What is normal teenage behaviour and what is depression?
How do you separate the results of brutal hormonal changes and social pressure from depressive symptoms?
This article helps you figure out if your child is “just being a teenager” or suffering from a treatable, although serious, mental disorder.
The last sections offer you advice on where to seek help
Treat depression at home
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Depression (regardless of age) brings an atmosphere of hopelessness, which is sometimes contagious. For this reason, I would like to begin by pointing out two things:
- Depression is a nasty BUT treatable condition. If you’re worried about your child or someone else you love, know that there are many roads which will lead a teen out of depression.
Hopelessness is not a mirror of reality. It’s depression talking.
- Multiple factors play a role in depression. And depression can happen to any teenager, even the ones with ‘perfect’ home conditions.
It’s easy to blame yourself for someone else’s depression, especially if you’re a parent. Try not to. Don’t play the blame game. It’s unlikely that one person (except in the case of neglect or abuse) is responsible for causing the depression.
So, how do you know what you’re dealing with? How do you separate teenage behaviour from depression?
Teenage hormones and social pressure can trigger occasional bouts of anxiety or anger, but not persistent unhappiness, constant irritability or a lack of interest in almost all enjoyable activities.
If you’re worried that your teenager might be experiencing depression, ask yourself these questions:
- For how long have your teenager seemed down or depressed?
Depression lasts for a minimum of two weeks (but usually much longer). A depressed person feels blue most of the day nearly every day and loses interest or pleasure in all (or almost all) activities most of the day.
- How severe are the symptoms?
- Have you noticed any drastic changes in your teenager’s behaviour? How different is your child from their usual self?
So, to separate ‘normal’ teenage moodiness from depression, consider:
- Duration: Depression comes with negative feelings that don’t seem to go away even when circumstances change.
- Severity: Depression can make it seem almost as if a person has switched personalities.
- Disability: Depression causes problems with keeping relationships, working and managing daily chores.
Now, let’s take a closer look at the specific signs of depression in teens.
The signs of depression in teens
So how do you know when to worry?
There are warning signs to look out for. But remember, if your child is showing some of these signs, it doesn’t necessarily mean they are depressed. It means you should try to receive more information about how they’re doing and consider contacting a health care professional.
14 signs of teenage depression:
- Does your teenager have a negative self-image? Or are they extremely sensitive to criticism?
Depression can make young (and old) people feel unwanted or that they’re a burden to their families. A depressed teenager can:
- put themselves down,
- feel worthless or unloved by everyone,
- be very self-critical,
- act as if they think everything they do is wrong.
That’s why they can be extremely sensitive to perceived rejections or failures.
- Is your teenager uninterested in things that previously seemed important?
A depressed teenager can suddenly decide to stop doing the things they love, such as playing football, singing or playing their favourite musical instrument. It’s common for depressed adolescents to lose interest in school assignments (even in their favourite subjects).
- Is your teenager aggressive or constantly irritated?
Depressed teens can be much more irritable and hostile than usual. They may be overly grumpy, frustrated or prone to angry outbursts. Some depressed teens are “looking for trouble” and frequently start conflicts with others. They put themselves in uncomfortable situations without regard for the consequences of their actions.
- Is your teenager unusually sad, tearful or frequently crying?
Feelings of sadness or hopelessness are common signs of depression in teens, especially when the tears don’t seem connected to a specific event or anything that happened in their lives.
- Is your teenager avoiding friends, family or loved ones?
Depressed teens are rarely isolated (which is more common among depressed adults), but they do tend to withdraw from important connections. They may socialize less or start hanging out with a different crowd than before.
- Does your teenager have difficulties concentrating or have sudden problems with school assignments?
A common sign of depression in teenagers is having a decreased attention span. Depressed teenagers can be much more forgetful than usual. They may find it difficult to remember directions or instructions and completing school work. These problems may lead to poor attendance and a drop in grades.
- Is your teenager sleeping much more or much less than usual?
Depression affects sleeping habits in 90% of people. So, it’s likely that a depressed teenager will either sleep too much or too little. Remember, teenagers need more sleep than adults (around 9-10 hours) and they tend to sleep late on weekends. That is no cause for concern. But if a teenager sleeps whenever possible and still seems fatigued when awake, depression can be the cause. Similarly, when a teenager finds it very difficult to fall asleep at night, sleeps restlessly, or wakes up in the early morning hours unable to fall asleep again, it can be a sign of depression.
- Do you notice any changes in your teenager’s appetite?
