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National Institute of Mental Health (NIMH)

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Learn about depression, including types, signs and symptoms, risk factors, treatments and therapies, and things you can do to help during treatment.

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Overview

Teen depression is a serious mental health problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenager thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although depression can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings - they're a symptom of depression.

Teen depression isn't a weakness or something that can be overcome with willpower - it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Symptoms

Teen depression signs and symptoms include a change from the teenager's previous attitude and behavior that can cause significant distress and problems at school or home, in social activities, or in other areas of life.

Depression symptoms can vary in severity, but changes in your teen's emotions and behavior may include the examples below.

Emotional changes

Be alert for emotional changes, such as:

Feelings of sadness, which can include crying spells for no apparent reason

Frustration or feelings of anger, even over small matters

Feeling hopeless or empty

Irritable or annoyed mood

Loss of interest or pleasure in usual activities

Loss of interest in, or conflict with, family and friends

Low self-esteem

Feelings of worthlessness or guilt

Fixation on past failures or exaggerated self-blame or self-criticism

Extreme sensitivity to rejection or failure, and the need for excessive reassurance

Trouble thinking, concentrating, making decisions and remembering things

Ongoing sense that life and the future are grim and bleak

Frequent thoughts of death, dying or suicide

Behavioral changes

Watch for changes in behavior, such as:

Tiredness and loss of energy

Insomnia or sleeping too much

Changes in appetite - decreased appetite and weight loss, or increased cravings for food and weight gain

Use of alcohol or drugs

Agitation or restlessness - for example, pacing, hand-wringing or an inability to sit still

Slowed thinking, speaking or body movements

Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse

Social isolation

Poor school performance or frequent absences from school

Less attention to personal hygiene or appearance

Angry outbursts, disruptive or risky behavior, or other acting-out behaviors

Self-harm - for example, cutting or burning

Making a suicide plan or a suicide attempt

What's normal and what's not

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

When to see a doctor

If depression signs and symptoms continue, begin to interfere in your teen's life, or cause you to have concerns about suicide or your teen's safety, talk to a doctor or a mental health professional trained to work with adolescents. Your teen's family doctor or pediatrician is a good place to start. Or your teen's school may recommend someone.

Depression symptoms likely won't get better on their own - and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're a teen and you think you may be depressed - or you have a friend who may be depressed - don't wait to get help. Talk to a health care provider such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

Symptoms

Suicide is often associated with depression. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your mental health professional.

Contact a suicide hotline.

In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. The Spanish language phone line is 1-888-628-9454 (toll-free). Services are free and confidential.

Or contact a crisis service for teenagers in the U.S. called TXT 4 HELP: Text the word "safe" and your current location to 4HELP (44357) for immediate help, with the option for interactive texting.

Seek help from your primary care doctor or other health care provider.

Reach out to a close friend or loved one.

Contact a minister, spiritual leader or someone else in your faith community.

If a loved one or friend is in danger of attempting suicide or has made an attempt:

Make sure someone stays with that person.

Call 911 or your local emergency number immediately.

Or, if you can do so safely, take the person to the nearest hospital emergency room.

Never ignore comments or concerns about suicide. Always take action to get help.

Causes

It's not known exactly what causes depression, but a variety of issues may be involved. These include:

Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems changes, leading to depression.

Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.

Inherited traits. Depression is more common in people whose blood relatives - such as a parent or grandparent - also have the condition.

Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that increase the risk of depression.

Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless - rather than learning to feel capable of finding solutions for life's challenges.

Risk factors

Many factors increase the risk of developing or triggering teen depression, including:

Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems

Having been the victim or witness of violence, such as physical or sexual abuse

Having other mental health conditions, such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia or bulimia

Having a learning disability or attention-deficit/hyperactivity disorder (ADHD)

Having ongoing pain or a chronic physical illness such as cancer, diabetes or asthma

Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic

Abusing alcohol, nicotine or other drugs

Being gay, lesbian, bisexual or transgender in an unsupportive environment

Family history and issues with family or others may also increase your teenager's risk of depression, such as:

Having a parent, grandparent or other blood relative with depression, bipolar disorder or alcohol use problems

Having a family member who died by suicide

Having a family with major communication and relationship problems

Having experienced recent stressful life events, such as parental divorce, parental military service or the death of a loved one

Complications

Untreated depression can result in emotional, behavioral and health problems that affect every area of your teenager's life. Complications related to teen depression may include, for example:

Alcohol and drug misuse

Academic problems

Family conflicts and relationship difficulties

Suicide attempts or suicide

Prevention

There's no sure way to prevent depression. However, these strategies may help. Encourage your teenager to:

Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise

Practice self-care, for example by creating a healthy sleep routine and using electronics responsibly and in moderation

Reach out for friendship and social support, especially in times of crisis

Get treatment at the earliest sign of a problem to help prevent depression from worsening

Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms

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This serious mental health problem affects how your teenager thinks, feels and behaves, and can cause emotional, functional and physical problems.

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National Institute of Mental Health (NIMH)

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Being a teenager can be tough, but it shouldn't feel hopeless. If you have been feeling sad most of the time for a few weeks or longer and you're not able to concentrate or do the things you used to enjoy, talk to a trusted adult about depression.

Do I have depression?

Do you often feel sad, anxious, worthless, or even "empty"?

Have you lost interest in activities you used to enjoy?

Do you get easily frustrated, irritable, or angry?

Do you find yourself withdrawing from friends and family?

Are your grades dropping?

Have your eating or sleeping habits changed?

Have you experienced any fatigue or memory loss?

Have you thought about suicide or harming yourself?

Depression looks different for everyone. You might have many of the symptoms listed above or just a few.
How do I get help for depression?

Talk to a trusted adult (such as your parent or guardian, teacher, or school counselor) about how you've been feeling.

Ask your doctor about options for professional help. Depression can be treated with psychotherapy (also called "talk therapy"), medication, or a combination of medication and talk therapy.

Try to spend time with friends or family, even if you don't feel like you want to.

Stay active and exercise, even if it's just going for a walk. Physical activity releases chemicals, such as endorphins, in your brain that can help you feel better.

Try to keep a regular sleep schedule.

Eat healthy foods.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIMH Identification No. OM 22-4321

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The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images in the publication. If you do use our materials, we request that you cite the National Institute of Mental Health. To learn more about using NIMH publications, refer to NIMH's reprint guidelines.

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Teen Depression: More Than Just Moodiness

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This fact sheet is intended for teens and young adults and presents information about how to recognize the symptoms of depression and how to get help.

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Impact Of Teen Depression On Academic Performance - Bright Path Adolescent Mental Health

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Teen depression is a mental health condition where teenagers experience persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in

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The Stats on Adolescent Depression in Schools

Adolescent depression in school is increasingly common. For various reasons, adolescents are at great risk for depression during high school and college.

Unfortunately, social stigma around mental illness still exists among people of all ages. As a result, high school and college students often hesitate to seek help for depression. In 2016, approximately 60 percent of teens who suffered a major depressive episode did not receive treatment of any kind.

In order to counteract adolescent depression in schools and the resulting stigma, teens and parents need to be educated about mental health. Thus, they will be better equipped to help others, offer support, and even save lives.

Statistics on Depression in School

According to the National Institute of Mental Health (NIHM), adolescent depression in schools is on the rise. Here are some 2016 statistics from NIMH.

An estimated 3.1 million adolescents aged 12 to 17 in the United States had at least one major depressive episode in 2016. This number represents 12.8 percent of the US population in that age group.

More females than males experienced a major depressive episode in 2016 (19.4 percent of females vs. 6.4 percent of males).

That year, an estimated 2.2 million American adolescents aged 12 to 17 had at least one major depressive episode with severe impairment.

Only 19 percent of these teens received care from a health professional.

These are worrying statistics, to say the least. Why is this happening to our teens? Why is depression in school so common? There are a number of reasons.

Adolescent Depression, Social Media, and Technology

Today's teens face perennial adolescent issues, as well as issues that were unknown to past generations. Among the biggest contemporary problems for teens are technology in general, and social media in particular.

A recent A&E documentary series, called Undercover High, sent a group of 20-something adults into a high school in Topeka, Kansas. Posing as students, they took classes, joined clubs, and interacted with high schoolers to find out what it's really like to be a teenager today.

What they discovered is that social media is a primary source of anxiety and pressure for adolescents. According to one undercover student, teens become depressed when they compare. And teens often compare their lives to the people they follow on social media.

Moreover, they feel they must uphold perfection on social media. Additionally, teen girls often feel pressured to share sexual images of themselves with male students, or to post such images online.

Furthermore, American teens consume an average of nine hours of media a day. In fact, 50 percent of teens feel they are addicted to their smartphones.

Ultimately, the focus on screens and social media causes damage to relationships, education, and extracurricular activities. Thus, it can contribute to teen depression, as well as ADHD, oppositional defiant disorder, and anxiety.

More Reasons for Adolescent Depression in Schools

Along with social media and other forms of technology, teens feel pressure in other areas of life. Depression in school is impacted by all of these factors. Here are a few of the issues they face.

School pressure: Many teens experience some degree of academic pressure. However, an uncertain economy and tough competition for college and graduate school make that pressure worse.

Relationships: Teens typically experience their first romantic relationships in high school or college. While this is an essential part of teen development, it can also be emotionally challenging. This is particularly true if teens don't have guidance and support in navigating this new terrain.

Lack of coping skills: Today's teens are more protected than in the past. Parents try to shield them from experiencing failure and disappointment. Therefore, teens often have fewer chances to build resilience. Thus, they don't learn how to cope with challenges.

A brain that's still growing: The prefrontal cortex, the part of the brain that controls self-regulation, is not fully developed in teens. Thus, they have a limited ability to exert control over their impulses. Consequently, this leads to teenage risk behaviors, such as substance abuse and unsafe sexual choices, which can negatively impact teen mental health.

Nature deficit disorder: Today's adolescents spend so much time doing homework and on screens that they don't get outside nearly enough. Nature deficit disorder is a phrase coined by Richard Louv in his 2005 book Last Child in the Woods. It refers to the fact that human beings, especially children, are spending less time outdoors, resulting in a wide range of behavioral and mental health problems, including depression.

Bullying: Bullying is directly correlated with adolescent depression in school. Below is more information about bullying and depression.

