Depression can change the way teenagers see themselves, their lives, and the people around them. Teenagers who are depressed usually see everything more negatively. They can't imagine that any problem or situation can be solved in a positive way.
Some or all of these symptoms of depression may be present:
Appetite changes (usually a loss of appetite but sometimes an increase)
Difficulty making decisions
Episodes of memory loss
Feeling upset, restless, and irritable
Feeling worthless, hopeless, sad, or self-hatred
Loss of interest or pleasure in activities that were once fun
Thinking or talking about suicide or death
Trouble sleeping, too much sleeping, or daytime sleepiness
Sometimes a person's behavior may change, or there may be problems at home or school without any symptoms of depression:
Pulling away from family and friends, spending more time alone
Use of alcohol or other illegal substances
If these symptoms last for at least 2 weeks and affect your mood or ability to function, get treatment.
Suicide is a risk for all teenagers with depression. See: Suicide and suicidal behavior for more information on how to recognize and treat suicidal feelings.
Signs and tests
True depression in teens is often difficult to diagnose, because normal teenagers have up and down moods. These moods may go back and forth over a period of hours or days.
Sometimes when children or adolescents are asked, they will say that they aren't happy or sad. Health care providers should always ask children or adolescents about symptoms of depression.
The health care provider will perform a physical examination and order blood tests to rule out medical causes for the symptoms. The doctor will also check for signs of substance abuse. The following can cause, or occur because of depression:
Regular marijuana (pot) smoking
Other drug use
The health care provider will also check:
The patient's history of sadness, irritability, and loss of interest and pleasure in normal activities
Signs of other mental health problems, such as anxiety, mania, or schizophrenia
Risks of suicide or homicide -- whether the teen is a danger to him or herself or others
Information from family members or teachers can often help identify depression in teenagers.
Treatment options for adolescents with depression include:
Supportive care from a medical provider
Antidepressant medications (possibly)
Treatment should be tailored to the teenager, and the symptoms. Families often help in treating adolescent depression.
The first medication tried is usually a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). Fluoxetine (Prozac) and escitalopram (Lexapro) are the only SSRIs approved for treating major depression in adolescents (ages 12 - 17). Fluoxetine is also approved for children age 8 and older.
NOTE: SSRIs and other antidepressants carry a warning that they may increase the risk of suicidal thoughts and actions in children and adolescents. Other evidence has not showed that these drugs increase suicide risk in children.
Doctors are still prescribing SSRIs and other antidepressant medications to adolescents with depression. Several important facts about taking any antidepressants include:
Children and adolescents who take medications should be followed by a doctor for side effects. Parents or caregivers should watch for suicidal thoughts or behaviors, nervousness, irritability, moodiness, or sleeplessness that is getting worse. Get medical help for these symptoms right away.
Do not stop taking medications without talking to your health care provider first.
Not all antidepressants are approved for use in children and teens. For example, tricyclic antidepressants are not approved for use in teens.
Almost all adolescents with depression benefit from some type of talk therapy. Talk therapy is a good place to talk about their feelings and concerns, and to learn ways to deal with them.
Types of talk therapy include:
Cognitive-behavioral therapy teaches depressed people ways of fighting negative thoughts. It makes people more aware of their symptoms, helps them learn what makes their depression worse, and teaches them problem-solving skills.
Family therapy may be helpful if family conflict is contributing to the depression. Support from family or teachers may help with school problems.
Talk therapy (psychotherapy) can help adolescents understand issues that may be causing their behavior, thoughts, or feelings.
Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for recommendations.
Sometimes people with severe depression, or those who are suicide risks may need to stay in the hospital for treatment.
Adolescents with depression should learn to:
Take medications correctly and manage their side effects
Watch for early signs that depression is getting worse, and react when it happens
Exercise more and seek out other activities that they enjoy
Avoid alcohol and drugs (whether or not they have been prescribed). These substances affect the brain and make the depression worse over time. They may also affect judgment about suicide.
When you are struggling, talk to someone you trust about how you are feeling. Try to be around people who are caring and positive.
Depression usually responds to treatment. Getting the right treatment as early as possible may prevent further episodes. However, about half of very depressed teens will keep having problems with depression as adults.
Drug, alcohol, and tobacco abuse
Effects on school performance and relationships
Other mental health problems, such as anxiety disorders
Violence and reckless behavior
Adolescents with other mental health problems usually need longer and more intensive treatment.
Calling your health care provider
There are numbers you can call from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.
Call your health care provider right away if you notice one or more of these suicide warning signs:
Depression that is not improving or is getting worse
Nervousness, irritability, moodiness, or sleeplessness that is new or getting worse
Side effects of medications
NEVER IGNORE A SUICIDE THREAT OR ATTEMPT!
Most teenagers feel down sometimes. Having support and good coping skills can help prevent these periods of sadness from leading to more severe depression. Talking openly with your teen can help identify depression early.
Make sure your teen gets professional help to deal with periods of low mood. Identifying and treating depression early may prevent or delay episodes.
In homes with adolescents:
Do not keep alcohol in the home or keep it securely locked
Lock all guns and keep ammunition separate
Lock up all prescription medications
US Preventive Services Task Force. Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2009;123:1223-1228.
Zuckerbrot RA, Cheung AH, Jenson PS, Stein REK. Identification, assessment, and initial management guidelines for adolescent depression in primary care. Pediatrics. 2007;120:e1299-e1312.
Cheung AH, Zuckerbrot RA, Jenson PS, Ghalib K. Treatment and ongoing management guidelines for adolescent depression in primary care. Pediatrics. 2007;120:e1313-e1326.
Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 69.
Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.