Teen depression

Teen depression is a serious mental health problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenager thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although depression can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings — they're a symptom of depression.

Teen depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Teen depression signs and symptoms include a change from the teenager's previous attitude and behavior that can cause significant distress and problems at school or home, in social activities, or in other areas of life.

Depression symptoms can vary in severity, but changes in your teen's emotions and behavior may include the examples below.

Emotional changes

Be alert for emotional changes, such as:

• Feelings of sadness, which can include crying spells for no apparent reason
• Frustration or feelings of anger, even over small matters
• Feeling hopeless or empty
• Irritable or annoyed mood
• Loss of interest or pleasure in usual activities
• Loss of interest in, or conflict with, family and friends
• Low self-esteem
• Feelings of worthlessness or guilt
• Fixation on past failures or exaggerated self-blame or self-criticism
• Extreme sensitivity to rejection or failure, and the need for excessive reassurance
• Trouble thinking, concentrating, making decisions and remembering things
• Ongoing sense that life and the future are grim and bleak
• Frequent thoughts of death, dying or suicide

Behavioral changes

Watch for changes in behavior, such as:

• Tiredness and loss of energy
• Insomnia or sleeping too much
• Changes in appetite — decreased appetite and weight loss, or increased cravings for food and weight gain
• Use of alcohol or drugs
• Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
• Slowed thinking, speaking or body movements
• Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
• Social isolation
• Poor school performance or frequent absences from school
• Less attention to personal hygiene or appearance
• Angry outbursts, disruptive or risky behavior, or other acting-out behaviors
• Self-harm — for example, cutting or burning
• Making a suicide plan or a suicide attempt

What's normal and what's not

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

When to see a doctor

If depression signs and symptoms continue, begin to interfere in your teen's life, or cause you to have concerns about suicide or your teen's safety, talk to a doctor or a mental health professional trained to work with adolescents. Your teen's family doctor or pediatrician is a good place to start. Or your teen's school may recommend someone.

Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're a teen and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care provider such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

When to get emergency help

Suicide is often associated with depression. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

• Call your mental health professional.
• Contact a suicide hotline.
  • In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. The Spanish language phone line is 1-888-628-9454 (toll-free). Services are free and confidential.
  • Or contact a crisis service for teenagers in the U.S. called TXT 4 HELP: Text the word "safe" and your current location to 4HELP (44357) for immediate help, with the option for interactive texting.
• Seek help from your primary care doctor or other health care provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

If a loved one or friend is in danger of attempting suicide or has made an attempt:

• Make sure someone stays with that person.
• Call 911 or your local emergency number immediately.
• Or, if you can do so safely, take the person to the nearest hospital emergency room.

Never ignore comments or concerns about suicide. Always take action to get help.

It's not known exactly what causes depression, but a variety of issues may be involved. These include:

• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems changes, leading to depression.
• Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
• Inherited traits. Depression is more common in people whose blood relatives — such as a parent or grandparent — also have the condition.
• Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that increase the risk of depression.
• Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.

Many factors increase the risk of developing or triggering teen depression, including:

• Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems
• Having been the victim or witness of violence, such as physical or sexual abuse
• Having other mental health conditions, such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia or bulimia
• Having a learning disability or attention-deficit/hyperactivity disorder (ADHD)
• Having ongoing pain or a chronic physical illness such as cancer, diabetes or asthma
• Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or other drugs
• Being gay, lesbian, bisexual or transgender in an unsupportive environment

Family history and issues with family or others may also increase your teenager's risk of depression, such as:

• Having a parent, grandparent or other blood relative with depression, bipolar disorder or alcohol use problems
• Having a family member who died by suicide
• Having a family with major communication and relationship problems
• Having experienced recent stressful life events, such as parental divorce, parental military service or the death of a loved one

Untreated depression can result in emotional, behavioral and health problems that affect every area of your teenager's life. Complications related to teen depression may include, for example:

• Alcohol and drug misuse
• Academic problems
• Family conflicts and relationship difficulties
• Suicide attempts or suicide

There's no sure way to prevent depression. However, these strategies may help. Encourage your teenager to:

• Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise
• Practice self-care, for example by creating a healthy sleep routine and using electronics responsibly and in moderation
• Reach out for friendship and social support, especially in times of crisis
• Get treatment at the earliest sign of a problem to help prevent depression from worsening
• Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms

When teen depression is suspected, the doctor will typically do these exams and tests.

• Physical exam. The doctor may do a physical exam and ask in-depth questions about your teenager's health to determine what may be causing depression. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your teen's doctor may do a blood test called a complete blood count or test your teen's thyroid to make sure it's functioning properly.
• Psychological evaluation. A doctor or mental health professional can talk with your teen about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications.

