Is your teen depressed? Seven tips for parents

Your daughter comes home from school, slams down her books and retreats to her room with a scowl. Since starting high school, you’ve noticed she’s been moody and irritable and her grades are starting to suffer. Should you be worried about depression?

“Almost everyone goes through periods of feeling sad or irritable for usually brief periods of time,” says Dr. Oscar Bukstein, associate psychiatrist-in-chief and vice chairman of psychiatry at Boston Children’s Hospital. “What sets depression apart is the presence of distress or impairment that interferes with daily life.”

Bukstein says he’s seen a steady rise in depression in young people over the past 25 years, as the stress of daily life increases. “The good news is that treatment generally works and more kids are seeking treatment.”

He offers the following seven tips for recognizing depression in your teen and getting help:

1. Look at key relationships

If you’re worried your child might be depressed, take a good look at his or her family relationships, social relationships and academic performance. “These are the big three areas in terms of functioning,” says Bukstein. “If your child is having difficulty in one or more of these areas, it could be a sign of depression.”

2. Watch for behavior changes

All teens are moody or irritable sometimes. But an overall change in your child’s behavior could be a sign of a problem. “We’re talking about an irritability that’s pervasive — not just a kid who cops an attitude from time to time,” says Bukstein. You might also notice sleep or appetite changes, or that your child no longer seems to have fun doing activities he or she once enjoyed.

3. Know that girls and young women have a higher risk

Before puberty, the rates of depression in boys and girls are about even. After puberty, girls are twice as likely as boys to have depression. “We’re not exactly sure why this occurs, but it may have something to do with hormonal changes,” says Bukstein. He also notes that girls often feel more pressure to keep up on social media, which can be a big source of stress.

4. Get help from your pediatrician

Early diagnosis and treatment are key. If you have concerns, call your pediatrician. “Many pediatricians are very good at diagnosing depression and are well-equipped to handle first-line treatment and referrals,” says Bukstein. “When kids are familiar with their doctor, they usually feel more comfortable talking about their concerns.”

The real ‘reason’ behind teen suicide
With the recent popularity of the show “13 Reasons Why,” teen suicide has become a hot topic — but many parents and mental health professionals have expressed concerns about the message the series sends to teens.
“Most adolescent suicide victims’ primary ‘reason’ for suicide is that they have a mental illness — almost always depression or another mood disorder — not because of the behavior of peers and adults,” says Bukstein. “This should be the primary lesson of any piece on adolescent suicide.”
If you’re worried your teen might be depressed or suicidal, call your pediatrician or a mental health care professional right away.

 

5. Ask about therapy 

Bukstein recommends therapy for mild depression before jumping in with medication. “For many kids, this is all they need,” he says. “These days, the focus is on therapy that gives kids skills to help deal with their mood or to look at the ways their thinking perpetuates depression.” For example, cognitive behavioral therapy (CBT) helps kids challenge their negative thoughts or beliefs. “The literature suggests that the kids who learn these skills do better in the long run, and have fewer severe recurrences of depression,” says Bukstein.

6. Don’t be afraid of medication  

Kids with moderate to severe depression usually do best with a combination of medication and therapy. Although some parents worry about the side effects of antidepressants, Bukstein says the benefits far outweigh the risks. “Negative side effects can occur with antidepressants, but if you look at the big picture, the number of kids who benefit far outnumber those who have problems.”

7. Know when to call a specialist

Bukstein says that teens who are suicidal or don’t get better with first-line treatment should generally be referred to a specialist or have their primary care physician receive consultation from a specialist. “I would generally say that anyone who has been on medication for four to eight weeks or has had at least four sessions of therapy with no improvement should be referred or receive consultation,” says Bukstein.

Meet the team at Boston Children’s Outpatient Psychiatry Services.