Your son comes home from school, slams down his books, and retreats to his room with a scowl. Since starting high school several months ago, you’ve noticed he’s been moody and irritable and his grades are starting to suffer. Should you be worried about depression?
“Almost everyone goes through periods of feeling sad or irritable for usually brief periods of time,” says Dr. Oscar Bukstein, associate psychiatrist-in-chief and vice chairman of psychiatry at Boston Children’s Hospital. “What sets depression apart is the persistence of symptoms over time and the presence of distress or impairment that interferes with daily life.”
Bukstein says he’s seen a steady rise in depression in young people over the past 25 years, as the stress of daily life increases. “The good news is that treatment generally works and more kids are seeking treatment.”
He offers the following seven tips for recognizing depression in your teen and getting help:
1. Look at key relationships
If you’re worried your child might be depressed, take a good look at their family relationships, social relationships, and academic performance. “These are the big three areas in terms of functioning,” says Bukstein. “If your child is having difficulty in one or more of these areas, it could be a sign of depression.”
2. Watch for behavior changes
All teens are moody or irritable sometimes. But an overall change in your child’s behavior could be a sign of a problem. “We’re talking about an irritability that’s pervasive — not just a kid who cops an attitude from time to time,” says Bukstein. You might also notice sleep or appetite changes, or that your child no longer seems to have fun doing activities he or she once enjoyed.
3. Know that girls and young women have a higher risk
Before puberty, the rates of depression in boys and girls are about even. After puberty, girls are twice as likely as boys to have depression. “We’re not exactly sure why this occurs, but it may have something to do with hormonal changes,” says Bukstein. He also notes that girls often feel more pressure to keep up on social media, which can be a big source of stress.
4. Get help from your pediatrician
Early diagnosis and treatment are key. If you have concerns, call your pediatrician. “Many pediatricians are very good at diagnosing depression and are well-equipped to handle first-line treatment and referrals,” says Bukstein. “When kids are familiar with their doctor, they usually feel more comfortable talking about their concerns.”
5. Ask about therapy
Bukstein recommends therapy for mild depression before jumping in with medication. “For many kids, this may be all they need,” he says. “These days, the focus is on therapy that gives kids skills to help deal with their mood or to look at the ways their thinking perpetuates depression.” For example, cognitive behavioral therapy (CBT) helps kids challenge their negative thoughts or beliefs. “The literature suggests that the kids who learn these skills do better in the long run, and have fewer severe recurrences of depression,” says Bukstein.
6. Don’t be afraid of medication
Kids with moderate to severe depression usually do best with a combination of medication and therapy. Although some parents worry about the side effects of antidepressants, Bukstein says the benefits far outweigh the risks. “Negative side effects can occur with antidepressants, but if you look at the big picture, the number of kids who benefit far outnumber those who have problems with treatment.”
7. Know when to call a specialist
Bukstein says that teens who are suicidal or don’t get better with first-line treatment should generally be referred to a specialist or have their primary care physician receive consultation from a specialist. “I would generally say that anyone who has been on medication for four to eight weeks or has had at least four sessions of therapy with no improvement should be considered for referral to a child and adolescent mental health specialist for consultation,” says Bukstein.
If you’re worried your teen might be depressed or suicidal, call your pediatrician or a mental health care professional right away.
Learn more about Boston Children’s Outpatient Psychiatry Services.
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