My Teen is Depressed. What Next?

Stephanie Specht's picture
By Stephanie Specht on March 21, 2016

According to research from the National Alliance on Mental Illness, in 2015 only about half of children aged 8 to 15 got help for their mental health issues. Is your teen in the group that did not get help? Teenagers might seem aloof and unwilling to talk, but they have to rely on their parents or caregivers to get the help they need for mental health issues.    

I sat down with John (Eric) Vance, M.D., a child and adolescent psychiatrist at Carilion Clinic, to find out what to do if you think your child is depressed.

Living: What should I do if I am concerned about mental, behavioral or emotional symptoms in my child?

Vance: First, talk to your child about why you are concerned and what you’ve noticed. Discuss the changes you have seen in your child that have you concerned, guage their response to that and see if he would be willing to go with you to a professional to get checked out.

Living: Do you need to go straight to a psychiatrist or should you go to your pediatrician?

Vance: Most people will go to their pediatrician first and that is perfectly ok. All pediatricians are very well trained to recognize the early signs of depression. If needed, your pediatrician can help you find a psychiatrist or work directly with your child and a counselor to start therapy as well as a first-line medication if counseling hasn’t helped with the symptoms. However, if the issue is something more complicated or if the child does not initially respond well to a first-line medication, then most pediatricians will send the patient on to a psychiatrist.

Living: How do I know if my child's problems are serious?

Vance: Situations such as cutting, suicidal statements or any other scary or dangerous incident that frightens you is an indication that your child could have a serious mental health issue. If you are so worried about what your child might be going through or doing that you can’t even sleep at night, then you should seek help as soon as possible. It also comes down to how disruptive things have been in your teen’s daily life, developmental progression or enjoyment of life. Take a moment and think about your teen’s life over the past few months or year. Has his level of functioning declined? Has he been struggling in school for the last few months, but before he was doing ok? Is he having any issues with family or friends? These are all signs that something could be wrong and your teen might be struggling with depression.

Living: How are mental illnesses diagnosed in children?

Vance: We use what is called a bio-psycho-social approach to diagnosis. We bring the child and the parent in for an evaluation and ask questions about how he is doing medically, physically, psychologically and functionally with his social life, school and home. The diagnostic interview will include a variety of questions about the child’s moods or any worries the child might have. Is he stressed? Is he angry? Has he had thoughts of guilt, hopelessness or self-harm? And we would also talk about how the teen’s body is functioning. How is his energy level, appetite and sleep? Does he often get headaches or stomach aches?

And during all of this we observe and perform a mental status evaluation as to how the child appears, behaves and reacts to different aspects of the interview. We also try to get as much input as we can from the parent, caregiver, teacher or any one who knows the child well. Depending on the age of the child, we will also talk to the child alone since sometimes there are issues (such as substance use and romantic relationships) that a teen might feel better talking about without the parent or caregiver present.

Living: What are the treatment options for children?

Vance: The main treatment options we use are psychotherapy or a combination of psychotherapy and medication. Typically, we won’t prescribe just medication for depression. In general, we would like to see a patient try therapy first and if the therapy does not seem to be helping or the depression worsens, we will add medication into the treatment plan. Things such as engaging in a hobby, journaling or exercise can also be helpful when it comes to dealing with depression, but I would not advise using those things alone without the guidance of a therapist or doctor to ensure that you are not neglecting other treatment needs. 

Living: If my child goes on medication, does he have to be on it for the rest of his life?

Vance: Not typically, and certainly not the first time around. Usually, an adolescent will stay on a medication for 6 months to a year while they also do some form of counseling or therapy. If it is just the first episode of depression, the child might taper off the medicine and live happily ever after. However, some people do experience a recurrence of depression later on in life and have to go back on medication. Some teens can have recurring depression, and in that case, we might keep them on the medication over time, since they seem to do better if they stay on it.

Living: Do I need to seek treatment or will my child get better with time?

Vance: Traditionally, it has been thought that people suffering from depression can get better without treatment, and although they can, it can take a very long time without any sort of intervention. Treatment certainly helps accelerate how quickly someone gets better. What we often find with teenagers is that by the time they come into our office for treatment, they have often already been dealing with depression for over a year or sometimes even two years. Overall, the success rates with proper treatment, whether that is psychotherapy or a combination of psychotherapy and medication, is about 95 percent. So, most kids do get better and treatment can certainly help accelerate that process.

Living: If depression is not treated, can it worsen or turn into a more serious mental disorder?

Vance: Depression does not turn into something else, but not treating depression can harm the brain and make you prone to more bouts of depression. In some cases, depression can stress your body and your brain to the point that if you are predisposed to other mental disorders, these can be more likely to come out. For example, if someone in your family has a history of schizophrenia or bipolar disorder, we feel that if we do early treatment and enough prevention work on their mental health as kids, there is less chance that any of these disorders will show up in later in life.

Living: What else can I do to help my child?

Vance: Help your child decrease the amount of stress in his life. Stress makes depression worse, so it is crucial to try to eliminate it as much as you can. If your child’s stress is being caused by a family issue, try family counseling. Or, if it is a social relationship that is high in conflict, try to remove your child from that situation. If school is causing extra stress, alert the school and see if your child can get extra help on his school work or see if his workload can be decreased. Keeping your child involved in structured, enjoyable activities in or outside of school can prevent social isolation as well as build self-esteem and good friendships. And finally, getting enough sleep, eating a healthy diet and exercising are crucial to reducing stress and fighting depression.

If you are concerned about your teen, talk to you doctor. Getting help could be the best thing for you and your child.  

NOTE: If your teen is hurting himself or talking about suicide, please seek medical help immediately as these can be signs of a serious mental health issue. If you are in the western Virginia region and you are concerned about the mental health of your child or a loved one, call CONNECT at 540-981-8181 or 800-284-8898.. CONNECT is a confidential, 24-hour emergency evaluation and referral service that is available at no cost to members of our community. CONNECT is staffed by psychiatric nurses and clinical social workers who are trained to help people connect to the psychiatric and behavioral medicine support they need to function well.