Teens and depression—a back-to-school concern

With many teens heading back to school, peer pressure and academic expectations are once again a reality. These added pressures can cause ups and downs during what can be an already tumultuous time of life. For some teens, though, the lows are more than just temporary feelings. They're symptoms of depression.

Depression is one of the most commonly diagnosed mental disorders in children, according to the Centers for Disease Control and Prevention.

Teen depression is a serious mental health problem. It affects how teenagers think, feel and behave, and it can cause emotional, functional and physical problems. Although depression can occur at any time in life, symptoms can differ between teens and adults.

What to look for

Signs and symptoms a teen may be depressed include a change in his or her previous attitude and behavior that can cause significant distress and problems at school or home, in social activities, or in other areas of life.

Be alert for emotional changes, including:

• Feelings of sadness, which can include crying spells for no apparent reason.
• Frustration or feelings of anger, even over small matters.
• Feeling hopeless or empty.
• Irritability or annoyed mood.
• Loss of interest or pleasure in usual activities.
• Loss of interest in, or conflict with, family and friends.
• Low self-esteem.
• Feelings of worthlessness or guilt.
• Fixation on past failures, or exaggerated self-blame or self-criticism.
• Extreme sensitivity to rejection or failure, and the need for excessive reassurance.
• Trouble thinking, concentrating, making decisions and remembering things.
• Ongoing sense that life and the future are grim and bleak.
• Frequent thoughts of death, dying or suicide.

Watch for changes in behavior, including:

• Tiredness and loss of energy.
• Insomnia or sleeping too much.
• Changes in appetite, including decreased appetite and weight loss, or increased cravings for food and weight gain.
• Use of alcohol or drugs.
• Signs of agitation or restlessness, including pacing, hand-wringing or an inability to sit still.
• Slowed thinking, speaking or body movements.
• Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse.
• Social isolation.
• Poor school performance or frequent absences from school.
• Less attention to personal hygiene or appearance.
• Angry outbursts, disruptive or risky behavior, or other acting-out behaviors.
• Self-harm, including cutting or burning.
• Making a suicide plan or a suicide attempt.

Treatment

Treatment depends on the type and severity of a teenager's depression symptoms. A combination of talk therapy and medication can be effective for most teens with depression. If a teen has severe depression or is in danger of self-harm, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

While antidepressant drugs often effectively treat depression and anxiety in children and teenagers, their use in children and teens must be monitored carefully, as rarely there can be severe side effects. Antidepressants carry a Food and Drug Administration black box warning about a risk of increased suicidal thinking and behavior in some people under 25.