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How to Tell if Your Teen is Depressed

And what to do if they are.

The first, and possibly most important thing to know right off the bat is that there truly is no way to be sure if your teen (or child, preteen, young adult) is depressed. Especially now, during this challenging COVID era, there is so much going on for adolescents. So, how can you tell what’s normal and what you should be more concerned about? While there is no perfect equation, there are often signs, and sometimes those signs make all the difference.

What is depression really?

In definition itself, and according to the American Psychiatric Association,

“Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act…Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.” https://www.psychiatry.org

There are a few root pieces to this definition. First, depression is a serious medical illness. The stigma around depression and other mental health concerns is deeply rooted in our society, and even in the year 2021, that stigma is very real. It causes people we care about to hurt longer than they should, to face their demons alone, to delay care and keep silent when they really need help. The first thing that any of you reading this can do is to stop contributing to that stigma (follow me on Medium to receive notifications, for example a future piece to come on what you can do to #stopthestigma).

Second, depression negatively affects the way one feels, thinks, and acts. It is not just sadness, being ‘down in the dumps’, crying now and then, or wishing you were happier. Depression sinks in, it attacks one’s thoughts, and how and why they do what they do.

Finally, depression can lead to a variety of emotional and physical problems and decrease…ability to function. When someone is depressed, they don’t just stay in bed because they’re lazy or show up late to work a lot because they don’t take their job seriously — depression kicks their butt and makes it near to impossible to do even these basic everyday tasks.

So, what does this look like in teenagers?

So, many of you reading this will likely concur that it’s already difficult to well…read…teenagers as it is. What are they thinking? What’s up with the brooding? Is it hormones? A breakup? Just the increasing weight of life? And, while I write this, I realize I want to be clear about teens — I do not in any way see them as gangly, unsure of themselves, moody, hormone-filled young people. Teenagers are AMAZING. Really. Sure, read that again, I said amazing. The teens I have had the privilege to know both in my personal life, and those I have worked with professionally, have been some of the brightest, creative, woke, critically thinking humans I have ever met — some much more so than adults I know.

It’s important to remember that being a teenager, being in middle and high school, and trying to figure oneself out is a gigantic undertaking [even before the 2020/2021 mocktail of pandemic and racial tensions served straight up with a twist of climate change]. Injecting depressive symptoms or other mental health concerns into that mix amplifies the everyday struggles our teens already face, and in the end it produces a whole that is most certainly more than the sum of its parts.

So what does depression look like in teens? Is it similar to how it presents in adults or entirely different? Can you tell by looking at a teen whether they are depressed? Is there really any way [apart from asking a professional] to know for sure whether your teen is facing clinical depression? The truth is, there are no clear cut answers to these questions, it’s more like “yes, no, maybe, sometimes, and…under certain conditions.”

A few semi-formed answers:

• Yes, depression can present similarly in teens v. adults.
• No, depression does not always present similarly in teens v. adults.
• Yes, there are times where a teen’s outward appearance may clue you in to depressive feelings.
• No, there are times where a teen’s outward appearance may not at all clue you in to depressive feelings. [See another article I co-authored re: this exact phenomenon here: Depressed Kids Do Not Have a Look.]
• You might, under certain circumstances, maybe be able to tell if your teen likely has depression, but there is no substitute for a professional assessment and evaluation — please consult a therapist before jumping to any conclusions or implementing any radical changes. Your instincts as a parent are likely to be spot-on, but I urge you to please use those instincts to speak with a professional about what to do next.

What should I look out for?

As previously noted, there are times when a teen’s symptoms of depression look very similar to what one would expect from an adult, and other times there is a vast difference. Here are some clues as to what to look out for:

Excessive sadness, tearfulness, withdrawal from social life

Teenagers may very well appear overly sad, cry more than usual, and seem as though they do not want to spend time with friends or family, even those they might be particularly close to. This withdrawal can also take the form of more hiding in their room or secretive behavior. One cautionary statement here: of course, many teens act in these ways because they’re…well, teens. So, for accuracy sake, but at the risk of stereotyping here — we were all adolescents at one point and wanted to do our own thing, in our own space. Usually, though, this withdrawal isn’t accompanied by general sadness, fatigue, etc.

