Teen Depression: Causes, Symptoms and Treatments

The teenage years are a tumultuous developmental period when adolescents are making that big push toward independence. Hormones are raging and they’re at that awkward place between childhood and adulthood. The physical and psychological shifts result in mood swings, and changes in behavior, and often involve conflicts with others as they struggle to find their way.

For most teens, these challenges resolve themselves over time with little more than a few tears and skirmishes. For others, however, the experience is quite intense and disruptive, sometimes involving periods of depression. If a teenager in your life is experiencing depression, it’s wise to educate yourself on the topic as you try to navigate through the various treatment options.

The Different Types of Depression

Depression is a common mood disorder that affects how you think, feel and engage with the world around you. The symptoms can manifest in different ways and within a broad range of intensity for different people. The way the depressed mood presents itself, its duration, and other clinical features can vary from person to person. Some types of depression include:^[1]

• Major Depression
• Persistent Depressive Disorder (previously known as Dysthymia)
• Bipolar Disorder (often referred to as “manic depression”)
• Seasonal Affective Disorder
• Postpartum Depression
• Premenstrual Dysphoric Disorder (PMDD)

Who Is at Risk for Teen Depression?

While teenage depression is nothing new, mental health researchers are seeing a disturbing trend. Teen depression is increasing at an alarming rate. A 2019 study found that the number of adolescents with mental health disorders has more than doubled in recent years. Rates of major depression increased by a staggering 52%. It is estimated that about 13% of teens now have at least one bout of major depression.^[2]

The study revealed some stark differences in terms of who might be at greatest risk:

• Teen girls (20%) are much more likely than boys (6.8%) to experience depression.^[3]
• Higher rates of depression are found with multiracial adolescents (16.9%).
• Having a parent with depression increases the rate of depression in teens by almost 50%.
• A history of trauma, abuse, or chronic illness is associated with higher rates of depression.

One of the most concerning findings of the study was that nearly 70% of teens with depression had what would be considered a severe impairment and 7.4% of teens in 9^th to 12^th grade reported at least one suicide attempt in the previous 12 months.^[2]

What Causes Teen Depression?

Several factors have been identified as playing a role in the development of depression in teens.

Genetics

Kids who have a parent with depression are more likely to develop depression.^[4]

Brain Chemistry

This is sometimes referred to as a “chemical imbalance” where there are neurotransmitters (brain chemicals) that aren’t working properly. As a result, the brain’s ability to regulate moods can become impaired, leading to depression.

Adverse Childhood Experiences (ACEs)

ACEs can have a profound effect later on and may alter the brain in a manner that makes a person more susceptible to difficulties. Early childhood trauma, profound loss, neglect, and other factors early in life have been shown to play a key role in the development of depression in adolescence and beyond.^[5]

Learned Patterns of Helplessness and Negative Thinking

Feelings of helplessness can leave teens feeling defeated and unable to find solutions to their problems. Instead, they take on patterns of pessimism and thinking negatively about themselves and the world around them which has been correlated with depressive symptoms.^[6] These patterns of thinking and behavior are learned from their surroundings.

What Happens if Teen Depression Is Not Treated?

Teenage depression is quite likely to go untreated. Depression doesn’t usually go away on its own. Left untreated, depression can cause problems that affect your teen’s ability to function and lead to some serious outcomes such as:

• Substance abuse
• Academic problems
• Increased conflicts with friends and family
• Involvement in illegal activities
• Thoughts and attempts of suicide^[7]

The pressing question is, why does teen depression go untreated so often? One answer is that it often does not present in the way parents expect. The signs can vary and may go unnoticed.

What Are the Symptoms of Teen Depression?

When you think of depression, you might think of someone crying all the time, acting morose, and refusing to get out of bed. If you were describing an adult, you wouldn’t be wrong. However, depression among teens presents in a very different way.

