Adolescence can be a difficult time for both teens and their parents. During this stage of development, many hormonal, physical, and cognitive changes occur. These normal and often turbulent changes make it difficult to recognize and diagnose underlying depression.

Symptoms of depression in teenagers are similar to those in adults. But they often manifest themselves in different ways. Some self-harmful behaviors, such as cutting or burning, are rare in adults but more common in teens.

Depression in adolescence may lead to behavioral problems such as:

  • irritability or moodiness
  • starting fights
  • defiance
  • skipping school
  • running away
  • drug use
  • risky sexual behavior
  • poor grades

According to the National Institute of Mental Health, 2.8 million adolescents experienced at least one major depressive episode in 2013. Those adolescents represent 11.4 percent of the 12 to 17-year-old population in the United States.

Teens may undergo emotional and behavioral changes when depressed. Emotional changes may include:

  • feelings of sadness, hopelessness, or emptiness
  • irritability
  • moodiness
  • loss of interest or pleasure in activities once enjoyed
  • low self-esteem
  • feelings of guilt
  • exaggerated self-blame or self-criticism
  • trouble thinking, concentrating, making decisions, and remembering things
  • frequent thoughts of death, dying, or suicide

Behavioral changes may include:

  • restlessness
  • tiredness
  • frequent crying
  • withdrawal from friends and family
  • angry outbursts
  • acting-out
  • changes in sleep
  • changes in appetite
  • alcohol or drug use
  • a drop in grades or frequent absences from school
  • self-harm (e.g., cutting or burning)
  • suicide attempt or planning a suicide

Self-injurious behaviors are a warning sign of depression. These behaviors are usually not intended 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.

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Sources: National Suicide Prevention Lifeline and Substance Abuse and Mental Health Services Administration

Read more: Symptoms of depression »

Risk factors for depression during adolescence include:

  • a family crisis, such as death or divorce
  • physical, emotional, or sexual abuse
  • frequent arguing
  • witnessing violence in the home

Young people who are struggling with their sexual identity have an especially high risk for depression. So do teens who have trouble adjusting socially, or have a lack of social or emotional support. However, depression in teens is highly treatable once a diagnosis is made.

Read more: Depression and sexual orientation »

Diagnosing depression in adolescents can be difficult. It’s important that your teen receives a comprehensive evaluation by a qualified mental health professional. Preferably, this professional should have experience or special training with teens. An evaluation should encompass the full developmental history of your teen. It should also include family history, school performance, and home behaviors. Your doctor may also perform a physical exam.

Early diagnosis is important. If depression is severe, teens may look to suicide. If your teen has suicidal thoughts or attempts suicide, you should seek help from a mental health specialist immediately.

According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death in young people between the ages of 10 and 24 in the United States. This means about 4,600 youths take their lives every year.

Risk factors for teenage suicide include:

  • a family history of mental illness
  • prior suicide attempts
  • alcohol or drug abuse
  • stressful events
  • access to firearms
  • exposure to other adolescents who have committed suicide
  • self-harmful behaviors, such as cutting or burning
  • being bullied at school

Treatment for adolescents with depression usually is a combination of medication and psychotherapy. Psychotherapy can include cognitive-behavioral and interpersonal therapies. Treatment plans should consider individual, family, school, and medical issues. Depression in teens often is related to problems at home. So enhancing parenting skills is an important part of treatment.

Depression in adolescents may result in academic delays. These delays may require changes to your teen’s school environment. An educational assessment may find that your teen would perform better in a private school rather than a public school.

Older adolescents will have a say in their treatments. These treatments may include medications. There are many types of antidepressant medications available. Be sure to talk to your doctor about which medications are right for your teenager. Always include your teenager in the discussion.

Read more: Therapy for depression »

There has been some debate in recent years on the effectiveness of selective serotonin reuptake inhibitor (SSRI) antidepressants on adolescents.

In 2007, the U.S. Food and Drug Administration (FDA) published a review of SSRI research. The review found that 4 percent of teens taking SSRIs experienced suicidal thoughts and behavior, twice the rate of those taking a placebo.

The FDA responded by placing a “black box” warning label on all SSRIs. The label warns against the increased risks of suicidal thoughts and behavior in people younger than 25.

However, a recent study suggests that the earlier studies were poorly designed. It also suggests that depressed patients who were treated with antidepressants did not have a higher risk for suicide attempts than untreated patients.

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
  • have healthy friendships to connect with other people
  • keep life simple
  • ask for help
  • 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 support groups for depression:

If things get bad, seek help from a mental health specialist immediately. In addition, here are some suicide prevention hotlines:

Teenage depression affects many youths. 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 psychotherapy and medication.