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The mental and emotional disorder known as teen depression is no different medically from adult depression. However, symptoms in teens may manifest themselves in different ways than in adults.

This may be because teens face different social and developmental challenges, such as peer pressure, changing hormone levels, and developing bodies.

Depression can be associated with high levels of stress, anxiety, and — in the most serious scenarios — suicide. It can also affect these aspects of a teen’s life:

  • personal life (which refers to how an individual feels, thinks, or behaves when they’re alone and away from others)
  • school life
  • work life
  • social life
  • family life

This can lead to social isolation and other problems.

Depression isn’t a condition people can “snap out of” or simply “cheer up” from. It’s a real medical condition that can affect a person’s life in every manner if it’s not treated properly.

According to the National Institute of Mental Health (NIMH), around 3.2 million Americans between 12 and 17 years old had at least one major depressive episode in 2017. They represent 13.3 percent of 12- to 17-year-olds in the United States.

Females were around three times as likely as males to report a depressive episode.

The symptoms of depression can often be difficult for parents to spot. Depression is sometimes confused with the typical feelings of puberty and teenage adjustment.

However, depression is more than boredom or a disinterest in school. According to the American Academy of Child and Adolescent Psychiatry (AACAP), symptoms of teen depression include:

  • appearing sad, irritable, or tearful
  • changes in appetite or weight
  • a decreased interest in activities once seen as pleasurable
  • regular complaints of boredom
  • a decrease in energy
  • difficulty concentrating
  • feelings of guilt, worthlessness, or helplessness
  • alcohol or drug misuse
  • major changes in sleeping habits
  • talking about or thinking of suicide
  • withdrawal from friends or after-school activities
  • worsening school performance

Some of these symptoms may not always be indicators of depression. Appetite changes are often normal, namely in times of growth spurts and particularly if your teen plays sports.

Still, looking out for changing behaviors in your teen can allow you to help them when they’re in need.

Self-injurious behavior

Self-injurious behaviors, such as cutting or burning, are also a warning sign. These behaviors may be rare in adults but are more common in teens.

The intention of these behaviors isn’t usually to end one’s life, but they must be taken very seriously. They’re typically transient and usually end as the teen develops better impulse control and other coping skills.

There’s no single known cause of teen depression. Multiple causes could lead to depression.

Differences in the brain

Research has shown that the brains of adolescents are structurally different than the brains of adults. Teens with depression can also have hormone differences and different levels of neurotransmitters.

Neurotransmitters are key chemicals in the brain that affect how brain cells communicate with one another. They play an important role in regulating moods and behavior.

The neurotransmitters that are important to our understanding of depression are serotonin, dopamine, and norepinephrine.

Low levels of these neurotransmitters may contribute to depression, according to available research.

Traumatic early life events

Most children don’t have well-developed coping mechanisms. A traumatic event can leave a lasting impression.

Loss of a parent or physical, emotional, or sexual abuse can have lasting effects on a child’s brain that could contribute to depression.

Inherited traits

Research shows that depression has a biological component. It can be passed down from parents to their children.

Children who have one or more close relatives with depression, especially a parent, are more likely to have depression themselves.

Learned patterns of negative thinking

Teens regularly exposed to pessimistic thinking, especially from their parents, can also develop depression. They may be lacking positive examples of how to overcome challenges.

Factors that may increase a teen’s risk for depression include:

  • a family crisis, such as death or divorce
  • having a difficult time with their sexual orientation, in the case of teens who are LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more)
  • having trouble adjusting socially
  • having no social or emotional support
  • living in a violent household
  • being bullied
  • having a chronic illness

Teens who have trouble adjusting socially or who lack a support system have an especially high risk of depression.

So do lesbian, gay, bisexual, and queer young people, according to a 2018 literature review.

Even LGBTQIA+ teens who aren’t feeling conflicted about their own sexuality are at an increased risk for depression. This is because external factors, such as stigma from the outside world or a lack of family acceptance, can have a negative impact on the way they view themselves.

However, depression in teens is highly treatable once a diagnosis is made.

In 2016, the U.S. Preventive Services Task Force (USPSTF) began to recommend that all youth ages 12 to 18 years old be screened for major depressive disorder (MDD). MDD is also known as clinical depression.

In 2018, for the first time, the American Academy of Pediatrics (AAP) endorsed universal depression screening for youth 12 years old and up. Youth can receive this screening from their primary care doctors.

Doctors may use the AAP guidelines or adult guidelines to screen for depression in 18- and 19-year-olds.

For proper treatment, it’s recommended that a psychologist or psychiatrist perform a psychological evaluation, asking the teen a series of questions about their moods, behaviors, and thoughts.

