With a Teen, How Can You Tell?

Deciphering and interpreting adolescent moods is one of the most challenging aspects of parenting a teenager.

Most parents know and understand the warning signs of mental health disorders, including major depressive disorder (MDD), which non-clinical people call depression. They know to watch for a sudden drop in grades, radical changes in appearance and attention to hygiene, and surprising changes in peer groups. They know sadness lasting every day for weeks on end is a warning sign. Most also know that anger and irritability – especially in boys – are signs of depression.

Parents who read articles like this one learn that a loss of interest in favorite activities is a warning sign for depression, too.

But there’s a catch to almost all those symptoms/warning signs of depression we just listed.

Here it is:

An important part of adolescence is exploring new things. It’s not only important – it’s essential. That’s how teens define who they are, decide who they want to be, and form an idea of who they’ll be and how they plan to live life as an adult. The process has an official developmental name: differentiation. Finding new hobbies, exploring new ways of living, and learning new ways to interact are all part of the differentiation process.

What creates the challenge – the catch – is distinguishing typical differentiation from the symptoms of a depressive disorder.

A study published in 2019 focused on a specific element of depressive symptoms in adolescents: the loss of interest in favorite activities. Mental health professionals call this anhedonia. The study took a novel approach to this specific symptom, and the results can help parents understand teenage behavior and make an initial judgment on whether their teen’s behavior is typical or a warning sign of depression.

We’ll talk about their unique approach and discuss the results below.

Losing Interest and Having a Tough Time Finding the Fun: Is There a Difference?

Let’s dig deeper into what mental health professionals mean by anhedonia. The Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-V) offers this definition:

“[Anhedonia is] a markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day.”

To meet criteria for a symptom of a depressive disorder, anhedonia must persist for two weeks or more. That’s the first thing that helps parents decide whether their teens behavioral change is typical or a red flag: the duration. Occasional resistance to band rehearsal, soccer practice, or drama club is par for the course. Total resistance or disinterest every day for a month – or for an entire semester – enters red flag territory.

But that’s still not enough to make a solid judgment. If your teen doesn’t want to go to [insert formerly favorite activity] anymore, is it because they’ve outgrown it and found something new, or is it because they’re in the early stages of depression?

That’s not so easy to determine.

The way most studies try to understand anhedonia is through self-reporting by teens who answer anonymous questionnaires. Questionnaires are tried and true methods used for decades by reputable researchers, but they often fail to reflect the gray areas in teen behavior. With regards to anhedonia, one way they fall short is the distinction between not wanting to do something and not enjoying something.

Parents of teens can relate.

Time and again a teen will say “I don’t feel like it” when asked if they want to do a particular activity, but once they get there and get involved, they love it the same as always.

A teen with depression, on the other hand, doesn’t feel like it and also doesn’t enjoy it like they used to once they’re doing it.

To unravel some of the details around the more elusive aspects of anhedonia, researchers replaced questionnaires with in-person interviews. We’ll talk about the content of those interviews now.

What Teens Say About Losing Interest in Activities: How Researchers Got Them Talking

In the study, called “Understanding Anhedonia: A Qualitative Study Exploring Loss of Interest and Pleasure in Adolescent Depression,” the research team took what they describe as a thematic approach to one-on-one interviews with teens.

They identified four primary themes related to how teens experience anhedonia in the context of depression:

1. Experiencing a loss of joy and a flattening of emotion
2. Struggling with motivation and active engagement
3. Losing a sense of connection and belonging
4. Questioning sense of self, purpose, and the bigger picture.

They conducted one-on-one interviews with 34 adolescents who were either diagnosed with depression or experienced elevated depressive symptoms. During the interviews, they went in depth on all the questions they asked. They explored the finer points of wanting/not wanting to do things, enjoying/not enjoying doing things, feeling connected/disconnected, and losing/questioning their concept of meaning/lack of meaning and purpose/lack of purpose in life.

During the interview process, they identified sub-themes, and recorded what teens had to say about each theme and sub-theme.

We’ll offer that information now, in order, for themes 1-4.

Theme 1: Experiencing a Loss of Joy and a Flattening of Emotion

Here’s a quote from a teen that expresses this overall phenomenon:

“I lost what I enjoyed doing.”

The teens used a variety of words to describe the presence of joy and positive emotion, including: enjoyment, interest, satisfaction, pride, curiosity, fun, endorphin rush, excitement, enthusiasm, relaxing, good, and happy.

Parents will not be surprised to learn they were less effusive when describing negative emotions. Here are some of the words and phrases they used: boredom, monotony, constant loop, and nothing feels exciting.

Subthemes: Feeling Dampened Emotions and Feeling Less Positive Emotion and Experiencing a Cycle of Boredom

Here are the words, phrases, and sentences teens used to describe their experience of these subthemes:

• Dampened Emotions
  • Words: dull, grey, flat, vacant, empty and emotionless
  • Phrases: a blank sheet
  • Full sentence: “Yeah like although they were the things I enjoyed, although I knew I should be enjoying them, for some reason like, I just like wouldn’t have the motivation to do it”
• Feeling Less Positive Emotion and Experiencing a Cycle of Boredom
  • Words: monotony, and bored
  • Phrases: constant loop of boring things
  • Key sentence: “Yeah like although they were the things I enjoyed, although I knew I should be enjoying them, for some reason like, I just like wouldn’t have the motivation to do it.”
  • Key sentence: “I was just like completely bored with it. Like you get bored with a TV show, and you’re like, okay leave it then, just move onto another one. I just get into a cycle of boredom, finding something else, bored with that, move on.”

