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How Is Depression Diagnosed in Teens?

By Holly Lebowitz Rossi

When Rebecca, now a college senior, was 14 years old, she started showing some classic signs and symptoms of depression. Concerned, her mother, Judy, began to seek an accurate, professional diagnosis.

Judy, who asked to withhold her family’s last name, was fortunate that Rebecca recognized her own struggles enough to request to see a therapist. So as a first step, Judy approached Rebecca’s school guidance counselor.

“I asked her to meet with my daughter to see what she thought,” recalls Judy. “It turned out that my daughter had been having a lot of suicidal ideation she had not told us about, and we quickly were moved into psychiatric care. She saw several psychiatrists, and a social worker, and left school for about a month during a partial inpatient treatment program.” When Rebecca returned to school, she had a 504 plan, which ensures students with disabilities have the opportunity for academic success, for anxiety and depression.

Parents, like Judy, will likely need to navigate a number of medical professionals as they seek out accurate diagnosis and treatment for a teen’s depression. But for most, the journey begins in the pediatrician’s office, where regular screenings can gauge a teen’s depression risk.

Screenings: Is There a Teen Depression Test?

The American Academy of Pediatrics (AAP) recommends screenings for depression at a child’s annual physical, beginning at age 11. The screening may be one of several established depression tests, which are questionnaires with results scaled to measure depression in teens. Even if a screening can’t serve as a conclusive teen depression test, it is considered a helpful first line of defense in diagnosing and treating depression in teens.

A typical screening conducted by a primary care doctor should include, according to the AAP’s guidelines:

  • A thorough history of symptoms of depression, including issues with mood, sleep, eating, and social relationships.
  • Direct questions about any suicidal thoughts the teen may have had.
  • Questions about family history of mental illness, including but not limited to depression.

In addition, primary care doctors should monitor teens for medical conditions that are linked with an elevated depression risk, including thyroid problems, asthma, anemia, or low vitamin D.

If medical causes are ruled out but depression is suspected, physicians will delve more deeply into the severity of symptoms. Through a series of questions and conversations, doctors can make a specific diagnosis as described in the Diagnostic and Statistical Manual of Mental Disorders, or the DSM, which is the medical standard for the classification of mental health disorders.

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The Two Most Common Teen Depression Diagnoses

The DSM contains a number of potential diagnoses, but the two most common—affecting an estimated 10 to 15 percent, or 1 or 2 out of every 10 teens—are major depression and dysthemia.

Major depression is diagnosed when a teen has 5 or more of these symptoms for a 2-week period or longer:

  • Depressed or irritable mood most of the day
  • Loss of pleasure or interest in activities the teen used to enjoy
  • Significant weight gain, weight loss, or changes in appetite
  • Insomnia or sleeping too much
  • Noticeable physical agitation or slowness
  • Significant fatigue and lack of energy
  • Feelings of worthlessness or guilt
  • Indecisiveness or inability to concentrate
  • Recurrent thoughts of suicide, either with or without a plan for committing suicide

While major depression can either present as an isolated episode or an ongoing disorder, dysthemia is a chronic, underlying condition that can either accompany major depression or manifest on its own. To be diagnosed with dysthemia, a teen needs to report feeling depressive symptoms for a year or more, during which time the teen has never been without some symptoms for more than a month or two at a time.

Parents: Talk (and Listen) to Your Teens

Experts advise parents to establish open lines of communication before, during, and after a diagnosis of depression. Doing so in a healthy way—without judging the teen’s emotions or provoking hostility or resistance in him or her—is a crucial tool parents can use to participate in getting their teens properly diagnosed and treated.

“It’s easy to get into an argument with kids about whether they’re doing okay or not doing okay,” says Dr. Theodore Murray, medical director of Child and Adolescent Intensive Services at the Cambridge Health Alliance in Cambridge, Mass.

Instead of pressing for simple or conclusive answers, Murray advises, parents should adopt a listening posture when talking to teens about difficult topics. In these conversations, he says, “the best stance is one of curiosity.” With an open mind from parents and a diagnosis from a trusted professional, the road to treatment will be that much clearer.

 

More from Holly Lebowitz Rossi:

Concerned Your Teen Is Depressed? Watch for These Signs and Symptoms

What Causes Depression in Teens?

Treating Depression in Teens: Getting the Help You Need

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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.

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