Adolescent depression

Adolescence can be a difficult time when young people go through significant physical, social, and emotional changes. Going through periods of emotional reactivity and/or emotional dysregulation is common in adolescence, but low mood and other psychological symptoms that persist for longer than two weeks may be a sign of ‘teen depression’.

What is adolescent depression?

Major depressive disorder, commonly referred to as clinical depression, is a very common mental health problem characterized by low mood, lack of interest in things that used to bring people pleasure, and a sense of hopelessness. Depression in teens isn’t clinically different than depression in adults, though symptoms might look a little different in teenagers.

Adolescent depression symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders ^[1], used by mental health professionals in the US to diagnose mental health problems, the symptoms of depression are:

• Low mood – feeling sad, empty, hopeless or tearful. In teenagers, this can present as irritability.
• A lack of interest in activities that would normally bring pleasure.
• Significant weight changes (which aren’t attributed to disordered eating habits) or a change in appetite.
• Sleep problems, such as insomnia or sleeping too much.
• Restlessness, anxiety or, conversely, a noticeable slowing down of thought and movement.
• Tiredness and low energy levels.
• Feeling worthless or guilty.
• Problems concentrating or making decisions.
• Suicidal thoughts, plans, or actions.

In teenagers, some of these symptoms may present as moodiness, refusal to attend school, a drop in academic achievement, substance abuse, and behavioral problems.^[2]

What causes depression in teenagers?

Teenagers have a lot to navigate that can affect their mental health, including school-related stress, friendships and relationships, self-esteem issues, body confidence, and family problems.^[3] Today’s young people are also dealing with the unique pressures of modern life, such as social media, and the fallout of the Covid-19 pandemic.^[4]

Depression often starts in adolescence.^[1] Causes and risk factors include:^[1][2][5]

• Family history of depression
• Stress
• Difficult life events such as bereavement
• Difficult or traumatic childhood experiences
• Another mental health problem such as anxiety disorder
• Alcohol and other substance misuse issues
• Physical health problems
• Problems at home
• Bullying
• Hormones

Can adolescent depression be prevented?

Research has identified factors that appear to lessen the risk of depression.^[2] A high level of intelligence appears to offer some resilience to adolescent depression. Also, building a young person’s ability to regulate their emotions by developing coping skills and thought processes can help. Good parental relationships and a warm, welcoming home life seem to reduce the risk of depression even in families where there is a history of depression.

Adolescent depression diagnosis

A depression diagnosis is done by a doctor or other mental health professional following a psychological evaluation. This will include a discussion about symptoms and signs of depression, a review of the person’s medical history, and may involve completing a questionnaire.

Someone can be diagnosed with depression if they experience five or more of the symptoms listed above for at least two weeks.^[1] At least one of the symptoms needs to be either low mood or a loss of pleasure in usual activities.

The doctor will rule out other causes such as physical health problems or other mental health conditions first. They will also consider whether symptoms are merely a normal response to a difficult life event such as bereavement.

The diagnosis may specify whether the depression is mild, moderate, or severe.

Adolescent depression treatment

The main treatments for teenage depression are medication and therapy. There are some differences between the treatment options offered to teenagers and adults. For example, older types of antidepressants aren’t usually considered suitable for young people. ^[2]

For mild depression, lifestyle changes such as improving sleep, exercise, and diet, together with a short course of therapy, may be sufficient. For moderate to severe depression, it is more likely that a combination of therapy and medication is needed.^[5]

Therapy

The main therapy options for teen depression are:^[2]

• Cognitive behavioral therapy (CBT), which explores how we think and act and can help us find ways to cope with difficult emotions.
• Interpersonal therapy (IPT), which looks to improve personal relationships that might be causing or triggering depression.

Medication

An antidepressant such as fluoxetine or escitalopram can be effective and should ideally be prescribed alongside therapy.^[6]

How to help teenagers with depression & tips for parents and carers

It can be difficult and distressing watching your child struggle with depression but there are things you can do to help, whether they are receiving professional help or not.

• Educate yourself. Learn about depression, the signs, and symptoms, how it can affect teenagers and the treatment options available. This will help you feel more confident about supporting your teenager.
• Look after yourself. Supporting someone with a mental health problem can be challenging and will have an impact on you, your partner, other children, and the rest of the family. Don’t forget to look after your own wellbeing and seek support if you need it.
• Encourage good habits. Lifestyle changes such as improving sleep, getting plenty of exercise, and eating healthily can go a long way in supporting better mental wellbeing. In the depths of depression, however, looking after yourself is one of the first things to fall by the wayside. Help your teenager by encouraging them to have these good habits.
• Help them open up. Let them know you have noticed a change and that you are there to support them. The UK charity YoungMinds has plenty of tips and tools for parents wanting to start a conversation with their teen.^[7] If they do open up to you, listen non-judgmentally to what they have to say and avoid overreacting or being defensive. And don’t give up – they might not want to talk the first time but a bit of gentle persistence can help them feel more confident.
• Look together at causes and triggers. What are they dealing with at that moment? Do they have thoughts on what would help? Are there things you can do that would help ease any stress they are facing?
• Help them seek professional help. You will want to do everything you can to help your child, bringing in professional support, involving their school, finding advice, and information sources. In some cases this will be appropriate, but taking over and trying to fix things can be disempowering. If possible, aim to have discussions with your teen about the options available to them and support them to make decisions about whether and how to seek help. You might be the one to make the appointment and go along with them but as much as possible encourage them to take the lead.

Suicide

The risk of suicide is higher in people – including teenagers – with depression and is the second most common cause of death in young people aged 15-24. If you believe your child might be experiencing suicidal thoughts, do not ignore them.

If you or someone you know is at risk, please call the National Suicide Prevention Lifeline on +1 (800) 273-8255. If it is an emergency, call 911. Please see our emergency resources here.

How common is depression in teenagers

Depression is a very common mental health problem. According to the National Institute of Mental Health, in 2020 more than 4 million adolescents 12-17 year olds in the United States had at least one episode of major depression, which is 17% of young people in this age group.^[9]