Depression in adolescents – learning all the nuances

How to distinguish teenage depression from the melancholy of adolescence

Depression is a mental disorder characterized by a prolonged state of depression, sadness and loss of interest in life. It can occur at any age, but most susceptible to it are adolescents and young adults in their 20s and 30s.

The first group deserves special attention. On the one hand, the course of the illness is complicated by the influence on the psyche of hormonal reorganization. On the other hand, it is easy to miss the symptoms, writing off the prolonged depressed mood to adolescence. This article will help parents to recognize them in time and prepare for treatment.

What is depression in a teenager

The term refers to a set of depressive disorders characteristic of adolescence. Destructive mood dysregulation disorder (MDDD) first appears in children between the ages of 6 and 10. It consists in regular (more than three times a week) flashes of rage and heightened irritability in relation to everyone around.

Major depressive disorder (MDD) more corresponds to a picture of depression in its usual sense. The adolescent plunges into a state of sadness unrelated to loss or disappointment for more than two weeks. He is either crying or bored. MDD more often develops during puberty.

Dysthymia (chronic depressive disorder) is a constant prevalence of irritation or depression. Follow-up of at least one year is necessary to make a diagnosis.


Medicine has not yet established why adolescent depression occurs. However, it is known for sure that it is based on an imbalance of neurotransmitters – serotonin, dopamine and noradrenaline – responsible for mood.

This distinguishes true depression from demoralization. The latter can be replaced at any moment by at least a brief period of cheerfulness. Under conditions of neurotransmitter imbalance this is impossible.

The provoking factors are:

  • genetic predisposition;
  • Loss suffered in early childhood without going through the usual sequence of psychological phenomena (shock, denial, aggression and comprehension)
  • Deprivation (unmet needs).

The factor of hormonal rearrangement characteristic of transitional age is also added. It especially concerns girls during the period of formation of the menstrual cycle. Fluctuations in the levels of sex hormones upset the balance of neurotransmitters.

How to recognize depression in a teenager?

If a person in 15-16 years of age is often sad, he may have reasons related to separation from parents and the search for his “I”. However, normal sadness does not last longer than two weeks and is occasionally replaced by joy.

It is also important to pay attention to the accompanying symptoms of depression in adolescents:

  • changes in appetite (toward both starvation and overeating);
  • insomnia (less often, an increase in the period of sleep);
  • increased fatigue;
  • loss of former energy;
  • impaired concentration.

With MDD, an adolescent may suffer from feelings of guilt (not always justified), feel worthless, and think about death. His social skills deteriorate: there are problems in communication not only with adults, but also with peers. In such a condition, the risk of addiction increases. Dysthymia is accompanied by a decrease in self-esteem and a sense of hopelessness.

Types of teenage depression

Above, we considered the types of depressive disorders characteristic of the age group 12-18 years: DRDN, MDD and dysthymia. There are also other classifications, in particular according to provoking factors and the clinical picture. The most accurate identification of the condition allows the right treatment regimen to be selected.

By triggering factors

Often they are mistakenly referred to as the causes of adolescent depression, but they are only triggers. It is common to distinguish such disorders:

  • Somatic. Are provoked by physiological processes, most often puberty or hypothyroidism.
  • Reactive. An external traumatic event (divorce of parents, unhappy love, loss of a loved one) served as a trigger.
  • Psychogenic. Are caused by long-acting psychological factors, causing internal stress (a dysfunctional family, bullying at school).
  • Pharmacogenic. The depressive disorder appears as a side effect of administration of medicines (combined oral contraceptives, painkillers, corticosteroids).

Seasonal depressive disorder is a controversial phenomenon. According to supporters of its existence, it occurs in the fall and winter against a background of a shortage of sunlight.

According to clinical manifestations.

The general symptoms of depressive disorder, noticeable even to a layman, were mentioned above. Here let us pay attention to the specific manifestations of its separate kinds.

With the features of youthful asthenic failure

fixation on a physical disability;

Complaints of an imaginary mental inferiority;


difficulties in communication;

an excessive tendency to reflection;

lack or reduction of empathy;

impaired thought process.

fixation on obscure religious or philosophical concepts;

belief in the meaninglessness of life;

Consideration of suicide.

fixation on ideas of protest;

increased inner tension.


Teenage depression is not a caprice or action to spite parents. The symptoms described above are grounds for referral to a psychotherapist. He starts the clinical assessment with the analysis of the information received from parents.

In work with patients, clarifying conversations (about changes in their lives, about stresses they have undergone) and various questionnaires with open and closed questions are used. Blood tests are also prescribed for:

  • electrolytes;
  • thyroid hormone;
  • vitamin B12;
  • drug content.

