The past year has been a difficult one for all of us as we grappled with the fallout of a global pandemic. But this is perhaps most true for teenagers.
Months of lockdown, virtual learning, isolation from friends, financial troubles for families, and more have taken their toll on teenagers. Studies have found that the mental health effects of the pandemic have the most significant impact on teenagers.1
This isn’t to say teenage depression is a new crisis. It has been an ongoing crisis for some time as depression rates in adolescents continue to rise.
Whether you’re feeling depressed yourself and looking for answers or you’re a concerned parent, you’re not alone. There are many resources, treatments, and sources of help out there. This guide is one of them.
We can begin by first looking at the scale of the problem. Indeed, for some teenagers and families, it helps to know that their experience isn’t unique. Teen depression is, sadly, quite common.
The CDC states that more than 4 million children are diagnosed with anxiety and just under 2 million have diagnosed depression. 2
These conditions are often diagnosed together as around 3 out of 4 of those diagnosed with depression are also diagnosed with anxiety.
Diagnoses for anxiety and depression are more common as age increases, with adolescents most likely to be diagnosed.
This is a stark figure and it has been steadily increasing over the last few decades. To make matters worse, teenagers living below the federal poverty line are also diagnosed more often with mental health disorders.
What all this means is that depression is one of the leading causes of illnesses in teenagers. The consequences of ignoring this mental health crisis are severe as suicide is also the third leading cause of death in 15 to 19-year-olds. 3
Even for those who don’t turn to the most drastic solution, failing to address adolescent mental health issues impairs physical and mental health in their later years. It limits their opportunities and is ultimately detrimental to their long-term well-being as well as their short-term well-being.
It can be difficult for those who haven’t experienced it first-hand to understand what depression is. Especially with teenagers, it can be difficult to distinguish between hormonal changes that may cause mood swings or something more severe.
As a diagnosis, the criteria for meeting depression is when it is severe enough to interfere with someone’s ability to function.
Like most mental health issues, it’s not clear what causes teenage depression. There are a lot of potential factors at play that may cause depression in a young adult.
While researchers don’t know for sure what the exact biological causes of depression are, there are many chemical factors within the body at play that could be a factor.
Depression is associated with chemical imbalances in the brain. Most often, a lack of serotonin. This is a key hormone that stabilizes mood.
Other neurotransmitters are also associated with depressive disorder. When these neurotransmitters aren’t functioning properly, it impairs nerve cell connections and growth.
As well as this, it’s now understood that having depression can change the way our brains function. 4 The hippocampus, the part of our brain responsible for memory, can shrink after a long depressive episode.
Meanwhile, the amygdala, the part of our brain responsible for emotional responses, enlarges. This increased activity can lead to further changes in hormones, activity levels and cause problems with sleeping.
Everyone knows that puberty is a time when the body is going through a staggering amount of hormonal changes. For most adolescents, this means navigating through mood swings, impulses, and emotions.
For some teenagers though, the hormonal changes during puberty combined with other biological or environmental factors may be a cause of depression.
Scientists believe genetic factors are also a factor in depression in teens.
This shouldn’t be surprising news. Many mental health disorders like bipolar disorder, schizophrenia, and ADHD run in families, suggesting genetic roots.
While it isn’t known how much of a factor genetics plays in causing teenage depression, children with a parent diagnosed with depression are more likely to be diagnosed themselves.
It’s common for adolescents struggling with depression to have gone through a traumatic event. This could be in recent times or early childhood trauma.
Traumatic events like the loss of a parent or abuse can cause changes in the brain during formative years. These changes can make children more susceptible to depression in both their adolescence and adulthood.
The environment in which we live has a huge impact on our development in childhood. Family, school, friends, community, and more all influence a child’s development and well-being.
As we said above, adolescents who live below the poverty line are diagnosed with depression more often. This is to do with the environmental factors in their lives. For example, a child living below the poverty line will have worse nutrition than a child who does not.
All these environmental factors will cause teenage stress. The brain is overwhelmed with hormones and doesn’t deal well with stress at this age and this can affect the possibility of depression in adolescence.
Teenagers' bodies are going through a lot of changes during puberty. These changes can make them self-conscious, give them low self-esteem and feel helpless.
In the last year, in particular, many teenagers have been more isolated from their social groups and extended family. This lack of socialization may well have contributed further to negative thoughts.
Teenagers who identify as LGBTQ+ are at a higher risk for depression. This is often due to a mix of environmental factors such as homophobia at school or home, combined with psychological factors like a fear of rejection.
Studies have found there is a possible correlation between depression in teens increasing and social media.
There was a sudden increase in diagnoses of depression in teens in 2012. This is about the same time smartphones came onto the market and unlimited access to social media became the norm.
