Everything you need to know about Depression in Teenagers

Teenagers in the UK have higher mental health needs than ever before. According to NHS statistics, 1 in 6 young people in England aged 5 to 16 experienced a mental health problem in 2020; this is up from 1 in 9 young people in 2017. Nearly one-third of 16- to 24-year-olds in the UK reported some evidence of depression or anxiety in 2017 to 2018.

In 2021, 24% more patients were in contact with the children and young people’s mental health service (CYPMHS) compared with 2020, and 44% more than in 2019. This included patients who were waiting to be seen.

What is depression?

Depression is a mood disorder that causes a persistent feeling of sadness and low mood. It can also cause people to feel irritable or hopeless. It can also be referred to as major depressive disorder or clinical depression.

Depression can affect how you think, feel and behave and can lead to a variety of emotional, behavioural and physical problems. It may affect your ability to sleep well, your appetite or your relationships with other people. Depression can also cause you to lose interest in hobbies or activities that you used to enjoy. In severe cases, depression can lead to thoughts of suicide or self-harm.

Most people go through periods of feeling low in mood, but when you are depressed, you feel persistently low in mood for weeks or months, rather than just a few days. Most people feel stressed, anxious or low in mood during difficult periods of their lives. Feelings of low mood may improve after a short period of time, rather than being a sign of depression.

Depression doesn’t only affect adults. Children and young people can also become depressed. Depression can affect their relationship with family and friends. It may affect their day-to-day life and prevent them from enjoying school or college, sports, hobbies or other normal activities. Depression and anxiety are among the most common mental health disorders seen in teenagers.

The symptoms of depression in both adults and children can range from being mild to severe. Mild depression may include feeling persistently low in mood, while severe depression can make you feel suicidal.

Depression is not a sign of weakness and it is important to seek help. Depression will not usually get better on its own and without the right help and support, it may continue to get worse.

Most people with depression feel better with medication, psychotherapy or receiving both treatments simultaneously.

What are the signs of depression in teenagers?

Teenagers are experiencing big changes hormonally and developmentally and it can feel like a difficult period of time for lots of young people. Issues such as peer pressure, academic expectations and hormones can be difficult for teenagers to experience, particularly as their brains are still developing. People often expect teenagers to be moody and irritable and for them to want to spend time on their own, away from family members. These common teenage behaviours can mean that the signs of a mental illness like depression can be missed.

The signs of depression in teenagers are similar to the signs of depression in anyone else, and can often include:

• A persistent sadness, or low mood.
• Being grumpy or irritable often.
• Often feeling tired and exhausted.
• Having trouble sleeping or sleeping more than usual.
• Having little interest in things they previously enjoyed.
• Being unable to concentrate.
• Agitation or restlessness.
• Not being as sociable with friends and family.
• Low confidence or self-esteem.
• Talking about feeling guilty or worthless.
• Feeling empty or inability to feel or express emotions.
• Eating less than usual or overeating.
• Noticeable changes in weight.
• Deterioration in hygiene or physical appearance.
• Regular physical symptoms, for example, headaches or stomach aches.
• Difficulties coping at school or college.
• Difficult or angry/aggressive behaviour.
• Bleak and pessimistic views of the future.
• Feeling hopeless or empty.
• Use of alcohol or drugs.
• Having thoughts of suicide or thoughts of self-harming.
• Self-harming, for example, cutting their skin or taking an overdose.

According to Young Minds, in 2018 and 2019, 24% of 17-year-olds reported having self-harmed in the previous year, and 7% reported having self-harmed with suicidal intent at some point in their lives. Nearly half of 17- to 19-year-olds with a diagnosable mental health condition had self-harmed or attempted suicide at some point.

Research shows that teenagers with depression are more likely to use drugs and alcohol. They may use these substances as a way of coping with the symptoms of depression. Drug and alcohol use can seem to provide temporary relief; however, it is likely to make symptoms worse in the long run.

Drug and alcohol use can also interfere with the effectiveness of the treatment for depression. They can interact negatively with some medications used to treat depression and can reduce the effectiveness of the medication and may cause harmful side effects. For further reading about drug and alcohol use in children, please see our knowledge base.

