Teen depression is a serious medical illness. It's more than just a feeling of being sad or "blue" for a few days. It is an intense feeling of sadness, hopelessness, and anger or frustration that lasts much longer. These feelings make it hard for you to function normally and do your usual activities. You may also have trouble focusing and have no motivation or energy. Depression can make you feel like it is hard to enjoy life or even get through the day.

Did you know that big and important changes happen in the brain during adolescence? Here are seven things to know about the teen brain:

1. Adolescence is an important time for brain development.

Although the brain stops growing in size by early adolescence, the teen years are all about fine-tuning how the brain works. The brain finishes developing and maturing in the mid-to-late 20s. The part of the brain behind the forehead, called the prefrontal cortex, is one of the last parts to mature. This area is responsible for skills like planning, prioritizing, and making good decisions.

2. Brain development is related to social experiences during adolescence.

Changes to the areas of the brain responsible for social processes can lead teens to focus more on peer relationships and social experiences. The emphasis on peer relationships, along with ongoing prefrontal cortex development, might lead teens to take more risks because the social benefits outweigh the possible consequences of a decision. These risks could be negative or dangerous, or they could be positive, such as talking to a new classmate or joining a new club or sport.

3. The teen brain is ready to learn and adapt.

The teen brain has an amazing ability to adapt and respond to new experiences and situations. Taking challenging classes, exercising, and engaging in creative activities like art or music can strengthen brain circuits and help the brain mature.

4. Teen brains may respond differently to stress.

Because the teen brain is still developing, teens may respond to stress differently than adults. This could increase teens’ chances of developing stress-related mental illnesses such as anxiety and depression. Recognizing possible triggers and practicing effective coping techniques can help teens deal with stress. Learn more about managing stress.

5. Most teens do not get enough sleep.

Research shows that the sleep hormone melatonin works differently in teens than in children and adults. In adolescence, melatonin levels stay high later at night and drop later in the morning, which may explain why teens may stay up late and struggle with waking up early. Many teens do not get enough sleep, making it harder to pay attention, control impulses, and do well at school. Getting good sleep at night can help support mental health. 

6. Mental illnesses may begin to appear during adolescence.

Ongoing changes in the brain, along with physical, emotional, and social changes, can make teens more likely to experience mental health problems. The fact that all these changes happen at one time may explain why many mental illnesses—such as schizophrenia, anxiety, depression, bipolar disorder, and eating disorders—emerge during adolescence.

7. The teen brain is resilient.

Despite the stresses and challenges that come with adolescence, most teens go on to become healthy adults. Some changes in the brain during this critical phase of development actually help support resilience and mental health over the long term.

Depression (also known as major depression or major depressive disorder) is a psychiatric disorder that affects mood, behavior, and overall health. It causes prolonged feelings of sadness, emptiness, or hopelessness, and a loss of interest in activities that were once enjoyed. People with depression may also have changes in appetite (leading to overeating or not eating enough), changes in sleeping patterns (sleeping too much or not being able to sleep), loss of energy, and difficulty concentrating. Although depression is considered primarily a mental health disorder, it can also have physical features including headaches, other unexplained aches and pains, unusually slow or fast movements, and digestive problems. To be diagnosed with depression, an individual must have signs and symptoms nearly every day for at least 2 weeks. However, the features of this condition vary widely.

Depression most commonly begins in late adolescence or early adulthood, although it can appear at any age. If untreated, episodes of depression can last for weeks, months, or years, and can go away and come back (recur). Affected individuals may have difficulty functioning in their daily lives, including at school or work. People with depression have a higher risk of substance abuse problems and dying by suicide than the general population.

Several health conditions are closely related to depression or have depression as a characteristic feature. These include dysthymia (which has long-lasting signs and symptoms that are similar to, but not as severe as, those of depression), perinatal or postpartum depression (which occurs around or following the birth of a child), seasonal affective disorder (which is triggered by the changing of the seasons), bipolar disorder (which can include both "highs," or manic episodes, and depressive episodes), and generalized anxiety disorder. In people with schizoaffective disorder, depression or another mood disorder occurs together with features of schizophrenia (a brain disorder that affects a person's thinking, sense of self, and perceptions).

