Having bad days occasionally is normal for teens, but what if your teen seems down in the dumps for a few weeks, or even a few months? If their feelings of sadness or irritability won’t go away, the cause might be depression. Depression is very common and can affect any person at any age, including teens. In surveys of high school students conducted across the United States in 2017 approximately 31.5%% of students said they felt so sad or hopeless at some point that they stopped doing some of their usual activities for ≥2 weeks in a row.

What is depression?

Depression is a persistent low mood that affects feelings, behaviors, thoughts, and physical well-being. There may be feelings of sadness or irritability, a lack of energy, trouble sleeping, feelings of hopelessness or worthlessness, or unhappy thoughts about life. Boys often experience depression by feeling angry or irritable and often do not identify sadness as how they feel. Depression may also affect a person physically, causing changes in sleeping, eating, or concentration, or aches and pains such as headaches or stomachaches. They may engage in behaviors to distract them from their feelings, such as drinking and drug use, skipping school, or getting into fights.

Who gets depressed?

Although we don’t know the exact number of people who have depression, we do know that it affects children, teens, and adults of all ages and all ethnic and racial backgrounds. Research has shown that teens who have a family history of depression may be at a higher risk of having symptoms.

What are the symptoms of depression?

Teens with depression may:

• Appear sad or listless a lot of the time. You may not notice this all the time, but it persists for at least two weeks.
• Pull away from doing things they used to enjoy, such as playing sports, hanging out with friends, or studying
• Act easily irritated or get angry or lose their temper quickly
• Feel tired or have less energy, or feel restless and edgy
• Experience changes in eating habits, eating more or less than they did before they started feeling depressed
• Experience changes in sleep, either sleeping a lot more or a lot less than before, and/or having trouble falling asleep or waking up
• Appear to have difficulty concentrating and/or making decisions
• Isolate themselves from family and friends
• Have increasingly worse self-esteem
• Express feeling guilty about things that they do or don’t do
• State that they feel “empty”, or unable to put their feelings into words
• Report feeling that things will never get better
• Have thoughts about not wanting to live or about hurting themselves
• May have tried to hurt themselves
• Show an increase in risk-taking behaviors
• Engage in drug or alcohol use
• Sometimes teens hide the way they feel, so it is not obvious that they are depressed.

Boys and young men are often reluctant to let anyone know that they are having a problem and may be unlikely to seek help. If you notice a change in your son’s mood or behavior, it’s a good idea to talk with him about your observations.

How do I know whether my teen is depressed or just sad?

It’s normal for everyone to feel depressed or sad sometimes. It can be particularly noticeable in teens who are experiencing typical, age-related mood variation. However, if your teen has some or many of the symptoms listed above much of the time for two weeks or more, he could have depression. There are no laboratory tests that can be done to prove that someone is depressed like there are for illnesses such as strep throat or diabetes. However, if you think your teen may be depressed, it is important to talk with his health care provider. It may also be a good idea to consult a mental health provider about ways to help your teen.

What are the effects of depression?

Depression has many different and powerful effects on people who have it and it also affects the people around them.

Depression can:

• Impact school and work performance
• Influence a teen’s ability to make and keep friends
• Make relationships with family members stressful
• Affect physical health
• Result in being more tempted to turn to alcohol, drugs, or sex as a way to escape from difficult feelings
• Make your teen feel extremely irritable, causing yelling and arguing
• Cause problems with staying focused, which can lead to car accidents and other serious mistakes
• Lead to serious injury and even suicide if left untreated

What causes depression?

No one knows for sure what causes depression. The most important thing to keep in mind is that it is not your teenager’s fault if he becomes depressed. Most likely, depression is caused by a combination of things, some of which have to do with the chemicals in the brain and some that have to do with life events. Sometimes depression can be the result of certain medical conditions such as anemia or a thyroid disorder. Other times, depression may be the consequence of dealing with a chronic health issue or another medical problem that causes chronic pain or other debilitating symptoms.

