Teen depression

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. A doctor or mental health professional can talk with your teen about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications.

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 professional's evaluation will help determine if the symptoms of depression are caused by one of these conditions:

• Bipolar 1 and 2 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. The symptoms are minimal or gone after the period ends.
• Other causes of depression. This includes depression that's caused by the use of recreational or illegal drugs, certain prescribed medications, or a medical condition.

Treatment

Treatment depends on the type and severity of your teenager's depression symptoms. A combination of talk therapy (psychotherapy) and medication can be very effective for most teens with depression.

If your teen has severe depression or is in danger of self-harm, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Here's a closer look at depression treatment options.

Medications

The Food and Drug Administration (FDA) has approved two medications for teen depression — fluoxetine (Prozac) and escitalopram (Lexapro). Talk with your teen's doctor about medication options and possible side effects, weighing the benefits and risks.

FDA alert

Most antidepressants are generally safe, but the FDA requires all antidepressants to carry a black box warning, the strictest warning for prescriptions. Though it's uncommon, some children, teens and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when first beginning a new medication or with a change in dosage. If your teen has suicidal thoughts while taking an antidepressant, immediately contact your doctor or get emergency help.

For most teens who need an antidepressant, the benefits of taking an antidepressant outweigh any risks. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Finding the right medication

Everyone's different, so finding the right medication or dose for your teen may take some trial and error. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as the body adjusts. Encourage your teen not to give up.

Managing medications

Carefully monitor your teen's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for teens with depression, the doctor may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your teen does not have a large amount of pills available at once. Locking up all pills in the home is one measure families can take to reduce the risk of suicide.

If your teen has bothersome side effects, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression.

Antidepressants and pregnancy

If your teen is pregnant or breastfeeding, some antidepressants may pose an increased health risk to the unborn or nursing child. If your teen becomes pregnant or plans to become pregnant, make certain your teen talks to the doctor about antidepressant medications and managing depression during pregnancy.

Psychotherapy

Psychotherapy, also called psychological counseling or talk therapy, is a general term for treating depression by talking about depression and related issues with a mental health professional. Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy.

Psychotherapy may be done one-on-one, with family members or in a group. Through regular sessions, your teen can:

• Learn about the causes of depression
• Learn how to identify and make changes in unhealthy behaviors or thoughts
• Explore relationships and experiences
• Find better ways to cope and solve problems
• Set realistic goals
• Regain a sense of happiness and control
• Help ease depression symptoms such as hopelessness and anger
• Adjust to a crisis or other current difficulty

Hospitalization and other treatment programs

In some teens, depression is so severe that a hospital stay is needed, especially if your teen is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your teen calm and safe until coping skills are learned and a safety plan is developed.

Day treatment programs also may help. These programs provide the support and counseling needed while your teen gets depression symptoms under control.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

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.

Lifestyle and home remedies

You are your teenager's best advocate to help him or her succeed. In addition to professional treatment, 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.
• Help your teen adopt healthy habits. Keep healthy foods in your home, keep unhealthy foods out, and set regular mealtimes. Encourage routine exercise, noting that even light physical activity can help reduce depression symptoms. Set a time for lights out at bedtime with no use of electronic devices in bed, which can help promote quality and quantity of sleep. If your teen is having problems with sleep, ask the doctor for advice.
• Help your teen avoid alcohol and other drugs. Your teen may feel as if 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.
• Eliminate or limit access to items your teen could use for self-harm. This can include removing or securing guns, and removing sharp items, alcohol or risky medications in your home if you live with a teen who has depression.

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. Sticking to a regular routine may help improve mood.
• 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 doctor or therapist 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.

Preparing for your appointment

It's a good idea to be well prepared for your appointment. Here's some information to help you and your teenager get ready, and what to expect from the doctor.

What you can do

To the extent possible, involve your teenager in preparing for the appointment. Then make a list of:

• Any symptoms your teen has had, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses or recent life changes your teen has experienced
• All medications, vitamins, herbal remedies or other supplements that your teen is taking
• Questions that you and your teen want to ask the doctor

Basic questions to ask the doctor may include:

• Is depression the most likely cause of my teen's symptoms?
• What are other possible causes for the symptoms?
• What kinds of tests will my teen need?
• What treatment is likely to work best?
• Are there any possible side effects with the medications you're recommending?
• Is there a generic alternative to the medicine you're prescribing?
• How will we monitor progress and effectiveness of treatment?
• What are the alternatives to the primary approach that you're suggesting?
• My teen has these other health conditions. Could they be linked to depression?
• Are there any restrictions that my teen needs to follow?
• Should my teen see a psychiatrist or other mental health professional?
• Will making changes in diet, exercise or other areas help ease depression?
• Are there any printed materials that we can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your teen's doctor

Your teen's doctor or mental health professional will likely ask your teen a number of questions, including:

• When did family members or friends first notice your symptoms of depression?
• How long have you felt depressed? Do you generally always feel down, or does your mood change?
• Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
• Do you ever have suicidal thoughts when you're feeling down?
• How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
• Do you have any blood relatives — such as a parent or grandparent — with depression or another mood disorder?
• What other mental or physical health conditions do you have?
• Are you using any mood-altering substances, such as alcohol, marijuana or recreational drugs? Do you use nicotine?
• How much do you sleep at night? Does the amount change over time?
• What, if anything, seems to improve your symptoms? What appears to worsen them?
• What is your diet like? Do you have a history of significant weight gain or loss?

The doctor or mental health professional will ask additional questions based on your teen's responses, symptoms and needs. Preparing and anticipating questions will help make the most of your appointment time.