Depression can happen at any age, but often begins in the teens or early adulthood. Certain teens are at higher risk of depression, such as those who

• Have other mental health conditions, such as anxiety, eating disorders, and substance use
• Have other diseases, such as diabetes, cancer, and heart disease
• Have family members with mental illness
• Have a dysfunctional family/family conflict
• Have problems with friends or other kids at school
• Have learning problems or attention deficit hyperactivity disorder (ADHD)
• Have had trauma in childhood
• Have low self-esteem, a pessimistic outlook, or poor coping skills
• Are lesbian, gay, bisexual, or transgender, especially when their families are not supportive

Many factors may play a role in depression, including

• Genetics. Depression can run in families.
• Brain biology and chemistry.
• Hormones. Hormone changes can contribute to depression.
• Stressful childhood events such as trauma, the death of a loved one, bullying, and abuse.

If you have depression, you have one or more of these symptoms most of the time:

• Sadness
• Feeling of emptiness
• Hopelessness
• Being angry, irritable, or frustrated, even at minor things

You also may also have other symptoms, such as

• No longer caring about things you used to enjoy
• Changes in weight - losing weight when you are not dieting or gaining weight from eating too much
• Changes in sleep - having trouble falling asleep or staying asleep, or sleeping much more than usual
• Feeling restless or having trouble sitting still
• Feeling very tired or not having energy
• Feeling worthless or very guilty
• Having trouble concentrating, remembering information, or making decisions
• Thinking about dying or suicide

Being a teenager can be tough, but it shouldn’t feel hopeless. If you have been feeling sad most of the time for a few weeks or longer and you’re not able to concentrate or do the things you used to enjoy, talk to a trusted adult about depression.

Do I have depression?

• Do you often feel sad, anxious, worthless, or even “empty”?
• Have you lost interest in activities you used to enjoy?
• Do you get easily frustrated, irritable, or angry?
• Do you find yourself withdrawing from friends and family?
• Are your grades dropping?
• Have your eating or sleeping habits changed?
• Have you experienced any fatigue or memory loss?
• Have you thought about suicide or harming yourself?

Depression looks different for everyone. You might have many of the symptoms listed above or just a few.

How do I get help for depression?

You’re not alone, and help is available. You can feel better. To get help:

• Talk to a trusted adult (such as your parent or guardian, teacher, or school counselor) about how you’ve been feeling.
• Ask your doctor about options for professional help. Depression can be treated with psychotherapy (also called “talk therapy”), medication, or a combination of medication and talk therapy.
• Try to spend time with friends or family, even if you don’t feel like you want to.
• Stay active and exercise, even if it’s just going for a walk. Physical activity releases chemicals, such as endorphins, in your brain that can help you feel better.
• Try to keep a regular sleep schedule.
• Eat healthy foods.

For immediate help, call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

If your child is between ages 12 and 18, ask the doctor about screening (testing) for depression — even if you don’t see signs of a problem.

Why do I need to get my teen screened for depression?

Depression can be serious, and many teens with depression don’t get the help they need.

The good news is that depression can be treated with counseling, medicine, or a combination of both. When you ask your child's doctor about screening for depression, find out what services are available in case your teen needs follow-up care.

What is depression?

Depression is an illness that involves the brain. It can affect your thoughts, mood, and daily activities — and make you feel sad or down. But depression is more than feeling sad for a few days.

Teen depression can be a serious mental illness. If you child is depressed, they may:

• Feel sad or irritable (easily upset) most of the time
• Lose interest in activities they used to enjoy
• Have aches and pains for no clear reason
• Have trouble concentrating, remembering things, or making decisions
• Sleep too much or be unable to sleep
• Eat too much or have trouble eating
• Use drugs or alcohol
• Think about death or suicide

It’s normal for teens to have mood swings, and it can be hard to tell if your child is feeling down or if they’re depressed. That’s why it’s so important for all teens to be screened for depression.

What causes depression?

Depression can happen to anyone. It’s not your fault or your teen’s fault. Some experiences may make it more likely that a teen will develop depression, like:

• Dealing with a big loss, like a death or divorce in the family
• Living with someone who's depressed
• Having another mental health problem, like anxiety or an eating disorder
• Feeling stressed at school or at home
• Having a family history of depression

Keep in mind that teen girls are more likely to get depressed than teen boys.