The study also found subjects were 71% more likely to have one risk factor for suicide if they spent more than 5 hours a day on their smart device, regardless of the content they consume. 5
Social media can also be linked to psychological factors. For example, Instagram in particular has long been accused of creating and sustaining unrealistic beauty standards. Young people who consume a lot of content on platforms like this may develop low-self esteem due to this.
It can be difficult to know when a sad phase has moved into a depressive one. This is why it helps to know the different signs of teenage depression.
Common signs of depression begin with feeling down, sad, or crying often. If this feeling lasts for more than a couple of days before feeling at least somewhat better, this can be an early sign of depression.
For major depressive episodes, the teenager may lose interest in things they once enjoyed doing like socializing or playing games. This is often accompanied by a significant change in appetite. This can be in either direction, so eating far more or eating far less.
Sleep can be affected too. For some, they’ll sleep far more than before and for others far less. Both the changes in diet and sleeping patterns can cause a loss of energy and fatigue.
For some teenagers, depression manifests itself in the form of irritability and anger. While all teenagers explode every now and then due to hormonal changes, if it’s happening often or is very out of character then this can be a sign of depression too.
Others may have difficulty concentrating, both at home and in school. However, if this sign is noticed with no other signs of depression, another mental health diagnosis like ADHD may be more appropriate.
We mentioned psychological factors above, but in terms of signs feelings of worthlessness and guilt are very strong signs of depression. These feelings cause teenagers to isolate themselves from both friends and family and further contribute to the illness.
The most worrying sign of all is suicidal thoughts, plans, or ideation. This is a huge warning sign for a teenager who is at risk of suicide and should be taken very seriously.
If a teenager exhibits 5 or more of the above symptoms for two weeks or more, they may have depression. However, there are less common signs of depression to consider as well.
Poor school performance due to a lack of ability to concentrate or a lack of interest is a sign of depression. Similar to this, persistent boredom is also a less common sign of depression.
Scarier signs include frequent complaints of minor illnesses like stomach upset or headaches. While the act of self-harm such as cutting or burning is scary enough on its own, the underlying cause of it is often depression.
Other risk-taking behaviors can also be a sign of depression in teens. This could include dangerous driving and unprotected sex. While drinking and taking drugs is risk-taking behavior, it can also be an attempt to self-medicate. Irrespective of the reasoning, both are a sign of depression in teens.
Around 3,000 teenagers in America die from suicide every year, and thousands more attempt suicide. As depression and suicide are so intrinsically linked, it’s important to distinguish the warning signs between depression and suicide, similar though some are.
Teenagers who are suicidal will have sudden changes in behavior. This includes a lack of motivation, changes in eating, and increased mood swings.
It’s very common for teenagers to withdraw and isolate themselves if they are having suicidal thoughts or ideation. When you speak with them they might seem hopeless or preoccupied with death or dying.
One of the most common signs of an imminent risk of suicide is if a teenager begins giving away valuable personal possessions. This suggests they have formulated a suicide plan and are moving through with it.
On the other end of the scale, a sudden improvement in mood after suffering from other signs of depression for a while can be a sign in itself. This change in mood is often due to resolving to go through with suicide to get away from the other painful feelings. It’s very bleak, but this can elevate the mood of many suicidal people and is a red flag for suicidal behavior.
Though all the information above has been a lot, the good news is, once you have a diagnosis of depression there are many options for successful treatments.
There are many healthcare providers who can help diagnose teenage depression. This includes pediatricians, psychiatrists, mental health therapists, and more.
Your chosen healthcare professional will talk to you or your child and evaluate their symptoms. This is to help rule out other mental health disorders in order to make sure you or your child gets the right diagnosis and treatment.
There is also sometimes a physical examination as part of the diagnosing process. This is to rule out that any symptoms are being caused by physical problems, as opposed to mental ones.
Once you have a diagnosis, you can move onto potential treatments. The treatment you choose is often recommended by your chosen healthcare professional, but you’ll be in control of which treatment options you pick.
The two most common treatments for teenage depression are psychotherapy and medication. They often work best in combination as medication can treat the current symptoms while psychotherapy can get to the underlying causes. We’ll look at both in more depth.
Psychotherapy is a form of counseling that’s also known as talk therapy.
This type of therapy can help you work through problems and figure out ways to cope with depression better. Sessions last between one to two hours and group sessions are often also available if you prefer.
There’s no clear timeline for success with therapy. This isn’t to say it isn’t an effective treatment, but instead to say that it takes different amounts of time for different people. Some people may see good results after only a few sessions, while for others it may take months before they have the same results.
There are two common approaches for treating teen depression with psychotherapy which are interpersonal therapy and cognitive behavioral therapy.