Bullying and Adolescent Depression

Research has found that bullying and depression in school are often related. Victims of bullying in school are at greater risk for depression. Hence, depression in school due to bullying may be a factor in teen suicide.

Additionally, a study by the US National Institutes of Health found that victims of cyber bullying showed more signs of depression than other bullying victims. Moreover, children who bully others also have an increased rate of depression in school years.

Furthermore, children who are bullied are more likely to be depressed as adults. Dr. Andre Sourander, a professor of child psychiatry at the University of Turku in Finland, found that children who are bullied in early childhood have an increased risk of depressive disorders and need psychiatric treatment later in life.

Depression in College

College students are dealing with many new situations. They are often living independently for the first time, and might not be taking good care of their physical health. Furthermore, they are typically facing a new level of academic challenge. Moreover, they may be exposed to more drugs and alcohol than ever before.

Consequently, depression in college is not uncommon. In fact, there are more than 1,000 suicides on college campuses every year, according to a study by Emory University. Additionally, the 2016 UCLA Higher Education Research Institute survey showed that 12 percent of college freshmen say that they are frequently depressed. Not only does school sometimes contribute to depression, depression can also interfere with school.

Moreover, research shows that 75 percent of all mental health conditions begin by age 24. Hence, the college years are a critical time for understanding and talking about teen mental health.

Types of Adolescent Depression

There are several types of depression. The most common depressive disorders include the following.

Major depression: a severe depression that can incapacitate those who are suffering, making it difficult or impossible to do normal daily activities, such as working, studying, sleeping, and eating

Persistent depressive disorder: a chronic, low-grade depression that can get better or worse over time

Melancholic depression: a particularly severe form of major depressive disorder characterized by persistent feelings of extreme sadness and hopelessness

Psychotic depression: severe depression, accompanied by delusions or hallucinations

Seasonal Affective Disorder (SAD): a cyclical depression that comes and goes with the seasons

Premenstrual Dysphoric Disorder: an extreme form of premenstrual syndrome that can manifest as intense and debilitating mood shifts

Find more terms and definitions related to teen mental health in our A-Z Teen Health Glossary .

30 percent of college students report that stress negative impacts their academic performance

85 percent of college students report feeling overwhelmed by everything they have to do

41.6 percent list anxiety as their top concern

24.5 percent of college students reported taking psychotropic medication for anxiety or depression.

Teen Anxiety in School

As well as depression in school, high school and college students suffer from anxiety. Anxiety disorders are one of most common mental health problems on college campuses, according to the Anxiety and Depression Association of America (ADAA). Here are some recent statistics from the ADAA:

1. Avoidance of social situations and a loss of interest in favored activities

2. Exhaustion, constant fatigue, and a generalized lack of energy

3. Sense of despair, sadness, and hopelessness (sometimes escalating into suicidal thoughts)

4. Lack of motivation (resulting in feelings of either guilt and/or failure)

5. Unexplained aches and pains, headaches, stomach problems

6. Hard time concentrating (particularly for teens who used to be focused)

7. Feeling worthless, irritable, frustrated, or having an extreme case of low self-esteem

8. Disturbed sleep patterns (taking naps during the day, insomnia at night)

9. Changes in appetite and weight (including not eating on a regular basis or binge eating)

10. Abusing alcohol or drugs to cope with the pain as a form of self-medication

10 Warning Signs of Adolescent Depression

It's important for teens and their friends and family members to know how to recognize symptoms of adolescent depression. Here are 10 of the most common warning signs.

Strategies for Warding Off Adolescent Depression

Spend time in nature

Spending time in nature through outdoor therapy can improve mental health in a number of ways. For one, time outdoors has been shown to decrease levels of stress, depression, and anxiety. Moreover, being outside in nature is proven to reduce stress by lowering the stress-associated chemical cortisol.

Teen Meditation and yoga

An increasing number of studies show that mindfulness meditation can help support teen mental health. Meditation encourages us to witness our emotions from a distance rather than getting caught up in them. A review study at Johns Hopkins found that meditation was just as effective as antidepressants in treating symptoms of anxiety and depression.

Exercise

Research shows that exercise combats depression by increasing the body's production of endorphins. These are the brain's "feel good" chemicals. Moreover, doing a physical activity you enjoy can increase feelings of mastery and self-confidence. Therefore, choose something you like to do so that exercise won't feel like a chore.

Reframing stress

We can turn distress into eustress, which means positive stress. A Harvard Business School study several studies involving karaoke singing, public speaking, and math performance showed that people who reframed their anxiety as excitement performed better than those who told themselves to stay calm when feeling stressed. Think of stressful situations as opportunities to learn and improve.

Sleep

Whether or not you get enough sleep can have a big impact on mental health. Researchers have found that teens feel more depressed and anxious when they don't get enough rest. In a study of nearly 28,000 high school students, scientists found that each hour of lost downtime was associated with a 38 percent increase in the risk of feeling sad or hopeless, and a 58 percent increase in suicide attempts.

Social support

Multiple studies have shown that social relationships improve mental and physical health. The more support we have, the more resilient we are against depression. Find people you trust who will listen to you and make an effort to understand what you're going through. Your support network can include family, peers, guidance counselors, and mentors. A mental health professional can also provide support.

Eating right

An increasing number of scientific studies show that there is a direct link between diet and mental health. Moreover, this is particularly true for children and teens, whose brains and bodies are still developing. Hence, nutrition is critical at this stage of life.

Tips for Parents

Encourage self-care. While your child is at home, help them instill healthy habits in terms of nutrition, sleep, and exercise. Hopefully, those habits will stick when the head off to college.

Listen carefully. Whether you're talking with your teen at dinner or on the phone while they're away at school, pay attention and watch for warning signs.

Don't get mad. Instead of punishing your teen if you find out they've been having behavior or mental health issues, respond with compassion and invite them to share what's going on.

Make sure they get help. If you're concerned that your teen is depressed, have them talk to a school counselor, therapist, or doctor. It's always better to address the problem before it gets worse.

Treatment for Depression in School Years

Treatment for teen depression begins with a mental health evaluation by a trained professional. Specifically, this evaluation should take into account a student's developmental and family history, school performance, and behaviors.

Once the evaluation is complete, teen depression can be addressed by a variety of therapeutic modalities:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) helps teens to identify and modify thought and behavior patterns, shifting them from the negative toward the positive.

Dialectical Behavioral Therapy

Dialectical Behavioral Therapy (DBT) helps teens acknowledge the unhealthy behaviors they are using to cope with deeper underlying issues, and develop ways to modify these behaviors. This behavioral modification helps aleviate depression in school.

Psychoeducation

In psychoeducation groups, clinical professionals educate teens on how the brain works, so they can begin to change their thought processes and increase overall mental health.

Acceptance Commitment Therapy

Acceptance Commitment Therapy (ACT) combines acceptance and mindfulness strategies with commitment and behavior-change strategies to increase psychological flexibility.

Attachment-Based Family Therapy

Attachment-Based Family Therapy strengthens the emotionally protective, secure-based, parent-child relationship while promoting adolescent autonomy.

Multi-Dimensional Family Therapy

Multi-Dimensional Family Therapy (MDFT) engages teens through a family-centered approach, empowering teens and their family members.

Person-Centered or Humanistic Therapy

This modality engages teens using unconditional positive regard, compassion, and empathy, so they feel accepted and can better understand their own feelings.

Adventure Therapy

Adventure Therapy is a positive tool to combat adolescent depression. Time in nature is highly therapeutic for everyone. Studies show that when adolescents participate in outdoor-based learning settings, outcomes can be profound. Teens have the opportunity to build self-esteem, learn lifelong skills, and form relationships with peers.
Adolesc Health Med Ther. 2011; 2: 37-44. JAMA Psychiatry. 2016 Feb;73(2):159-65. PNAS. 2015 July;112(28) 8567-8572. Environ Health Prev Med. 2010 Jan;15(1):18-26. J Exp Psychol Gen. 2014 Jun;143(3):1144-58. Child Dev. 1998 Aug;69(4):875-87. J Youth Adolesc. 2015 Feb;44(2):362-78. J Health Soc Behav. 2010; 51(Suppl): S54-S66. Health Technol Assess. 2015 Sep;19(73):1-124. Common Sense Media
Finally, sometimes the hardest part of seeking treatment for teen depression in school is taking the first step . But support is essential. Once trained professionals are involved, the entire family can focus on healing.

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Adolescent Depression in Schools | Newport Academy

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Adolescent depression in school is increasingly common. For various reasons, adolescents are at great risk for depression during high school and college. Unfortunately, social stigma around mental illness still exists among people of all ages. As a result, high school and college students often hesitate to seek help for depression.

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Polaris Teen Center: Premier Adolescent Treatment Center in Los Angeles

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Distinguishing Between Signs of Depression or “Moodiness” in Teens

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Is your teen depressed or just moody? Learn the difference between depression vs moodiness in teens. Find answers. Read the complete guide for parents here.

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Hillside Atlanta - Behavioral Health Support for Youth, Adolescents, and Their Families

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Teenagers face many challenges, and one of the most significant obstacles is managing their mental health, including seeking help for conditions like anxiety and depression. While speaking about these conditions might be more acceptable now than before, it doesn't minimize the struggles teens face when living with mental health illnesses.

That's why understanding the factors preventing teenagers from getting mental health treatment is essential. As parents, you can find appropriate and long-lasting relief and care for your child by identifying and addressing why teens refuse treatment.
In This Article
Why Don't Teenagers Seek Help for Anxiety and Depression?

Social, economic and information barriers are some reasons teens do not seek help for anxiety and depression. Teens might feel judged by their peers and families about seeking help significantly due to the stigmas around mental health. They may also worry about the costs of getting treatment and support services, especially in families or households with limited finances.

Another reason is the lack of or access to information on getting support and treatment. By identifying the barriers to mental health treatment, you can better better understand the reasons teens refuse help for anxiety and depression.

Mental Health Stigmas

Stigma in mental health is often a lack of understanding or fear of mental illness conditions. These perspectives lead to negative quotations around mental health and treatments. Media and inaccurate representations can also create stigmas around mental illness.

