Teens are known for being a moody, rebellious, egocentric and emotional bunch. But while this is normal adolescent behavior, depression is a real disorder that affects one in 20 teens (point prevalence statistic from Essau & Dobson, 1999).
According to Michael Strober, Ph.D, clinical psychologist and senior consultant to the Pediatric Mood Disorders Program at the UCLA Neuropsychiatric Institute and Hospital, depression in teens is “a serious mental health problem” which isn’t necessarily temporary. “Depression can linger for months and a significant number of young people can have a recurrence,” he said.
Here, Dr. Strober along with Alice Rubenstein, Ed.D, a clinical psychologist in private practice who treats teens, dole out the facts about this commonly misunderstood disorder.
1. Depression goes beyond moodiness.
Temperamental teens are common. But moodiness doesn’t mean depression, Dr. Rubenstein said. Neither does sleeping a lot, which is typical for teens; they actually require more sleep than adults and have trouble falling asleep early. (See more on sleep in teens here.)
So how do you know the difference between normal teenage doldrums and depression? Consider if there’s been “a real change in the functioning of [your] child’s behavior,” Strober said. You also might notice changes in appetite and sleep, poor school performance, an inability to concentrate, lack of interest and withdrawal from regular social activities.
“Agitation and irritability in teens may be a sign of depression” as well, according to Rubenstein. However, research hasn’t shown the presence of increased agitation as a distinct symptom, Strober said.
In general, look for consistent patterns. “If depression lasts more than two, certainly three weeks, you want to pay attention,” she said.
2. There’s no quintessential face of depression.
We tend to create categories and stereotypes around certain mental illnesses. That is, many people assume that teens with depression are troublemakers, loners, nerds or artsy types. But depression does not discriminate, Rubenstein noted. It affects all types of teens. (Depression does seem to affect girls twice as much as boys.)
3. Comorbidity is common.
Teens rarely just struggle with depression. “Depressive symptoms are part of a bigger picture,” Rubenstein said. For instance, anxiety commonly co-occurs with depression.
In fact, in her private practice, Rubenstein has noticed more teens coming in with symptoms of anxiety largely because of the combination of academic pressures and attempts to balance school with sports (or other extracurricular activities) and social events. In other cases, depression may be the primary problem, but other disorders, like learning difficulties, still exist.
4. Teen depression is treatable.
Most people think that depression is difficult to treat, Rubenstein said, but treatments like cognitive-behavioral therapy (CBT) can help. According to Strober, research has found that CBT “should be considered as treatment for mild to moderate depression.” “Between four to six weeks, we can bring some relief,” Rubenstein said.
There’s also some evidence that shows certain antidepressants are effective in teen depression. Fluoxetine (Prozac) has shown the most benefit, according to research, Strober said. If the antidepressant is helping, it’s recommended the teen take the medication for a year, he said. Whether medication is necessary “really depends on the seriousness and persistence [of depression].”
When treating depression in teens, Rubenstein helps her clients create a toolbox to cope with life. Her first goal is to “actively do something that’s helpful to them…to give the message that I want to help you where it hurts.” She does this by finding out one change that will relieve the teen’s pain. For instance, if a teen is super stressed at school, dropping one class and picking it back up in the summer may be a reasonable option. In addition to empowering the client, she also lets them know that they can improve, that they don’t have to feel this way.
How Parents Can Help a Depressed Teen
Again, “Teens who are suffering from depression can be helped,” Rubenstein said, so it’s important to get them treatment. If you think your teen has depression, seek a psychologist who specializes in treating adolescents. It’s key to see an expert. As Rubenstein said, “you wouldn’t hire a plumber to put on your new roof.” Even if your teen doesn’t want to go to therapy or you haven’t discussed the option yet, an appointment is critical. A psychologist can educate you on depression (also consider checking out sources on your own), how to help and give you the tools you need.
Similarly, if medication is going to be considered as part of a treatment plan, try to find a psychiatrist who treats children and adolescents. Sometimes, psychologists and psychiatrists will work as a team. For instance, Rubenstein has worked with the same psychiatrist for years. A team approach is important. “This way everyone is on the same page,” she said. Also, your family doctor might be able to recommend a psychologist or psychiatrist.
Essau C., & Dobson K. (1999). Epidemiology of depressive disorders. In: Depressive Disorders in Children and Adolescents: Epidemiology, Course, and Treatment, Essau C, Petermann F, eds. Northvale, N.J.: Jason Aronson.