When she was 14, Rebecca’s grandmother died after six months of terminal illness. At the same time she’d been watching the disease progress, Rebecca started at a new, very large, school. She joined an after-school activity that took up endless hours and proved difficult to leave even after she realized it wasn’t a good fit for her. Her mother, Judy, started to notice something in Rebecca she thought might be depression.
“She had begun crying a lot, more than usual, she wasn’t sleeping well, and she was lying on the couch a lot, mindlessly eating,” recalls Judy, who asked to withhold her and Rebecca’s last names. “At first I thought that she was just going through an adjustment period to high school and normal teen angst, but her mood swings were too severe for that, and I knew there was a problem.”
Teenage Depression: The Statistics
Rebecca was ultimately diagnosed with major depressive disorder, one of several terms used to describe what is generally regarded as “clinical depression.” According to the Adolescent Depression Awareness Program at Johns Hopkins University, as many as 5 percent of adolescents, or 1 in 20 teenagers, will experience at least one episode of major depression during their teen years. The National Institutes of Mental Health estimate that 11 percent of teens will have a depressive disorder by age 18.
Judy knew some signs to watch for, but the truth is, depression in teenagers can be difficult to spot. This leaves many parents confused and overwhelmed by trying to figure out the difference between a normal, expected stress level in their teen and a clinical depression that needs treatment and attention.
For one thing, depression in teens doesn’t always look like depression in adults, says Janet Lehman, a clinical social worker with 40 years of experience working with teens and families and the co-creator of The Total Transformation Program.
“Teens often present in a very different way when they’re truly depressed than adults,” she says.
The most notable difference is that while some depressed teens, like Rebecca, may exhibit hallmark symptoms of adult depression—such as reporting feeling sullen, withdrawn, sad, and moody—many other teenagers’ depression might manifest as anger, irritability, or rage.
Diagnosing Depression in Teens: A Constellation of Symptoms
To make matters even more complicated for parents, no single sign or symptom can lead to an accurate depression diagnosis, says Dr. Theodore Murray, medical director of Child and Adolescent Intensive Services at the Cambridge Health Alliance in Cambridge, Mass. “The diagnosis rests on a constellation of symptoms and changes in function within a specific time period,” says Murray.
For a diagnosis of major depression, for example, a teen needs to report experiencing five or more symptoms consistently for two weeks or more.
The symptoms of depression a pediatrician or mental health professional will look for during a screening fall into distinct categories:
- Physical symptoms might include increased or decreased appetite, disturbed or increased sleep, fatigue and a “slowed down” feeling, unexplained stomach pain, headaches, or muscle tension and pain.
- Attitude and outlook symptoms are common as well, with depressed teens more likely to report feelings of guilt, hopelessness, or worthlessness.
- Mood changes are likewise typical. These include social detachment, failing to take pleasure in things the teen used to enjoy, and prolonged periods of sadness or anger.
Additionally, panic or anxiety attacks may accompany the symptoms of depression.
Symptoms Easy to Overlook
There are signs of depression some parents may overlook, says Peter Sacco, a professor of addiction studies at McMaster University in Canada who works with schools as well as teen and tween groups. Over- or under-eating are red flags that something might be going on emotionally. Parents should also watch for teens who are preoccupied with reading stories about teen suicides or teens who have died.
Mainly, says Sacco, parents should be vigilant for signs that their teen might be stuck in an unrelenting negative pattern. “Stress is momentary, and it varies in its intensity,” he says, “Depression seems to drag on, stay constant, or get worse.”
Above all, Lehman advises, parents need not panic if they suspect their teenager is struggling emotionally. “Don’t jump to conclusions” that a moody teen is headed for a serious depressive episode or a lifetime of mental health concerns, she advises. “Remember that this is a new developmental phase” for your teen, and it will take time, and a team of supportive people, to help you interpret your teen’s moods and behaviors and determine whether he or she is truly exhibiting signs of depression.
However, if you do suspect that your teen is depressed, don’t wait to act. Establish open lines of communication with your teen and express your concerns, then reach out to your pediatrician or a trusted school guidance counselor to begin the process of screening your teen for depression.
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About Holly Lebowitz Rossi
Holly Lebowitz Rossi is a freelance writer who specializes in health, parenting and religion. She’s the co-author of Yoga for a Healthy Lower Back: A Practical Guide to Developing Strength and Relieving Pain, and she lives with her husband and son in Arlington, Massachusetts.