These stigmas can affect how teens view themselves and others, making them more reluctant to seek treatment. According to the World Health Organization, 14% of people aged 10-19 experience mental health conditions. Many of these adolescents do not seek help, significantly due to stigmas. These stigmas can include public, self and institutional ideas:

Public: Negative attitudes about mental health can often lead to teens experiencing discrimination, social exclusion and prejudice.

Self: This involves cynical or unfavorable opinions and attitudes towards oneself, including negative self-perception criticism and internalized shame.

Institutional: This stigma refers to unintentional or intentional systemic biases in governments, schools and workplaces.

These views, actions or beliefs can impact teenagers seeking treatment for mental illness, including stopping their treatment or delaying it. Here are some common ways depression and anxiety stigmas prevent teens from seeking help:

Embarrassment: Teens fear judgment or feel ashamed or their mental health condition.

Exclusion: Kids worry about not being accepted or getting bullied or harassed by peers.

Confidentiality: Teens are afraid others might find out about their condition or treatment, especially when their culture or traditions oppose mental health treatment.

Doubt: When teenagers try speaking out and seeking support and do not get suitable help or understanding, they can feel hopeless and less willing to try the treatment.

Defensiveness: Negative attitudes like bias, judgment or exclusion can make teens feel aggravated and become sensitive when you bring up getting help for their condition.

Self-reliance: Associations of mental illness and weakness can lead teens to ignore or deny their condition and refuse to ask for help or open up about their feelings.

Practical Barriers

Teenagers might feel support services are too expensive, especially in families with limited resources or single incomes. While your kid knows you'll do anything to support them, it is normal for them to feel concerned about the cost of treatment. Your child may be unaware that there are many affordable and convenient support services. Teenagers may also think that seeking treatment takes up too much time and worry about becoming committed to taking medication.

Lack of Information and Awareness

When teenagers have limited information on anxiety and depression, they might not understand the seriousness of their condition. Your teen might believe treatment is unnecessary or not for them because they don't understand the roles of support services and the types of practices they offer. Additionally, some schools or facilities might be ill-equipped to identify mental health conditions or lack the resources to provide appropriate support. This lack of awareness and support can make kids feel hopeless or less trustworthy about treatment solutions.

Peer Influence

Peers can influence the way teens view and deal with their condition. Feeling accepted by one's peers is vital for teens, and your child might fear being rejected or victimized for seeking treatment. They might want help but worry about their social standing and how their friends will receive them. This predicament can be challenging for teens, and many might choose to avoid treatment to prevent rejection from their schoolmates.

How Families Can Support Their Teens

Families play a vital role in helping kids deal with their anxiety and depression. You can help your child feel comfortable discussing their condition, including stigmas and negative perceptions about mental health. Encouraging them to explain their feelings and providing caring responses and solutions can make them feel understood and supported. It can also help strengthen your bond and relationship and make them feel more positive about treatment.

Change the Narrative

Your child might have a negative view of treatment due to various stigmas. This perception can make them less eager to get treatment. One way to address their concerns is by changing the narrative around getting support. Instead of thinking of treatment as a consequence of their condition, you can frame it more positively and transform their ideas on the role of support.

For example, you can compare the support to having a mentor, coach or teacher similar to a sports professional or musician. Help them understand that every person needs coaching or help not to fix them but to help them improve their skills and succeed in all they do. Involving your family in treatment can also help your teenager know that everyone can benefit from support, making them feel less isolated or singled out.

Prioritize Your Teenager's Needs

Your kid might feel discouraged or helpless about improving or overcoming their anxiety and depression. These feelings can often be a side effect of their condition, making it challenging for them to see a positive or successful outcome. Focusing on your teenager's objectives for treatment is an excellent way to motivate them to reach their goals.

Ask questions like "What do you want to achieve from this treatment?" or "What goals do you want to reach?" Their response can be as simple as waking up earlier in the morning or completing more homework, but if your teen knows and believes they're doing this for themselves, they may feel more inspired to get treatment.

Get Compatible Treatment

When your teenager feels comfortable with their specialist or respects them, they can be more willing to engage and complete treatment. If they received treatment prior and did not want to return, you must try to understand why.

Find out what they didn't like about their previous treatment or what qualities they prefer in someone so you can find a more compatible specialist. Another way to get accurate professional help is by interviewing and selecting a specialist as a family. This way, your teen will feel like they have more control over their treatment.

Keep Supporting Your Teen

It's normal for teens to be reluctant when getting treatment. If they say no the first time, don't get discouraged - continue supporting your teen and let them know you're here for them. You can also use the strategies above and speak to your specialist about more strategies to encourage your teen to get treatment.

Get Treatment and Support for Your Teen at Hillside®

Helping resistant teens into treatment can be challenging, and numerous barriers can make this task more overwhelming. By understanding these barriers, like the stigmas, lack of awareness and peer factors affecting your child, you can address them appropriately and use suitable strategies to encourage your teen to get treatment.

At Hillside®, we understand the resistance you may face when your child suffers from anxiety and depression and know that you are doing all you can to get them suitable care. That's why we prioritize you and your teen in our treatment and work to ensure your family gets reasonable solutions that focus on strengthening your relationships and providing the care your child needs.

Contact us today to get support for your teen in need.

Director of Clinical Education & Outreach - Gaan has been working with children, adolescents, and families for over 10 years in various settings. In her current role, she provides education and training for mental health professionals, parents, and the community. She lives in Atlanta with her husband. In her free time, she enjoys reading, hiking, climbing, and cooking. She is a donut aficionado and a national park enthusiast!

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Top Reasons Teens Don't Receive Treatment

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Understanding why teens don't receive treatment can help you address these issues and find suitable, long-lasting care for your teenager. Learn more!

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Some teens find sharing about their mental health embarrassing. This causes them to hide their true feelings and not seek help.

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There are differences between being moody and being depressed.

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Depression Factsheet (for Schools) (for Parents)

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What teachers should know about depression and how to help a student who is depressed.

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Dealing with Teen Depression - HelpGuide.org

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Depression is common in teens. Here's what you can do to help yourself or a friend feel better.

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Mental health is a crucial component to overall health and well-being and mental health among children and adolescents continues to be a significant public health concern. According to a report in Morbidity and Mortality Weekly Report (MMWR), 20.9% of adolescents aged 12-17 years had ever experienced a major depressive episode and in 2019, 36.7% of high school students reported feeling sad or hopeless and 18.8% seriously considered attempting suicide. It is essential to be able to notice the signs and symptoms of depression in children and adolescents and know best practices in support and intervention.

Depression in children and adolescents often presents differently than it does in adults. Feelings of sadness and loneliness are common, but moodiness or irritability may be more predominant expressions of these underlying feelings.

Additional symptoms may include:

Loss of appetite or overeating

Sleep disturbances (e.g., excessive sleeping, insomnia, or day-night reversal)

Social withdrawal

Depression rates are soaring among children and adolescents and disproportionately among children of color, children who identify as LGBTQ, and children with special health care needs including cognitive and learning disabilities.

Depression can impact school attendance, school performance, and/or social interactions with peers and teachers. Depression negatively impacts a child's development. Major depressive disorder in children is also associated with increased risk for the following:

Suicidal ideations, attempts and completion

Substance use

Cutting

Exposure to violence

Driving while impaired

Risky sexual behaviors and

Running away from home

How Schools Can Help
Schools can play an important role in supporting the resilience and mental health of children and youth. This can be done through the same promotion and prevention strategies to support general health.
Connectedness (Mental Health Promotion and Illness Prevention)
School staff can promote mental wellbeing by helping students feel connected to school and family through building strong relationships and bonds. Being connected to a community can help a child or teen feel cared for and valued. This sense of connectedness can promote mental health as well as prevent other outcomes such as substance use and suicide.

Depression Screenings (Mental Health Illness Prevention or Early Identification)
School-based health centers or nurses can administer depression screenings which can be helpful early identification of symptoms and timely referrals for further in-depth evaluations with mental health professionals. Examples of depression screenings include:

KADS (Kutcher Adolescent Depression Scale)

CDS (Columbia Depression Scale)

CES-DS (Center for Epidemiological Studies- Depression Scale for Children)

PHQ9 (Patient Health Questionnaire)

If a student is diagnosed with depression, school staff together with families and providers can help develop treatment or safety plans to help the student manage their depression symptoms.

Care Coordination Between Schools and the Pediatrician
Communication between school staff and the student's pediatrician can help gather and share important information regarding behavioral concerns, withdrawal from social activities with friends or family, and changes in academic performance. This information together with appropriate screenings or evaluation can help assess the best individualized support or intervention needed.
Pediatrician's Role
Pediatricians are key in supporting the mental health of youth experiencing or at risk of depression.

AAP has guidelines for adolescent depression in primary care. These guidelines can be used to address practice preparation, identification, assessment, and initial management of adolescent depression in primary care settings as well as treatment and ongoing management.

Pediatricians can educate, support and empower families for how navigate disclosing and addressing depression with schools from the clinical setting. Pediatricians can partner with a child's behavioral health team, including their family, school, and treating behavioral health providers. Doing so can help broker communication to suggest and develop accommodations for a 504 disability accommodation plan and/or goals/services to be considered for an individualized education program (IEP) when and where appropriate.

Pediatricians can utilize strategies to promote relational health in families and mitigate toxic stress (REF: 2021 AAP Garner update policy statement); this along with screening practices to identify children with increased risk factors can lead to earlier identification and treatment of depression and emotional dysregulation symptoms in children prior to manifestation of a major depressive disorder.

Helpful Resources

AAP: Guidelines for Adolescent Depression in Primary Care The Guidelines are to be used to address practice preparation, identification, assessment and initial management of adolescent depression in PC settings.
Resource for Schools
School and Classroom Depression Strategies (uaschools.org)
This Fact Sheet contains strategies designed to address potential symptoms of student depression and should be used in consultation and collaboration with your school's mental health personnel or as part of a larger intervention approach.
Resources for Parents & Families
The following resources from American Academy of Pediatrics offer parent tips on teens' Mental Health:

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Supporting Students with Depression in School

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Discover effective strategies for supporting students with depression in a school setting. This webpage provides valuable resources and guidance for educators, administrators, and school personnel to create a supportive environment for students struggling with depression. Learn about the signs and symptoms of depression, evidence-based interventions, and practical tips for promoting mental health and well-being in schools. With the right knowledge and tools, you can make a positive impact on the lives of students facing depression, fostering their academic success and emotional growth.

