HelpGuide – September 2021

Authors: Melinda Smith, M.A., Lawrence Robinson, Jeanne Segal, Ph.D., and Sheldon Reid.

It isn’t always easy to differentiate between normal teenage growing pains and depression. But here’s how you can recognize the signs and symptoms and best help your child.

Understanding teen depression

The teen years can be extremely tough and depression affects teenagers far more often than many of us realize. In fact, it’s estimated that one in five adolescents from all walks of life will suffer from depression at some point during their teen years. However, while depression is highly treatable, most depressed teens never receive help.

Teen depression goes beyond moodiness. It’s a serious health problem that impacts every aspect of a teen’s life. Fortunately, it’s treatable and parents can help. Your love, guidance, and support can go a long way toward helping your teen overcome depression and get their life back on track.

If you’re a teen feeling depressed…

Help is available—and you have more power over your mood than you may think. No matter how despondent life seems right now, there are many things you can do to change your mood and start feeling better today. Read Dealing with Teen Depression.

Is my teen depressed?

While occasional bad moods or acting out is to be expected during the teenage years, depression is something different. The negative effects of teenage depression go far beyond a melancholy mood. Depression can destroy the essence of your teen’s personality, causing an overwhelming sense of sadness, despair, or anger.

Many rebellious and unhealthy behaviors or attitudes in teenagers can be indications of depression. The following are some the ways in which teens “act out” in an attempt to cope with their emotional pain:

Persistent negative mood. Frequent crying due to an overwhelming sense of hopelessness is a common sign of depression. However, teens with depression may not necessarily appear sad. Instead, irritability, anger, and agitation may be the most prominent symptoms.

Problems at school. Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.

Loss of interest in activities. Outside of school, you might notice that your teen shows less enthusiasm for their favorite hobbies. They may quit a sports team or hobby, for example, or withdraw from family and friends.

Running away. Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.

Drug and alcohol abuse. Teens may use alcohol or drugs in an attempt to self-medicate their depression. Unfortunately, substance abuse only makes things worse.

Low self-esteem. Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.

Smartphone addiction. Teens may go online to escape their problems, but excessive smartphone and Internet use only increases their isolation, making them more depressed.

Reckless behavior. Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, binge drinking, and unsafe sex.

Violence. Some depressed teens—usually boys who are the victims of bullying—can become aggressive and violent.

Sudden changes in sleep and diet. Depressed teens may spend more time sleeping in bed than usual, or conversely, experience insomnia. You may also notice that your teen is eating more or less than normal.

While depression can cause tremendous pain for your teen—and disrupt everyday family life—there are plenty of things you can do to help your child start to feel better. The first step is to learn what teen depression looks like and what to do if you spot the warning signs.

Depression in teens vs. adults

Depression in teens can look very different from depression in adults. The following signs and symptoms are more common in teenagers than in their adult counterparts:

Irritable or angry mood. As noted, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.

Unexplained aches and pains. Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.

Extreme sensitivity to criticism. Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”

Withdrawing from some, but not all people. While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

Is it depression or teenage “growing pains”?

If you’re unsure if your teen is depressed or just “being a teenager,” consider how long the symptoms have been going on, how severe they are, and how different your teen is acting from their usual self. Hormones and stress can explain the occasional bout of teenage angst—but not continuous and unrelenting unhappiness, lethargy, or irritability.

Suicide warning signs in depressed teens

Seriously depressed teens, especially those who also abuse alcohol or drugs, often think about, speak of, or make attempts at suicide—and an alarming and increasing number are successful. So it’s vital that you take any suicidal thoughts or behaviors very seriously. They’re a cry for help from your teen.

Suicide warning signs to watch for

• Talking or joking about committing suicide
• Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out”
• Speaking positively about death or romanticizing dying (“If I died, people might love me more”)
• Writing stories and poems about death, dying, or suicide
• Engaging in reckless behavior or having a lot of accidents resulting in injury
• Giving away prized possessions
• Saying goodbye to friends and family as if for the last time
• Seeking out weapons, pills, or other ways to kill themselves

Get help for a suicidal teen

If you suspect that a teenager is suicidal, take immediate action! For 24-hour suicide prevention and support in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK. To find a suicide helpline outside the U.S., visit IASP or Suicide.org.

To learn more about suicide risk factors, warning signs, and what to do in a crisis, read Suicide Prevention.

Causes of teen depression

Biological factors, such as genes, can increase a teen’s risk of developing depression. However, environmental and social conditions also have a role to play. The following factors may trigger or exacerbate symptoms of depression in your teen:

Bullying. Being bullied by peers can add stress to a teen’s life and affect their self-esteem. This can, in turn, trigger feelings of intense helplessness and hopelessness.

Other mental and physical health conditions. Teen depression is associated with a number of other mental health problems, including eating disorders, self-injury, anxiety, ADHD, or a learning disorder. The struggles that accompany these conditions may lead a teen to feel unconfident and frustrated when it comes to academics and socializing. Similarly, physical disabilities or chronic illness can also play a role.