Extreme changes in eating habits, whether it’s eating more or less than usual, is a sign of depression. Some teenagers eat less when depressed. Their appetite changes, they don’t gain weight and they grow more slowly than usual. Others use food as a form of self-medication. When they feel sad or angry, they overeat. The same is true for depressed adults.
- What about your teenager’s energy level?
Lack of energy is another sign of depression in teens. No teenager I’ve ever met has expressed any kind of enthusiasm for household chores, but when a teenager is sitting around the house all day, unable to perform even the most basic chores, there is cause for concern. If you notice an extreme decrease in your child’s energy level – that they refuse to help and put off all tasks until later – depression may be the reason.
- Is your teenager more fearful than usual?
Extreme fearfulness is another sign of depression in teens. They may be avoiding activities they used to enjoy because of fear, or they may be much more hesitant and anxious than before.
- Is your teenager complaining about aches and pains?
Depression sometimes masks itself in physical discomfort. Your teenager may complain about stomach aches or headaches which don’t seem to have a physical cause. Some teenagers seek comfort and attention because of this discomfort.
- Has your teenager tried to run away from home? Or talked about doing it?
If so, it may be a sign of teenage depression. It tells you that your teenager needs more help and attention.
- Does your teenager suddenly seem hyperactive?
Yes, most depressed teens lack energy and avoid chores, but some mask their depression in an endless stream of activities. They never seem to rest or relax. They’re trying to avoid their depression by filling their schedule to the max. For some teens, this overactive state is expressed through absenteeism, risk taking, reckless driving, unsafe sex or binge drinking.
- Does your teenager have frequent thoughts about death? Or thoughts about suicide?
If you notice that your child is preoccupied with death or suicide, seek professional help immediately. The sooner the better. Depressed teens may talk or make jokes about death or dying. They may write about morbid themes or be preoccupied by murders or terrorism. Another common thought inside a depressed teenager’s brain is the misconception that “everyone would be better off without me”. If you notice these tendencies, be sure not to dismiss them. Contact a healthcare professional without hesitation. (Read more about teenage suicidality in the next section.)
All adolescents can exhibit these signs from time to time, regardless of whether they are depressed. But if several of these signs are present at the same time, for at least two weeks, make sure to seek professional help.
Signs of suicidality in teens
These are suicide warning signs, common in depressed teenagers:
- Making jokes about dying or committing suicide
- Talking about committing suicide.
- Writing poems or stories about death, dying or suicide.
- Expressing thoughts like “Everyone would be better off without me”, “See how you feel when I’m dead”, “I wish I could just disappear forever”, “Life is pointless”, or “There’s no way out”.
- Speaking positively about dying or death. For example “If I died, people would love me”, or “If I disappear, maybe people will realize how good I am”.
- Saying goodbye to loved ones as if for the last time.
- Giving away valuable or prized possessions.
- Being reckless or involved in accidents.
- Searching for topics related to suicide on the Internet.
- Looking for methods to commit suicide, such as seeking out guns, poison or pills.
What to do when a teenager is depressed
Don’t wait to seek help.
Depression is more easily treated at an early stage. So, the earlier you make that important call, the better. But first, ask for your teenager’s input. Don’t contact a healthcare professional before first communicating with your teen.
Talk to your teen about what worries you. Tell them about the specific symptoms you’ve noticed and that you think they may be going through depression. Ask your teenager to share what they’re going through, but don’t pressure them with a lot of questions. Instead, make sure to tell them that you’re willing to listen when they’re ready to talk. Most people with depression struggle with expressing themselves and appreciate getting extra time to explain. So, don’t be afraid to offer extra long silences.
Teenagers have a greater tendency than adults to read facial expressions as critical or angry. So, make sure what you’re saying is not perceived as criticism or pointing out flaws. Use a loving and non-judgmental tone.
If your teenager refuses to talk to you, encourage them to talk to someone at school, such as a favourite teacher or a school nurse. Or, suggest they open up to a spiritual teacher or a relative. The important thing is to get them to talk to someone.
A reminder: don’t play the blame game! It’s difficult to talk to teenagers. And it’s even more difficult to talk to depressed teenagers. The conversation may not play out the way you had hoped. It’s not your fault. It’s not anybody’s fault. It’s depression.
If you want more advice on how to talk to a depressed person or what to do when your help is rejected, read: How to help someone with depression – Psychologists’ best advice for helping depressed people
Depression treatment for teens
Antidepressant lifestyle changes.
Teenagers are famous for their unhealthy habits (staying up late, eating junk food, never leaving their tablets…). But a few lifestyle changes can have a significant impact on depressive symptoms.
