Teens, anxiety, and depression: How worried should parents be?

Part of the work of being a teenager is making connections outside of the family and becoming attuned to world issues. But add social media, an ongoing pandemic, and academic and extracurricular pressures to the mix, and teens can become vulnerable to mental health issues.

“Anxiety and depression are the most common mental health concerns we see in teens,” says Kimberly O’Brien, a clinical social worker in the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital.

For many parents of teens, however, these conditions can be hard to detect. “We have a cultural stereotype of a depressed person as someone who keeps the shades drawn and can’t get out of bed,” says Nanci Ginty Butler, director of mental health services in the Division of Adolescent/Young Adult Medicine. Anxiety is often associated with weakness or meekness. “But in adolescents, anxiety and depression can look very different.”

Here, Ginty Butler and O’Brien talk about how teens experience anxiety and depression and how parents can help.

What do anxiety and depression look like in teenagers?

Nanci Ginty Butler: A common sign of depression in teens is irritability and an inability to tolerate stress or adversity. Depression can also make it hard for teens to get along with their family and friends. They often isolate themselves and lose interest in activities they once enjoyed.

Kimberly O’Brien: In younger adolescents, anxiety often arises as social anxiety and fear of group situations or not performing well — in or out of school. As teens approach graduation and early adulthood, the source of their anxiety can shift to fear about the future or their identities.

Signs of anxiety and depression in teens
Anyone can go through a slump. Parents should take notice when their teen’s behavior changes abruptly or they exhibit any of the following signs for two weeks or longer:

Depression
– extreme irritability
– inability to tolerate stress or adversity
– trouble getting along with people
– lost interest in activities
– inability to concentrate
– insomnia

Anxiety
– panic attacks: episodes of sudden, intense fear
– excessive worry about social acceptance
– crippling concern about the future

What goes on in the teen years that may trigger anxiety or depression?

Ginty Butler: Whether it’s gender identity or separating from parents and attaching to a peer group, the teen years are a time when kids are figuring out who they are. “Fitting in” can be a big source of stress for teens. Meanwhile, their bodies are changing and they’re becoming more aware of how they and their peers are affected by real-world issues such as climate change and racial injustice. It can be a lot for teens to deal with.

O’Brien: Teens in this country are under a lot of pressure to excel — socially, academically, and in numerous extracurricular activities. Many are also living with the stress of family conflict and financial uncertainty. If they don’t have a way to take a break, stress escalates and makes it harder for them to enjoy the activities they’re involved in.

How can parents help teens with anxiety and depression?

Pay attention to the kind of pressure you put on your teen

O’Brien: Parental expectations can be a source of stress for a child who thinks their parents’ love depends on how they do in school, sports, or another activity. While it’s important to let children know their parents love them unconditionally, it is also important that parents support their teens in overcoming their fears. Gentle encouragement to try out (safe) situations that scare them can help teens learn how to manage their anxiety. They need these exposures to help them develop resilience in the face of fear or adversity.

Help your teen build strong connections

Ginty Butler: Having a strong connection with an adult helps protect teens against anxiety and depression. This relationship could be with a parent, but it might not be. Depression and anxiety come with an enormous amount of shame and self-blame. Teens who feel this way may push their parents away. If so, parents can help their child cultivate a connection with a trusted adult, such as a coach, school counselor, or the parent of a friend.

Normalize mental health issues

O’Brien: Talking about anxiety and depression without judgment can go a long way toward counteracting the stigma around these issues. Parents may not realize how effective it is to talk openly about mental health. Even if they seem unresponsive at the time, children remember these conversations and know they can talk with their parents in the future if they need to.

Help your teen identify their feelings

O’Brien works with kids of all ages to help them (1) identify their feelings and (2) figure what they need to do to feel better. Parents can do this too.

O’Brien: If your child is feeling anxious, what do they need to do to feel calm? If they’re sad, what do they need to do to feel happy? The path to feeling calmer or happier may involve doing a puzzle to feel calm or watching a funny video to lighten a dark mood. It depends on the teen.

Encourage self-soothing

O’Brien: Sometimes, the best antidote for anxiety or depression is breathing. By getting oxygen into your brain, you’re tricking it into thinking you’re in a relaxed state. Teens can practice 3-3-6 breathing. This involves breathing in for a count of three, holding the breath for a count of three, and exhaling for a count of six. Or they can simply take a few minutes to slowly inhale and slowly exhale.

If you are worried about your teenager, seek help

Ginty Butler: One of the things that often gets lost is the fact that anxiety and depression are both treatable illnesses. With appropriate treatment, people can and do get better.

Parents who are concerned that anxiety or depression is causing their teen to withdraw from friends or activities they used to enjoy should seek professional care for their child. The best place to start is with a trusted health care provider, such as a family pediatrician. You can also reach out to Boston Children’s or another pediatric health provider for resources.

Learn more about the Division of Adolescent Medicine/Young Adult Medicine and the Department of Psychiatry and Behavioral Sciences.