Uncharacteristically poor school performance

If a teen is experiencing depression, they are likely to have a difficult time concentrating on many other things, especially school. In fact, many precipitating/risk factors for teen depression are tied to academic life: the pressure to be perfect, not fitting in, difficulty of homework and schoolwork, and most of all — bullying. Kids are bullied both in school by their peers and online, sometimes by those same peers and sometimes by peers who hide behind fake accounts. If your child shows a rapid or significant change in how they feel about going to school, how well they are doing grade-wise, or become much more closed off about the goings-on at school, it is safe to say that something is going on in their life that is causing or responding to this type of disruption.

Loss of interest in hobbies, sports, after school activities

Loss of interest is a classic depressive disorder symptom. For adults, this may play out as a dread of going to work, difficulty enjoying family time, or a reduction in time spent on hobbies. It is very common for teens to display their loss of interest in semi-similar ways. Often, a kid who has danced or played soccer their whole life may suddenly want to quit the team, skip the recital, or stop talking to their sports or dance friends altogether. They may assert that “nothing has happened” they just “don’t want to anymore.” Other teens may have thrived on music as part of their toolkit of coping skills — singing, mixing, playing and instrument, or just listening to music can come as a great form of expression for young people. If your teen suddenly loses interest in something they used to love, this may be a sign that something more is going on with them.

Exaggerated irritability/sensitivity

This symptoms occurs also in adult depression but is much more common in teens. It is especially apparent in teens who have never been very sensitive, have always had the ability to self-soothe, or are characteristically slow-burners — it takes a lot for them to anger. Many teens suffering from depression take the way they feel extremely personally, and believe that it is their fault they feel this way and that if they could simply “stop,” everything would go back to normal. This results in a heightened sense of sensitivity, of judgement of self and perseveration on the judgements [or even jokes] of others. This usually goes beyond moodiness, and can often seem like odd behavior for the teen, something that parents or teachers would never normally expect.

Regular complaints of body aches, pain, or upset stomach

The brain is a complicated organ, and we still know little about it, even in 2021. One thing we do know is that there is truly a connection between our brain and our ‘gut’. We will keep it that simple for our purposes, as it doesn’t take a biologist or physician to experience this connection. Have you ever told someone you had a ‘gut feeling’ about something, or that you had ‘butterflies in your stomach.’ These phrases are more than just part of a cute rhetoric we use to explain how we ‘know when we’ve found the one,’ or ‘just had a feeling that was the school for me,’ they are much more — representative of a larger connection. This often gets referred to as the brain-gun connection. In lay man’s terms, there is a pathway of neurons that connect the brain in our skull to our “second brain” — the enteric nervous system [ENS], which is responsible for running the gastrointestinal system. It is the reason that we get a ‘pit in our stomach’ before a big race, become nauseous right before going on stage, and even how we ‘feel in our gut’ whether we are making the right decision on something important. It is also the reason that GI symptoms are so common in teens with depression. The depressive feelings themselves link to changes in our digestion, leaving us [especially teens] vulnerable to a rollercoaster or ups and downs both emotionally and physically.

How do I talk to my teen about this?

Look, this part isn’t easy. I say that not to scare those of you about to undertake this task, but rather to validate that no one, not even professionals, can have this conversation perfectly. The one advantage you have is that you know your teen better than many others, even when it seems like you don’t.

And, while there is no perfect way to talk to your teen about depression, there are a few things that are helpful to keep in mind.

1. Manage expectations — try to pick a time when you can speak freely and uninterrupted; set some ground rules, such as not interrupting the other person when they’re speaking
2. Take small bites — don’t try to have this entire conversation all at once; start small and only talk until it becomes apparent that you or your teen need a break
3. Validate feelings — tell them, out loud, that it’s okay to not be okay, that this is hard stuff to talk about, and that you might feel awkward, too
4. Mention the positives — remind your teen about all the things they have going for them; maybe it’s their grades, their free throws, their singing voice, their drive, or their compassion
5. Leave the door open — remind them that this is something they can always come to you with, and that you will as open minded as you can and try to figure things out alongside them

And what if they are depressed — what do I do?

