One of the things that can make depression so difficult to recognise is that the symptoms can be things we all struggle with from time to time – sadness, hopelessness, lethargy, lack of engagement. When these very normal human experiences happen in a combination, duration or intensity that start to interfere with day-to-day life (school, relationships), it’s possible that depression might be waving a heavy hand over your teen.

During adolescence, the rates of depression skyrocket. According to the World Health Organisation, depression is the number one cause of illness and disability in adolescents. But there’s something else. Research shows that in half of all adults who have problems with their mental health, their symptoms showed up before age 14. Three-quarters had symptoms by age 24. This puts flashing lights around the importance of noticing when our teens are struggling and making sure they get the support they need. The earlier symptoms are caught, the easier it will be to stop those symptoms expanding into something bigger and more difficult to shift.

What are the symptoms of depression in teens to watch out for?

For a diagnosis of depression, a particular cluster of symptoms needs to have been there for at least for two weeks. These symptoms must include at least one of either a depressed mood, or a loss of interest or pleasure in things that were once enjoyable. Many times these will just be a normal part of adolescence and nothing at all to worry about, but if depression is happening, there will be other telltale signs. Here are some to watch out for:

1. Happiness, anger, indifference – the many faces of depression.

   Depression doesn’t always look like sadness or withdrawal. Some of depression’s classic disguises are:

   •  Anger or irritability.

   Depression often comes with lethargy, pain and/or hopelessness. Understandably, this can make people angrier, more irritable or more impatient than usual.

   •  Happy, but reluctant to spend time with friends or family.

   It’s takes a huge amount of strength to move through the day with depression hanging on. If your teen has depression they might use this strength to put on a happy face, but where there is depression, there is also likely to be increasing withdrawal. It’s very normal for teens to withdraw from family activities – it’s part of them experimenting with their growing independence. The thing to watch out for is if they withdraw more from friends and spend more time on their own than usual.

•  Indifference.
Depression doesn’t just steal happy feelings. Sometimes it can steal all feelings, which can make people seem flat or indifferent. In teens, it can be difficult to tell whether their indifference is just a normal part of adolescence or whether it’s something more. It’s not at all unusual for teens to seem more indifferent and there’s a good reason for this. Dopamine is the chemical that creates the feel-good when we get something we want, and in teens the baseline levels in the brain are lower than they are in adults or children, creating a sense of flatness. There is a way though, to tell the difference between normal adolescence and depression. Watch out for what happens when your teen does something that feels good or when they get something they want. When adolescents do something that feels good, the dopamine levels are higher than they are in adults, so the feel-good feels better. In depression, this doesn’t happen. There is a constant sense that nothing makes a difference, and the flatness or indifference doesn’t shift even when they are doing something that they would normally have enjoyed.

3. Pulling back from people and activities that were once enjoyable.

   Depression takes away the sense of enjoyment from things that were once enjoyable. Watch out for your teen cancelling plans or making excuses to avoid the things they once wouldn’t have missed. 

4. Tiredness, lethargy, exhaustion.

   Depression is exhausting and can make people more tired than usual, even if they seem to spend more time sleeping.

5. Depression hurts, literally.

   Depression is a physical illness, so sometimes the symptoms will show up physically. Watch out for unexplained headaches and migraine, stomach aches, back pain, joint aches and pains. Mood and pain share the same pathways in the brain and they are regulated by the same brain chemicals (serotonin and norepinephrine). When the balance of these neurochemicals is out, pain and mood might both be affected. 

5. Giving up on things that are important.

   The hopelessness, helplessness and lowered self-esteem that come with depression might see depressed teens giving up on school, friendships, or other things that are important to them.

6. Change in physical movements and speech.

   Depression can speed up movement (restlessness, agitation, fidgeting, pacing, leg shaking or hand-wringing), or it can slow down movement and speech.

7. Fuzzy thinking, difficulty concentrating and remembering.

   As well as draining physical and emotional energy, depression can also take a swipe at mental energy. Teens with depression might have difficulty concentrating, remembering, or making decisions. Slowed thinking might mean they take longer to collect their thoughts, which can show itself as slowed speech.

8. Isolating from others.

   There’s nothing wrong with wanting some alone time, but when there’s a noticeable withdrawal, it might be a problem. This might be because being with people no longer brings joy (because nothing brings joy), or because fatigue, or having to put on a happy face when there is no ‘happy’ to hold it up feels too hard. Depression also has a way of convincing even the strongest of minds that they are a burden to those around them and that they are best keeping themselves to themselves.