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This serious mental health problem affects how your teenager thinks, feels and behaves, and can cause emotional, functional and physical problems.

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Antidepressants for children and teens

Learn why antidepressants have warnings about suicidal thinking in children and teens, what to do before your child starts taking an antidepressant, and the warning signs of a potential problem.
By Mayo Clinic Staff
Antidepressant drugs are often an effective way to treat depression and anxiety in children and teenagers. However, antidepressant use in children and teens must be monitored carefully, as rarely there can be severe side effects.

Antidepressants carry a U.S. Food and Drug Administration (FDA) black box warning about a risk of increased suicidal thinking and behavior in some individuals under the age of 25.

Although at first you may find the suicide warning alarming, it's important to get the facts. Find out what the warning means and ask about all treatment options. This will help you make an informed decision about your child's health and weigh the benefits and risks of treatment options with your child's doctor.

Why do antidepressants have a warning about suicidal behavior in children?

The FDA reported that an extensive analysis of clinical trials showed that antidepressants may cause or worsen suicidal thinking or behavior in a small number of children and teens. The analysis showed that some children and teens taking antidepressants had a small increase in suicidal thoughts, compared with those taking a sugar pill (placebo).

None of the children in any of the studies actually took their own life. Still, the FDA considered the findings concerning enough to issue a public health advisory and require manufacturers to label antidepressants with strong warnings about the link to suicidal thinking and behavior in children, teenagers and young adults under 25.

However, not all mental health researchers believe these warnings are necessary. Newer research indicates that the benefits of antidepressants may be greater than the risk of suicide. And some research indicates that suicide rates in children decrease when they take antidepressants.

Which antidepressants must have the warning about suicide?

Although the FDA analysis examined only nine antidepressants, the FDA extended the warning to all prescription antidepressants. This black box warning is the strongest safety warning that the FDA can issue about a prescription drug. The warning is printed in bold type framed in a black border at the top of the paper inserts that come with antidepressants.

How can medication meant to help treat depression and other illnesses lead to suicidal behavior in children?

Because of the risk of suicide from depression, it's difficult to establish a clear causal relationship between antidepressant use and suicide. There could be a variety of potential reasons for an increased risk. In some children, antidepressants may also trigger anxiety, agitation, hostility, restlessness or impulsive behavior. These effects may indicate that the child's depression is getting worse or that the child is starting to develop suicidal thoughts.

Should children be treated with antidepressants at all?

The warning about a possible link between antidepressants and suicidal thoughts does not mean that antidepressants should not be used in children. Nor is the warning meant to frighten people away from antidepressants. However, the warning should be taken as a caution to carefully weigh the pros and cons of using antidepressants in children and teenagers against the real risk of suicide as a result of untreated depression.

For many children and teens, antidepressants are an effective way to treat depression, anxiety, obsessive-compulsive disorder or other mental health conditions. If these conditions aren't treated effectively, your child may not be able to lead a satisfying, fulfilled life or do everyday activities.

What should you do before your child starts taking an antidepressant?

It's important that your child have a thorough evaluation before starting to take an antidepressant. A mental health evaluation by a psychiatrist - or a pediatrician or family physician who is experienced in the treatment of child and adolescent mood disorders - should include:

A detailed review of any potential risk factors your child may have that increase the risk of self-harm

An assessment of whether your child may have another mental illness, such as attention-deficit/hyperactivity disorder, substance misuse, bipolar disorder, or an anxiety disorder or an eating disorder

An evaluation of whether there's a family history of mental illnesses or suicide

Talk with your doctor about treatment options, treatment goals and the expected results of any recommended treatment.

Which antidepressants can children take?

The FDA has approved certain antidepressants for use in children and teenagers for different types of diagnoses. Antidepressants come with a medication guide that advises parents and caregivers about risks and precautions. Be sure to carefully read the medication guide and package insert, and discuss any questions with the prescribing physician and your pharmacist.

Antidepressants can also be used for other conditions. The antidepressant imipramine is approved by the FDA to treat daytime or nighttime involuntary urination (childhood enuresis) in children 6 years of age and older.

Physicians may use their medical judgment to prescribe other antidepressants for children for what's called off-label use. This is a clinically common practice for many types of medications for both children and adults.

What should you do once your child starts taking an antidepressant?

The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. Locking up all pills in the home is one measure families can take to reduce the risk of suicide. Careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition.

The highest risk of suicidal thinking and behavior occurs:

During the first few months of treatment with an antidepressant

When the dosage is increased or decreased

Parents and caregivers should closely observe the child on a daily basis during these transition periods and watch for worrisome changes for the whole time the child takes antidepressants.

The FDA also recommends that your child receive close monitoring by a health care professional during the first few months of treatment, and ongoing monitoring throughout treatment. Frequency of contact with doctors or mental health professionals depends on your child's needs. Make sure you stick to your child's recommended appointment schedule.

What warning signs should you watch for when your child is taking antidepressants?

Sometimes the signs and symptoms of suicidal thoughts or self-harm are difficult to see, and your child may not directly tell you about such thoughts. Here are some signs that your child's condition may be worsening or that he or she may be at risk of self-harm:

Talk of suicide or dying

Suicide attempts

Self-injury

Agitation or restlessness

New or worsening anxiety or panic attacks

Irritability

Increasing sadness or worsening of depression symptoms

Impulsiveness

Extreme increase in talking, energy or activity

Aggression, violence or hostility

Trouble sleeping or worsening insomnia

Spending more time alone

Contact your child's health care professional right away if any of these signs occur, if they get worse, or if you, your child, a teacher or other caregiver has concerns.

Make sure your child doesn't stop antidepressant treatment without the guidance of the prescribing doctor. Suddenly stopping an antidepressant may cause flu-like symptoms, an increase in anxiety and other side effects referred to as discontinuation syndrome. Stopping too suddenly may also result in the return of depression symptoms.

What other treatment options are available for children with depression?

Most children who take antidepressants for depression will improve with medication. However, combining medication with talk therapy (psychotherapy) is likely to be even more effective. Many types of psychotherapy may be helpful, but cognitive behavioral therapy and interpersonal therapy have been scientifically studied and shown to be effective for treating depression.

Cognitive behavioral therapy. In cognitive behavioral therapy, a mental health professional can help your child improve coping skills, communication and problem-solving skills. Your child can also learn how to become aware of harmful ideas and behaviors, replace them with positive approaches, and manage emotions.

Interpersonal therapy. With a focus on relationships, this therapy may help your teenager adapt to changes in current relationships and develop new ones.

For some children and teenagers with mild symptoms, talk therapy alone may be beneficial.

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Show references

1. Dwyer JB, et al. Antidepressants for pediatric patients. Current Psychiatry. 2019;8:26F.

2. Suicidality in children and adolescents being treated with antidepressant medications. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications. Accessed May 12, 2021.

3. Antidepressants - Pediatric dosing chart. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Program/Education/Resource-Library/antidepressants-pediatric-dosing-chart. Accessed May 12, 2021.

4. Depression: Parents' medication guide. American Academy of Child and Adolescent Psychiatry. https://www.aacap.org/aacap/custom/googlesearch.aspx?q=parent%20guide&cx=005963334930150341854:fhyugbr2cou. Accessed May 12, 2021.

5. Boaden K, et al. Antidepressants in children and adolescents: Meta-review of efficacy, tolerability and suicidality in acute treatment. Frontiers in Psychiatry. 2020; doi:10.3389/fpsyt.2020.00717.

6. Teen depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/teen-depression/. Accessed May 15, 2021.

7. Spielmans GI, et al. Duty to warn: Antidepressant black box suicidality warning is empirically justified. Frontiers in Psychiatry. 2020; doi:10.3389/fpsyt.2020.00018.

8. Kaminski JA, et al. Antidepressants and suicidality: A re-analysis of the re-analysis. Journal of Affective Disorders. 2020; doi:10.1016/j.jad.2020.01.107.

9. Hussain H, et al. Recent developments in the treatment of major depressive disorder in children and adolescents. Evidence-Based Mental Health. 2018; doi:10.1136/eb-2018-102937.

10. Gabriel M, et al. Antidepressant discontinuation syndrome. CMAJ. 2017; doi:10.1503/cmaj.160991.

11. Revisions to product labeling. U.S. Food and Drug Administration. https://www.fda.gov/media/77404/download. Accessed May 15, 2021.

12. Anafranil (prescribing information). Patheon Inc.; 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4074b555-7635-41a9-809d-fae3b3610059. Accessed May 15, 2021.

13. Cymbalta (prescribing information). Eli Lilly and Company; 2020. http://uspl.lilly.com/cymbalta/cymbalta.html. Accessed May 15, 2021.

14. Drizalma Sprinkle (prescribing information). Sun Pharmaceutical Industries Limited; 2019. https://drizalmasprinkle.com/. Accessed May 15, 2021.

15. Fluvoxamine maleate (prescribing information). Actavis Pharma Inc.; 2017. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8bbd7e39-b9ab-4716-9522-aa8c4b92210e&audience=consumer. Accessed May 15, 2021.

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See more In-depth

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What to know about antidepressants for kids and teens

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Learn why antidepressants have warnings about suicidal thinking in children and teens, what to do before your child starts taking an antidepressant, and the warning signs of a potential problem. By Mayo Clinic Staff Antidepressant drugs are often an effective way to treat depression and anxiety in children and teenagers.

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Teen Depression: The Pros and Cons of Medication

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If your teenager is struggling with depression, you might be wondering about medications. Antidepressant medications, while generally safe, can have unpleasant side effects.

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Patient education: Depression treatment options for children and adolescents (Beyond the Basics) - UpToDate

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Patient education: Depression treatment options for children and adolescents (Beyond the Basics)

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Read below to discover what research tells us about how antidepressants are being prescribed for children and teenagers and which antidepressants are effective for depression and anxiety.

Mental health care for children and teenagers: introduction

More and more children and teenagers have poor mental health. For some, it was made even worse by the COVID-19 pandemic.