Types of depression

Symptoms caused by major depression can vary from person to person. To clarify the type of depression your teen has, the doctor may use one or more specifiers, which means depression with specific features. Here are a few examples:

• Anxious distress — depression with unusual restlessness or worry about possible events or loss of control
• Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness
• Atypical features — depression that includes the ability to be temporarily cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in arms or legs

Other disorders that cause depression symptoms

Several other disorders include depression as a symptom. An accurate diagnosis is the key to getting appropriate treatment. The doctor or mental health professional's evaluation will help determine if the symptoms of depression are caused by one of these conditions:

• Bipolar 1 and 2 disorders. These mood disorders include mood swings that range from major highs to major lows. It's sometimes difficult to distinguish between bipolar disorder and depression.
• Cyclothymic disorder. Cyclothymic (sy-kloe-THIE-mik) disorder involves highs and lows that are milder than those of bipolar disorder.
• Disruptive mood dysregulation disorder. This mood disorder in children includes chronic and severe irritability and anger with frequent extreme temper outbursts. This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood.
• Persistent depressive disorder. Sometimes called dysthymia (dis-THIE-me-uh), this is a less severe but more chronic form of depression. While it's usually not disabling, persistent depressive disorder can prevent functioning normally in daily routines and from living life to its fullest.
• Premenstrual dysphoric disorder. This involves depression symptoms associated with hormone changes that begin a week before and improve within a few days after the onset of a menstrual period. The symptoms are minimal or gone after the period ends.
• Other causes of depression. This includes depression that's caused by the use of recreational or illegal drugs, certain prescribed medications, or a medical condition.

Treatment depends on the type and severity of your teenager's depression symptoms. A combination of talk therapy (psychotherapy) and medication can be very effective for most teens with depression.

If your teen has severe depression or is in danger of self-harm, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Here's a closer look at depression treatment options.

Medications

The Food and Drug Administration (FDA) has approved two medications for teen depression — fluoxetine (Prozac) and escitalopram (Lexapro). Talk with your teen's doctor about medication options and possible side effects, weighing the benefits and risks.

FDA alert

Most antidepressants are generally safe, but the FDA requires all antidepressants to carry a black box warning, the strictest warning for prescriptions. Though it's uncommon, some children, teens and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when first beginning a new medication or with a change in dosage. If your teen has suicidal thoughts while taking an antidepressant, immediately contact your doctor or get emergency help.

For most teens who need an antidepressant, the benefits of taking an antidepressant outweigh any risks. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Finding the right medication

Everyone's different, so finding the right medication or dose for your teen may take some trial and error. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as the body adjusts. Encourage your teen not to give up.

Managing medications

Carefully monitor your teen's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for teens with depression, the doctor may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your teen does not have a large amount of pills available at once. Locking up all pills in the home is one measure families can take to reduce the risk of suicide.

If your teen has bothersome side effects, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression.

Antidepressants and pregnancy

If your teen is pregnant or breastfeeding, some antidepressants may pose an increased health risk to the unborn or nursing child. If your teen becomes pregnant or plans to become pregnant, make certain your teen talks to the doctor about antidepressant medications and managing depression during pregnancy.

Psychotherapy

Psychotherapy, also called psychological counseling or talk therapy, is a general term for treating depression by talking about depression and related issues with a mental health professional. Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy.

Psychotherapy may be done one-on-one, with family members or in a group. Through regular sessions, your teen can:

• Learn about the causes of depression
• Learn how to identify and make changes in unhealthy behaviors or thoughts
• Explore relationships and experiences
• Find better ways to cope and solve problems
• Set realistic goals
• Regain a sense of happiness and control
• Help ease depression symptoms such as hopelessness and anger
• Adjust to a crisis or other current difficulty

Hospitalization and other treatment programs

In some teens, depression is so severe that a hospital stay is needed, especially if your teen is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your teen calm and safe until coping skills are learned and a safety plan is developed.

Day treatment programs also may help. These programs provide the support and counseling needed while your teen gets depression symptoms under control.

Make sure that you and your teenager understand the risks as well as possible benefits if your teen pursues alternative or complementary therapy. Don't replace conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a good substitute for medical care.

Examples of techniques that may help in dealing with depression include:

• Acupuncture
• Relaxation techniques, such as deep breathing
• Yoga or tai chi
• Meditation
• Guided imagery
• Massage therapy
• Music or art therapy
• Spirituality

Relying solely on these methods is generally not enough to treat depression. But they may be helpful when used in addition to medication and psychotherapy.

