By Ash Miller, MD
It’s perfectly normal for teenagers to be moody, to jealously guard their privacy and to try on different personas while they figure out just who they are becoming in life. So how can you tell when your adolescent’s sullenness, irritability or social withdrawal is a sign of something more serious—like depression?
Teenage depression is on the rise, yet the number of adolescents receiving treatment is not increasing. That means a lot of unhappy teens are not getting the help they need. In 2015, according to the National Institute of Mental Health, 3 million people between ages 12 and 17—or 12.5 percent of that population—had at least one major depressive episode, defined as four or more symptoms of serious depression lasting at least two weeks (more on these symptoms below). And teenage girls are almost four times as likely as boys to suffer from depression.
Why should we be concerned about adolescent depression? For one, depressed teens are 12 times more likely to attempt suicide, and 30 percent of teens with depression also develop a problem with substance abuse. Depression also places young people at risk for other risky behaviors, like running away, self-injury, eating disorders and engaging in violence. So, no, it’s not “just a phase.” We must take it seriously.
What to look for
A young person who suddenly loses interest in activities or friends who were important to them, stops caring about schoolwork or their appearance or becomes more irritable or sensitive than usual could be struggling with depression. Younger teens, such as those in middle school, may start complaining of headaches or stomachaches. Suddenly, everything has become boring to a depressed adolescent.
Changes in eating and sleeping patterns—excessive weight loss or gain, sleeping too much or too little—are also signs that your teen might be depressed. And unlike adults, who tend to manifest depression with visible sadness and low energy, adolescents who are depressed might not exhibit these symptoms but instead will become irritable and angry more frequently. These symptoms might last for weeks at a time.
Excessive reliance on social media can be a cause, as well as a symptom, of depression in adolescents. Kids often compare their lives unfavorably to the glossy depictions their friends present on Facebook or Instagram. Everyone else seems to be more popular, to have better clothes and to be having way more fun. Some youngsters use social media as a coping mechanism to avoid dealing with uncomfortable emotions. So it’s important to monitor the amount of time your children spend on social media as well as the nature of their interactions on those sites.
Communication is key
The best way to understand your teen’s emotional state is to communicate daily and ask open-ended questions: How are things at school? Are you worried about anything in your life? You may only get a mumbled one-word answer, but don’t give up. It’s important for your teen to know that you care and that you’re interested in how things are going. That way, if and when a problem arises, your teen will know that it’s safe to approach you.
When I come out into my reception area to greet a patient, I am often dismayed to see a mom or dad busy on their smartphones, not interacting with their child. It gives me a window into some of the communication challenges that may be contributing to the child’s difficulties.
Healthy relationships are built upon meaningful communication, and that requires focused attention. It’s a great idea for families to have some screen-free interaction every day. Dinnertime is a great opportunity for this. Everyone puts their phones away—and that means mom and dad, too. Riding in the car offers another good opportunity to chat without the distraction of cellphones.
If your teen seems unusually stressed out or sad, try to get him to talk about what’s causing those feelings. If you can’t get him to open up to you, encourage him to confide in other adults he trusts or consider seeking counseling.
The good news is that you and your teen don’t have to go it alone. There are antidepressant medications that can relieve symptoms, and counseling, or talk therapy, is often very effective in helping depressed teens to develop healthy coping skills and to reframe their outlooks.
Encourage your teen to develop healthy habits, such as daily exercise, eating well, sleeping regular hours, engaging in rewarding activities and hobbies and spending time with friends and family. I have seen a lot of success in my patients when they adopt these changes, especially if parents are also doing them.
The teenage years, while certainly challenging, should not be gloomy and dark. If you have any concerns about your child’s mental health, consult your pediatrician. He or she will examine your child and, if indicated, refer you to a therapist who specializes in the care of children and adolescents.
To find out more about the signs of depression in teens, visit the National Institute of Mental Health’s health education pages. To learn more about the difference between anxiety and depression in children, visit the Centers for Disease Control and Prevention mental health pages.
Ash Miller, MD, is a child and adolescent psychiatrist with the Kaiser Permanente Burke Medical Center in Northern Virginia.