Teenagers who are depressed may also have symptoms of anxiety. Most people feel anxious at times. It’s particularly common to experience some anxiety while experiencing stressful events or life changes. Anxiety is a feeling of unease, such as worry or fear that can be mild or severe. People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.

The signs of anxiety in teenagers include:

• Physical symptoms can include panic, sweating, dizziness, stomach ache or headaches.
• Refusing to go to school or college, or becoming socially isolated.
• Excessive worry that a parent or family member may die or become seriously ill.
• Having high levels of anxiety about the future.
• Experiencing panic attacks.

Anxiety becomes a problem for teenagers when it starts to get in the way of their everyday life and you should seek some support for this.

Causes of depression in teenagers

Similar to adults, teenagers have times when they feel low in mood, or sad. Emotional fluctuations are perfectly normal; however, if those feelings and behaviours last longer than two weeks, it may be a sign of depression. Depression in teenagers is a serious mental health issue, but it is treatable. Similarly, as in adults, teenagers can become depressed for a variety of reasons and it can be complex to determine the exact cause.

Depression can often be caused by a combination of things or a singular issue.

Things that can increase the risk of depression in teenagers can include:

• A family history of depression.
• Bullying.
• Difficulties at school.
• Difficulties at home.
• Abuse.
• Living in a household with domestic abuse.
• A bereavement.
• Physical health difficulties or a disability.
• Having a learning difficulty or ADHD.
• Drug and alcohol use in children.
• Childhood trauma.
• Hormone changes.
• Low self-esteem.

Childhood trauma has been linked to the development of depression in children, teenagers and adults. Traumatic experiences during childhood, for example physical or emotional abuse, neglect or sexual abuse, can affect brain development and cause long-term changes in the brain’s functioning.

These experiences can lead to changes in the brain’s stress response system, which can increase vulnerability to developing depression and other mental health problems. Trauma can also negatively impact upon someone’s self-esteem, relationships with other people, and their ability to cope in stressful situations.

If you are worried that any child is being abused, or if a child discloses something to you that you are worried about, you can speak to the NSPCC who will be able to offer advice and tell you how you can report your concerns.

Poverty and other socio-economic problems have also been linked to poor mental health outcomes. Young people in the lowest income bracket are 4.5 times more likely to experience severe mental health problems than those in the highest income bracket.

Social media use has also been linked to having a negative impact on young people’s mental health. Internet use can expose young people to dangers, such as cyberbullying, online grooming and sexual abuse. Teenagers can easily be exposed to unsuitable or harmful materials online which can cause emotional harm. Think U Know provide some helpful online safety advice and resources. NSPCC also offer a helpful resource for parents and carers with advice on how to keep children and young people safe from bullying and cyberbullying.

How is depression diagnosed in teenagers?

In order to diagnose depression in a teenager, a mental health professional will carry out a thorough assessment. The assessment will take into account symptoms and family history and other health issues will usually be ruled out before a diagnosis is made.

Mild depression may be diagnosed if there is persistent sadness, low mood, or irritability plus two other associated symptoms.

Moderate depression may be diagnosed if there is persistent sadness, low mood or irritability plus three or four other associated symptoms.

Severe depression may be diagnosed if there is persistent sadness, low mood or irritability plus four or more other associated symptoms.

How to deal with depression in teenagers

If a teenager is feeling depressed, they may try to hide this. The most important thing you can do is to keep the lines of communication open, and listen with understanding, empathy and without judgement. If you can encourage them to talk, gently ask what is wrong. If they do not want to talk, do not apply too much pressure on them as this could make them even more reluctant to open up. You can then repeat the process at another time, until they are ready to talk.

If a young person opens up to you about how they are feeling, whatever is causing the problem, you should take it seriously, even if it seems trivial to you. You could let them know that you are concerned about them and that you are there if they need you. You should encourage them to talk to someone else they trust, such as another family member, a friend, or someone at school or college.

If you think your child is showing the symptoms of depression, it is important not to ignore it as depression will not go away on its own. Educate yourself on the symptoms of depression and also what can happen as a result of a young person being depressed, for example self-harming or substance misuse issues, in order for you to be able to support and protect them as best you can.

