Depression is one of the most common mental health conditions. Many people think of depression as a disorder that primarily impacts adults. However, it also impacts a significant number of teens. As with adults, a bout of depression in teens may range from mild to severe. It may last for a couple weeks, several months, or a year or longer. For some teens, depression may elicit suicidal thoughts and even result in death by suicide. Needless to say, it should never be ignored or dismissed as a typical “symptom” or phase of adolescence. The clinical picture of adolescent depression often looks quite different than adult depression. This is one of the many reasons why parents sometimes completely miss the signs. They often misinterpret things like irritability, laziness, excessive sleep, low motivation, and moodiness – attributing them to adolescent hormones and assuming they’ll eventually pass. Symptoms of depression can vary significantly, so one depressed teen may look quite different than another. Gender often makes a difference as well. Adolescent boys battling depression may be more withdrawn, irritable, restless, or hostile, while adolescent girls may be more tearful, sad, agitated or moody. Here are some of the most common warning signs of depression in teens:
Low energy and loss of motivation
If your usually active, energetic teen has become increasingly lazy, it could be a symptom of depression. Depression robs a person of energy, enthusiasm and excitement. It becomes very difficult just to get up out of bed or off the couch, let alone to get moving. What may look like laziness may be an inability to find the energy to do anything. Take note if your teen is often lying around the house doing nothing, feeling listless, or complaining of boredom – especially if this is a significant change from normal behavior. Even if it’s not new behavior, it could be due to underlying depression that’s been there for a long time.
Isolation and withdrawal
Not all teens are gregarious extroverts who love spending time with friends and family. Some teens are happy investing significant amounts of time exploring solo interests. But most teens, regardless of where they fall on the introvert – extrovert continuum, enjoy spending at least some of their time with others, especially their closest friends. Social isolation and becoming increasingly withdrawn may signal depression. Depressed teens may frequently go off by themselves or spend hours on end in their bedroom, pushing everyone else away. Social events – particularly those they once enjoyed – are no longer fun or interesting. Time with family may take too much energy or feel uncomfortable. They may find it too difficult to put on an upbeat façade or show enthusiasm when their internal world has become dark and bleak. Depression can take a serious toll on relationships with both friends and family, creating even more internal pain for the suffering teen. Friends begin to resent being shut out, pushed away, and having plans cancelled time and again. Some friends eventually give up and walk away, leaving the teen feeling more hurt, misunderstood, and alone. Family members often get tired of and frustrated with the teen’s sullen, moody, “leave me alone” attitude. When loved ones attempt to reach out, they’re often met with hostility, irritability, or the socially acceptable but tiresome “everything’s fine (so leave me alone)” response. Depressed teens often feel that no one truly cares or could possibly understand them. They may also feel that they’re not worthy of anyone’s time or love. It’s often easier to just shut out the whole world than risk having their worst fears validated.
Notable changes in sleep or appetite
As mentioned earlier, teens who sleep excessively may not be doing so out of laziness. Granted, teens require more sleep than adults due to growth spurts and other factor unique to their age. But depression may be playing a major role in hypersomnia as well. Insomnia can also be an indicator of depression, especially if anxiety is also present. If your teen constantly struggles to get out of bed on school days, wants to sleep well past noon on the weekends, or needs frequent naps, don’t just assume it’s normal adolescent behavior. Staying up late every night to watch TV or spend time on the computer may also be a way of avoiding a nightly battle with depression-induced insomnia. Just as sleep may increase or decrease due to depression, appetite changes are also a common symptom. Some teens will start eating more than usual, while others lose interest in food and struggle to eat anything. Increased eating, especially starchy comfort foods high in sugar or salt, may also be a way to soothe or “stuff” painful emotions. Unfortunately, an increase in appetite – especially combined with no energy or motivation to exercise – quickly leads to unwanted pounds, lowered self-esteem and self-loathing, and even more feelings of depression. While it’s not always the case with depression, it’s not uncommon for the pattern to be either a combination of increased sleep and appetite, or difficulties sleeping with a decrease in appetite.
Loss of Interest / Feelings of Apathy
One of the hallmarks of depression in both adults and adolescents is a loss of interest in anything and everything they once enjoyed. With teens, this apathetic attitude is often expressed with phrases like “who cares,” “I don’t care,” “I don’t know,” or “whatever.” For normal teens, this time of life should be filled with a variety of activities and experiences such as sports and other extra-curricular activities, hobbies, spending time with friends, dating, movies and music. Depressed teens, however, tend to lose interest in almost everything. Having fun and experiencing joy become difficult, if not impossible. Not to mention, everything begins to take far too much effort. Interests and goals may change often during adolescence. However, it’s important to pay attention if your teen suddenly drops out of a much-loved sport or activity (e.g. quits the football team or no longer wants to take dance lessons). This could be a possible sign of depression and not just a change of heart.