You are your teenager's best advocate to help him or her succeed. In addition to professional treatment, here are some steps you and your teen can take that may help:

• Stick to the treatment plan. Make sure your teen attends appointments, even if he or she doesn't feel like going. Even if your teen is feeling well, make sure he or she continues to take medications as prescribed. If your teen stops taking medications, depression symptoms may come back. And quitting suddenly may cause withdrawal-like symptoms.
• Learn about depression. Education can empower your teen and motivate him or her to stick to a treatment plan. It can also benefit you and other loved ones to learn about depression and understand that it's a treatable condition.
• Encourage communication with your teen. Talk to your teen about the changes you're observing and emphasize your unconditional support. Create an environment where your teen can share concerns while you listen.
• Pay attention to warning signs. Work with your teen's doctor or therapist to learn what might trigger depression symptoms. Make a plan so that you and your teen know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
• Help your teen adopt healthy habits. Keep healthy foods in your home, keep unhealthy foods out, and set regular mealtimes. Encourage routine exercise, noting that even light physical activity can help reduce depression symptoms. Set a time for lights out at bedtime with no use of electronic devices in bed, which can help promote quality and quantity of sleep. If your teen is having problems with sleep, ask the doctor for advice.
• Help your teen avoid alcohol and other drugs. Your teen may feel as if alcohol, marijuana or other drugs lessen depression symptoms, but in the long run they worsen symptoms and make depression harder to treat. Talk with the doctor or therapist if your teen needs help to deal with alcohol or drug use.
• Eliminate or limit access to items your teen could use for self-harm. This can include removing or securing guns, and removing sharp items, alcohol or risky medications in your home if you live with a teen who has depression.

Showing interest and the desire to understand your teenager's feelings lets him or her know you care. You may not understand why your teen feels hopeless or has a sense of loss or failure. But listen without judging and try to put yourself in your teen's position. Help build your teen's self-esteem by recognizing small successes and offering praise about competence.

Encourage your teen to:

• Make and keep healthy friendships. Positive relationships can help boost your teen's confidence and help him or her stay connected with others. Encourage your teen to avoid relationships with people whose attitudes or behaviors could make depression worse.
• Stay active. Participation in sports, school activities or a job can help keep your teen focused on positive things, rather than negative feelings or behaviors.
• Ask for help. Teens may be reluctant to seek support when life seems overwhelming. Encourage your teen to talk to a family member or other trusted adult whenever needed.
• Have realistic expectations. Many teens judge themselves when they aren't able to live up to unrealistic standards — academically, in athletics or in appearance, for example. Let your teen know that it's OK not to be perfect.
• Simplify life. Encourage your teen to carefully choose obligations and commitments, and set reasonable goals. Let your teen know that it's OK to do less when he or she feels down.
• Structure time. Help your teen plan activities by making lists or using a planner to stay organized. Sticking to a regular routine may help improve mood.
• Keep a private journal. Journaling may help improve your teen's mood by allowing your teen to express and work through pain, anger, fear or other emotions.
• Connect with other teens who struggle with depression. Ask the doctor or therapist if there are local support groups for teen depression. Depression support groups are offered online, but check them out to make sure they're trustworthy sites — such as the National Alliance on Mental Illness or the Depression and Bipolar Support Alliance.

It's a good idea to be well prepared for your appointment. Here's some information to help you and your teenager get ready, and what to expect from the doctor.

What you can do

To the extent possible, involve your teenager in preparing for the appointment. Then make a list of:

• Any symptoms your teen has had, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses or recent life changes your teen has experienced
• All medications, vitamins, herbal remedies or other supplements that your teen is taking
• Questions that you and your teen want to ask the doctor

Basic questions to ask the doctor may include:

• Is depression the most likely cause of my teen's symptoms?
• What are other possible causes for the symptoms?
• What kinds of tests will my teen need?
• What treatment is likely to work best?
• Are there any possible side effects with the medications you're recommending?
• Is there a generic alternative to the medicine you're prescribing?
• How will we monitor progress and effectiveness of treatment?
• What are the alternatives to the primary approach that you're suggesting?
• My teen has these other health conditions. Could they be linked to depression?
• Are there any restrictions that my teen needs to follow?
• Should my teen see a psychiatrist or other mental health professional?
• Will making changes in diet, exercise or other areas help ease depression?
• Are there any printed materials that we can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your teen's doctor

Your teen's doctor or mental health professional will likely ask your teen a number of questions, including:

• When did family members or friends first notice your symptoms of depression?
• How long have you felt depressed? Do you generally always feel down, or does your mood change?
• Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
• Do you ever have suicidal thoughts when you're feeling down?
• How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
• Do you have any blood relatives — such as a parent or grandparent — with depression or another mood disorder?
• What other mental or physical health conditions do you have?
• Are you using any mood-altering substances, such as alcohol, marijuana or recreational drugs? Do you use nicotine?
• How much do you sleep at night? Does the amount change over time?
• What, if anything, seems to improve your symptoms? What appears to worsen them?
• What is your diet like? Do you have a history of significant weight gain or loss?

The doctor or mental health professional will ask additional questions based on your teen's responses, symptoms and needs. Preparing and anticipating questions will help make the most of your appointment time.