For a complete clinical picture, it is important to find out if the patient suffers from any diseases and what medications he or she is taking. Some medications cause a depressive state, and it is enough to stop taking them to overcome it.

Treatment methods

The set of treatment methods varies depending on age. Up to 14 years old, they are limited to psychotherapy with obligatory normalization of the psychological climate in the close environment.

Hospitalization is not usually necessary. The only exception is the manifestation of suicidal tendencies.

With 15-16 years, it is possible to combine these measures with reception of antidepressants. Their purpose is to restore normal functioning of the neurotransmitter system. For this purpose they are used:

  • Selective serotonin and norepinephrine reuptake inhibitors;
  • Non-serotoninergic antidepressants;
  • tricyclic antidepressants.

The duration of drug therapy is at least one year after symptoms subside. Relatives should be prepared for side effects from antidepressants. Usually these are aggression, lethargy or, on the contrary, activation of behavior, sharply contrasting with the previous apathy.


Depression is not a common adolescent phenomenon, but a mental illness. Genetically determined risk factors cannot be excluded, but prevention is possible in a psychological context.

It is possible to prevent the development of a depressive disorder in a girl or boy if symptoms of emotional malaise are noticed in time. Preventive programs are based on the principles of cognitive-behavioral therapy.

They imply forming skills in the teenager:

  • relaxation;
  • overcoming negative thoughts;
  • Recognizing one’s thinking style (optimistic and pessimistic)
  • the analysis of expectations;
  • discussion with oneself (an inner dialogue).

Having these skills not only prevents a plunge into depression. They help to overcome stress in the future and reduce anxiety.

ABC-analysis as a method of prevention of teenage depression

The practice of ABC analysis is of particular interest. It allows the teenager to develop skills of conscious control over emotions, experiences, and thoughts. At the age of 15-16, a person can easily master this technique.

To understand the essence of ABC-analysis, here is an abbreviation for it:

  • A – Adversity. At the first stage, the troubles accompanying the life of the teenager are identified.
  • B – Belief (belief). In the second stage, his or her subjective beliefs about these negative events are discussed.
  • C – Consequence (consequence). In the third stage, emotional experiences based on judgments about unpleasant events are revealed.

The essence of the method is to demonstrate that emotional experiences become consequences not of the event itself, but of its certain subjective interpretation. If a person learns to separate objective events from his or her judgments about them, he or she will also learn to react appropriately.

The Danger of Depressive Disorders

A depressed teenager becomes susceptible to addictions – from alcohol, drugs, and social media. All this leads to a significant deterioration in his physical and mental health.

According to the World Health Organization, depression ranks 15th in the list of causes of disability among adolescents under the age of 14 and in fourth place between the ages of 15 and 18. This disorder often pushes young boys and girls to self-harm or suicide attempts. Therefore, timely treatment gives not only a return of interest in life, but also prevents fatal consequences.

Depression in adolescents

Depression in adolescents is a common condition. 11% of adolescents under the age of 18 suffer from depressive disorders. Girls suffer from depression more often than boys. If depression is ignored and not treated in a timely manner, the condition can lead to a tragic outcome, such as suicide.

Causes of teenage depression

At the transition age there is a rapid growth of the body, which is accompanied by a hormonal shift, restructuring in the vital activity of the entire body. Adolescents also experience stress due to the learning load, increasing responsibility, difficulties in interacting with peers and adults. The above-mentioned points make a child extremely vulnerable. The reasons for the development of depression can be external (stress, poor performance at school, problems in relationships within the family, with peers, serious illness), and internal causes associated with a violation of biochemical processes in the brain.

Symptoms of depression in adolescents

Diagnosis of depression in adolescence causes some difficulties, since the typical picture of depression does not always manifest itself in children. Puberty imposes a mark on the pattern of symptoms of depression, determines the specificity of painful experiences. Much more frequently, depression in teenagers manifests itself in the form of behavioral disorders, interest in alcohol and drugs, and constant boredom. There is a decrease in progress in learning, an abundance of somatic complaints about health, etc. It is important to pay attention to changes in the child’s behavior that may hide symptoms of depression so as not to miss the time and at the right time to consult a psychiatrist, psychotherapist or psychologist for assistance.

“Masks” of depression in a child

Depression in teenagers can hide behind “masks”, when the typical manifestations of depression are not the first, conspicuous component. Conventionally, there are several “masks” or so-called “equivalents” of depression in adolescents.

