I think my teen is depressed. How can I get them help and what are the treatment options?

Sydney: Moody, withdrawn, down. These words are often used by parents of teens. And young people may say they feel so “depressed” about upcoming exams, or that the world is “just so depressing” these days.

But how do you know if your teen is experiencing what health professionals call “major depression”? And when should you seek help? First, let’s understand what is meant by this term. Major depression is characterised by persistent low mood and/or irritability and loss of interest or pleasure in usual activities for at least two weeks.

It also includes physical symptoms, such as sleep disturbance and fatigue, and cognitive symptoms, such as negative thoughts about themselves and the future, difficulty concentrating or making decisions.

Major depression is more than brief sadness, or an expected reaction to loss or a stressful event.

While the diagnosis is the same for adolescents and adults, teens may be more likely to present with irritability and mood changes rather than the low mood typical of adults.

Increasing over time

There is evidence depression is increasing among young people, with an international study in 2021 estimating 25% of children and adolescents experienced elevated depression symptoms – double pre-pandemic levels.

While Australia was not included in this study, a recent Australian study showed psychological distress have spiked in Australian millennials (born between the early 1980s and late 1990s) and Gen-Z Australians (born late 1990s to early 2010s).

While the cause of this increase is unclear, it is likely due to multiple factors, such as financial pressures, social isolation, and climate change, and made worse by the COVID pandemic.

Given the understandable distress experienced by many young people, how can parents or carers know when to seek help?

Listen up

Begin by talking to your child. Let them know you have noticed some changes and you are concerned about them. If your child opens up about their difficulties, listen carefully and validate their feelings. Being able to talk about difficulties, and knowing support is there if they need may be enough for some teens.

Read up on depression from reputable sources, so you are better equipped to understand and support a young person.

Try not to dismiss a teen’s feelings or punish irritable behaviour. It can be tempting to remind them of positives or offer solutions – but this can often backfire, leaving them feeling misunderstood. While it might be difficult or uncomfortable to talk openly with your teen about their mental health, it is often a huge relief for them.

Professional help may be needed if they are highly distressed, or if their difficulties are having a significant impact on their usual activities and relationships (this may include withdrawing from many activities, avoiding school, or avoiding friends and family most of the time).

Start with a GP

The good news is, effective treatments are available. The first step to finding appropriate treatment will likely be supporting your teen to see a GP. Again, simply talking through their concerns with the doctor may be very helpful. Your young person might prefer to discuss this with the GP without you.

The GP may refer them to a mental health professional, such as a psychologist or psychiatrist.

Teens can also go directly to an organisation like Headspace, which provides information, support and services to young people aged 12 to 25 and their families and friends via centres across Australia.

What does depression treatment look like?

A recent review on recognising and managing teen depression examined clinical practice guidelines from Canada, Australia, the United Kingdom, the United States and New Zealand found a comprehensive treatment approach is typically used.

Treatment can include:

• education about depression and its treatment
• lifestyle interventions (such as improving sleep, diet and exercise)
• psychological therapy (often focused on understanding and changing unhelpful thinking patterns)
• prescription of antidepressants when needed.

Whether to start a teen on antidepressant medication can be a difficult decision. It should be a collaborative decision involving the teen, their parents and health professionals.

Like all medication, antidepressants have side effects and potential risks. They are typically used in cases of severe depression, or if psychological treatments have been unsuccessful.

Suicidal thoughts or behaviour are a possible side effect of antidepressants for a small proportion of adolescents and should be carefully monitored. However, untreated depression is also a risk factor for suicide, so the potential benefits and risks of antidepressant use by teens needs to be carefully considered.

Assessing risk

Suicidal thoughts and self-harm are common in depression but can be effectively treated.

Suicide risk assessment is a critical part of any treatment for depression, and should include the development of a safety plan with the teen and their parents or carers. Safety plans can be very helpful in times of distress, listing helpful coping strategies and contact details for family, friends and health professionals.

If you are concerned your teen might be at risk of suicide, take it seriously. Ask them direct questions, such as “Are you thinking about suicide?”

Get professional support as soon as possible and take the young person to the nearest emergency department or call 000 if you are worried about their immediate safety. You can also contact Kids Helpline 24 hours a day 1800 55 1800.

Importantly, look after yourself. Supporting a teen with depression can take a toll and lead to significant tension in a household.

Find someone (other than your child) you can confide in. Make sure you’re getting rest, nutrition and exercise. Seek professional support if you find yourself struggling. Taking care of yourself means you are better equipped to support your child. (The Conversation)