While adults tend to talk about emotional pain, depressed teens tend to have somatic symptoms.^[8] Complaints of headaches, stomachaches, and similar symptoms that have no medical basis are common. You might also see grades begin to fall. However, depressed teens can also maintain high grades, but feeling the pressure to do so can further complicate the condition.

Rather than overt sadness, depressed teens often display more irritability, agitation, and sometimes even defiance. While some mood shifts are normal, significant irritability should be considered a warning sign to be monitored. Abrupt changes in peer groups or increased social isolation are common.

Teens don’t always become “loners.” Sometimes they just change their friends, which can make seeing a potential problem difficult. They might also retreat into the virtual world and begin spending inordinate amounts of time online. With today’s tech-savvy kids, it’s hard to know what’s normal and what’s cause for concern.

In addition, there can be a change in their sleep patterns, appetite, and weight.^[9] Between the expected angst of adolescence and not quite fitting typical conceptions of depression, it’s easy to miss the subtle cues that something is amiss. With rates of teen depression increasing, it’s more important than ever to understand what’s happening and how to help them.

Why Is Teen Depression on the Rise?

There is currently no single theory that can fully explain the rising rates of teen depression. As researchers explore the rise of teen depression, a few key factors seem to be emerging:

Increased Awareness and Diagnosis of Teen Depression

Until the 1990s, clinicians were reluctant to diagnose teens with mood disorders. Not only was it hard to differentiate between normal teenage turmoil and depression, but their growing brains need to be taken into consideration. A diagnosis of depression was generally considered inappropriate.

Technological Influences

Each successive generation of teens has become more engaged with technology. Tech has become the predominant way teens socialize and communicate. It is thought that the increase in depression, distress, and suicidal behaviors may be connected to the influence of social media. Teens are quite sensitive to the “likes” and “comments” they receive, and often base their self-worth on this feedback. Cyberbullying has also become particularly problematic.^[10]

Poor Sleep Habits

Sleep disturbances have long been associated with depression and people are now more sleep-deprived than ever. Teens tend to get about half of the recommended seven to nine hours of sleep per night. Their sleep can be further disrupted by excessive use of electronics in the evening. Insufficient sleep has consistently been shown to increase hopelessness, depressive symptoms, and suicidal ideation.^[11]

Feeling a Lack of Security

Of course, every generation has its trials, but teens are increasingly confronted with the realities of the times. They are living in a world where violence has become commonplace and played out instantly on social media and 24-hour news outlets. This can result in them feeling isolated from their community which can contribute to depression and other issues.^[12]

Dealing With Teen Depression

The good news is that there is a lot that can be done, whether the teen is depressed or whether they are simply showing some signs that are of concern that warrant taking steps to avoid depression.^[13]

Get Professional Help

If you think your teen may be depressed, the first step is to get help. Depression isn’t likely to go away on its own and you should get an accurate diagnosis. A mental health clinician can do an assessment and provide you with care recommendations.

Don’t be surprised if your teen is resistant to seeking help. They may even become quite upset about it. This is normal since the idea of seeking help can be hard, and for a teen, it can be mortifying. Even if they resist, take them anyway. A good place to start might be with their family doctor or another health provider with whom they have a good relationship. 

Medication

In addition to counseling, a treatment plan may include medication. Not every teen needs antidepressant medications, though antidepressants certainly have their time and place.^[14]

Open the Lines of Communication

Talk to your teen about depression. They may find all the things they’re feeling to be confusing or overwhelming. Talk to them about treatment options and explain that there is always hope.

When you’re talking with your teen, listen to what they’re saying and to what they are not saying. Listen to understand, because what you think they’re feeling might be very different from what they really feel.

Encourage Them to Seek Additional Support

Let your teen know you support them. It’s also important they know they also can talk to someone other than you if they need to. There may be a close relative or family friend to who they feel particularly close. It’s ok if it’s not you. Sometimes, kids need to confide in someone other than a parent.

