Sometimes your teen or young adult may seem really down and hopeless. It’s not uncommon to wonder if this is a passing phase. Are they depressed because of a certain situation like a break-up, not doing well in school, being turned down for a job, or something else that you think they will get over? Or, is it ongoing and a reason for concern? It’s important to understand the signs of depression and know what to do if help is needed.
Understanding depression
While adults with depression may be sad and tired, depressed teens are usually more irritable, restless, and negative. What parents often notice first is that their teen stops doing things they usually like to do. Of course, teens often make big changes that are completely normal. The key for parents is to notice when the change lasts for more than two weeks. That can be the main difference between moody teen behavior and depression.
The most common kind of depression is called Major Depressive Disorder (MDD). This disorder is made up of more severe symptoms that last at least two weeks. Persistent Depressive Disorder (PDD) has milder symptoms lasting much longer – at least a year or more.
Major Depressive Disorder
If your loved one has been in a consistent depressed or irritable mood and/or has lost pleasure in daily activities for at least two weeks, they could have Major Depressive Disorder. Signs of MDD include:
- Marked weight loss or gain
- Sleeping too much or too little
- Restlessness, tiredness or exhaustion
- Feelings of worthlessness or excessive or inappropriate guilt
- Cloudy or indecisive thinking
- An obsession with death, plans of suicide or an actual suicide attempt
Persistent Depressive Disorder
Much like a low-grade fever, Persistent Depressive Disorder is like “low-grade” depression. It isn’t quite as severe as MDD. It’s diagnosed when a young person is in a depressed mood or very irritable for most of the day for at least a full year.
Download Your Co-Occurring Disorder Guide
This collaboration between Child Mind Institute and Partnership to End Addiction can help you determine if your child is struggling with a mental health disorder as well as a substance use disorder, and what to do about it.
Treatment for depression
Depression can be treated with therapy or medication alone, but most experts agree that a combination that includes both is usually the best approach. Depression in young people is often treated with Cognitive Behavioral Therapy (CBT), which focuses on changing behaviors and thinking patterns. Other approaches include:
- Interpersonal therapy (IPT) focusing on changing relationships in the individual’s life;
- Behavioral activation (BA) targeting activities in order to improve one’s mood;
- and Dialectical behavior therapy (DBT) helping to control emotions.
Additionally, as a parent or family member, it’s helpful for you to be involved. Family therapy can be used to understand how best to support your loved one.
Medications for depression may include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Antidepressants need to be taken daily as prescribed for at least 2-4 weeks to start feeling the effects. Parents should closely monitor their children when they are starting the medication, or when there are changes to the dose. Keeping track of symptoms on a daily basis is helpful information for the prescriber. The dosage will likely need to be adjusted by a psychiatrist, Advanced Practice Nurse (APN), or pediatrician during the first few visits.
Depression and substance use don't mix
Teens and young adults with depression often use alcohol or other drugs to dull their painful feelings and cope with negative thoughts. It may seem to work at first, but over time, substance use makes depression worse.
Substances affect the reward centers of the brain, which are the same areas that are associated with depression. Because of this, teenagers become more depressed when they’re not using substances. As a result, they are at higher risk for problematic substance use including addiction.
In addition, alcohol use is especially damaging to adolescents because it affects them differently than it does adults. Rather than getting sedated or relaxed with alcohol, as adults can be, adolescents get more energetic and are likely to engage in riskier behavior.
Look for integrated care
If your young person is struggling with depression and substance use, it’s important to look for integrated care. Integrated care treats depression and substance use together, rather than addressing only one issue at a time. In addition, a good treatment program will address all of your child’s mental and physical health needs with input from them as well as the family.
For more information on depression, finding quality treatment, encouraging your loved one to get care and how to best support them, read our guide.