Does My Adolescent Need Treatment for Depression?

The teenage years present problems for parents on virtually every level imaginable. With the arrival of puberty – when physical and sexual characteristics mature – children enter a period of psychological, emotional, and behavioral change. This period between childhood and adulthood is known as adolescence. Adolescence is, by definition, a transitional time. It’s when we transform from the kids we were, dependent on parents and caregivers for almost everything, to the adults we become, independent and capable of managing life on our own. Therefore, aside from birth and death, it’s one of the most significant biological phenomena in the lifespan of any human.

We all go through it. Which means that, as parents, we should all be able to relate to what happens to our teens. However, as time passes, we forget exactly how it felt. Here’s a reminder: everything feels like a big deal. Scratch that: everything feels like the biggest deal.

That’s as true for teens who have a comparatively smooth adolescence as it is for teens who have a turbulent adolescence.

The simple fact is that all kids change during adolescence. Some follow an even, almost predictable trajectory. Their personalities solidify, they dive deeper into passions, interests, or hobbies they already have. They create stronger bonds with their friends, classmates, and peers. For these teens, the person they are at age 18 looks a lot like the person they were at 13, only bigger, more mature, hopefully smarter, and with a more clearly defined personality.

Other teens follow a completely different trajectory. They change they way they look, talk, and behave. They find new passions, interests, and hobbies. Some completely change their friend and peer group. When these teens reach age 18, they might not look or behave anything like the person they were at age 13.

How to Read and Understand Teenage Moods: Does My Teen Have Depression?

We say all of the above to remind parents that during adolescence, their teenagers may be all over the map emotionally, psychologically, and behaviorally. They try on and discard new moods and attitudes like the clothes they try on and discard in a dressing room at a department store. What this means is that, in order to read and understand teenage moods, parents need to step back, take perspective, and consider the big picture.

Teens are the ones who get caught up in the ups and downs.

Parents should resist doing that as much as they possibly can.

Therefore, for parents who wonder if they need to seek support for their teenager at an adolescent treatment facility, a teenage depression treatment center, a pediatric psychiatric hospital, or with a therapist in an outpatient setting, it’s important to get a clear understanding of the difference between clinical depression and typical adolescent moodiness.

That’s what we’ll do for the rest of this article: review the signs and symptoms of depression, talk about risk factors that increase the chances of teenage depression, and briefly talk about what parents should expect if their teenager does need help.

First, a clinical definition, as published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V):

“[Depression is] …an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

Parents should pay close attention to the key phrase “….that last for two weeks or longer at a time.”

More on that in a moment.

First, the signs and symptoms of depression.

Moody Teens: What Parents Should Watch For

• Constant sadness and low mood
• Daily or constant crying
• Daily hopelessness or pessimism
• Frequent irritability
• Frequent anger or hostility
• Persistent feelings of hopelessness or worthlessness
• Withdrawal from friends
• Withdrawal from family
• Decreased interest favorite activities
• Decreased participation in extracurricular activities, including sports, band, or academic clubs
• Extreme, daily fatigue
• Problems discussing issues with friends or family
• Feeling restless or agitated all the time
• Difficulty concentrating and making decisions
• Problems with memory
• Difficulty following through on tasks at home or at school
• Drastic changes in sleep: too much or not enough
• Drastic changes in habits around food and eating
• Dramatic weight loss or weight gain
• Ailments that have no clear origin or cause such as headaches or stomachaches, that do not improve with common remedies
• Suicide-related thought and behavior: thinking about, talking about, or attempting suicide*

* If your teen is in immediate danger or poses an imminent threat to themselves or someone else, call 911 immediately or take them to an emergency room at a regular hospital or a psychiatric hospital.

Again, parents reading this should understand those symptoms in light of the key phrase in the clinical diagnosis which read “…that last for two weeks or longer at a time.”

Since we all know teen moods – driven by hormones – can be all over the place, it’s worth repeating that short bouts of sadness, anger, or withdrawal are common. But when they last for two weeks or more, that’s a clear red flag.

Now it’s time to talk about risk factors. Experiencing the following things can increase the chance that a teenager will develop clinical depression:

• Past history of mental illness (family)
• Past history of depression (personal)
• Significant events such as moving or changing schools
• Traumatic life events, such as a death in the family, major accidents, significant illness
• Extreme stress, such as a worldwide pandemic

Let’s be clear: the presence of a risk factor, or multiple risk factors, does not mean your teen will develop depression. Also, the presence of symptoms and risk factors simultaneously does not mean your teen has or will develop depression. However, if your teen displays signs and symptoms of depression every day for two weeks or more – and risk factors are also present – then it’s time for you to do something about it.

I Think My Teen Has Depression: What Next?

We’ve now come close to answering the question posed in the subtitle of this article:

Does My Adolescent Need Treatment for Depression?

But we’re not quite there yet.

The next step for parents with a teen who meet the criteria above is to arrange for a full mental health evaluation administered by a licensed professional clinician. This article cannot diagnose a teenager with a mental health disorder.

Only a professional can do that.