The deviant equivalent. This equivalent manifests itself in the sudden onset of behavioral disorders that were not peculiar before. The teenager begins to experience a craving for “bad” companies, to skip school, to run away from home, to show interest in alcohol, to steal. Self-harming behavior takes place (guys cut themselves, burn themselves, get into fights). However, unlike true deviant behavior, the child’s condition is marked by despair, and he or she does not get real pleasure from his or her actions. Alcohol and drug use is associated with the fact that the teenager wants to relieve his emotional state. As a rule, teenagers hide their inner feelings from the adults, but in their head they may hide rather gloomy thoughts about their own failure, lack of meaning in life, lack of prospects. Psychologists explain such behavior by the fact that the child intentionally seeks punishment, as he thinks of himself as “bad.”

Case study. Boy R., who in his junior year of school was a model child, academically solid and a favorite of teachers, suddenly began using drugs, cheating on adults, stealing and injuring himself as a teenager. Teachers and parents attributed the behavioral changes to adolescence and took the child’s condition seriously only after an incomplete suicide attempt. Subsequently, the boy admitted to doctors that he had been in a depressive condition for a long time, saw his future in a gloomy light, believed he was useless, thought that he would achieve nothing, but would let everyone down. After visiting a doctor, undergoing treatment and psychotherapy, the boy returned to a normal life, his interest in his studies and plans for the future returned, and his family relations became more trusting.

Apathetic equivalent.It is characterized by difficulties in learning. Children complain of rapid fatigue, reduced concentration, impaired memory, and constant boredom. Often adolescents say that they have become “as if sillier. The above-mentioned problems lead to a decrease in academic performance. Children begin to skip school, stay at home, lose interest in communication, abandon hobbies, hobbies, and neglect personal hygiene. The teenager’s digital activity changes, for example, social networks are replaced by monotonous games or watching videos on the Internet that are not meaningful. With this condition, thoughts of “not wanting to live” often arise, as teenagers begin to blame themselves for their failure. Often adults attribute the teenager’s condition to laziness and scold the child, thereby aggravating the severity of his or her condition and creating a “vicious circle.

Case from practice. The teenager B. after her father’s death stopped attending school and sports activities, began to complain of memory impairment, rapid exhaustion, could not concentrate on the plot of a movie or book, lost contact with friends, and with time almost stopped getting up from bed. After referral to a psychiatrist and the selection of therapy, the girl became more active, proactive, began to communicate with peers again, returned to school, successfully completed 10th grade. Psychotherapy helped her to accept the loss of a loved one. Subsequently, the girl became a great support for her mother.

The hypochondriacal equivalent. This variant of “the mask of depression” is less frequent than the first two. It is manifested by numerous complaints about health, a desire to be constantly examined by doctors. Referring to poor health, such adolescents skip school. Thus they do not deceive parents, but actually experience various physical ailments (dizziness, nausea, a rise in temperature to 38 degrees may be noted).

Case study. Patient K., constantly complained of headaches, abdominal pain, aching extremities, dizziness, nausea, asked to be examined and read about diseases on the Internet. Full examination ruled out the presence of any disease, which calmed the girl down for a while. After a short time, she again found symptoms of serious illness. On her own initiative, the girl visited a psychiatrist. After a selection of treatment, her somatic complaints gradually disappeared, and after working with a psychotherapist, she found out the cause of her depression and was able to overcome it.

“It was like heavy metal was pumped inside me.”

In addition to depressive “masks” in older adolescence, more classic depressive pictures can occur. Young boys and girls complain of homesickness, depressed moods, tearfulness, and anxiety. The voice becomes quiet, speech slows down, and facial expressions become impoverished. Classical depression is characterized by insomnia with night and early morning awakenings, decreased appetite. Food tastes “like grass”; previously favorite dishes are no longer satisfying. Ideas of self-blaming arise, physical defects are exaggerated, begin to seem “ugly. Teenagers periodically describe their experiences in very colorful ways. For example, one girl described her condition as follows – “It is as if heavy metal is being pumped into her and it pours out all over the body. My chest was like a stone. My thoughts were taken and turned over with a meat grinder. My head is a mess.”

How to cope with teenage depression

Parents need to pay attention to such changes in the child’s behavior and seek help from a psychiatrist or psychologist in time. Also during this difficult period, the support of the family and the environment is extremely important. In the treatment of depression in adolescents, a complex approach (medication therapy, individual psychotherapy, family psychotherapy, other rehabilitation activities) is most often used. However, each case of depression is unique. The situation must be considered on a case-by-case basis for optimal selection of treatment. If there are symptoms of depression in a child, it is important not to turn away from him or her, not to be afraid to ask for help in time to restore the smile and joy of life to your son or daughter.

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