Theme 2: Struggling With Motivation and Active Engagement

Here’s a quote from a teen that expresses this overall phenomenon:

“I’m never motivated to do anything”

Researchers did not report words and phrases related to this overall phenomenon. They got more out of the teens when discussing a subtheme of motivation, which we offer next.

Subthemes: Feeling Unmotivated but Maintaining Long Term Aspirations and Feeling Unable to Gain Momentum to Engage in Activities that Take Effort

Here are the words, phrases, and sentences teens used to describe their experience of these subthemes:

• Feeling Unmotivated
  • Phrases: not wanting to do anything at all and not wanting to live
  • Key sentence: “Yeah like although they were the things I enjoyed, although I knew I should be enjoying them, for some reason like, I just like wouldn’t have the motivation to do it.”
• Feeling Unable to Engage in Activities that Take Effort
  • Most common word: force as in they had to force themselves to do anything, or parents have to force them to do anything.
  • Key sentence/phase: “I just can’t be bothered”
  • Another key sentence: “So it’s kind of, putting in effort to go and do things that will decline. I would do more, kind of, passive things, so like TV and movies, where it’s just in front of you.”

Theme 3: Experiencing a Loss of Joy and a Flattening of Emotion

Here’s a quote from a teen that expresses this overall phenomenon:

“I’ll be there but I won’t be present.”

Subthemes: Feeling Disconnected from People and Feeling Disconnected from Reality

Here’s the sentiment, phrase, and a key sentence teens used to describe their experience of these subthemes:

• Feeling Disconnected from People
  • Most common sentiment: Teens reported the value in “feeling connected” to others and said receiving emotional support from friend or peers helped them feel connected. With no connection or support, they felt disconnected
• Feeling Disconnected from Reality
  • Common phrase: being on autopilot
  • Key sentence: “I just go through the normal stuff, but being more looking on than actually doing it…with me in my head watching rather than me just being there.”

Theme 4: Questioning Purpose in Life and the Big Picture

Here’s a teen quote that expresses this overall phenomenon:

“What’s the point in trying anymore?”

Subthemes: Reflections on Identity and Purpose and Lack of Agency/Shrinking Perspective

Here are the sentiments, words, phrases, and sentences teens used to describe their experience of these subthemes:

• Reflections on Identity and Purpose
  • Most common sentiment: Teen connected this subtheme with not wanting to do things and questioning why they should even bother with day-to-day activities
  • Key sentence: “ When I think, I realize that there’s really no point to all this…eventually we’re all gonna die, what use does it really have?”
• Lack of Agency/Shrinking Perspective
  • Common words: stuck, trapped, enclosed
  • Common phase: mental battle between how they felt – emotionless – and how they wanted to feel – excited.
  • Key phrase: “…no way of getting back to the way I was…”
  • Key sentence: “Like you don’t feel yourself. People point it out to you, and you don’t change ‘cause that’s how you feel.”

After conducting and analyzing these interviews, researchers concluded that adolescents with depression have a complex relationship with anhedonia that goes beyond a markedly diminished interest in activities.

The four themes they identified – and we shared, above – are an initial attempt to describe this complexity. The words, phrases, sentiments, and sentences we provide above represent how teens themselves describe the nuanced themes related to anhedonia. This research is important because it’s one of the first structured efforts that can help parents and therapists get past the inherent limitations of anonymous surveys and one-off questionnaires. While those tools are valuable, they lack the ability to reflect the various shades of gray that exist between the binary choices like “I’m excited” and “I’m bored” found on most surveys that measure teen depression.

How Parents Can Use This Information

We opened this article by admitting a big part of parenting a teen is deciphering their quixotic moods. That’s a critical job for parents who think their teen experiences depressive symptoms or may be on the verge of developing major depressive disorder (MDD).

The catch is discerning between typical adolescent differentiation and the symptoms of MDD. That’s where this information helps. The words in italics and quotes above are words teenagers diagnosed with MDD used to describe their feelings with regards to the specific depressive symptom anhedonia, a.k.a. loss of interest/loss of pleasure in things they used to enjoy.

We know teens lose interest and pleasure in things they used to enjoy. That’s a plain fact of growing up. However, not all teens use the kind of language we report above. And in most cases, when they lose interest in one thing, they develop a new interest in another.

We know teens also question life, the universe, and everything. That’s another plain fact of growing up. However, not all teens conclude life is pointless and decide there’s no real compelling reason to continue participating in day-to-day activities. We need to be careful here, because now we’re in proximity to suicidal ideation. That’s a different topic altogether, with a different set of concurrent symptoms that are related to, but not identical, to the anhedonia we discuss above.

We encourage parents to read the actual words the teens said above. Those words can help a parent decide whether the changes in their teen’s life are typical examples of adolescent development or the initial symptoms of clinical depression. Parents who read the words above and say “That’s my kid exactly” should consider arranging a full psychiatric evaluation with a licensed mental health professional experienced in working with teenagers.

Why? Because treatment for depression works – the sooner, the better. A mental health disorder like MDD rarely improves or goes away on its own. An accurate diagnosis and high-quality professional support and care can be exactly what a teen with depression needs.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.