Poor School Performance, Increased Absences
Depression makes it difficult to concentrate, focus, make decisions and think clearly. It also causes fatigue and lethargy. Each of these things can have an adverse impact on your teen’s academic performance (as well as his or her performance at a job or in sports and other activities). Increased absences may also occur as part of the desire to isolate or because schoolwork simply takes too much effort. Depressed teens may also find it too draining to maintain an upbeat façade several hours a day, five days a week. Constant interaction with friends, classmates, and teachers can feel very draining. When grades begin to suffer, depression often worsens. This is especially true for a teen who’s planning to go to college, as a drop in GPA can quickly ruin the chance of getting into a prestigious or competitive college. If he or she is already attending college, poor grades or frequent absences can lead to a suspension or being kicked out altogether.
Drug or Alcohol Abuse
Many teens experiment with alcohol or drugs at some point, often due to peer pressure, curiosity, or the desire to “fit in” or “look cool.” But some teens turn to substances for a much more serious reason. They use them as a means of escape – a way to self-medicate painful symptoms of depression or other mental health disorders. If your teen is abusing alcohol or drugs (including “legitimate” prescription drugs that aren’t prescribed for him or her), it needs to be addressed. An evaluation by a mental health professional can help determine if depression or another disorder is part of the problem, and suggest the best treatment approach.
Angry or Irritable Mood
While depression is often associated with profound feelings of sadness, sadness may not be the observable (or even conscious) emotion. Many depressed teens become irritable or angry, acting out their painful feelings. Their anger is often aimed at their parents, but friends, siblings, coworkers, and other adults may feel the brunt of it as well. Lashing out verbally can be a sign of thinly veiled depression. Attempts to cope with internal anguish – e.g. loss of hope, excess guilt, grief, pessimism, feelings of worthlessness, self-loathing, and despair – are often expressed in the form of sarcasm, aggression, hostility, cynicism and harsh criticism.
Hopelessness is a very common part of depression. For teens, this is partially because every negative event or feeling often seems so big, so powerful, so major, so life-altering, so “forever.” For example, the painful end of a three-month romantic relationship can feel like the end of the world to a 16-year-old who’s never dated before. Most adults have a more realistic perspective when a relationship ends, knowing that the pain will eventually pass and someone new will come into their life. Teens lack that perspective because they simply don’t have the life experience. And that can quickly lead to an overwhelming sense of hopelessness in a vulnerable teen. Another reason teens are particularly vulnerable to feelings of hopelessness is because they have little control over their lives. Unlike most adults, they don’t have the luxury of finding a new home or a new school if they are in a difficult or unbearably painful situation. For example, adults can (usually) end a toxic relationship with a spouse, significant other, or boss. Teens, however, have little to no options if they live in a toxic home environment or endure relentless bullying at school. The harsh realization that they are trapped or stuck in an unbearable situation for a few or several more years can dangerously fuel their sense of hopelessness.
Suicidal Thoughts and Behavior
One of the greatest dangers of depression (and especially feelings of hopelessness) is that it can trigger suicidal thoughts. While people commit suicide for a variety of reasons, hopelessness is one of the greatest motivators. Hope is what gives people the courage to keep going during times of crisis, pain, or despair. Without it, suicide often appears to be the only solution. Teens, who are naturally short-sighted and impulsive anyway, are especially prone to regarding suicide as the best (and only) means of escape. The catch-22 is that most depressed teens keep their thoughts and feelings of hopelessness and suicide to themselves. If suicide is regarded as especially taboo (e.g. due to religious beliefs), most teens will be even more secretive about how they are feeling. This is usually due to fear of being reprimanded, ridiculed, or punished for such sinful, foolish, or selfish thoughts. The mere mention of suicide is often shunned in highly religious homes, making a depressed, hopeless teen feel even more hopeless because he or she can’t confide in anyone. Some teens reveal their feelings of hopelessness or thoughts of suicide in subtle ways. For example, they may hint at not having a future or give their most cherished possessions to friends or loved ones. They may talk about being a burden or suggest that everyone would be better off if they were no longer around. Other teens are much more straightforward with regard to how they’re feeling and what they’re planning. They may post “goodbye” statements on Facebook or other social media sites. Some will state several times that they wish they were dead or threaten to kill themselves. If no one takes them seriously, this can increase the risk of a suicide attempt by 1) reinforcing their belief that they don’t matter or have a voice and 2) making it easy for them to carry out a suicide plan. There’s nothing more tragic than hearing a grieving parent say something like, “If only I’d taken my child seriously. I thought she (or he) was just being dramatic (or manipulative or seeking attention)”.
Suicide is the third leading cause of death in adolescents. Take any and all warning signs of depression and suicide seriously. Parenting is hard enough, but it’s even more difficult if your teen is struggling with depression. If your teen is expressing anything that suggests feelings of hopelessness or thoughts of suicide, or displaying any of the signs of depression listed above, don’t ignore it. Don’t make the mistake of assuming it’s just hormones or a phase of adolescence that will pass soon enough. Reach out to your teen. Don’t pressure, ridicule, shame, or lecture. Do calmly and gently express genuine concern and show real support. Make sure your teen knows that you are always willing to listen and help in any way you can (and be sure to follow through on that promise). If you suspect that your teen is struggling with depression, set up an appointment for an evaluation with a mental health professional. With proper treatment – which typically includes psychotherapy and, in some cases, medication as well – symptoms of depression can be significantly reduced and even overcome. Don’t let your teen suffer in silence, and please don’t ignore the signs and risk a tragic outcome.