Overview

Teen depression is a serious mental health problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenager thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although depression can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings — they're a symptom of depression.

Teen depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Teen depression care at Mayo Clinic

Source: http://www.mayoclinic.com

Symptoms

Teen depression signs and symptoms include a change from the teenager's previous attitude and behavior that can cause significant distress and problems at school or home, in social activities or other areas of life.

Depression symptoms can vary in severity, but changes in your teen's emotions and behavior may include the examples below.

Emotional changes

Be alert for emotional changes, such as:

• Feelings of sadness, which can include crying spells for no apparent reason
• Feeling hopeless or empty
• Irritable or annoyed mood
• Frustration or feelings of anger, even over small matters
• Loss of interest or pleasure in normal activities
• Loss of interest in, or conflict with, family and friends
• Low self-esteem
• Feelings of worthlessness or guilt
• Fixation on past failures or exaggerated self-blame or self-criticism
• Extreme sensitivity to rejection or failure, and the need for excessive reassurance
• Trouble thinking, concentrating, making decisions and remembering things
• Ongoing sense that life and the future are grim and bleak
• Frequent thoughts of death, dying or suicide

Behavioral changes

Watch for changes in behavior, such as:

• Tiredness and loss of energy
• Insomnia or sleeping too much
• Changes in appetite — decreased appetite and weight loss, or increased cravings for food and weight gain
• Use of alcohol or drugs
• Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
• Slowed thinking, speaking or body movements
• Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
• Social isolation
• Poor school performance or frequent absences from school
• Neglected appearance
• Angry outbursts, disruptive or risky behavior, or other acting-out behaviors
• Self-harm — for example, cutting, burning, or excessive piercing or tattooing
• Making a suicide plan or a suicide attempt

What's normal and what's not

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

When to see a doctor

If depression symptoms continue or begin to interfere in your teen's life, talk to a doctor or a mental health professional trained to work with adolescents. Your teen's family doctor or pediatrician is a good place to start. Or your teen's school may recommend someone.

Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're a teen and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care provider such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

When to get emergency help

Suicide is often associated with depression. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

• Call your mental health specialist
• Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
• Seek help from your primary care doctor or other health care provider
• Reach out to a close friend or loved one
• Contact a minister, spiritual leader or someone else in your faith community

If a loved one or friend is in danger of attempting suicide or has made an attempt:

• Make sure someone stays with that person
• Call 911 or your local emergency number immediately
• Or, if you can do so safely, take the person to the nearest hospital emergency room

Never ignore comments or concerns about suicide. Always take action to get help.

Source: http://www.mayoclinic.com

Causes

It's not known exactly what causes depression, but a variety of issues may be involved. These include:

• Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems change, leading to depression.
• Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
• Inherited traits. Depression is more common in people whose blood relatives also have the condition.
• Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that make a person more susceptible to depression.
• Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.

Source: http://www.mayoclinic.com

Diagnosis

When teen depression is suspected, the doctor will typically do these exams and tests.

• Physical exam. The doctor may do a physical exam and ask in-depth questions about your teenager's health to determine what may be causing depression. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your teen's doctor may do a blood test called a complete blood count or test your teen's thyroid to make sure it's functioning properly.
• Psychological evaluation. This evaluation includes a discussion with your teen about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications.

Your mental health provider may use the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose major depression.

Types of depression

Symptoms caused by major depression can vary from person to person. To clarify the type of depression your teen has, the doctor may use one or more specifiers, which means depression with specific features. Here are a few examples:

• Anxious distress — depression with unusual restlessness or worry about possible events or loss of control
• Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness
• Atypical features — depression that includes the ability to be temporarily cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in arms or legs

Other disorders that cause depression symptoms

Several other disorders include depression as a symptom. An accurate diagnosis is the key to getting appropriate treatment. The doctor or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of these conditions:

• Bipolar I and II disorders. These mood disorders include mood swings that range from major highs to major lows. It's sometimes difficult to distinguish between bipolar disorder and depression.
• Cyclothymic disorder. Cyclothymic (sy-kloe-THIE-mik) disorder involves highs and lows that are milder than those of bipolar disorder.
• Disruptive mood dysregulation disorder. This mood disorder in children includes chronic and severe irritability and anger with frequent extreme temper outbursts. This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood.
• Persistent depressive disorder. Sometimes called dysthymia (dis-THIE-me-uh), this is a less severe but more chronic form of depression. While it's usually not disabling, persistent depressive disorder can prevent functioning normally in daily routines and from living life to its fullest.
• Premenstrual dysphoric disorder. This involves depression symptoms associated with hormone changes that begin a week before and improve within a few days after the onset of a menstrual period, and are minimal or gone after the period ends.
• Other causes of depression. This includes depression that's caused by the use of recreational drugs, certain prescribed medications or another medical condition.

