Major Depression in Teens

Major depression is a serious type of mood disorder. It’s also known as clinical depression or unipolar depression. There are different types of depression, including:

• Major depression (clinical depression)
• Bipolar disorder (manic depression)
• Persistent depressive disorder (dysthymia)

Major depression goes beyond the day’s normal ups and downs. It affects a person’s body, mood, and thoughts. It can affect and disrupt eating, sleeping, or thinking patterns.

Depression is not the same as being unhappy or in a blue mood. It's also not a sign of personal weakness. It can’t be willed or wished away. Teens with depression can’t merely pull themselves together and get better. Treatment is often needed.

Depression has no single cause. Many factors, such as genetics and the environment, play a role.

A teen may be more likely to have major depression if they have experienced:

• Family history of depression, especially if a parent had depression when young
• Lots of stress
• Abuse or neglect
• Physical or emotional trauma, including peer problems, bullying, and academic trouble
• Other mental health problems
• Loss of a parent, caregiver, or other loved one
• Cigarette smoking
• Loss of a relationship, such as moving away or losing a partner
• Other chronic illnesses, such as diabetes
• Other developmental, learning, or conduct disorders
• Gender issues, especially if the person is bullied
• A traumatic brain injury

Each teen with major depression may have different symptoms. A teen often needs to have several of these symptoms during the same 2-week period to be diagnosed with major depression.

• Lasting feelings of sadness
• Feelings of despair, helplessness, or guilt
• Low self-esteem
• Feelings of not being good enough
• Feelings of wanting to die or wishing to already be dead.
• Loss of interest in usual activities or activities once enjoyed
• Trouble with relationships
• Sleep problems, such as insomnia
• Changes in appetite or weight
• A drop in energy
• Problems concentrating or making decisions
• Suicidal thoughts. Always take self-harm comments seriously. Get help right away.
• Suicide attempts. A suicide attempt is a self-harm behavior that is meant to cause death, but results in the person surviving. This is an emergency situation and needs immediate help.
• Frequent physical complaints, such as headache, stomachache, or severe tiredness (fatigue)
• Running away or threats of running away from home
• Sensitivity to failure or rejection
• Irritability, hostility, aggression

Symptoms of major depression may look like other mental health problems. Make sure your teen sees their healthcare provider for a diagnosis.

A teen with major depression may have other mental health problems, such as substance abuse or an anxiety disorder. So early diagnosis and treatment is important to your teen getting better.

A mental health professional often diagnoses major depression after a mental health evaluation. They may also evaluate the family and talk with teachers and care providers.

Treatment will depend on your teen’s symptoms, age, and general health. It will also depend on how bad the condition is.

Major depression can often be treated. Treatment may include one or more of the following:

• Antidepressant medicines. Antidepressant treatment includes ongoing monitoring of the medicine effectiveness and side effects. These medicines can be very helpful, especially when used with psychotherapy.
• Talk therapy (psychotherapy). This treatment helps teens with depression change their distorted views of themselves and the environment around them. It also finds stressors in the teen’s environment and teaches them how to stay away from and manage them. A teen will also learn how to work through hard relationships.
• Family therapy. The support and encouragement of family members can give the teen hope and a sense of self-worth. Therapy can also help the family.
• School assistance. School counselors and school psychologists can serve as resources and advocates for the teen.

Without treatment, major depression can last for weeks, months, or even years. It can cause relationship and social problems. Depression is also linked to a higher risk for suicide. This risk rises when the depressed teen has other mental health problems. These include conduct disorder and substance abuse. This is especially true for teen boys.

Experts don’t know how to prevent major depression in a teen. But knowing the risk factors, spotting it early, and getting expert help for your teen can help ease symptoms and improve your teen’s quality of life.

As a parent, you play a key role in your teen’s treatment. Here are things you can do to help:

• Talk to your teen, especially about what's going on in school and on social media. Bullying is a major contributor to mental health problems among teens.
• Give medicines as prescribed. Don't increase or decrease the dose without talking to your child's healthcare provider. Don't share your child's medicines or give them someone else's, even if it is the same medicine and dose.
• Focus on your teen's strengths and talk to them with love and support. Let your teen know you are ready to listen, especially if they are so sad they are thinking of self-harm.
• To prevent self-harm, lock up all guns, knives, prescription and over-the-counter medicines, and alcohol.
• Keep all appointments with your teen’s healthcare provider.
• Work to find a balance between your teen's safety and mental health needs and their concern for privacy. Talk about who needs to know about the depression and why. Emphasize the fact that depression is a serious illness, not a lifestyle choice. Explain that many concerned people are ready to help them manage the condition.
• Talk with your teen’s healthcare provider about other providers who will be involved in your teen’s care. Your teen may get care from a team that may include counselors, therapists, social workers, psychologists, school staff, and psychiatrists. Your teen’s care team will depend on your teen's needs and how severe the depression is.
• Reach out for support from local community services. Being in touch with other parents who have a teen with depression may be helpful.
• Take all symptoms of depression and suicide very seriously. Get treatment right away. Suicide is a health emergency. Talk with your teen’s healthcare provider for more information on suicide including whom to call and what to do (for example never leaving the teen alone). Have a written emergency plan. Remove guns and other weapons, alcohol, medicines, and harmful household chemicals. If you can’t remove these items, store them safely in a lockbox.

For several reasons, many parents never seek the right treatment for their teen with depression. This is true even though many people with major depression who get treatment get better. They often improve within weeks. Continued treatment may help keep symptoms from coming back.

Call your healthcare provider right away if your teen:

• Expresses thoughts of self-harm
• Feels extreme depression, fear, anxiety, or anger toward themselves or others
• Feels out of control
• Hears voices that others don’t hear
• Sees things that others don’t see
• Can’t sleep or eat for 3 days in a row
• Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to get help

Give your teen a list of emergency numbers and have them put the numbers in their phone. These numbers can include your teen's healthcare provider, trusted family members or adults, and the 988 Suicide & Crisis Lifeline at 800-273-8255.

Call or text 988 if your teen has thoughts of harming themselves or others and has a plan to do so. When you call or text 988, you will be connected to a trained crisis counselor at the 988 Suicide & Crisis Lifeline. An online chat choice is also available at www.suicidepreventionlifeline.org. You can call Lifeline too at 800-273-TALK (800-273-8255). Lifeline is free and available 24/7.

• Major depression is a serious type of mood disorder. It's not the same as being unhappy or in a blue mood. It's not a lifestyle choice.
• Depression can be treated with a combination of medicine and psychotherapy.
• Let you child know it will take a few weeks to start feeling better, but things will change.
• Depression is caused by a combination of factors, such as genetics and the environment.
• A teen may have a higher risk for depression if they have a family history of it. Trauma, stress, and abuse can also make a teen prone to it.
• Symptoms include feelings of sadness, despair, and guilt. A teen may lose interest in activities and have problems sleeping and eating.
• A mental health professional can diagnose major depression after a mental health evaluation.
• Talk therapy and certain medicines can help treat depression.
• Major depression is linked to a higher risk for suicide.
• A team including health professionals, family members, and school personnel may be needed to help your teen get better.
• An emergency plan should be discussed, put in writing, and shared with significant others. Ask you teen to enter emergency numbers in their phone for easy access.
• Be clear with your teen that you can be approached on any subject, especially if they are so sad they are thinking of harming themselves.
• Get immediate help for a teen expressing thoughts of self-harm.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.