What happens during a depression screening?

The doctor will ask your teen questions about their feelings and behaviors. This may include asking how often your teen:

• Feels hopeless or sad
• Has low energy or feels tired during the day
• Has trouble paying attention at school
• Eats too much or has trouble eating

Screening for depression usually takes about 5 minutes. It can be part of your teen’s yearly checkup.

What if the doctor finds signs of depression?

If your child is showing signs of depression, the doctor will:

• Refer your teen to a therapist or doctor with special training in helping young people with emotional or behavioral problems
• Talk about medicines or other treatments — like talk therapy — that could help your teen manage their depression
• Order tests to check for other health problems

Make sure to include your teen when you make any decisions about treatment.

Talk to your teen’s doctor about depression screening.

Ask the doctor to screen your child for depression. If you’re worried about your teen, be sure to let the doctor know. Find out what services are available in case your teen needs treatment.

Write down any concerns you have.

Keep track of your teen’s actions and words that make you think they might be depressed. If you see a change in your child’s behavior, make a note about the change and when it happened. Include details like:

• How long the behavior's been going on
• How often the behavior happens
• How serious you think it is

Share these notes with your teen’s doctor. You can also use them to start a conversation with your child.

Watch for signs that your teen may be thinking about suicide.

Most people who are depressed don’t attempt suicide, but depression can increase the risk of suicide and suicide attempts. Suicide is the second leading cause of death for people ages 10 to 34.

These behaviors may be signs that your teen is thinking about suicide:

• Talking about wanting to kill or hurt themselves
• Taking risks, like driving recklessly
• Spending less time with friends and family
• Talking about not being around in the future or “going away”
• Giving away prized possessions
• Increasing the use of alcohol or drugs
• Talking about feeling hopeless or very angry

If your child is showing some or all of these warning signs, get help right away. Visit the National Suicide Prevention Lifeline or call 1-800-273-TALK (1-800-273-8255) to learn how to help.

If you think your child may be in immediate danger, call 911 or take them to the emergency room.

If you think you might be depressed, tell someone that you trust, such as your

• Parents or guardian
• Teacher or counselor
• Doctor

The next step is to see your doctor for a checkup. Your doctor can first make sure that you do not have another health problem that is causing your depression. To do this, you may have a physical exam and lab tests.

If you don't have another health problem, you will get a psychological evaluation. Your doctor may do it, or you may be referred to a mental health professional to get one. You may be asked about things such as

• Your thoughts and feelings
• How you are doing at school
• Any changes in your eating, sleeping, or energy level
• Whether you are suicidal
• Whether you use alcohol or drugs

Effective treatments for depression in teens include talk therapy, or a combination of talk therapy and medicines:

Talk therapy

Talk therapy, also called psychotherapy or counseling, can help you understand and manage your moods and feelings. It involves going to see a therapist, such as a psychiatrist, a psychologist, a social worker, or counselor. You can talk out your emotions to someone who understands and supports you. You can also learn how to stop thinking negatively and start to look at the positives in life. This will help you build confidence and feel better about yourself.

There are many different types of talk therapy. Certain types have been shown to help teens deal with depression, including

• Cognitive behavioral therapy (CBT), which helps you to identify and change negative and unhelpful thoughts. It also helps you build coping skills and change behavioral patterns.
• Interpersonal therapy (IPT), which focuses on improving your relationships. It helps you understand and work through troubled relationships that may contribute to your depression. IPT may help you change behaviors that are causing problems. You also explore major issues that may add to your depression, such as grief or life changes.

Medicines

In some cases, your doctor will suggest medicines along with talk therapy. There are a few antidepressants that have been widely studied and proven to help teens. If you are taking medicine for depression, it is important to see your doctor regularly.

It is also important to know that it will take some time for you to get relief from antidepressants:

• It can take 3 to 4 weeks until an antidepressant takes effect
• You may have to try more than one antidepressant to find one that works for you
• It can also take some time to find the right dose of an antidepressant

In some cases, teenagers may have an increase in suicidal thoughts or behavior when taking antidepressants. This risk is higher in the first few weeks after starting the medicine and when the dose is changed. Make sure to tell your parents or guardian if you start feeling worse or have thoughts of hurting yourself.