Regular exercise is as effective as antidepressant medication for treating depression. But it doesn’t have to be tedious. Find out what type of physical activity your teenager may be interested in (or was interested in before becoming depressed) and suggest it. It can be dancing, skateboarding, riding, playing with a dog… It doesn’t have to be scheduled appointments at the gym.
There is research which suggests that spending time with horses and other animals is particularly beneficial for depressed teenagers.
Other antidepressant routines include:
If you don’t know how to suggest healthy habits to your teenager – don’t worry. There’s an app for that.
The Flow Depression App includes over 50 therapy sessions focusing on how to eat, move, sleep and meditate to reduce depressive symptoms. The chatbot therapist, Flow, guides depressed people through the treatment programme in a light and non-judgmental tone. The app is completely free, so you can download it yourself to see if the content may benefit your teenager.
Psychotherapy (talk therapy). Talk therapy with a licensed psychologist is usually a good treatment option for mildly to moderately depressed teenagers. Find a mental health professional willing to have an open discussion with you and your teen about different treatment options. And make sure they have a strong background treating teenagers.
Psychotherapy comes in many forms. The following methods are as effective as antidepressant medication:
- Cognitive Behavioural Therapy (CBT)
- Short-term Psychodynamic Psychotherapy (STPP)
- Interpersonal Psychotherapy (IPT)
Antidepressant medication. Antidepressants can be helpful, especially in severe cases of depression or in case your teenager is acting out in dangerous ways. However, antidepressants are designed for and tested on adults. Researchers don’t yet know exactly how these medications affect brain development. So, make sure to carefully discuss the risks and benefits of antidepressant medication with your doctor.
Are antidepressants safe for teenagers?
A medical doctor must carefully consider the severity of depressive symptoms, possible side effects, efficacy and withdrawal symptoms before recommending antidepressant medication to teenagers.
Teens don’t respond to antidepressants in the same way adults do. In fact, it seems as if fluoxetine is one of few choices which is both safe and effective for teenagers.
Mental health researcher Marco Somi and colleagues studied the safety of 80 different types of psychotropic drugs for children and adolescents. Their meta-review included 337,686 children and adolescents and showed that fluoxetine and escitalopram were the safest antidepressants to give to teenagers. However, no data on long-term use was included.
“…fluoxetine probably has the best harm-benefit ratio among all antidepressants for youth, and might be proposed as the first-line treatment for depressive disorders in children and adolescents.”
Side effects and efficacy. The study points out that most research on antidepressant medication for teenagers and children focus primarily or solely on efficacy, NOT side effects. A lot of research studies don’t include adverse events.
In addition, adverse events from antidepressants are most often reported spontaneously. So, the frequency of harmful effects are likely underrepresented in current research.
According to Somi’s study, these were the main adverse events for antidepressants:
- Nausea and vomiting
- Discontinuation due to adverse event
- Extrapyramidal side effects (drug-induced movement disorders)
- Weight gain
The researchers concluded that venlafaxine was the least safe antidepressant medication for teenagers and children.
“…potentially least preferred agents based on safety are likely to be venlafaxine among antidepressants”
Solmi et. al, 2020
Another systematic review and network meta-analysis from 2020 (including 71 trials and 9510 children and adolescents) found that the antidepressant fluoxetine and fluoxetine in combination with Cognitive Behaviour Therapy (CBT) were significantly more effective than placebo pills for moderate to severe depression.
Similar to Somi’s study, the analysis showed that fluoxetine was best tolerated among children and adolescents.
The researchers are careful to point out that the effects may vary between individuals and that you should always consider the individual child’s unique profile before making a decision regarding antidepressants.
“However, the effects of these interventions might vary between individuals, so patients, carers, and clinicians should carefully balance the risk-benefit profile of efficacy, acceptability, and suicide risk of all active interventions in young patients with depression on a case-by-case basis.”
Zhou et. al, 2020
Teenage depression can look different from adult depression. It’s more common for teenagers to “act out” their depression and to express anger or irritation. Be sure to seek professional help if you notice several of these signs of teenage depression:
- Negative self-image
- Loss of interest or pleasure in almost all activities
- Aggression or irritability
- Sadness, being frequently tearful or crying
- Avoiding friends and family
- Concentration difficulties
- Changed sleeping habits (sleeping too much or too little)
- Appetite changes
- Lack of energy
- Extreme fearfulness
- Aches and pains
- Running away from home
- Frequent thoughts about death, dying or suicide