Depression is common in adolescence and is often underrecognized. As a parent it can be hard for us to think about our little ones having depression symptoms, but it is important to check in with teens to see if they are feeling depressed. Signs of depression can sometimes be different in teens compared to adults. In my family medicine practice, I always make sure to screen for teen depression because of safety concerns as it is an important contributor to adolescent suicidal thoughts, self-harm, and suicide attempts. I want to make sure that the teens I am treating are as safe as possible, so I screen regularly if they are feeling depressed.
Teen depression is surprisingly common and it affects about 1 in every 10 teens aged 12-17 years old. The illness is important to treat because your teen’s brain is still growing and developing. A depressive episode can result in school avoidance, academic failure, social withdrawal, and conflicts with their parents, peers, or teachers. Depression symptoms in teens are similar to the symptoms in adulthood, however some signs of depression may be slightly different.
If your teen is feeling like their mood is down, low, or sad nearly all day, nearly every day – they could be suffering from depression. Sometimes teens do not articulate what their mood is, so another symptom to look out for is if they don’t seem like they are getting the same enjoyment out of activities that they once loved. Other symptoms of teen depression include:
Low or irritable moods: Signs of depression in teens may include overly irritable moods. Although typical depression symptoms include low moods, it is actually not uncommon for teens to seem more irritable when they are depressed. They might be feeling more annoyed, grouchy, or bothered easily.
Diminished interest or pleasure in activities they once loved: Some teens experience hobbies, activities, and interests as less fun and interesting, or more boring, stupid, and lame than they once found them. They may lose interest in close friends, and withdraw from social activities.
Changes in appetite or weight: In teen depression, they may lose their appetite, or on the other end may have a great increase in appetite. This can result in weight loss, or failure to gain weight normally as they grow, or it can also result in weight gain.
Lack of sleep, sleeping too much, or a change in sleep pattern: Adolescents might experience depression symptoms that interfere with their sleep. They may have difficulty falling asleep, staying asleep, waking up in the middle of the night, or waking up much too early and not being able to fall back asleep. They might also have day-night reversal where they are staying up late at night and sleeping throughout the day.
Feeling worthless, hopeless, or guilty: They may be stricken with strong feelings of inadequacy, feeling like they are a failure or they let their parents down, or feeling like they are inferior to other kids their age. They might not verbalize these thoughts to you, so some things to look out for are:
- Is your child criticizing themselves a lot?
- Does your child feel excessively guilty about events and outcomes that weren’t their fault?
- Do they feel preoccupied with what other kids think about them, or with the success of other children compared to their own?
- Does your child have difficulty complimenting themselves or taking a compliment and noticing their positive attributes?
- Do they think they deserve to be punished or shunned by other people or their peers?
- They might be reluctant to engage in activities or join peers because “what’s the point” or believe they will just fail.
Difficulty focusing in school or making decisions: While this may be a symptom of Attention Deficit Hyperactive Disorder (ADHD), people with depression often have difficulty making decisions or focusing. If your child has a new onset of difficulty with decision-making, their grades have dropped in school, they cannot follow through with tasks or homework, or they forget things – this might be a symptom of depression.
When concentration difficulties are caused by depression, the difficulties usually start with the onset, or shortly after the onset, of the change in mood (compared to ADHD – concentration and focus difficulties usually have gone on longer and are not associated with low moods).
Recurrent thoughts of death or not wanting to be around anymore, or thoughts of suicide: One rather common symptom of depression in all age groups is thoughts of death, not wanting to be around anymore, or wanting to end their life. This is a very important symptom because this is a safety concern.
If your child is having thoughts of not wanting to be around anymore, it is important to seek medical attention promptly. Safety is the number one priority when treating depression.
Having low energy or feeling fatigued and tired very often: Children and adolescents with depression may lack of energy, they may look very tired, exhausted, or unmotivated. They may start needing to sleep in the middle of the day, or not have the motivation or energy to do things they once did.
So as a parent, what is important know about depression in childhood and adolescence and how can you help your child? It’s important to know that if your child or teen is truly depressed, it is crucial not to scold them for it or tell them to “snap out of it.” Conflicts between parents and teens can result when parents believe their child is being lazy, oppositional, or avoiding responsibilities. If your child is truly depressed, it is important to take them to their doctor or a psychologist to start the process of getting them help.
- Saluja G, Iachan R, Scheidt PC, et al. Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med 2004; 158:760.
- Perou R, Bitsko RH, Blumberg SJ, et al. Mental health surveillance among children–United States, 2005-2011. MMWR Suppl 2013; 62:1.
- Zuckerbrot RA, Cheung AH, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics 2007; 120:e1299.