You should not stop taking the antidepressants on your own. You need to work with your doctor to slowly and safely decrease the dose before you stop.

Programs for severe depression

Some teens who have severe depression or are at risk of hurting themselves may need more intensive treatment. They may go into a psychiatric hospital or do a day program. Both offer counseling, group discussions, and activities with mental health professionals and other patients. Day programs may be full-day or half-day, and they often last for several weeks.

Talk Therapy (“Psychotherapy”)

Several types of psychotherapy—or “talk therapy”—can help people with depression. There are several types of psychotherapies that may be effective in treating depression. Examples include cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy.

"Now I'm seeing the specialist on a regular basis for "talk therapy," which helps me learn ways to deal with this illness in my everyday life, and I'm taking medicine for depression. I'm starting to feel more like myself again. Without treatment, I felt like everything was dark-as if I was looking at life through tinted glasses. Treatment is helping it clear."

Cognitive-Behavioral Therapy (CBT)

CBT can help an individual with depression change negative thinking. It can help you interpret your environment and interactions in a positive, realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse.

Interpersonal Therapy (IPT)

IPT is designed to help an individual understand and work through troubled relationships that may cause the depression or make it worse. When a behavior is causing problems, IPT may help you change the behavior. In IPT, you explore major issues that may add to your depression, such as grief, or times of upheaval or transition.

Problem-Solving Therapy (PST)

PST can improve an individual’s ability to cope with stressful life experiences. It is an effective treatment option, particularly for older adults with depression. Using a step-by-step process, you identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an individual or group format.

For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.

Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behavior. Most psychotherapy takes place with a licensed and trained mental health care professional and a patient meeting one on one or with other patients in a group setting.

Someone might seek out psychotherapy for different reasons:

• You might be dealing with severe or long-term stress from a job or family situation, the loss of a loved one, or relationship or other family issues. Or you may have symptoms with no physical explanation: changes in sleep or appetite, low energy, a lack of interest or pleasure in activities that you once enjoyed, persistent irritability, or a sense of discouragement or hopelessness that won’t go away.
• A health professional may suspect or have diagnosed a condition such as depression, bipolar disorder, post-traumatic stress or other disorder and recommended psychotherapy as a first treatment or to go along with medication.
• You may be seeking treatment for a family member or child who has been diagnosed with a condition affecting mental health and for whom a health professional has recommended treatment.

An exam by your primary care practitioner can ensure there is nothing in your overall health that would explain your or a loved one’s symptoms.

Antidepressants are medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults.

The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include:

• Fluoxetine
• Citalopram
• Sertraline
• Paroxetine
• Escitalopram

Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and includevenlafaxine and duloxetine.

Another antidepressant that is commonly used is bupropion. Bupropion is a third type of antidepressant which works differently than either SSRIs or SNRIs. Bupropion is also used to treat seasonal affective disorder and to help people stop smoking.

SSRIs, SNRIs, and bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.

Antidepressants act on the theory that depression is caused by a lack of the key neurotransmitters responsible for mood: serotonin, norepinephrine, and dopamine. The idea is to keep these neurotransmitters "on" by preventing them from early reuptake after they are released into the synapses, or from being broken down by monoamine oxidase.

There are four main classes of antidepressants. In order of earliest to latest, they include the monoamine oxidase inhibitors (MAOIs), tricyclics, selective serotonin reuptake inhibitors (SSRIs), and norepinephrine-serotonin reuptake inhibitors (NSRIs). All antidepressant medications can have side effects, including weight gain and sexual dysfunction.

Scientists are not sure about the actual relationship between neurotransmitters and depression. For example, many people who are depressed have low levels of norepinephrine. Some antidepressants can increase the level of norepinephrine in the brain and subsequently relieve depressive symptoms. Conversely, other people who are depressed have high levels of norepinephrine, and the same scenario may hold true for other neurotransmitters. So, while we know there is a strong relationship between neurotransmitter levels in the brain and clinical depression, and that antidepressant medications work for a great many people, we are not absolutely certain of the actual relationship between neurotransmitters and depression.