Past and present stressful experiences. Past trauma from violent or abusive situations can put teens at risk of depression as well as post-traumatic stress disorder (PTSD). Recent events, such as the loss of a loved one, can also trigger a depressed mood.

Lack of social support. Teens who feel unsupported by family or peers are at risk of depression. For example, a teen may be struggling with their sexual identity in a hostile or unaccepting environment.

Depression and social media use

Some studies draw a connection between teen depression and social media use. Teens that spend more time on social media tend to report higher rates of depression than their peers. Several explanations may explain this connection:

• Online interactions may be emotionally unsatisfying or increase fear of missing out (FOMO). For example, your teen may see images of their peers enjoying time together and feel excluded.
• Teens on social media may spend lots of time comparing their looks and their lives with those of their peers. This can damage self-esteem.
• Spending time on social media may decrease the amount of time your teen spends being physically active or developing skills. Some studies show that a sedentary lifestyle can have a negative effect on mental health.
• Too much time on social media may interfere with your teen’s sleep routine, indirectly affecting their mood.

Other causes of teen depression can include alcohol and drug abuse, family problems, and academic struggles. Depression can cause or worsen these issues as well, creating a cycle that needs to be broken.

How to help a depressed teenager

Depression is very damaging when left untreated, so don’t wait and hope that worrisome symptoms will go away. If you suspect that your teen is depressed, bring up your concerns in a loving, non-judgmental way. Even if you’re unsure that depression is the issue, the troublesome behaviors and emotions you’re seeing are signs of a problem that should be addressed.

Open up a dialogue by letting your teen know what specific depression symptoms you’ve noticed and why they worry you. Then ask your child to share what they’re going through—and be ready and willing to truly listen. Hold back from asking a lot of questions (most teenagers don’t like to feel patronized or crowded), but make it clear that you’re ready and willing to provide whatever support they need.

How to communicate with a depressed teen

Focus on listening, not lecturing. Resist any urge to criticize or pass judgment once your teenager begins to talk. The important thing is that your child is communicating. You’ll do the most good by simply letting your teen know that you’re there for them, fully and unconditionally.

Be gentle but persistent. Don’t give up if they shut you out at first. Talking about depression can be very tough for teens. Even if they want to, they may have a hard time expressing what they’re feeling. Be respectful of your child’s comfort level while still emphasizing your concern and willingness to listen.

Acknowledge their feelings. Don’t try to talk your teen out of depression, even if their feelings or concerns appear silly or irrational to you. Well-meaning attempts to explain why “things aren’t that bad” will just come across as if you don’t take their emotions seriously. Simply acknowledging the pain and sadness they are experiencing can go a long way in making them feel understood and supported.

Trust your gut. If your teen claims nothing is wrong but has no explanation for what is causing the depressed behavior, you should trust your instincts. If your teen won’t open up to you, consider turning to a trusted third party: a school counselor, favorite teacher, or a mental health professional. The important thing is to get them talking to someone.

Helping a depressed teen tip 1: Encourage social connection

Depressed teens tend to withdraw from their friends and the activities they used to enjoy. But isolation only makes depression worse, so do what you can to help your teen reconnect.

Make face time a priority. Set aside time each day to talk—time when you’re focused totally on your teen, without distractions or trying to multi-task. The simple act of connecting face to face can play a big role in reducing your teen’s depression. And remember: talking about depression or your teen’s feelings will not make the situation worse, but your support can make all the difference in their recovery.

Combat social isolation. Do what you can to keep your teen connected to others. Encourage them to go out with friends or invite friends over. Participate in activities that involve other families and give your child an opportunity to meet and connect with other kids.

Try to reduce their social media use. Remind your teen that social media isn’t an ideal substitute for face-to-face interactions. Encourage them to turn off their phone—or at least disable notifications—when socializing in person, focusing on work, or preparing for bed.

Get your teen involved. Suggest activities—such as sports, after-school clubs, or an art, dance, or music class—that take advantage of your teen’s interests and talents. While your teen may lack motivation and interest at first, as they reengage with the world, they should start to feel better and regain their enthusiasm.

Promote volunteerism. Doing things for others is a powerful antidepressant and self-esteem booster. Help your teen find a cause they’re interested in and that gives them a sense of purpose. If you volunteer with them, it can also be a good bonding experience.

Tip 2: Make physical health a priority

Physical and mental health are inextricably connected. Depression is exacerbated by inactivity, inadequate sleep, and poor nutrition. Unfortunately, teens are known for their unhealthy habits: staying up late, eating junk food, and spending hours on their phones and devices. But as a parent, you can combat these behaviors by establishing a healthy, supportive home environment.

Get your teen moving! Exercise is absolutely essential to mental health, so get your teen active—whatever it takes. Ideally, teens should be getting at least an hour of physical activity a day, but it needn’t be boring or miserable. Think outside the box: walking the dog, dancing, shooting hoops, going for a hike, riding bikes, skateboarding—as long as they’re moving, it’s beneficial.