Depression and anxiety are particularly common. These mental health conditions can greatly affect young people's school attendance, relationships with their family and friends, loneliness and sleep. It is vital they receive the help they need as early as possible to prevent lasting mental health difficulties, including serious problems such as suicide attempts.

Psychological (talking) therapies are considered the main treatment. The National Institute for Health and Care Excellence (NICE) recommends these therapies as the first treatment for depression and anxiety in children and teenagers. Unfortunately, they are not always available.

Antidepressants are another important treatment option, but their use is controversial. There are only limited studies on how well they work, and how safe they may be, particularly in certain groups such as younger children.

Addressing young people's mental health is a national priority and a focus of the NHS Long Term Plan. However, mental health services struggle to meet demand. Many young people cannot access the help they need, or have to wait a long time for treatment. In 2018, 4 in 5 young people had to wait more than 4 weeks to start treatment, with many waiting months.

This Collection brings together accessible summaries of research - NIHR Alerts - and other high quality reviews supported by the NIHR. They were all published in the last couple of years. The Collection covers evidence on antidepressants for children and teenagers, including how they are being prescribed, and their effectiveness and safety for depression and anxiety disorders.

The Collection provides useful information for members of the public, as well as for GPs and other healthcare professionals who treat these vulnerable young people.

Podcast: How to help young people with depression

In this podcast, we discuss the help available for young people with depression, and the times when antidepressants could be the right choice. Read a full transcript of the episode here.

In this Collection

Trends in prescribing antidepressants

Prescriptions for teenagers are rising

Antidepressants are prescribed to children and teenagers for a variety of reasons, including depression, anxiety, pain and bedwetting. The way GPs in England prescribe antidepressants has changed over time. Research found that the number of 12 to 17 year olds prescribed antidepressants more than doubled between 2005 and 2017. By contrast, prescriptions for 5 to 11 year olds decreased between 1999 and 2017.

Prescribing varied according to where the children and teenagers lived and their ethnic group. Those in more deprived areas were more likely to be prescribed antidepressants. Prescriptions for two antidepressants from a class of drugs called selective serotonin reuptake inhibitors (SSRIs) increased most over the study period. Those drugs were fluoxetine (Prozac) and sertraline (Lustral).

More recent information suggests that prescriptions have continued to increase, especially during the COVID-19 pandemic.

Many teenagers are prescribed antidepressants without seeing a specialist

Clinical guidelines from NICE for treating depression and obsessive compulsive disorder (OCD) (an anxiety disorder, described below) recommend selected antidepressants for children and teenagers. But the guidelines state that these medicines should be given alongside talking therapies, and only after assessment by a child and adolescent psychiatrist (a specialist mental health doctor). Recent research suggests this often does not happen.

A study included a large group of 12 to 17 year olds (more than 21,000) who were prescribed SSRI antidepressants for the first time by their GP between 2006 to 2017. It found that only 1 in 4 of the teenagers had visited a child and adolescent psychiatrist. 1 in 6 had visited a general specialist children's doctor (a paediatrician), and 1 in 25 had attended adult mental health services. Just over half of their prescriptions were for depression (53%), with the next most common reason being for anxiety (16%). The most commonly prescribed SSRIs were fluoxetine, followed by sertraline and citalopram (Celexa).

There is a need to understand why GPs prescribe antidepressants to teenagers and what prevents them following guidelines. It may be that the recommended talking therapies are not available, or that there are long waiting times for specialist services ( average 53 days in 2018/2019). If a GP feels a teenager needs urgent treatment for their mental health condition, and psychological therapies are not immediately available, they may prescribe antidepressants despite the guidelines.

Which antidepressants are effective and safe for children and teenagers?

Depression: Fluoxetine may be the best antidepressant and venlafaxine should be avoided

Where does the evidence come from?

Five recent reviews supported by the NIHR drew conclusions on the effectiveness and/or safety of antidepressants used for treating depression in children and young people.

All reviews included randomised controlled trials, which are the best source of evidence available. However, there is much less evidence for children and young people than for adults, and it is more uncertain. For example, a review of antidepressants for depression in adults included 522 trials, whereas a similar review in children and adolescents included 26 trials.

What does the evidence tell us?

All reviews found fluoxetine (Prozac) to be more effective for treating depression than placebo (a dummy pill that does not contain any medicine). Fluoxetine was also effective when combined with cognitive behavioural therapy (CBT). The combination may be better than either treatment alone, although one review reported that it was no different to fluoxetine by itself.

Sertraline (Lustral), escitalopram (Cipralex), and duloxetine (Cymbalta and Yentreve) may also reduce depressive symptoms. One major review found all these antidepressants reduced symptoms more than placebo. However, the overall effects were small.

All reviews found that the antidepressant venlafaxine (Efexor) was associated with an increased risk of suicidal thoughts or attempts, compared to placebo. The findings for other antidepressants were more uncertain and more research is needed (described below). This highlights the need for young people taking antidepressants to be carefully monitored for suicidal thoughts and behaviours.

How do these findings fit with clinical guidelines?

NICE clinical guidance for depression (last updated in 2019) recommends psychological therapies alone (such as CBT within a group) for children and teenagers with mild depression. For those with moderate to severe depression, NICE recommends more intense psychological therapies (such as individual CBT) as initial treatment. However, the guidelines state that combined therapy (fluoxetine and psychological therapy) is an alternative initial treatment for 12 to 18 year olds after assessment by a specialist.

The reviews in this Collection broadly support this approach. Fluoxetine was consistently found to be more effective than placebo. The major review mentioned above concludes that the guidelines could be broadened to include sertraline, escitalopram and duloxetine.

What's next?

The reviews were comprehensive but were based on relatively poor-quality studies. Uncertainty remains over the use of antidepressants to treat depression in young people. More research is needed, especially on whether these medicines can increase suicidal thoughts and behaviours.

Most trials included in the reviews did not include children and teenagers at risk of suicide. In the 'real world', young people seeking help for depression may have suicidal thoughts. Excluding this group from studies weakens their conclusions about antidepressants. Patients, carers and clinicians should continue to balance carefully the potential benefits of treatments with how acceptable they are, and the possible risk of suicide in a young person with depression. Psychological therapies, as recommended in guidance, remain an important part of any treatment approach.

Anxiety disorders: Fluvoxamine, sertraline and fluoxetine may help

Where does the evidence come from?

Three recent reviews supported by the NIHR drew conclusions on the effectiveness and/or safety of antidepressants used for treating anxiety disorders in children and young people. OCD is usually considered to be an anxiety disorder but is considered separately in the reviews and in this Collection. People with OCD have unwanted thoughts or urges (obsessions) and may use repetitive behaviours (compulsions) to relieve the unpleasant feelings.

What does the evidence tell us?

Anxiety disorders

Fluvoxamine (Faverin) was consistently found to be more effective than placebo (a dummy pill) for treating anxiety disorders. Other SSRIs (fluoxetine, sertraline and paroxetine) were more effective than placebo by some but not all measures of anxiety (depending on the specific assessment tool used).

Sertraline (Lustral) consistently reduced the risk of suicidal thoughts and behaviours in young people more than placebo. Paroxetine (Seroxat) increased them.

OCD

Sertraline and fluoxetine (Prozac) were consistently found to be more effective than placebo for treating OCD. The combination of sertraline and CBT was also effective according to one review.

The reviews did not contain information about risk of suicidal thoughts and behaviours in OCD.

How do these findings fit with clinical guidelines?

NICE guidelines do not cover the full range of anxiety disorders. Currently, there are guidelines for children and teenagers for social anxiety disorder, post-traumatic stress disorder and OCD. All recommend specific psychological therapies as first treatment. Only the guideline for OCD (published in 2005 and due to be updated) recommends antidepressants. When prescribed, NICE states an SSRI antidepressant should be combined with CBT. The reviews in this Collection broadly support this approach for OCD: sertraline and fluoxetine are both SSRIs.

No antidepressants are licensed in the UK for anxiety in children and teenagers under 18 years (except for OCD). Yet both specialists and GPs prescribe them. The reviews in this Collection indicate that certain antidepressants are effective and may be safe. Up to date guidelines are needed for the full range of anxiety disorders in children and teenagers.

What's next?

Uncertainty remains about the safety of antidepressants in young people with anxiety, especially over the long-term. More research is needed. The limited evidence about suicidal thoughts and behaviours highlights the importance of careful monitoring of children and teenagers taking antidepressants.

Conclusion

Thousands of children and teenagers in the UK are taking antidepressants for depression and anxiety. The numbers continue to rise and many have not seen a specialist.

This Collection brings together recent NIHR evidence showing that some antidepressants are effective and may be safe for children and teenagers. It also highlights uncertainties that remain.

Very few of the studies included in major reviews looked at long-term treatment. Treatment was usually for between 2 and 16 weeks. This is problematic because symptoms of depression and anxiety can last a long time, even into adulthood, and they require long‐term treatment. More research is therefore needed into the effectiveness and safety of long-term antidepressant use in young people.

Clinical guidelines stress the need to involve child and adolescent psychiatrists in decisions to use antidepressants in children and teenagers. We know this often does not happen. Limited access to mental health services and a lack of child and adolescent psychiatrists seem to prevent it. Some GPs start prescribing to help young people in urgent need, which may be life saving if they are very depressed. Treatment decisions need to balance the drugs' effectiveness with the possible risk of extreme side effects such as suicidal thoughts and behaviours as well as how severely depressed the young person is.

Depression and anxiety can profoundly affect the lives of children and teenagers and all of those around them. Evidence-based treatments, including psychological therapies and antidepressants, can help. But young people must be able to access mental health services they need. In the NHS Long Term Plan, the Government commits to expanding mental health services for children and young people and reducing unnecessary delays. This should improve the support available.

NIHR-supported studies included in the Collection

Disclaimer: This publication is not a substitute for professional healthcare advice. It provides information about research which is funded or supported by the NIHR. Please note that views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

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Antidepressants for children and teenagers: what works?

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Read below to discover what research tells us about how antidepressants are being prescribed for children and teenagers and which antidepressants are effective for depression and anxiety. More and more children and teenagers have poor mental health. For some, it was made even worse by the COVID-19 pandemic.

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Depression has spiked since the pandemic began and teenagers are among the most affected. Many teens have seen specialists to help treat their mental health, but many others may not have the resources or the desire to see a therapist. Luckily, there's a variety of resources available to help teens who are struggling with depression. Here are 10 resources to help Support those teens who are going through tough times right now.