Some factors that may increase the risk for depression include:

• Genetics: If other people in the family have had a depressive illness, your teenager may have similar genes and be more likely to become depressed.
• Family problems: A major loss or disruption in your family, or conflict among members of your family may cause your teen to feel depressed.
• Low self-esteem: If your teenager is constantly being criticized, abused, neglected, bullied, or if she is having difficulty at school or other activities, she may be more likely to feel depressed. Similarly, teens that have recently broken up with a boyfriend or girlfriend are vulnerable.
• Feeling alone: Some teens feel that they are different from their peer group and that their friends and family do not understand. This is sometimes true for teens who are gay, lesbian, bisexual, or transgender. Teens that have a parent with a physical illness, mental illness, or a substance abuse problem are at particular risk if they feel that their family stability is threatened.
• Isolation. Especially during the challenging times of COVID-19, isolation may increase a teens risk for depression. The decrease and/or loss of frequent face to face social interaction can be a challenge for teens.
• Transgender and homosexual teens are often at a higher risk for developing depression. Many struggle with an overwhelming amount of anxiety regarding acceptance, whether it’s from their own families or in society. The anxiety and fear of being accepted not only by their families, but in society, can be overwhelming.
• Medical conditions: Medical conditions such as thyroid disorders, anemia, diabetes, or chronic disease or pain can contribute to depression. If there is a history of any significant medical conditions in your family, be sure to tell her health care provider.

Your teen may not have any of these problems but still feel depressed.

Treatment Options

How is depression treated?

There are many different kinds of treatment for depression. Deciding on the right treatment depends on how much difficulty your teenager is having, what treatments are available to him, and personal preference.

• Counseling or Psychotherapy. Counseling or psychotherapy is something that can help with depression, and often the first treatment recommended by health care providers. It involves talking about thoughts, feelings, and behaviors in a confidential setting. Therapy can create a safe environment for your teen to discuss painful or frightening issues without feeling judged. It can teach your teen strategies for coping with situations in his life and with his feelings. It can also help him to understand himself better and provide an opportunity for him to learn how to solve problems more effectively. It is extremely important that your teen feel comfortable with his mental health provider. It is worth the extra effort it can take to find someone with whom he feels he can have a trusting relationship. He will probably be able to tell if it is a good match within a few sessions. Therapy can be done in a few different settings. Individual therapy is when your teen meets with the therapist alone. Often there is an opportunity for the parent(s) to meet with the therapist either at the beginning or end of sessions, or occasionally as the sessions continue. Group therapy puts your teen in touch with others close to his age who are experiencing similar problems, and may be supportive and reassuring in addition to, or instead of individual therapy. Sometimes, when a teenager is depressed, family therapy is useful because members of families are often unclear about how to help. The purpose of family therapy is to be supportive of a family’s attempt to communicate better and support each other more skillfully.
• Medication. If depression is significantly interfering with your teenager’s life, or if you or he feel that therapy alone isn’t helping, your son’s health care provider or therapist may suggest medication. The levels of certain chemicals in the brain are directly related to depression. Taking medication can help these chemicals become more balanced and help a person feel less depressed.
  
  Medication does not take the place of therapy. The primary goal of medication in treating depression is to reduce a person’s debilitating symptoms. This can enable your teen (with his therapist’s help) to understand the causes of his depression and make the necessary behavioral changes he needs to move beyond this period in his life.
  A doctor, a psychiatrist, or a nurse practitioner can prescribe medications. There are some primary care doctors and nurses who are familiar with current trends in anti-depressant medication. When possible, however, it is useful to use a prescriber who is skilled in mental health issues with adolescents, such as a psycho-pharmacologist or psychiatrist who works with teens. There are many different medications that treat depression and the prescriber will choose one based on your child’s symptoms, age, medical history and other individual factors. Parents often have concerns about their children taking medication for depression, so it is helpful to ask about both the benefits and possible side effects. Anti-depressant medication has generally been shown to be safe when used as prescribed. Both your teen and you should feel comfortable talking with the prescriber and have a direct way in which to contact him/her when needed. Additionally, it is important that there be a clear line of communication between the prescriber and the treating therapist.When your teen is feeling better, he may want to stop taking the medication, but most medications need to be decreased gradually. You and your teen should always talk with his health care provider before making any changes with the medication.
• Day Programs, Residential Programs, and Hospitals. If your teen becomes so depressed that he has trouble with his everyday life, or he is having thoughts about hurting himself, he needs more help than outpatient visits. In day programs at counseling centers or hospitals, patients arrive in the morning and spend all day in counseling, group discussions, and activities with mental health professionals and other teens who are experiencing similar issues. Residential treatment programs are overnight programs and are usually at hospitals where patients receive professional care all-day and are supervised overnight. Both treatments are used for teens who are severely depressed. Sometimes when a teen is in a crisis due to depression he may require in-hospital care. He may also be hospitalized if the depression has been going on for a long time and there are no signs of improvement. A person can be hospitalized against his will only if he is medically deemed to be harmful to himself or others, is clearly having trouble functioning or is behaving in extremely strange ways. If this is the case with your teen, he cannot sign himself out of an in-patient program until he is considered to be medically and emotionally safe.