Interpersonal therapy can help teenagers develop better skills for social and interpersonal relationships. This, in turn, can help lessen symptoms of depression caused by environmental or psychological factors.
This therapy works by educating teenagers about depression. This knowledge helps them know it’s not uncommon and it’s entirely treatable.
Once they have the knowledge they need about the disease, interpersonal therapy looks at defining unique problems. This could be conflicts with friends or family, anxiety around school, or any number of other issues.
After the problem is defined, the therapist will help solve problems they can and set realistic goals for better coping with them. For example, in conflicts with family, they could help the patient figure out how better to express themselves to reduce the conflict.
Cognitive behavioral therapy is very effective in the treatment of adolescent depression, even in severe cases. This therapy focuses on changing the way a person thinks about certain issues. They achieve this with a couple of techniques.
First, the therapist will look at setting up positive expectations for therapy. Much like with IPT, some of this revolves around knowledge about depression and how treatable it is. This technique also involves creating a relationship so the patient is comfortable and happy during the treatment process.
After this, the therapist will look to identify the ways of thinking that influence the patient’s behavior. This could be by examining assumptions we make about ourselves, other people, or the world around us.
The final technique helps to modify these assumptions and beliefs by changing behaviors. The patient learns better strategies to cope with issues as they arise. This can help patients deal with underlying trauma and psychological factors, as well as learn to cope with environmental factors better.
The symptoms of depression can leave us feeling dreadful. While therapy is a great option for treatment, it takes time to work. That’s why medication is often prescribed to help patients cope with the symptoms of depression in the meantime.
SSRIs are by far the most common prescription these days, as TCAs and MAOIs have more associated side effects. SSRIs work by helping the brain create better levels of serotonin to help balance moods. They’re highly effective for the vast majority of adolescents in treating depression.
While medication and psychotherapy are the most common treatments, there are other successful treatments for depression. This includes ECT and TMS.
ECT stands for electroconvulsive therapy. It’s a treatment where electric currents are sent through the brain which causes a surge of electrical activity. For some people, this therapy can be very effective in dealing with severe symptoms of depression or other mental health disorders like bipolar.
Patients need to be put under general anesthetic to receive ECT treatment. In general, ECT is only recommended where all other options for treatment are exhausted.
TMS stands for transcranial magnetic stimulation. It works by stimulating the neurotransmitters in the brain that control mood. As suggested by the title, this stimulation is achieved with a magnet.
This stimulation helps to balance the chemical messengers within the brain, leading to the possibility of long-term remission.
Though it sounds similar to ECT, patients don’t need to be put under general anesthetic for this treatment and the potential side effects are far less severe. This treatment is relatively modern but has shown good signs of success in treating moderate and severe depression.
The most important help you can get your teenager is the diagnosis so they can get the treatment they need for depression. But this doesn’t mean there’s nothing else you can do to help.
Educating yourself about depression (like you are by reading this article!) helps give you a better idea of what your teenager is dealing with. This can make conversations you have with them about depression easier.
You should be available to talk with your teenager and encourage them to do so. But don’t make the mistake of feeling you need to fix all their problems as there are many you won’t be able to. Often it’s enough to know you’re there and ready to listen to them.
You can also help your teenager by encouraging positive daily routines, as recommended by their therapist or doctor. This could include things like making sure they take their medications, helping them achieve tasks like tidying their room, and helping them eat a healthier diet.
Some teenagers with severe depression will resist any attempts to help them or to get them the help they need. This isn’t personal and it isn’t unique.
You can encourage them to learn about depression with you, as well as how common and treatable it is. Remind them that they have full autonomy over their own health and wellbeing and at no point will they be forced to do anything they don’t want to do.
Teenage depression is a very common illness. While this is sad, it is also very treatable with a huge range of treatment options available. Getting the help you or your teenager need as soon as possible is the best thing you can do. To find out more about our treatment options, just get in touch.
1. Mostafavi, B. (2021, March 15). National Poll: Pandemic Negatively Impacted Teens’ Mental Health. Retrieved from https://healthblog.uofmhealth.org/childrens-health/national-poll-pandemic-negatively-impacted-teens-mental-health
2. Centers for Disease Control and Prevention. (2021, March 22). Data and Statistics on Children’s Mental Health. Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html
3. World Health Organization. (2020, September 28). Adolescent mental health. Retrieved from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
4. Harvard Health Publishing. (2019, June 24). What causes depression? Retrieved from https://www.health.harvard.edu/mind-and-mood/what-causes-depression
5. Garcia-Navarro, L. (2017, December 17). The Risk Of Teen Depression And Suicide Is Linked To Smartphone Use, Study Says. Retrieved from https://www.npr.org/2017/12/17/571443683/the-call-in-teens-and-depression
