Teen Depression: What to Look For

COVID has affected everyone in one way or another. Four in 10 adults reported struggling with mental health or substance use in a pandemic-related survey by the Centers for Disease Control and Prevention (CDC). Young people, ages 18 to 24, reported the highest rate of having suicidal thoughts, according to the CDC.

Mental illness among young people was already on the rise when the pandemic hit. COVID and the COVID-related changes, such as social distancing and virtual learning, added new stressors and for some exacerbated existing mental health conditions.

“Teenagers can be moody and temperamental at times. Keep in mind, they’re going through physical changes and asking questions about who they are and what they want to do with their lives as they become more independent,” says Gurinder Dabhia, MD, a pediatrician at Scripps Clinic Rancho Bernardo. “But while occasional bad moods and acting out can be normal adolescent conduct, these types of behaviors also can indicate underlying depression or anxiety.”

Because normal behaviors vary as children and teens develop, it can be challenging to know if your teen is going through a temporary phase or is experiencing depression or anxiety. However, there are warning signs for both conditions that can help parents.

For the past year, COVID restrictions have limited the type of social interactions and peer group activities that are so important in the lives of teenagers and for their development, such as sport activities, school performances, proms and graduations.

While a return to normal is on the horizon with the arrival of COVID vaccines, the struggles of the past year will likely continue to affect families for some time.

Dr. Dabhia recommends parents to continue checking in with their teen and watch and listen for signs of depression or anxiety.

Signs that may indicate depression include:

• Sudden bursts of anger coupled with irritability
• Negative thinking
• Extreme sensitivity to criticism
• Sulking
• Feeling misunderstood
• A drop in school grades, attendance or not doing homework
• High-risk behaviors, such as using alcohol and drugs
• A change in sleeping patterns or trouble sleeping
• A change in eating habits, such as eating more or less than usual
• Difficulty concentrating
• Unexplained aches and pains, such as headaches
• Withdrawal from family and friends, including texting and video chatting

Everyone experiences feelings of anxiety at times, and it is a normal reaction to stress. When anxiety seems to be continually out of proportion to the situation and affects your teen’s daily life and happiness, then it may signal an anxiety disorder. Symptoms include:

• Excessive worry most days of the week
• Trouble sleeping at night or sleepiness during the day
• Restlessness or fatigue during waking hours
• Trouble concentrating
• Irritability

“Depression and anxiety often occur together, although they should be diagnosed separately and treated as two separate issues,” says Dr. Dabhia.

If your teen exhibits signs of either depression or anxiety that persist for more than two weeks, make an appointment with your teen’s doctor or pediatrician.

The doctor will ask the appropriate screening questions, usually with the parents present, and will also have a confidential discussion with your child. If necessary, your doctor can refer you to a specialist.

“Be ready to discuss specific information about your adolescent’s symptoms, including how long they’ve been present, how much they’re affecting your teen’s daily life and any patterns you’ve noticed,” Dr. Dabhia says.

In addition, bring up any family history of close relatives who have been diagnosed with a mood disorder or mental illness, as well as events in your own immediate family.

Sometimes depression or anxiety may be triggered by changes within the family unit, such as a divorce, remarriage, a new sibling or move. During the pandemic, it could be a loss of a family member or friend to COVID or another illness or the loss of a job.

Pediatricians can screen for depression and ask about other concerns like anxiety or trouble coping with stress. They can also screen for suicide risk.

Any suicide talk should be taken seriously. Seek help immediately by calling the National Suicide Prevention Lifeline at 1-800-273-TALK or texting the Crisis Text Line by texting 'TALK' to 741741.

“It’s important that parents stay positive and that they keep the lines of communication open with their teen,” says Dr. Dabhia. “Most people think these conditions are difficult to treat, but there are a variety of options that can help, including talk therapy. Early treatment can shorten the period of illness and help your teen cope.”

The University of Michigan poll noted what parents were doing to help improve their teens' mental health during the pandemic. Many relaxed social media rules. One in four said they sought help from a mental health professional for their teen. Most said it had a positive effect. Many also reported using mental health apps.

“Make sure to talk to your teen frequently and offer your support,” adds Dr. Dabhia. “Make it clear you are willing to offer whatever support they need.”

Be persistent, she says. “Don’t give up if your adolescent refuses to talk at first. Talking about depression can be tough, but helpful.”

Also, don’t lecture. “Accept what your teen tells you without judging or criticizing,” Dr. Dabhia says. “It’s important to validate their feeling,” she says. “Don’t think you can just talk your adolescent out of his or her anxiety or depression. Learn to take the stresses and worries of your teen seriously and never dismiss talk of suicide.”