A full evaluation means that a professional clinician will collect information on all the factors in the life of the teenager. They’re called biopsychosocial evaluations because they include questions on:

Biological Factors:

• Personal medical history
• Family medical history
• Current physical circumstances

Psychological Factors:

• Present mental health symptoms or disorders
• Past mental health symptoms or disorders
• Present cognitive state
• Present emotional state
• Family mental health history
• Ongoing or current psychiatric issues
• Past psychiatric issues
• Ongoing psychological stress
• Past personal trauma
• Past family trauma

Social Factors

• Present social circumstances
• Present home/family circumstances
• Condition of primary relationships: friends, family, and peers
• Gender identity
• Sexual identity
• Educational history
• Present risk factors
• Present strengths

Once a clinician gathers all this information, they have the information they need to diagnose a mental health disorder such as depression. The experts at Harvard University identify three primary types of depression:

1. Major depressive disorder (MDD)

This is what most people think of when they hear the phrase clinical depression. MDD may be mild, moderate, or severe, depending on the frequency, severity, and level of disruption associated with the depressive symptoms observed in the biopsychosocial evaluation.

2. Persistent depressive disorder (PDD)

Clinicians used to call this type of depression dysthymia. This type of depression is characterized by the common symptoms of depression – sadness, low mood, sleep disruption, persistent feelings of hopelessness – that are present for at least two years but are neither as intense nor severe as the symptoms of MDD. People with PDD can typically carry out all their day-to-day responsibilities, but on the whole, they feel sad or down almost every day.

3. Seasonal affective disorder (SAD)

This type of depression most often affects people during the long, dark winter months. However, people can develop SAD during the summer, as well. As the name implies, this form of depression aligns with a particular season. The symptoms peak during that season – winter or summer – and fade when the season passes.

After reaching a diagnosis, parents should expect a clinician to recommend a course of treatment at one of the following levels of care:

1. Outpatient Treatment
2. Intensive Outpatient Treatment
3. Partial Hospitalization Treatment
4. Residential Treatment

We’ll explain these levels of care now.

Inpatient, Outpatient, Residential – What Do They Mean for Teen Depression?

Here’s a basic description of the levels of care we just mentioned:

1. Outpatient

Outpatient treatment is the least immersive level of care. This is a common entry level for teens with symptoms of depression that are not significantly disruptive. Teens in outpatient treatment can typically carry out the regular responsibilities of daily life, and receive treatment for an hour per session, once or twice a week. Outpatient treatment most often occurss in an office environment, rather than at an adolescent psychiatric hospital or adolescent behavioral health center.

2. Intensive Outpatient Programs (IOP)

Teens who receive a recommendation for an IOP program need more support than teens in outpatient programs. IOP programs are for teens whose symptoms are disruptive, but can still meet their daily responsibilities and live at home. Teens in IOP programs for depression participate in treatment 3-5 days a week for 2-3 hours per day. IOP treatment most often occurs at an adolescent treatment facility, rather than in an office setting.

3. Partial Hospitalization (PHP)

Teens who receive a recommendation for a PHP program need more support than teens in outpatient or intensive outpatient programs. PHP programs are for teens whose symptoms are severe and disruptive – preventing them from participating in school or other activities – but are stable enough to live at home. Teens in PHP programs for depression participate in treatment for 5-6 hours a day, five days a week. PHP programs most often occur in residential treatment centers for teens or residential treatment centers for youth – but participants do not live at the treatment facility.

4. Residential Treatment Programs (RTC)

Teens who receive a recommendation for an RTC program need more support than teens in outpatient, intensive outpatient, or partial hospitalization programs. RTC programs are for teens with symptoms so severe and disruptive they need immersive, full-time support and care. Teens in RTC programs live at the treatment facility because they need 24/7 medical support and monitoring. They receive a full day of treatment, seven days a week. Weekend schedules vary, but they’re still considered treatment days. RTC programs occur in adolescent psychiatric residential treatment centers. Residential treatment sounds like a type of teen inpatient treatment, but it’s not exactly the same: whereas adolescent inpatient psychiatric programs last for 5-7 days, residential treatment may last for a month or more, depending on symptom severity and treatment progress.

Next Steps: Finding Treatment for Teen Depression

The most reputable programs for teenagers with depression follow the integrated model and include a combination of individual therapy, group therapy, family therapy, mindfulness-based practices, experiential therapies, expressive therapies, and community support. Treatment center clinicians will collaborate with teens and families to design a treatment plan that incorporates therapies like dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) with complementary supports like mindfulness, art, and exercise to increase the likelihood of treatment success.

Teens learn, alongside treatment peers and with the help of mental health professionals, the skills and tools they need to participate fully in all areas of their lives. Treatment helps them return to school, family, social life, and extracurricular activities with the practical knowledge they need to manage their depressive symptoms and live the life they want to live, rather than a life dictated by their mental health diagnosis or the symptoms of their mental health disorder.

Treatment works – and evidence shows that the sooner a teen with depression receives appropriate, evidence-based care, the greater their chances of a full and sustained recovery.

Finding Help: Resources

Parents seeking treatment for their teen can 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. 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 right now