Source: http://www.mayoclinic.com

Complications

Untreated depression can result in emotional, behavioral and health problems that affect every area of your teenager's life. Complications related to teen depression may include, for example:

• Alcohol and drug abuse
• Academic problems
• Family conflicts and relationship difficulties
• Involvement with the juvenile justice system
• Suicide

Source: http://www.mayoclinic.com

Prevention

There's no sure way to prevent depression. However, these strategies may help. Encourage your teenager to:

• Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise
• Reach out for friendship and social support, especially in times of crisis
• Get treatment at the earliest sign of a problem to help prevent depression from worsening
• Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms

Alternative medicine

Make sure that you and your teenager understand the risks as well as possible benefits if your teen pursues alternative or complementary therapy. Don't replace conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a good substitute for medical care.

Examples of techniques that may help in dealing with depression include:

• Acupuncture
• Relaxation techniques, such as deep breathing
• Yoga or tai chi
• Meditation
• Guided imagery
• Massage therapy
• Music or art therapy
• Spirituality

Relying solely on these methods is generally not enough to treat depression. But they may be helpful when used in addition to medication and psychotherapy.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

You are your teenager's best advocate to help him or her succeed. Here are some steps you and your teen can take that may help:

• Stick to the treatment plan. Make sure your teen attends appointments, even if he or she doesn't feel like going. Even if your teen is feeling well, make sure he or she continues to take medications as prescribed. If your teen stops taking medications, depression symptoms may come back. And quitting suddenly may cause withdrawal-like symptoms.
• Learn about depression. Education can empower your teen and motivate him or her to stick to a treatment plan. It can also benefit you and other loved ones to learn about depression and understand that it's a treatable condition.
• Encourage communication with your teen. Talk to your teen about the changes you're observing and emphasize your unconditional support. Create an environment where your teen can share concerns while you listen.
• Pay attention to warning signs. Work with your teen's doctor or therapist to learn what might trigger depression symptoms. Make a plan so that you and your teen know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
• Make sure your teen adopts healthy habits. Regular exercise, even light physical activity, can help reduce depression symptoms. Sleeping well is important for all teens, especially those with depression. If your teen is having trouble sleeping, ask the doctor for advice.
• Help your teen avoid alcohol and other drugs. Your teen may feel like alcohol, marijuana or other drugs lessen depression symptoms, but in the long run they worsen symptoms and make depression harder to treat. Talk with the doctor or therapist if your teen needs help to deal with alcohol or drug use.
• Remove all guns from your home if you live with a teen who has depression.

Source: http://www.mayoclinic.com

Coping and support

Showing interest and the desire to understand your teenager's feelings lets him or her know you care. You may not understand why your teen feels hopeless or has a sense of loss or failure. But listen without judging and try to put yourself in your teen's position. Help build your teen's self-esteem by recognizing small successes and offering praise about competence.

Encourage your teen to:

• Make and keep healthy friendships. Positive relationships can help boost your teen's confidence and help him or her stay connected with others. Encourage your teen to avoid relationships with people whose attitudes or behaviors could make depression worse.
• Stay active. Participation in sports, school activities or a job can help keep your teen focused on positive things, rather than negative feelings or behaviors.
• Ask for help. Teens may be reluctant to seek support when life seems overwhelming. Encourage your teen to talk to a family member or other trusted adult whenever needed.
• Have realistic expectations. Many teens judge themselves when they aren't able to live up to unrealistic standards — academically, in athletics or in appearance, for example. Let your teen know that it's OK not to be perfect.
• Simplify life. Encourage your teen to carefully choose obligations and commitments, and set reasonable goals. Let your teen know that it's OK to do less when he or she feels down.
• Structure time. Help your teen plan activities by making lists or using a planner to stay organized.
• Keep a private journal. Journaling may help improve your teen's mood by allowing your teen to express and work through pain, anger, fear or other emotions.
• Connect with other teens who struggle with depression. Ask the treatment provider if there are local support groups for teen depression. Depression support groups are offered online, but check them out to make sure they're trustworthy sites — such as the National Alliance on Mental Illness or the Depression and Bipolar Support Alliance.
• Stay healthy. Do your part to make sure your teen eats regular, healthy meals, gets regular exercise and gets enough sleep. Bring healthy foods into the home and keep unhealthy foods out, and establish a lights out time at bedtime.

Source: http://www.mayoclinic.com

Risk factors

Many factors increase the risk of developing or triggering teen depression, including:

• Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems
• Having been the victim or witness of violence, such as physical or sexual abuse
• Having other conditions, such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia or bulimia
• Having a learning disability or attention-deficit/hyperactivity disorder (ADHD)
• Having ongoing pain or a chronic physical illness such as cancer, diabetes or asthma
• Having a physical disability
• Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or other drugs
• Being gay, lesbian, bisexual or transgender in an unsupportive environment

Family history and issues with family or others may also increase your teenager's risk of depression, such as:

• Having a parent, grandparent or other blood relative with depression, bipolar disorder or alcoholism
• Having a family member who committed suicide
• Having a dysfunctional family and conflict
• Having experienced recent stressful life events, such as parental divorce, parental military service or the death of a loved one

Source: http://www.mayoclinic.com