- Asarnow JR, Jaycox LH, Duan N, et al. Depression and role impairment among adolescents in primary care clinics. J Adolesc Health 2005; 37:477.
- Wesselhoeft R, Sørensen MJ, Heiervang ER, Bilenberg N. Subthreshold depression in children and adolescents – a systematic review. J Affect Disord 2013; 151:7.
- Avenevoli S, Swendsen J, He JP, et al. Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment. J Am Acad Child Adolesc Psychiatry 2015; 54:37.
- Seedat S, Scott KM, Angermeyer MC, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 2009; 66:785.
- Maughan B, Collishaw S, Stringaris A. Depression in childhood and adolescence. J Can Acad Child Adolesc Psychiatry 2013; 22:35.
- Douglas J, Scott J. A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children. Bipolar Disord 2014; 16:5.
- Fleming JE, Offord DR. Epidemiology of childhood depressive disorders: a critical review. J Am Acad Child Adolesc Psychiatry 1990; 29:571.
- Kutcher S, Marton P. Affective disorders in first-degree relatives of adolescent onset bipolars, unipolars, and normal controls. J Am Acad Child Adolesc Psychiatry 1991; 30:75.
- Warner V, Weissman MM, Mufson L, Wickramaratne PJ. Grandparents, parents, and grandchildren at high risk for depression: a three-generation study. J Am Acad Child Adolesc Psychiatry 1999; 38:289.
- Lewinsohn PM, Roberts RE, Seeley JR, et al. Adolescent psychopathology: II. Psychosocial risk factors for depression. J Abnorm Psychol 1994; 103:302.
- Rutter, M. Children of sick parents: An environment and psychiatric study, Oxford University Press, London 1966.
- Reinherz HZ, Giaconia RM, Pakiz B, et al. Psychosocial risks for major depression in late adolescence: a longitudinal community study. J Am Acad Child Adolesc Psychiatry 1993; 32:1155.
- Adrian C, Hammen C. Stress exposure and stress generation in children of depressed mothers. J Consult Clin Psychol 1993; 61:354.
- Garber, J, Hilsman, R. Cognition, stress and depression in children and adolescents. Child Adolesc Psychiatr Clin N Am 1992; 1:129.
- Hilsman R, Garber J. A test of the cognitive diathesis-stress model of depression in children: academic stressors, attributional style, perceived competence, and control. J Pers Soc Psychol 1995; 69:370.
- Burke P, Elliott M. Depression in pediatric chronic illness. A diathesis-stress model. Psychosomatics 1999; 40:5.
- Kendler KS. Genetic epidemiology in psychiatry. Taking both genes and environment seriously. Arch Gen Psychiatry 1995; 52:895.
- Williamson DE, Birmaher B, Frank E, et al. Nature of life events and difficulties in depressed adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37:1049.
- Stringaris A, Lewis G, Maughan B. Developmental pathways from childhood conduct problems to early adult depression: findings from the ALSPAC cohort. Br J Psychiatry 2014; 205:17.
- Tsai MC, Tsai KJ, Wang HK, et al. Mood disorders after traumatic brain injury in adolescents and young adults: a nationwide population-based cohort study. J Pediatr 2014; 164:136.
- Chrisman SP, Richardson LP. Prevalence of diagnosed depression in adolescents with history of concussion. J Adolesc Health 2014; 54:582.
- Luby JL, Gaffrey MS, Tillman R, et al. Trajectories of preschool disorders to full DSM depression at school age and early adolescence: continuity of preschool depression. Am J Psychiatry 2014; 171:768.
- Pearson RM, Evans J, Kounali D, et al. Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 2013; 70:1312.
- Bowes L, Joinson C, Wolke D, Lewis G. Peer victimisation during adolescence and its impact on depression in early adulthood: prospective cohort study in the United Kingdom. BMJ 2015; 350:h2469.
- Hamm MP, Newton AS, Chisholm A, et al. Prevalence and Effect of Cyberbullying on Children and Young People: A Scoping Review of Social Media Studies. JAMA Pediatr 2015; 169:770.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Cicchetti D, Toth SL. The development of depression in children and adolescents. Am Psychol 1998; 53:221.
- Stringaris A, Maughan B, Copeland WS, et al. Irritable mood as a symptom of depression in youth: prevalence, developmental, and clinical correlates in the Great Smoky Mountains Study. J Am Acad Child Adolesc Psychiatry 2013; 52:831.
- Stringaris A, Cohen P, Pine DS, Leibenluft E. Adult outcomes of youth irritability: a 20-year prospective community-based study. Am J Psychiatry 2009; 166:1048.