Helping your teen with depression

You, your teen, and your teen's health care provider should discuss what might help your teen the most. The most effective treatments for depression are:

• Talk therapy
• Antidepressant medicines

If your teen has a problem with drugs or alcohol, discuss this with the provider.

If your teen has severe depression or is at risk for suicide, your teen may need to stay in the hospital for treatment.

Talk to your teen's provider about finding a therapist for your teen.

• Most teens with depression benefit from some type of talk therapy.
• Talk therapy is a good place to talk about their feelings and concerns, and to learn ways to deal with them. Your teen can learn to understand issues that may be causing their behavior, thoughts, or feelings.
• Your teen will likely need to see a therapist at least once a week to start.

There are many different kinds of talk therapy, such as:

• Cognitive-behavioral therapy teaches your teen to reason through negative thoughts. Your teen will be more aware of their symptoms, and will learn what makes their depression worse and problem-solving skills.
• Family therapy is helpful when family conflict is contributing to the depression. Support from family or teachers may help with school problems.
• Group therapy can help teens learn from the experiences of others who are struggling with the same type of problems.

Check with your health insurance company to see what they will cover.

You, your teen, and your provider should discuss whether antidepressant medicine might help your teen. Medicine is more important if your teen is severely depressed. In these cases, talk therapy alone won't be as effective.

If you decide that medicine would help, your provider will most likely prescribe a type of anti-depressant medicine called a selective serotonin reuptake inhibitor (SSRI) for your teen.

The two most commonly used SSRI medicines are fluoxetine (Prozac) and escitalopram (Lexapro). These are approved to treat depression in teenagers. Fluoxetine is also approved for children age 8 and older.

Another class of antidepressants, called tricyclics, is not approved for use in teens.

There are risks and side effects of taking antidepressants. Your teen's provider can help manage these side effects. In a small number of teens, these medicines can make them more depressed and give them more suicidal thoughts. If this happens, you or your teen should talk to the provider right away.

If you, your teen, and your teen's provider decide that your teen will take an antidepressant, make sure that:

• You give it time to work. Finding the right drug and dose can take time. It could take 4 to 8 weeks to get to full effect.
• A psychiatrist or other provider who treats depression in teens is watching for side effects.
• You and other caregivers watch your teen for suicidal thoughts or behaviors, and for nervousness, irritability, moodiness, or sleeplessness that is getting worse. Get medical help for these symptoms right away.
• Your teen does not stop taking the antidepressant on their own. Talk to your teen's provider first. If your teen decides to stop taking the antidepressant, your teen may be instructed to lower the dose slowly before stopping altogether.
• Keep your teen going to talk therapy.
• If your teen is depressed in the fall or winter, ask your doctor about light therapy. It uses a special lamp that acts like the sun and may help with depression.

Keep talking with your teen.

• Give them your support. Let your teen know that you are there for them.
• Listen. Try not to give too much advice and do not try to talk your teen out of being depressed. Try not to overwhelm your teen with questions or lectures. Teens often shut down with that kind of approach.

Help or support your teen with daily routines. You can:

• Schedule your family life to help your teen get enough sleep.
• Create a healthy diet for your family.
• Give gentle reminders for your teen to take their medicine.
• Watch for signs that depression is getting worse. Have a plan if it does.
• Encourage your teen to exercise more and to do activities they like.
• Talk to your teen about alcohol and drugs. Let your teen know that alcohol and drugs make depression worse overtime.

Keep your home safe for teens.

• Do not keep alcohol in the home, or keep it securely locked.
• If your teen is depressed, it is best to remove any guns from the home. If you feel you must have a gun, lock up all guns and keep ammunition separate.
• Lock up all prescription medicines.
• Work out a safety plan of who your teen feels comfortable talking to if they are suicidal and need urgent help.

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Warning signs of suicide include:

• Giving possessions away
• Personality change
• Risk-taking behavior
• Threat of suicide or plans to hurt oneself
• Withdrawal, urge to be alone, isolation

Teen depression - helping; Teen depression - talk therapy; Teen depression - medicine

American Psychiatric Association website. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.

Bostic JQ, Prince JB, Buxton DC. Child and adolescent psychiatric disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 69.

National Institute of Mental Health website. Child and adolescent mental health. www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health. Updated May 2021. Accessed December 9, 2022.

US Preventive Services Task Force, Mangione CM, Barry MJ, Nicholson WK, et al. Screening for depression and suicide risk in children and adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(15):1534-1542. PMID: 36219440 pubmed.ncbi.nlm.nih.gov/36219440/.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.