Untreated depression can lead to other problems, for example:

• Problems with learning.
• Drug or alcohol misuse issues.
• Relationship difficulties.
• Self-harm or suicide.

If a young person has at least one positive relationship with a safe adult, this can be the biggest protective factor for them. Your teen’s relationship with you is the most important resource you have.

Spending quality time with them, doing a fun activity or something they enjoy and making them feel important and valuable will help build their self-esteem. Many young people with depression have low self-esteem and therefore building upon this will be an important part of the process. Encouraging them without applying too much pressure and telling them how proud you are of them can also help.

Some useful tips for young people who are struggling with their mental health include:

• Regular exercise.
• Good sleep hygiene.
• Avoiding being socially isolated.
• Talking to friends, family or a counsellor. If talking is difficult they could write you a letter or send a text message – this can sometimes feel less intense for a young person.
• Writing down their thoughts and feelings – journaling.
• Trying to reduce anything that is causing them stress.
• Accessing support and treatment early.
• Painting, drawing or anything that is creative.
• Spending time with animals/animal therapy.

Support and treatment available

Dealing with depression in children and teenagers early on is important as the effects of depression can be detrimental in the long term, as it can impact upon their learning and brain development, leading to long-term implications.

Dealing with depression can often involve healing from early trauma. Making sense of our experiences can help in moving forward. For this reason, therapy can be a powerful way to help resolve early trauma and overcome depression.

One of the most effective therapies for depression is cognitive behavioural therapy (CBT). CBT is a talking therapy that can help an adult or child manage their problems by changing the way they think and behave.

Talking therapies can help all sorts of people in lots of different situations. You may also hear them referred to as counselling, talking treatments or psychological therapies.

When therapy alone isn’t enough, young people can also take medication for depression. A psychiatrist can prescribe medication. If medication is prescribed, this will usually be given as well as therapy being recommended.

While antidepressants have been shown to be effective in treating severe depression and anxiety in young people, they should be used cautiously and monitored closely to make sure there are no serious side effects. The most serious potential side effect of antidepressant use is their potential to increase the risk of suicidal thoughts and behaviours. This side effect is rare. Most medications used to treat depression in children and teenagers have a black box warning about the possibility they could increase the risk of suicidal thoughts.

The signs of suicidal thoughts in young people can include:

• Expressions of hopelessness about the future.
• Feelings of worthlessness, shame, guilt or self-hatred.
• Anxiety or restlessness.
• Aggressive or hostile behaviour.
• Withdrawal from friends and family and increased social isolation.
• Being missing from home.
• Increased risk-taking behaviours.
• Giving away their possessions.
• Preoccupation with death in conversation, writing or drawing.
• Having many of the symptoms of depression.

If you are worried about your teenager’s mental health, you should make an appointment to see your GP. Your GP can refer them to a local children and young people’s mental health service (CYPMHS) which provide specialist mental health support.

CYPMHS is used as a term for all services that work with children and young people who have difficulties with their mental health or wellbeing. You may also be able to refer your child directly to this service without seeing your GP. Specialist CYPMHS are NHS mental health services that focus on the needs of children and young people.

 They are multi-agency teams that often consist of:

• Psychiatrists.
• Psychologists.
• Social workers.
• Nurses.
• Occupational therapists.
• Support workers.
• Specialist substance misuse workers.
• Education mental health practitioners – who work in mental health support teams in schools and colleges.
• Children’s wellbeing practitioners.
• Primary mental health workers.

Accessing support from a specialist CYPMHS is different depending on where you live and waiting times can also vary. Most CYPMHS have their own website, which will have information about how to access the service, including phone numbers, so you can get in touch directly to ask for advice.

You may also find it helpful to speak to someone at your child’s school or college.

If you or your child is being supported by social services or the youth offending team, your key worker will also be able to refer them to CYPMHS.

If you need help for a mental health crisis or emergency, you should get immediate expert advice and assessment. Here you can find access to an urgent NHS mental health crisis helpline.

If you are worried about any aspect of your child’s mental health, you can call the charity Young Minds free parents helpline for advice on 0808 802 5544. Their lines are open Monday to Friday from 9.30am until 4pm.