Depression in teenagers: signs, assessment and treatment

The NHS says depression does not only affect adults and that children and young people can become depressed too. Its list of signs in children and young people includes sadness or a low mood that does not go away, being irritable or grumpy all the time, not being interested in things they used to enjoy, and feeling tired and exhausted a lot of the time.

The NHS adds that a young person may also have trouble sleeping or sleep more than usual, be unable to concentrate, interact less with friends and family, be indecisive, lack confidence, eat less or overeat, have big changes in weight, seem unable to relax or be more lethargic, talk about feeling guilty or worthless, feel empty or numb, or have thoughts about suicide or self-harming. Some also have anxiety and physical symptoms such as headaches and stomach aches. Problems at school and problem behaviour can be a sign, and older children who are depressed may misuse drugs or alcohol.

The NHS says things that increase the risk include family difficulties, bullying, physical, emotional or sexual abuse, and a family history of depression or other mental health problems. Sometimes it is triggered by a difficult event, such as parents separating, a bereavement or problems with school or other children, and often it is a mixture of factors, for example a tendency to depression plus difficult life events.

NICE guidance for professionals adds that assessment should routinely consider coexisting conditions and the social, educational and family context, always ask directly about alcohol and drug use, bullying or abuse, self-harm and ideas about suicide, and offer the young person a chance to discuss these issues first in private. It also advises considering parental depression, substance misuse or other mental health problems, as these are often associated with depression in a young person.

The NHS suggests talking to them, trying to find out what is troubling them and how they feel, and taking it seriously even if it does not seem like a big deal to you. If your child does not want to talk to you, let them know you are concerned and available, and encourage them to talk to another trusted person such as a family member, friend or someone at school. You could also contact the school to ask whether staff have concerns.

The NHS says to make an appointment with a GP if you think your child is depressed or you are concerned about their wellbeing. If needed, the GP can refer to children and young people's mental health services, and you may be able to refer without seeing a GP. If there is immediate danger or your child cannot keep themselves safe, call 999 or go to A&E.

NICE guideline NG134 recommends that clinicians build a supportive relationship with the young person and the family, engage them in treatment decisions, and seek consent. It says that children and young people aged 11 or over referred to CAMHS without a diagnosis of depression should be routinely screened with a self-report questionnaire, and that the Mood and Feelings Questionnaire can be considered to help monitor progress in secondary care. A family history should be obtained to check for depression or bipolar disorder in parents and grandparents.

NICE says that when mild depression is diagnosed and the young person does not want an intervention, or may recover without one, a further assessment should be arranged normally within 2 weeks, which it calls watchful waiting. It says antidepressant medication should not be used for the initial treatment of mild depression, and that choices of psychological therapy should be discussed with the young person and family, including what each involves and the evidence for each age group.

NICE says children and young people with moderate to severe depression should be reviewed by a CAMHS team. For 12 to 18-year-olds it recommends offering individual cognitive behavioural therapy (CBT) for at least 3 months. If CBT would not meet clinical needs, options include interpersonal therapy for adolescents, family therapy, brief psychosocial intervention or psychodynamic psychotherapy. For 5 to 11-year-olds it lists family-based interpersonal therapy, family therapy, psychodynamic psychotherapy and individual CBT as options.

NHS care usually begins with a GP, school mental health support or a direct route into local children and young people's mental health services. Private child and adolescent psychiatry and psychology can reduce waiting times for assessment and therapy. Whoever is involved, ask which therapy is proposed, how long it will last and how progress will be measured, and whether medicine is being suggested alongside therapy, in line with the NICE approach above.