Is Your Teen Depressed or Just Moody?

If you have a teenager in your household, moodiness often comes hand-in-hand. So, when your child is quiet, seems sad or retreats to their room and won’t talk to you, it’s sometimes hard to know if it’s just a normal part of growing up or a sign of depression that needs attention.

Depression often goes undiagnosed — partly because parents may have trouble distinguishing normal teenage moodiness from a more serious problem. But you don’t have to figure it out alone.

A family doctor can help you decipher the signs of depression in your child and sort out treatment if it’s needed.

Why is my teen so moody?

It’s normal for teens to keep to themselves or retreat from their parents a little — and it can actually represent a sign of growth.

“They’re developing a sense of independence, which is a good thing,” says pediatric psychologist Ethan Benore, PhD, “and they’re developing more reliance on social relationships, which is also a good thing. But they’re also incredibly sensitive to being evaluated negatively because they’ve had so many years of adults assessing their performance.”

Teens already have a lot to deal with, from schoolwork and extracurricular activities to pressures from parents, friends, teachers and coaches — all while their brains and bodies are still developing. Though teens often look and act like young adults, their prefrontal cortexes (the part of the brain that regulates emotions) won’t fully develop until their 20s.

“Right now, they have the ability to generate emotions, but not necessarily to regulate and monitor those emotions yet,” Dr. Benore says. “Add in a bunch of hormones at varying levels and varying times, and it all makes a chaotic brain environment for children to modulate the emotional changes they’re going through.”

In other words, your teen might just be stressed and a little sad — and that might be totally normal. But sometimes, it can be symptomatic of something more.

Signs of depression in teens

“We know that depression in teenagers is on the rise,” warns pediatrician Veronica Issac, MD. In a 2021 study, the Centers for Disease Control (CDC) found that more than four in 10 teenagers feel “persistently sad or hopeless,” and 1 in 5 teens has contemplated suicide.

Signs of depression in your teen may include:

• Changes in mood, like acting more sullen and irritable.
• Changes in behavior, like sleeping more or eating less.
• Withdrawing from family, friends or activities they used to enjoy.
• Problems in multiple areas of life, like friendships, family relationships, academic performance and leisure activities.
• Signs of cutting and other forms of self-harm, like hair-pulling or skin-picking.
• Drug and alcohol use.
• Sudden lack of confidence or significant drop in self-esteem.
• Expressions of hopelessness.
• Explicit talk of suicide or more subtle comments like, “I wish I weren’t here.”

“I encourage parents to ask,” Dr. Benore says. “Have an ongoing conversation with your child and be open for them when they are ready to talk.”

Treating depression in teens

If you’re worried about trying to figure out a course of treatment for your depressed teen — or to figure out whether they’re depressed to begin with — take a step back and turn to a source you already know well: your pediatrician.

You may feel inclined to find your teen a therapist ASAP to start talking it out, but Dr. Benore says it’s best to start with your pediatrician or family doctor. “They’ve had a longer-term relationship with you, so they understand you and your child and how they’re developing,” he notes.

And your child’s doctor is trained to help identify depression in children and teens. The American Academy of Pediatrics (AAP) guidelines encourage pediatricians to conduct depression screening for children ages 12 and up. That means you can expect them to ask your child about depression as part of routine exams.

“Routine screening for depression helps pediatricians identify adolescents who are struggling and may need treatment,” Dr. Issac adds.

How doctors screen for teen depression

Your pediatrician may use a number of strategies, starting with asking your teen to fill out a questionnaire to gather more information. Two common tools are the PHQ-9 (Patient Health Questionnaire-9) and the Pediatric Symptom Checklist. Both contain questions about low mood, problems with sleep and appetite, and behavioral changes.

And don’t be alarmed or upset if your doctor asks to speak privately with your teen without you in the room.

“Sometimes, teens have trouble telling their parents they’re depressed because they’re not sure what kind of reaction they’re going to get,” Dr. Issac says. The doctor will then fill you in on any serious concerns.

How teen depression is treated

Besides screening for depression, the AAP guidelines encourage pediatricians to have processes in place for helping their patients get treatment.

Your pediatrician may suggest a treatment plan for your adolescent that may involve medication, therapy or both. Some medical practices have their own mental health professionals on staff, while others will make referrals to individuals they trust.

Dr. Issac says she only suggests antidepressants in certain cases. Depression is caused by an imbalance of neurotransmitters in the brain, which is why medications may be helpful — but some teens respond well to talk therapy alone.

“It depends on the severity of your child’s symptoms and how much it’s impacting their daily functioning,” she says. “There are definitely teens who benefit just from seeing a therapist, while those who are more severely impacted may need medication.”

What if suicide is a concern?

If your teen is severely depressed and has had thoughts of suicide, your pediatrician can help you create a safety plan. This will outline steps for you and your child to take if their symptoms worsen.

Your doctor will also advise you on crisis resources you can use if your child experiences a mental health emergency. And you can always access free, confidential, expert help by:

• Calling, texting or chatting with the 988 Suicide & Crisis Lifeline.
• Texting “HOME” to 741741, the Crisis Text Line.

Mental health is a critical part of everyone’s well-being, including teens. Having routine screenings for depression can help keep the lines of communication open and ensure that your child is healthy and supported.

“If you have a concern, talk to your pediatrician or primary care doctor and have them do a full examination and assessment,” Dr. Benore reiterates. “Together, you can figure out the best way forward.”

To learn more on this topic from Dr. Benore, listen to the Health Essentials Podcast episode, “The Teen Mental Health Crisis.” New episodes of the Health Essentials Podcast publish every Wednesday.