1. Erika's Lighthouse

Erika's Lighthouse was started by a couple who lost their daughter, Erika, to depression. It's funded by individual donations and charity events and run by volunteers. They have programs catered to grades K-12, and they offer online lesson plans, videos, assessments, and a variety of activities. Teens can create their own clubs, receive up to $250 in grant money, and be guided through various "Awareness into Action" activities to help empower them and promote positivity. There are also resources for family members and faculty to help Support the teens.

Source: Erika's Lighthouse/Youtube

2. The Heard Alliance

The Heard Alliance is based out of the San Francisco Bay Area and is composed of professionals working in the mental health and healthcare industries. They offer resources for families, youth, educators, and health care professionals. They have a downloadable toolkit that promotes mental health, gives protocols for the intervention of suicide, and assists in dealing with suicide in the community. They also offer crisis hotlines and make it easy for you to find local mental health resources.

3. Go Ask Alice

Go Ask Alice is a website run by healthcare professionals, writers, and a research team from Columbia University. They have a Q&A section on their website where it shows a wide variety of specific mental health questions and answers organized by the week. If you don't see something on there for you, you can submit your own question, which may be useful to someone else. They also offer quizzes on nutrition and exercise and a newsletter that will deliver all the recent Q&As to your inbox.

4. Teen Counseling

Teen Counseling is an app where you're connected with a therapist and can text them anytime or schedule a phone or video call. You'll need a parent to fill out a consent form initially, but after that, it's just you and your therapist. The drawbacks are that it's not free, and the therapists can't prescribe medication.

5. NAMI

The National Alliance on Mental Health (NAMI) offers a variety of resources for teens dealing with depression. It provides resources that guide you on when to ask for help, how to ask for it, how to talk with your friends and parents, and how to navigate social media and school with depression. It also has video resources, online discussion groups, and a helpline to find resources in your local area.

6. The Youth Mental Health Project

The Youth Mental Health Project is a nonprofit organization that seeks to destigmatize mental health issues and empower individuals. They offer downloadable resource sheets on everything from sleep, loneliness, depression, peer pressure, self-care, and self-esteem. They also explain various therapies, including cognitive-behavioral therapy, dialectical behavioral therapy, eye movement desensitization and reprocessing, play therapy, and many others. Finally, they have two films about children's mental health that you can watch privately or host a screening.

7. Mental Health Literacy

Mental Health Literacy is the place to go if you're looking to learn as much as you can about your depression and what you can do about it. The site is packed with videos, pdfs, e-books, animations, and online training programs about mental health backed by science and continuously improved upon. They even tweak their materials after getting input from their audiences.

8. The JED Foundation

The JED Foundation is an easy-to-navigate website that partners with high schools and colleges to bolster their various mental health programs. They have partnered with MTV to create mental health storytelling campaigns designed to help teens feel less alone and take action to improve their lives. Other programs they offer are Set to Go, which helps high schoolers navigate the potentially stressful transition to college, and JED High School, an 18 to 24-month program that schools can implement to Support students' mental health.

9. Headspace For Teens

Headspace is a popular app to help people meditate, sleep better, and feel less stressed. Last year, they announced their "Headspace For Teens" initiative to give teens from 13 to 18 free access to the app. To get access, they must register to become a member of the nonprofit's Peer Health Exchange or Bring Change 2 Mind. The site also has various articles on things like mindfulness, being grateful, and how to form habits.

Source: Headspace/Youtube

10. The Trevor Project

The Trevor Project is a nonprofit which seeks to prevent suicide among LGBTQ youth. They offer a toll-free number with trained counselors, guides on how to have intersectional conversations, and facts about suicide among LGBTQ youth. They also have a large community of members you can chat with, get advice from, etc.

When you're going through tough times it's important to know you're not alone and that there are people out there who care for you. Hopefully, these resources help provide that service, as well as some insights into what is making you feel depressed, and what can be done about it.

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10 Resources for Teenagers With Depression

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Depression has spiked since the pandemic began and teenagers are among the most affected. Many teens have seen specialists to treat their mental health.

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AACAP's Facts for Families provide concise up-to-date information on issues that affect children, teenagers, and their families.

Ellie's Depression
This animated short video shows a teenager and is designed to be seen by teens. Produced by teenmentalhealth.org, it provides an excellent description of depression. Watch Video

Why We Need to Talk About Depression
In this TED talk, Kevin Breel describes secretly struggling with severe depression throughout his teenage years. He wants to talk about his experience so others won't suffer as long. Watch Video

5 Ways to Talk about Depression with Your Parents
K- In this video, made for and by teenagers, a narrator provides information about depression and practical advice about how to talk with parents about it, as well as how to ask parents for help. Watch Video

These apps can be helpful tools for people with depression. They should be used alongside comprehensive assessment and treatment from a trained mental health professional.

mADAP mADAP is a video-based mobile health app based on Johns Hopkins University's Adolescent Depression Awareness Program (ADAP). It was developed specifically to provide information about depression to adolescents. The app, which contains information about how adolescents can get help for depression, is available for free on Apple's App Store and Google Play.

CBT Tools for Youth CBT Tools is another app designed specifically for youth. It provides information about depression as well as templates with which users familiar with CBT can practice their CBT skills. Coping skills and safety plans and can recorded and easily accessed. This app has an associated cost and is available at Apple's App Store.

Mood Tools Mood Tools is another app that provides information about depression, templates that can help people practice and use their CBT skills, as well as fields for entering preferred coping skills and safety plans. The app, which does not contain advertisements, is free and is available at both Apple's App Store and Google Play.

CBT Diary
CBT Diary is still another app that makes it easy for mobile users to practice their CBT skills. This app is free but contains advertisements. It is available on Google Play.

My3
Developed by the California Mental Health Authority, this app allows users to easily access contact information for the three individuals who are best positioned to support them in a crisis, as well easily review and update their personal warning signs and coping strategies. The app is free and is available at both Apple's App Store and Google Play.

Additional Related Web Sites

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content_area AACAP's Facts for Families provide concise up-to-date information on issues that affect children, teenagers, and their families. Ellie's Depression This animated short video shows a teenager and is designed to be seen by teens. Produced by teenmentalhealth.org, it provides an excellent description of depression.

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Six things adolescents need from their communities to face the epidemic of depression and suicide

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A new report from Crisis Text Line and Common Good Labs uses data science to provide solutions to the teen mental health crisis in the United States.

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The good news is that, throughout the pandemic, many people have recognized the unprecedented need to support youth mental health and wellbeing and have taken action to do so. Many young people found ways to cope with disruption and stay connected. Families helped children adjust to remote learning. Educators and school staff supported their students while facing unprecedented challenges themselves. Health care professionals rapidly shifted to telehealth. Community organizations stepped in to protect at-risk youth. Employers helped employees adapt to remote work environments. And governments invested trillions of dollars to mitigate financial hardship for families, support COVID-19 testing and vaccination, provide health care and other social services, and support the safe reopening of schools, among other policies.,,

But there is much more to be done, and each of us has a role to play. Supporting the mental health of children and youth will require a whole-of-society effort to address longstanding challenges, strengthen the resilience of young people, support their families and communities, and mitigate the pandemic's mental health impacts. Here is what we must do:

Recognize that mental health is an essential part of overall health. Mental health conditions are real, common, and treatable, and people experiencing mental health challenges deserve support, compassion, and care, not stigma and shame. Mental health is no less important than physical health. And that must be reflected in our how we communicate about and prioritize mental health.

Empower youth and their families to recognize, manage, and learn from difficult emotions. For youth, this includes building strong relationships with peers and supportive adults, practicing techniques to manage emotions, taking care of body and mind, being attentive to use of social media and technology, and seeking help when needed. For families and caregivers, this means addressing their own mental health and substance use conditions, being positive role models for children, promoting positive relationships between children and others as well as with social media and technology, and learning to identify and address challenges early. Youth and families should know that asking for help is a sign of strength.

Ensure that every child has access to high-quality, affordable, and culturally competent mental health care. Care should be tailored to children's developmental stages and health needs, and available in primary care practices, schools, and other community-based settings. It's particularly important to intervene early, so that emerging symptoms don't turn into crises.

Support the mental health of children and youth in educational, community, and childcare settings. This includes creating positive, safe, and affirming educational environments, expanding programming that promotes healthy development (such as social and emotional learning), and providing a continuum of supports to meet the social, emotional, behavioral, and mental health needs of children and youth. To achieve this, we must also expand and support the early childhood and education workforce.

Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers. Priorities should include reducing child poverty and ensuring access to quality childcare, early childhood services, and education; healthy food; affordable health care; stable housing; and safe neighborhoods.,

Increase timely data collection and research to identify and respond to youth mental health needs more rapidly. The country needs an integrated, real-time data infrastructure for understanding youth mental health trends. More research is also needed on the relationship between technology and mental health, and technology companies should be more transparent with their data and algorithmic processes to enable this research. We also need to better understand the needs of at-risk youth, including youth facing multiple risk factors. Governments and other stakeholders should engage directly with young people to understand trends and design effective solutions.

What Health Care Organizations and Health Professionals Can Do

Our health care system today is not set up to optimally support the mental health and wellbeing of children and youth. In addition to changing government policy (see recommendations for Governments on page 33), we must reimagine how health care organizations and health professionals prevent, identify, and address mental health challenges. Below are some steps health care organizations and health professionals can take:

Routinely screen children for mental health challenges and risk factors, including adverse childhood experiences (ACEs). Screenings can be done in primary care, schools, emergency departments, and other settings. For example, primary care providers can conduct screenings during well-visit appointments, annual physicals, or routine vaccinations using principles of trauma-informed care. Screenings should account for the diverse ways in which mental health challenges can manifest, such as changes in physical health, sleep patterns, and behaviors. It's critical that screening services link to appropriate follow-up care. The American Academy of Pediatrics offers tools and resources for screening processes. California's ACEs Aware initiative offers ACEs screening tools for children, adolescents, and young adults.

