends, support groups, and organizations such as NAMI (National Alliance on Mental Illness).

Your teenager will look 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 them. Together – with teamwork, commitment, and hope for the future – you can help your teen heal, grow, and live a full and productive life.