The evaluation should also take into account the teen’s family history, school performance, and comfort in peer settings.

To be diagnosed with MDD, a teen must meet the criteria spelled out in the new edition of the Diagnostic and Statistical Manual of Mental Disorders.

They must also have two or more major depressive episodes for at least 2 weeks. Their episodes must involve at least five of the following symptoms:

  • agitation or psychomotor retardation that’s noticed by others
  • a depressed mood most of the day
  • a diminished ability to think or concentrate
  • a diminished interest in most or all activities
  • fatigue
  • feelings of worthlessness or excessive guilt
  • insomnia or excessive sleeping
  • recurring thoughts of death
  • significant and unintentional weight loss or weight gain

In addition, the psychologist or psychiatrist will ask the parent or caregiver questions about the teen’s behavior and mood.

A physical examination may also be used to help rule out other causes of their feelings. Some medical conditions can also contribute to depression.

Just as depression has no single cause, there’s no single treatment to help everyone who has depression. Finding the right treatment is often a process of trial and error. It can take time to determine which one works best.

Treatment for adolescents with depression is usually a combination of medication and psychotherapy.

Numerous classes of medications are designed to alleviate the symptoms of depression.

However, for people who are 10 to 21 years old and have moderate or severe depression, the AAP recommends selective serotonin reuptake inhibitors (SSRIs).

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most commonly prescribed class of antidepressants. They’re preferred because they tend to have fewer side effects.

SSRIs work on the neurotransmitter serotonin. SSRIs prevent the body from absorbing serotonin so it can be more effectively used in the brain.

Current SSRIs approved by the Food and Drug Administration (FDA) include:

Most SSRIs have only been approved for use in adults. However, fluoxetine has received FDA approval for youth with MDD who are 8 years old and up. Escitalopram has received FDA approval for youth with MDD who are at least 12 years old.

The most common side effects reported with SSRIs include:

  • sexual problems
  • nausea
  • diarrhea
  • headaches

All youth who are taking antidepressants should be monitored for potential side effects. Talk to a doctor if the side effects are interfering with your teen’s quality of life.

The bottom line on treatment for teens

If symptoms don’t improve after 6 to 8 weeks, then the AAP strongly recommends that the clinician reassess the treatment and initial diagnosis. The AAP also suggests a mental health consultation.

IMPORTANT WARNING

The Food and Drug Administration (FDA) requires the manufacturers of antidepressant medications to include a “black box warning,” so named because the label warning is offset within a black border. The warning says that the use of antidepressant medications in young adults aged 18 to 24 has been associated with an increased risk of suicidal thinking and behavior, known as suicidality.

Teens with depression should see a qualified mental health professional before or at the same time as starting medication therapy. The AAP recommends either cognitive behavioral therapy (CBT) or interpersonal therapy (IPT).

CBT is guided to replace negative thoughts and emotions with good ones.

In IPT, the aim is to strengthen personal relationships by improving communication and problem-solving skills. Parents or caregivers will participate in select sessions.

Lifestyle changes may also help to relieve the symptoms of depression.

Exercise

Research shows that regular exercise stimulates the production of “feel good” chemicals in the brain that elevate mood. Encourage your teen to enroll in a sport they’re interested in, or come up with games to promote physical activity.

Sleep

Sleep is important to your teen’s mood. Make sure they get enough sleep each night and follow a regular bedtime routine.

Diet

It takes the body extra energy to process foods high in fat and sugar. These foods can make you feel sluggish. Prepare meals that are full of a variety of nutritious foods.

Caffeine

Caffeine can momentarily boost mood. However, regular use can cause your teen to “crash,” feeling tired or down.

Alcohol

People with depression may self-medicate with alcohol. However, drinking can create more problems, especially for teens. People with depression should avoid alcohol.

Depression can have a profound impact on a person’s life and can only compound the difficulties associated with the teenage years.

Teen depression isn’t always the easiest condition to spot. However, with proper treatment your teen can get the help they need.

If depression is affecting your teen’s life, you should seek help from a mental health specialist. The specialist will create a treatment plan specifically for your teen. It’s also important that your teen follows that plan.

Other things your teen can do to help manage depression are:

  • stay healthy and exercise
  • have realistic expectations and goals
  • keep life simple
  • ask for help
  • connect with other people through healthy friendships
  • keep a journal to express their thoughts and feelings

There are many support groups to help your teen connect with other teens who have depression. Here are some organizations offering support groups for depression:

Teen depression affects many young people. Depression causes a high rate of teen suicides, so it should be taken seriously.

It’s important to diagnose depression in teens early. If your teen has symptoms of depression, make sure to see a mental health specialist. Treatment can be highly effective and usually includes both medication and psychotherapy.