Combine the efforts of clinical staff with those of trusted community partners and child-serving systems (e.g., child welfare, juvenile justice). For example, hospital-based violence intervention programs (HVIPs) identify patients at risk of repeat violent injury and link them to hospital- and community-based resources to address risk factors for violence.,,, Another example initiative is school-hospital partnerships, such as behavioral health urgent care clinics supported by schools. New payment and delivery models, such as the Centers for Medicare & Medicaid Services Innovation Center's Integrated Care for Kids (InCK) Model, can be used to support the mental health-related needs of children across settings.

Build multidisciplinary teams to implement services that are tailored to the needs of children and their families. Enlist children and families as partners and engage them in all stages of decision-making, from screening to treatment. Recognize that a variety of cultural and other factors shape whether children and families are able or willing to seek mental health services. Accordingly, services should be culturally appropriate, offered in multiple languages (including ASL), and delivered by a diverse mental health workforce. Additionally, support the wellbeing of mental health workers and community leaders, building their capacity to support youth and their families.

What Media Organizations, Entertainment Companies, and Journalists Can Do

Note: See next section for recommendations specific to technology platforms such as social media companies.

Media organizations, entertainment companies, and journalists can have a powerful impact on young people. In some cases, this impact can be positive. For example, television programs can keep children and adolescents informed about current events and teach them valuable lessons. On the other hand, false, misleading, or exaggerated media narratives can perpetuate misconceptions and stigma against people with mental health or substance use problems., In addition, media coverage of traumatic events, such as bombings and natural disasters, can contribute to psychological distress among consumers.,,,, Particularly in times of global crisis, such as the COVID-19 pandemic, people can come away from news stories feeling anxious and powerless. Below are steps media organizations can take to protect the mental health of viewers while staying true to their role in informing the public:

Normalize stories about mental health and mental illness across all forms of media, taking care to avoid harmful stereotypes, promote scientifically accurate information, and include stories of help, hope, and healing. Example best practices include:

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Avoiding harmful stereotypes about mental illness, such as the idea that people who have a mental illness are prone to violence or that mental illness causes violence. Research shows this is not the case.

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Avoiding demeaning language (e.g., "crazy," "psycho," "looney," "wacko", "nut," "junkie"). This includes using person-centered language, or language that focuses on the person rather than a disease label. For example, instead of referring to someone as a "schizophrenic," refer to them as a "person living with schizophrenia."

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Include stories of people seeking help, getting treatment, and successfully recovering. These can also include examples of people getting help from friends, family neighbors, or even strangers (not just mental health professionals).

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Direct consumers to mental health resources (as part of any mental health-related TV episode, movie, news story, podcast, or other media).

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Craft more authentic stories by consulting with subject matter experts and people with personal experience of mental illness or mental health challenges.

Whenever depicting suicide or suicidal ideation, adhere to best practices such as the National Recommendations for Depicting Suicide. For example:

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Convey that suicide is complex and often caused by multiple factors, not a single event.

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Show that help is available. For example, in TV shows or movies, show characters reaching out to health professionals, talking to supportive peers, friends, or family, or calling or texting a crisis hotline.

What Social Media, Video Gaming, and Other Technology Companies Can Do

Over the past two decades, more and more of our lives have moved onto social media platforms and other digital public spaces. The COVID-19 pandemic has rapidly accelerated this trend. During the pandemic, the time teenagers spent in front of screens for activities not related to school more than doubled, from 3.8 to 7.7 hours per day. In 2020, 81% of 14- to 22-year-olds said they used social media either "daily" or "almost constantly."

In these digital public spaces, which privately owned and tend to be run for profit, there can be tension between what's best for the technology company and what's best for the individual user or for society. Business models are often built around maximizing user engagement as opposed to safeguarding users' health and ensuring that users engage with one another in safe and healthy ways.,This translates to technology companies focusing on maximizing time spent, not time well spent.

In recent years, there has been growing concern about the impact of digital technologies, particularly social media, on the mental health and wellbeing of children and young people.,, Part of the challenge with research on this topic is that digital technology involves a vast range of devices, platforms, products, and activities, so it's hard to generalize. Researchers also have limited access to data to inform potential research.

Importantly, the impact of technology almost certainly varies from person to person, and it also matters what technology is being used and how. So, even if technology doesn't harm young people on average, certain kinds of online activities likely do harm some young people. For example, some research has linked "passive" social media use (such as scrolling through posts and auto-play video) to declines in wellbeing (versus more "active" use such as commenting on posts or recording videos).

There can also be benefits to certain online activities, such as connecting meaningfully with friends and family, learning a new skill, or accessing health care, and these also vary from person to person. For example, LGBTQ+ young people may be more vulnerable than other young people to cyberbullying but also more likely to consider social media important for feeling less alone, expressing themselves, finding inspiration, and getting support.,

There is a clear need to better understand the impact of technologies such as social media on different kinds of users, and to address the harms to users most at risk. We need more research using strong data and research methods, such as longitudinal and experimental designs, behavioral (as opposed to self-reported) measures of time spent online and types of content engaged with, as well as data on subgroups of users (e.g., boys vs. girls).,

Most importantly, technology companies must step up and take responsibility for creating a safe digital environment for children and youth. Today, most companies are not transparent about the impact of their products, which prevents parents and young people from making informed decisions and researchers from identifying problems and solutions. At a minimum, the public and researchers deserve much more transparency. More broadly, below are specific recommendations for how these companies can prioritize the wellbeing of users above monetizing those users for profit:

Prioritize user health and wellbeing at all stages of product development.

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Elevate user safety, health, and wellbeing in the culture and leadership of technology companies. Senior technology executives should acknowledge that their products can harm some young people and take material and measurable steps to prevent and mitigate these harms, even at the expense of engagement, scale, and profit. Leaders should be accountable for creating a safe, accessible, and inclusive digital environment for their users and designing safe products.

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Assess and address risks to users at the front end of product development. Build products and services using a precautionary approach that focuses on making them safe for youth before they are deployed. Company employees at all levels, especially those involved in product development, should be expected to prioritize user health and wellbeing in their day-to-day work. For example, consider how to align performance incentives for product developers to measures of user wellbeing. Develop consistent procedures for receiving input on proposed products from youth, parents, health and youth development professionals, and civil society, for example through advisory groups. Create ways for employees to voice concerns about products without fear of retaliation.

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Continually measure the impact of products on user health and wellbeing and share data with the public. Supplement traditional product success metrics, such as monthly active users, with dedicated metrics for user health and wellbeing. In addition to relying on user-reported data (e.g., surveys), consider using behavioral data (e.g., analysis of user inputs such as typed keywords). Make results publicly available. Take corrective action to address harms.

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Recognize that the impact of platforms and products can vary from user to user, and proactively ensure that products designed for adults are also safe for children and adolescents. Consider many kinds of users, including users of different ages and developmental stages, when developing new products and features. Talk to those users and collect data to identify subgroups who may be harmed by certain products or ways of engaging. Use this data to inform product design and research.

Promote equitable access to technology that supports the wellbeing of children and youth. For example, donate digital technology and remote services (e.g., internet access) to under-resourced populations.

What Community Organizations Can Do

Thousands of community organizations are doing heroic work every day to support the mental health of children and young people. While different groups address different parts of the problem, serve different youth populations, and implement different solutions, all community organizations can keep the following recommendations in mind as they continue their work:

Educate the public about the importance of mental health, and reduce negative stereotypes, bias, and stigma around mental illness. Community groups can play a key role in fostering open dialogue about mental health at the local level and correcting misconceptions and biases. For example, community groups can partner with trusted messengers such as faith leaders and health care professionals to speak to community members about youth mental health needs. It's particularly important to address misconceptions in populations that have an outsized influence over young people, such as families, educators, health care professionals, juvenile justice officials, online influencers, and the media.

Implement evidence-based programs that promote healthy development, support children, youth, and their families, and increase their resilience. Examples include youth enrichment programs (e.g., mentoring, after-school programs), skill-based parenting and family relationship approaches, and other efforts that address social determinants of youth health such as poverty, exposure to trauma, and lack of access to education and health care. A few respected programs include The Incredible Years, Strengthening Families, The Martinsburg Initiative, and the Drug-Free Communities (DFC) Support Program.

Address the unique mental health needs of at-risk youth, such as racial and ethnic minorities, LGBTQ+ youth, and youth with disabilities. Youth-serving organizations should think intentionally about how and to whom program services are offered. For example, actively recruit and engage populations who have historically been prevented from equal access to opportunities and may benefit the most from services. Engage with youth to understand what unique barriers prevent them from accessing mental health services. Recruit program staff directly from communities being served. Build program staff capacity to recognize personal biases, as well as structural challenges in these communities. For example, provide training on cultural and linguistic competence and related topics.

Elevate the voices of children, young people, and their families. Youth are experts on their own lives, so it is important to engage youth in community-based mental health efforts. Explore youth advisory councils and other ways to involve young people in all phases of programming, from ideation to implementation. Gather feedback to understand what is and isn't working. Include youth and families directly in delivering services, for example by creating peer support programs.

What Funders and Foundations Can Do

Philanthropic and other funding organizations play a critical role in supporting the mental health of children and young people across the full continuum of need. For example, they can make bets on promising but untested technologies or programs for which government funding may not be available. They can also serve as reliable partners to community-based organizations across the country, and promote and build cross-sector partnerships. Below are some recommendations for how funding organizations can support youth mental health:

Incentivize coordination across grantees and foster cross-sector partnerships to maximize reach and bring together a diversity of expertise. The scale and complexity of mental health issues among young people require collaborative approaches. Consider leveraging resources across sectors to advance practices, policies, and research that support the mental health of children, youth, and families. And support grantees in developing and sharing meaningful mental health outcome measures.

Scale up evidence-based interventions, technologies, and services. Use a structured process to assess an intervention's readiness to scale and support high-quality implementation at a community level. Share information and convene stakeholders to provide education and consultation to spread innovation.

Invest in innovative approaches and research on mental health. For example, fund participatory research that involves young people in understanding their online experiences. Develop and test new solutions, including digitally enabled solutions that can reach young people at scale and in underserved communities. Consider different kinds of funding models, such as incubators and accelerators, that can drive funding toward promising projects at very early stages.,

Elevate and amplify the voices of youth and families in all stages of funding and evaluation. Listening to young people is critical to understanding what kinds of solutions will work and what communities need to scale successful interventions. Bring young people, parents, and caregivers to the table to identify their needs and create ongoing meaningful opportunities to inform grantmaking strategies and decision-making. Engage youth from different identities and backgrounds-particularly those that come from vulnerable communities.