Pay Close Attention

Another thing you can do is monitor their sleep patterns and other behaviors. Make sure your teen is getting a good, restful night’s sleep. Additionally, you should manage screen time to avoid difficulty with sleep. It is also important to be aware of what your teen is doing online, so keep an eye on social media use and talk to your teen about it often.

In Summary

Teen depression is on the rise in recent years. The most important thing you can do is to stay engaged with your teen. Changes that indicate depression can be subtle. When you know your child’s habits and what’s “normal” for them, you’re more likely to pick up on those changes that can signal a problem. Whether it’s depression or just that “teenage turbulence,” they’re counting on you to help them get through these stressful years, even if they don’t tell you so. If you feel your teenager is depressed, don’t hesitate to get consult with a mental health professional.

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References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition. Published. https://doi.org/10.1176/appi.books.9780890425596
2. Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. Journal of abnormal psychology, 128(3), 185–199. https://doi.org/10.1037/abn0000410
3. Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102
4. Institute of Medicine, National Research Council, Education, D. O. B. A. S. S. A., Children, B. Y. O., & Committee on Depression, Parenting Practices, and the Healthy Development of Children. (2009). Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention (1st ed.). National Academies Press.
5. Lee, H. Y., Kim, I., Nam, S., & Jeong, J. (2020). Adverse childhood experiences and the associations with depression and anxiety in adolescents. Children and Youth Services Review, 111, 104850. https://doi.org/10.1016/j.childyouth.2020.104850
6. Rood, L., Roelofs, J., Bögels, S. M., & Alloy, L. B. (2010). Dimensions of Negative Thinking and the Relations with Symptoms of Depression and Anxiety in Children and Adolescents. Cognitive therapy and research, 34(4), 333–342. https://doi.org/10.1007/s10608-009-9261-y
7. Forman-Hoffman, V., McClure, E., McKeeman, J., Wood, C. T., Middleton, J. C., Skinner, A. C., Perrin, E. M., & Viswanathan, M. (2016). Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Annals of internal medicine, 164(5), 342–349. https://doi.org/10.7326/M15-2259
8. Bohman, H., Jonsson, U., Von Knorring, A. L., Von Knorring, L., Päären, A., & Olsson, G. (2010). Somatic symptoms as a marker for severity in adolescent depression. Acta paediatrica (Oslo, Norway : 1992), 99(11), 1724–1730. https://doi.org/10.1111/j.1651-2227.2010.01906.x
9. The National Institute of Mental Health. (n.d.). NIMH » Teen Depression: More Than Just Moodiness. NIMH. Retrieved October 10, 2021, from https://www.nimh.nih.gov/health/publications/teen-depression
10. Anderson, M., & Jiang, J. (2018, May 31). Teens, Social Media and Technology 2018. Pew Research Center: Internet, Science & Tech. https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/
11. Mystakidou, K., Parpa, E., Tsilika, E., Galanos, A., & Vlahos, L. (2009). Does quality of sleep mediate the effect of depression on hopelessness?. International journal of psychology : Journal international de psychologie, 44(4), 282–289. https://doi.org/10.1080/00207590802194226
12. Fairbrook, S. W. (2013). The Physical and Mental Health Effects of Community Violence Exposure in Pre-Adolescent and Adolescent Youth. Journal of Student Nursing Research, 6(1), Article 6. Available at: https://repository.upenn.edu/josnr/vol6/iss1/6
13. Mendelson, T., & Tandon, S. D. (2016). Prevention of Depression in Childhood and Adolescence. Child and adolescent psychiatric clinics of North America, 25(2), 201–218. https://doi.org/10.1016/j.chc.2015.11.005
14.  Cheung, A. H., Emslie, G. J., & Mayes, T. L. (2006). The use of antidepressants to treat depression in children and adolescents. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 174(2), 193–200. https://doi.org/10.1503/cmaj.050855