Helping Your Son Cope with Depression

The following are strategies that you can use to help your son cope with depression:

• Let your son know that you are interested in how he is feeling and that you are available to talk. Just knowing that you care is helpful, even if he is not ready to talk to you right now.
• Encourage your teen to keep up with his daily activities, even for shorter periods of time. Help him to participate in activities that he enjoys and that help him relax. Staying busy and in touch with others whom he trusts is especially important.
• Sometimes depressed teens isolate themselves from their friends and family. Encourage your son to choose a few people; peers, family members, teachers, etc. to whom he can go for support and be in touch with at least once a day.
• Encourage your son to get some form of exercise at least 3 to 4 times a week. Being active can help improve his mood. He should also be encouraged to keep to his usual sleep schedule and eat regular and healthy meals and snacks.
• Suggest that he keep a journal. Writing about his feelings, drawing, coloring, and writing poetry are some ways that teens like to express themselves. Sometimes he may be asked to do this by his therapist as well, and maybe share some of the entries. Often being able to identify and express feelings will improve how your teen feels.
• Brainstorm with your son about other strategies to cope with depression: What works for him?

What else do I need to know?

Depression in teenagers is more common than people realize, and most people who receive treatment for depression get better. Unfortunately, many people who are depressed don’t get help for many reasons. Some people think that seeking treatment is a sign of weakness. Others are afraid to be seen as “crazy” for seeing a counselor or taking medication. Some parents don’t recognize signs of depression in their teens, or sometimes they don’t want to face it because they feel they are to blame, or that others will blame them. It is also important to know that some teens conceal their depressed thoughts and feelings, so if your teen seems note quite himself, it is a good idea to inquire about how he is feeling. Some teens tell their friends or post on Facebook instead of talking with their parents. If your son’s friend or another adult tells you they think your son is depressed, it is important to take them seriously. Some parents find it threatening to have another person (such as a therapist) so intimately involved in their family’s life. However, every parent needs objective guidance sometimes, and if your teen is depressed, it’s wise to seek outside help. Mental health providers who work with teens and their families have expertise in this area and can significantly change lives for the better. Although finding the right help may take time and courage, it greatly improves your teen’s chances of moving beyond the depression.

How to Get Help for Your Teen

What should I do if I think my teen is depressed?

If you think your teen may be depressed, ask him. Has he been feeling down, depressed, sad, irritable or hopeless? It’s important to let him know that you noticed that he seems unhappy, and that you care. It’s very important to consult a professional if your teen shows feelings or behaviors of concern, such as depression for more than a short time, drinking or using drugs, lack of appetite, decline in grades, increased social isolation, increased irritability, risky behavior, or self-harm.

Any of the following professionals should be able to provide treatment or help you get treatment for your teenager.

• A mental health professional such as a social worker, psychologist, or psychiatrist
• A health care provider. Your son’s health care provider likely can be helpful with making a referral to a mental health provider. Additionally, they may suggest that your teen be seen for a check-up to rule out any physical cause for her change in his mood, etc.
• A school counselor
• A clergy person
• Your health insurance company has lists of mental health providers in your community who accept your insurance. Often there is a phone number on the back of your insurance card for mental health or behavioral health services. This number can be used for general questions, referrals and emergencies. While medical insurance policies have to include coverage for mental health care, both out-patient and in-patient, many people don’t have health insurance and many mental health providers don’t accept health insurance. This means that you may need to work closely with your HCP and your insurance company to find options in your community.

What if my son says he is thinking about hurting himself?

Anyone who has thoughts or feelings about hurting themselves should be taken seriously and should get professional help immediately. Suicide is the third leading cause of death in teens and young adults, but can usually be prevented with urgent treatment.

It’s important to know that most people who feel suicidal (teenagers included) will usually tell someone before they kill themselves, or make an attempt to kill themselves.

Teenagers may injure themselves by cutting or with drugs or alcohol without intending to kill themselves. However, self-injury is serious and should always be taken as a sign that the teen is feeling overwhelmed and cannot cope with his feelings. If a teen is harming himself or says that he thinks about killing himself, he needs immediate intervention which should include an evaluation by a mental health professional.

If you are unable to obtain urgent care from a mental health provider, take him to the nearest emergency room or call 911.