9. Change in sleeping habits.

   About 40% of young adults with depression have hypersomnia, which is excessive sleeping. Depression can make people oversleep, or wake earlier than usual and have trouble going back to sleep.

10. Change in eating habits.

    Depression can create an emptiness that feels unbearable, and people might turn to food to try to fill the void. Eating habits can also change in the other direction, with people eating less.

11. Change in grades.

    Depression brings fuzzy thinking, low energy and difficulty concentrating. All of this can make studying, listening and learning more difficult. The clue that this is happening will be a change in grades.

12. Taking more, using more, doing more.

    Depression is more than sadness. It’s an inability to feel joy. This is confusing and frightening for anyone to feel, and as a way to find relief from that, or to distract themselves from their pain, teens might turn to all sorts of risky or addictive behaviour. They might be driven to do more of what has felt good before, or anything that helps them to feel – something. This might look like drinking, drugs, skipping school, gaming excessively, eating excessively or self-harm. 

13. Self-injury.

    All of us can only push down big feelings for a certain amount of time before they start to push for attention. Physical pain and emotional pain share the same pathways in the brain. When emotional pain feels too big or when it stops making sense, self-harming can be a way to find short but needed relief from the heaviness that comes with depression. Teens don’t do this to manipulate or to control the people around them – they wish they could stop too. They do it to make the pain go away.

If you suspect your teen is depressed …

Depression is such a persuasive beast, and it can convince anyone it’s holding onto that nothing will make a difference. This hopelessness is a classic symptom of depression, and the very thing that gets in the way of healing from it. If you suspect your teen might have depression, the first step is getting a diagnosis so everyone knows what they’re dealing with. A doctor or mental health professional can help with this. Depression doesn’t always need medication, but it might. Having the support of a loving adult will be important for any teen who is trying to find their way through depression. If that supportive and loving adult is you, here are some things you can do to help your teen strengthen and heal:

• Help them find ways to connect with other teens.

  Healthy friendships can be comfort and protection against the messy times that can come with adolescence. The problem can be finding these friends. School isn’t the only source of friendship. In fact, sometimes school friendships can be a huge source of sadness, fear and hurt. If your teen is struggling with friendships at school, it’s easy for them to be drawn into believing that it will be like this everywhere, but it won’t. Explain that school comes with different pressures and different problems that won’t be found in other environments. There will be people out there who would love to know your teen. Their tribe is out there, but sometimes they might have to look beyond the school ground to find them. Encourage your teen to try activities or join groups to expose themselves to people who share a more similar view of the world than the people at school. Some ways to do this are through sport, drama, music, part-time jobs, art classes, cooking classes. This might not be easy – depression drains energy for everything. Point out to your teen that it’s not necessarily about the activity, but about expanding their opportunity to find the people who will love being with them – and for certain those people are out there.

• Meditation and exercise.

  Recent research has found that depression can be reduced by up to 40% in two weeks through a combination of thirty minutes of mindful meditation and thirty minutes of exercise (treadmill or static bike), twice a week. Encourage your teen to try anything that will get his or her heart pumping. If they’re depressed, they might not be jumping at the opportunity to exercise. It’s part of what depression does, so you might need to be a bit creative – let one of their chores be to take the dog for a walk, take a sibling to the park to kick a ball, or to walk with you at night-time to keep you company. For the meditation part, the Smiling Mind app is a free app that has guided meditations for teens. It’s an easy and no-hassle way to get started with mindfulness, which has been proven by a mountain of research to be helpful with depression.

• And while we’re on apps …

  A collection of 13 apps developed by researchers from Northwestern University has been found to reduce depression and anxiety by up to 50%. 

• Keep it real.

  Push against the ridiculous ideas of how they ‘should’ look by helping them to develop a healthy idea of what ‘beautiful’ means. The concept of beauty isn’t the problem, the definition is. Our teens are barraged with unrealistic and very narrow versions of what ‘body beautiful’ means. Help them to expand this, and to nurture a healthy body image by pointing out the many different versions of body beautiful that you see. This important for teen boys too.

• When they feel heard they feel cared for.

  Teens, particularly girls, will connect listening with caring. They might not always listen to you, and that’s okay, but if they feel as though you aren’t listening to them, they might feel as though you don’t care. It’s easy to dismiss their worries or mood swings as part of the normal ups and downs of adolescence – and it absolutely might be – but it’s still important to let them know that you hear them, that you notice them, and that you’re there for them.

• Reduce gaming time – let them game with friends.