As with anything else important, this will depend on what you learn about your child and what level of concern exists. If you suspect or, in an ideal situation, your teen confides in you that they may be struggling with depressive symptoms, thank them for sharing. Help them to know that you are there for them and want to help them in any way you can. Let them know that it’s important to monitor our feelings, and that sometimes means including professionals. The only way to confirm a diagnosis of depression, after all, is by professional evaluation. And while a diagnosis isn’t always necessary, it does help give some clarity into what you might be dealing with.

To start, here are a few things to keep in mind when discussing therapy:

• therapy should never be used or discussed as a punishment or as recourse for something “done wrong,” as this will only lower motivation
• a teen’s personal buy-in and desire to learn new coping skills has the potential to directly affect their progress, as is your engagement as their parent/guardian
• acknowledge that it’s not easy to open up to a stranger, and that it’s perfectly normal for things to take time, or to
• remember, and remind them too, nothing will be “fixed” in a few sessions, in fact, it’s better not to think of anything being “fixed” at all
• therapy is hard work, so let them know that it’s normal to feel tired afterward, and therefore sometimes helpful to schedule sessions closer to the end of the day
• sometimes, if there is a high need or risk, therapy may need to come before other after-school activities or other outings; certainly, it is important to continue normal routines, but also necessary to take steps to reduce the chance of further distress down the road
• and finally, acknowledge that it’s not easy to open up to a stranger, and that it’s perfectly normal for things to take time, or even to not find the right therapist on the first attempt; things will get better

And when searching for that “right fit”, some information to keep in mind:

• there are many ways to find a clinician — by personal recommendation, websites such as Psychology Today, googling your state or county along with the word “mental health,” or by calling your insurance company and requesting a list of in-network providers
• there are several types of professionals that provide similar services; Licensed Professional Counselors (LPC), psychologists (PhD), Licensed Marriage and Family Therapists (LMFT), and Licensed Clinical Social Workers (LCSW) are all trained to provide individual counseling, and may be certified in various specific methods
• when calling agencies or individual clinicians, confirm that they see clients your child’s age, and that they take your insurance, if that’s important to you
• you will begin by making an intake appointment, which sometimes last up to 60 minutes, following the intake, sessions are most often held weekly for 50–60 minutes per session
• certain modalities and therapeutic frameworks may work better for your child than others; a good clinician will assess for individual needs
• depending on your child’s age and state regulations around mental health treatment, your child’s consent may be needed, but some information discussed may still be confidential and stay between your teen and their therapist
• if at first you don’t succeed, it’s okay to break up with your child’s therapist and try again [and don’t worry, they won’t be offended; they want your child to get the help they need]

If you have trouble finding a therapist for your teen or have further questions before looking, connect with your child’s primary care physician for some referrals or ideas.

Anything else I should know?

Why yes, there is. If you’ve made it this far and you’re a parent or guardian of a teen or child, I want to validate that you have learned so much already. If you’re still with me, it is clear that you care very much about what is best for your child.

Sometimes, despite the absolute best efforts and intentions of parents, teachers, therapists, and other important adults in a child’s life, major depression can go unnoticed, untreated, or underestimated. This is not, I repeat, NOT a reflection on how much you care about your child, how much you listen and pay attention to them, or how well you know them. When teens are in severe pain, they are often very adept at hiding it.

If at any time you find that your teen is self harming, expressing suicidal thoughts, or makes a suicidal gesture or attempt, please seek help immediately. Professionals are available in various formats to assess risk and explain next steps. It is always, always, better to be overly cautious and risk upsetting or angering your child, rather than taking their word for it and potentially leaving room for things to get worse.

If there is any chance your teen or child is in danger, you can use any of the following resources:

• National Suicide Hotline: 800–273–8255
• Crisis Text Line: text HOME to 741741 to be connected to a crisis counselor; free, anonymous, 24/7
• State or county Mobile Crisis team: google your state NOW and save the number in your phone [or, please please feel free to comment if you have any issue finding it, I’m happy to help!]
• Call 911 or proceed directly to your nearest emergency room

Thank you for reading, for educating yourself, and for looking out for our youth and our future.