Set limits on screen time. Teens often go online to escape their problems, but when screen time goes up, physical activity and face time with friends goes down. Both are a recipe for worsening symptoms. Gently encourage your teen to take an occasional vacation from their devices or engage in family activities that don’t involve screen time. You can also set an example by reducing your own time spent online.

Provide nutritious, balanced meals. Make sure your teen is getting the nutrition they need for optimum brain health and mood support: things like healthy fats, quality protein, and fresh produce. Eating a lot of sugary, starchy foods—the quick “pick me up” of many depressed teens—will only have a negative effect on their mood and energy.

Encourage plenty of sleep. Teens need more sleep than adults to function optimally—up to 9-10 hours per night. Make sure your teen isn’t staying up until all hours at the expense of much-needed, mood-supporting rest.

Tip 3: Know when to seek professional help

Support and healthy lifestyle changes can make a world of difference for depressed teens, but it’s not always enough. When depression is severe, don’t hesitate to seek professional help from a mental health professional with advanced training and a strong background treating teens.

Involve your child in treatment choices

When choosing a specialist or pursuing treatment options, always get your teen’s input. If you want your teen to be motivated and engaged in their treatment, don’t ignore their preferences or make unilateral decisions. No one therapist is a miracle worker, and no one treatment works for everyone. If your child feels uncomfortable or is just not ‘connecting’ with the psychologist or psychiatrist, seek out a better fit.

Explore your options

Expect a discussion with the specialist you’ve chosen about depression treatment options for your teen. Talk therapy is often a good initial treatment for mild to moderate cases of depression. Over the course of therapy, your teen’s depression may resolve. If it doesn’t, medication may be warranted.

Unfortunately, some parents feel pushed into choosing antidepressant medication over other treatments that may be cost-prohibitive or time-intensive. However, unless your child is acting out dangerously or at risk for suicide (in which case medication and/or constant observation may be necessary), you have time to carefully weigh your options. In all cases, antidepressants are most effective when part of a broader treatment plan.

Medication comes with risks

Antidepressants were designed and tested on adults, so their impact on young, developing brains is not yet fully understood. Some researchers are concerned that exposure to drugs such as Prozac may interfere with normal brain development—particularly the way the brain manages stress and regulates emotion.

Antidepressants also come with risks and side effects of their own, including a number of safety concerns specific to children and young adults. They are also known to increase the risk of suicidal thinking and behavior in some teenagers and young adults. Teens with bipolar disorder, a family history of bipolar disorder, or a history of previous suicide attempts are particularly vulnerable.

The risk of suicide is highest during the first two months of antidepressant treatment. Teenagers on antidepressants should be closely monitored for any sign that the depression is getting worse.

Teens on antidepressants: Red flags to watch out for

Call a doctor if you notice…

New or more thoughts/talk of suicide Suicidal gestures or attempts New or worse depression New or worse anxiety Agitation or restlessness Panic attacks

Difficulty sleeping (insomnia) New or worse irritability Aggressive, angry, or violent behavior Acting on dangerous impulses Hyperactive speech or behavior (mania) Other unusual changes in behavior

Tip 4: Support your teen through depression treatment

As your depressed teenager goes through treatment, the most important thing you can do is to let them know that you’re there to listen and offer support. Now more than ever, your teenager needs to know that they’re valued, accepted, and cared for.

Be understanding. Living with a depressed teenager can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it’s important to remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.

Stay involved in treatment. Make sure your teenager is following all treatment instructions, whether it’s attending therapy or correctly taking any prescribed medication. Track changes in your teen’s condition, and call the doctor if depression symptoms seem to be getting worse.

Be patient. The road to your depressed teenager’s recovery may be bumpy, so be patient. Rejoice in small victories and prepare for the occasional setback. Most importantly, don’t judge yourself or compare your family to others. As long as you’re doing your best to get your teen the necessary help, you’re doing your job.

Tip 5: Take care of yourself (and the rest of the family)

As a parent, you may find yourself focusing all your energy and attention on your depressed teen and neglecting your own needs and the needs of other family members. However, it’s extremely important that you continue to take care of yourself during this difficult time.

Above all, this means reaching out for much needed support. You can’t do everything on your own so enlist the help of family and friends. Having your own support system in place will help you stay healthy and positive as you work to help your teen.

Don’t bottle up your emotions. It’s okay to feel overwhelmed, frustrated, helpless, or angry. Reach out to friends, join a support group, or see a therapist of your own. Talking about how you’re feeling will help defuse the intensity.

Look after your health. The stress of your teen’s depression can affect your own moods and emotions, so support your health and well-being by eating right, getting enough sleep, and making time for things you enjoy.

Be open with the family. Don’t tiptoe around the issue of teen depression in an attempt to “protect” the other children. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your children to ask questions and share their feelings.

Remember the siblings. Depression in one child can cause stress or anxiety in other family members, so make sure “healthy” children are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.

Avoid the blame game. It can be easy to blame yourself or another family member for your teen’s depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it’s unlikely—except in the case of abuse or neglect—that any loved one is “responsible.”