  True, it might feel easier to catch a falling star in a glass jar, but anything you do can make a difference. Research has found that teens who spend more than four hours a day gaming can be vulnerable to depression, but there is a way to turn that risk around – let them game with friends. Boys who spend time gaming with friends, or those who are connected to friends either online or in real life appear to be protected from the depressive effects of heavy gaming. Girls who spend a lot of time gaming and who are socially active online are less lonely and less socially anxious, but they also show lower self-esteem. The reason behind your teen’s gaming is important. Researchers suggest that if it seems to be an attempt to ward of loneliness or to cope with the world, it might be time to step in to reduce the time spent at the console. Otherwise, if it’s a way to socialise or to connect with others, either in person or online in interactive games, there’s less likely to be a need for concern.

• Every day say something positive, and find something positive in everything.

  Even when teens mess up there’s gold in there somewhere, but they (you) might have to work hard to find it. Whether it’s about the way they come to you for advice or to download, whether it’s the way they learn from their experience, or that they didn’t pick a worse choice – there will be something. Try to say something positive every day, even if they don’t seem to take it in. Depression gives teens plenty of reasons to feel ‘less than’, so it’s important to protect them by pushing back against it whenever you can. 

• Be available, but not intrusive.

  As little people, children turn to their parents for comfort and protection when they scrape against the hard edges of the world. As teens though, they are driven by the very important developmental goal of separating from parents and family. There can often be pressure (from inside of themselves or outside), to deal with things on their own, or at the very least without their parents. This can be tough for everyone. Finding the balance between holding them close and respecting their need for autonomy and independence isn’t easy, but it’s so important. Let your teen know they can talk to you about anything at all. When they do, listen and absorb whatever they tell you, even if it’s shocking. The more they can feel you as a strong, steady presence through their turmoil, the more they’ll trust that you can be there for them, even when things are messy.

• All of their feelings are okay.

  Feelings that don’t get felt or expressed cause breakage. All feelings are valid and they are all okay to be there. It’s never feelings that cause trouble, it’s the way they are dealt with – or not dealt with. When feelings are pushed down or ignored, they’ll sprout little roots and they’ll grow. If teens don’t feel safe enough to feel anything they’re feeling – angry, confused, scared, guilty, jealous – the risk is they’ll cut themselves off from one feeling, then another and another. When they cut themselves off from bad feelings, it becomes easier to also cut themselves off from the good ones. 

• Be available on their terms.

  Depression can be relentless, convincing people that they aren’t worthy of love or worthy of the fight. Your teen might crave company and someone to talk to, but at the same time push everyone away. Anything you can to do let them know that you’re there for them on their terms will be important. Some ways to gently do this are by sitting with them and watching whatever they’re watching on tv, or popping into their room just before they fall asleep – it’s often a time when they’re feeling safe and bundled away from the world, and when they might give you a little window into theirs. 

• Know their ‘normal’.

  There are so many different versions of normal. Your teen’s version of ‘normal’ will change during adolescence, but the more you can get a handle on whatever their ‘normal’ is – feelings, behaviour, habits – the quicker you’ll get a feel for when something is off. This can be particularly difficult during adolescence because they’re changing so much, but trust your instincts. If you’re in doubt, ask. ‘I notice you’re sleeping a lot lately. Do you feel as though you are?’ If they say it’s fine, trust it for a while. If it feels like things aren’t fine, be open to the possibility that you’re absolutely right. Trust your intuition and continue to be gently curious.

• You don’t have to fix them.

  See them and notice them but remember that you don’t have to fix them. None of us like feeling as though we’re a problem that needs fixing, which is how it can feel when people jump into problem-solving mode, even when it’s done with the most loving intent. Instead, listen with an open heart and an open mind and without judgement. Create opportunities for your teen, but express them incidentally and without expectation. Rather than, ‘You know if you exercised you’d probably feel better,’try, ‘I’m taking the dogs for a walk a little bit later if you want to come.’

And finally …

Adolescence is a time of massive change, which can be confusing for teens and the people who love them. Adding to the confusion, ‘normal’ teenage behaviour and signs of a mental health struggle can look the same. Changes in sleep and eating patterns, moodiness, pulling away from family, irritability – these can all be a very normal part of adolescence, or they can be symptoms of depression. It’s important to let your teen pull away when they need to. The push for independence from family and parents is a really important part of adolescence, but it’s also important to stay gently curious, vigilant and available. The more we notice when those we love are struggling, or the more we listen to the heart whispers when something isn’t right, the more empowered we are to respond in a way that can heal and strengthen.