What Employers Can Do

Employers can play an outsized role in supporting the mental health of children and young people. They can directly help younger employees, such as high school students working part-time jobs or young adults starting out in the labor force after high school or college. For example, employers can provide affordable health insurance that covers mental health needs.

Employers can also support children and youth indirectly. For example, they can offer insurance coverage for employees' dependent children, offer parent-friendly benefits such as family leave and childcare, and promote work-life balance and a positive culture at work to reduce family stress.

Below are some recommendations for how employers can support the mental health of young people:

Provide access to comprehensive, affordable, and age-appropriate mental health care for all employees and their families, including dependent children. Research shows that parental mental health challenges not only impact their productivity in the workplace, but can also affect the mental health of their children., Employers should offer health insurance plans that include no or low out-of-pocket costs for mental health services, and a robust network of high-quality mental health care providers.

Implement policies that address underlying drivers of employee mental health challenges, including both home and workplace stressors. Employers should:

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Offer paid family leave and sick leave where feasible. Consider additional employee benefits such as respite care for caregivers and mental health and wellness tools.

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Help caregivers secure affordable childcare, or offer more flexible work arrangements. This can reduce stress and improve productivity.,

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Ensure employees are aware of and can easily make use of these benefits. For example, include information on mental health benefits in emails, webinars, and during onboarding and training for all new hires.

Regularly assess employees' sense of wellbeing within the workplace. Tools such as employee surveys can help employers understand the wellbeing of employees across demographic groups (e.g., gender, race, sexual orientation), levels of seniority, business units, and geographies, and to identify opportunities for improvement. Employers should make sure to assess the wellbeing of young adults just starting out in the workforce, as well as of parents with young children.

What Federal, State, Local, and Tribal Governments Can Do

Note: For actions taken by the Biden Administration from January to October 2021 to support youth mental health, see Fact Sheet: Improving Access and Care for Youth Mental Health and Substance Use conditions.

Ultimately, youth mental health challenges cannot be addressed solely by the efforts of youth, their families, local communities, and private organizations. Federal, state, local, and tribal governments all have a role to play. While the below recommendations are not comprehensive, their implementation would mark an enormous step forward in supporting youth and their families:

Take action to ensure safe experiences online for children and young people. Example opportunities include but are not limited to increasing investment in research on the role of social media and technology in youth mental health; educating consumers about potential mental health risks online; requiring companies to be more transparent with researchers and the public (e.g., disclosing meaningful data for research purposes, enabling systemic auditing of social media algorithms), and developing safety standards for online services (e.g., standards for data collection, age verification, user engagement techniques such as 'nudges', and advertising aimed at kids and teens). For instance, the United Kingdom's Age appropriate design code has led companies including Instagram, TikTok, and YouTube to announce product changes to protect their users' safety, rights, and privacy., In addition, the Australian government's Safety by Design initiatives have resulted in a set of principles for user safety, tools for companies to assess their safety practices, resources for investors and financial entities to manage online safety risks, and a pilot program with universities to embed Safety by Design materials into curricula.

Ensure all children and youth have comprehensive and affordable coverage for mental health care. Example opportunities include strengthening public and private insurance coverage for children and young adults (e.g., by promoting enrollment), ensuring adequate payment for pediatric mental health services, investing in innovative payment models for integrated and team-based care, increasing the participation of mental health professionals in insurance networks, and ensuring compliance with mental health parity laws. Local, state, and tribal governments can access outreach and enrollment resources to help enroll and retain eligible children in Medicaid and CHIP at InsureKidsNow​.gov.

Support integration of screening and treatment into primary care. For example, continue expanding Pediatric Mental Health Care Access programs, which give primary care providers teleconsultations, training, technical assistance, and care coordination to support diagnosis, treatment, and referral for children with mental health and substance use needs.,, Expanding screening for ACEs is also critical. For instance, California recently enacted a law that will significantly expand coverage for ACEs screening.

Provide resources and technical assistance to strengthen school-based mental health programs. Example opportunities include improving education about mental health, increasing screening of students for mental health concerns, investing in additional staff (e.g., school counselors) to support student mental health needs, improving care coordination, and financing school-based mental health services. As mentioned in the earlier section with recommendations for educators, the American Rescue Plan's Elementary and Secondary School Emergency Relief funds can be used for these purposes, along with Project AWARE (Advancing Wellness and Resilience in Education) program funds, which provide support for state, local, and tribal governments in building school-provider partnerships and coordinating resources to support prevention, screening, early intervention, and mental health treatment for youth in school-based settings. In California, a recent law will ensure that all middle and high school students learn about mental health in health education classes. And, in New Jersey, a recent program will provide funding for school districts to screen students for depression.

Expand and strengthen suicide prevention and mental health crisis services. Example opportunities include providing flexible funding to fund crisis care needs, increasing access to intensive outpatient and other "step-down" programs, supporting access to trauma-informed services for traumatized children, implementing the 988 mental health crisis and suicide prevention hotline, and promoting public awareness of crisis hotlines and other resources. Governments should also collaborate with the private sector and local communities to reduce access to firearms and other lethal means of suicide and promote best practices such as safe storage.

Support continued reduction in biases, discrimination, and stigma related to mental health. Example opportunities include enforcing laws that support the needs of at-risk youth (e.g., students with disabilities), identifying and improving policies and programs that inappropriately target or harm youth with mental health needs, and conducting targeted education campaigns to address stigma, promote new cultural norms, and increase safety and trust in local communities.

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The good news is that, throughout the pandemic, many people have recognized the unprecedented need to support youth mental health and wellbeing and have taken action to do so.

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Supporting Students with Depression in School

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Discover effective strategies for supporting students with depression in a school setting. This webpage provides valuable resources and guidance for educators, administrators, and school personnel to create a supportive environment for students struggling with depression. Learn about the signs and symptoms of depression, evidence-based interventions, and practical tips for promoting mental health and well-being in schools. With the right knowledge and tools, you can make a positive impact on the lives of students facing depression, fostering their academic success and emotional growth.

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Adolescent Depression In Schools | Sandstone Care

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Is your teen depressed because of school? Get answers to these 8 common questions about school and mental health in adolescents.

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This is a plain English summary of an original research article

Shame, stigma, and a lack of knowledge about mental health problems, are some of the barriers that prevent young people from seeking professional help for anxiety and depression . New research has identified many of these barriers.

Some, such as a lack of trust in professionals, or limited support from their families, could also affect other groups. But others were specific to teenagers, such as a growing need for autonomy and independence.

Anxiety and depression are the most common mental health problems in teenagers, yet only a minority access professional help. The new findings emphasise the need for interventions that target teenagers and reach their families, schools, and society as a whole. They also show how working with teenagers could ensure that new interventions in mental health and help-seeking are meaningful for this age group.
Further information on mental health in children, teenagers and young adults is available on the NHS website.
What's the issue?

The most common mental health disorders teenagers experience are anxiety and depression. One in twelve (8%) experience anxiety and one in twenty (5%) depression. Some have both at the same time.

One in three teenagers with these conditions (and their families) do not seek or access any professional help. Existing research into the barriers they face has mainly come from studies of young people who have successfully accessed a mental health service. This means little is known about those who do not seek or access help. A better understanding of the barriers they face is needed to improve their access to care.

This study aimed to improve understanding of how teenagers with anxiety or depression identified in local secondary schools feel about seeking and accessing professional help.

What's new?

Children at two secondary schools filled in a questionnaire. The researchers used their answers to identify 22 young people (aged 11-17) who had anxiety and/or depression. They were then interviewed about their knowledge, attitude and experience of the disorders and of seeking help. Their parents were interviewed separately.

Four themes were identified.
1. Understanding their problem: "I just thought I was my kind of normal." 2. Revealing their feelings: "I was scared of telling people how I felt.. I thought they will judge me and then they'll think that there's something wrong with me."
Teenagers recognised some symptoms of anxiety and depression but they, along with parents and teachers, struggled to distinguish symptoms from typical teenager experiences. Young people often did not know where help was available outside school. Older teenagers in particular wanted to learn more about mental health problems and available support, even though they made limited use of existing resources.

Teenagers could feel embarrassed about disclosing their problem and worried what others would think of them. They struggled to put their feelings into words, and to start a conversation. They preferred their parents or professionals to bring up the subject and would only discuss it with someone they trusted. Shyness and feelings of hopelessness created further barriers. Older adolescents and boys in particular were worried about upsetting their parents or friends by sharing their feelings.

3. Indecision: " There's like a part of me that wants help and a part that doesn't."

Teenagers, especially boys, wanted to be self-reliant and to show themselves and others that they are strong enough to cope on their own. They were concerned about being seen as weak or as an attention-seeker. They were unclear about what professional help would involve and sometimes 'too proud' to seek it.

4. The role of others: " If it wouldn't be for X, I would still be suffering."

Adolescents did not seek professional help on their own and needed adults to arrange it. But parents and teachers did not always recognise the need. Parents reported lacking knowledge about child and adolescent mental health services (CAMHS) and said they needed to be persistent to get help. Families had different experiences of the process but emphasised the need to be well-supported by schools.

Why is this important?

Many of the barriers to seeking help relate to common experiences of adolescence, such as a growing need for autonomy and being concerned about what others think. The study highlights the important role of parents and school staff in helping teenagers access support. The balance between a teenager's autonomy and adult input is a delicate one.

Policymakers and those creating interventions to increase the uptake of mental health services by teenagers need to take these factors into account.

Better understanding of anxiety and depression, and of the help available, is needed. Teenagers want age-appropriate interventions and parents need support to enable their young people to access professional help. Interventions developed with the input of young people are more likely to meet their needs.

What's next?

The researchers aim to develop interventions for anxiety and depression in teenagers that address these barriers.

The teenagers in the study suggested regular screening for mental health problems in schools. Health assemblies could introduce the warning signs of anxiety and depression. Regular, informal conversations about mental health with their parents and other adults could help them better explain their feelings.

Parents need to know where to seek help. Schools and GPs are the first place they go to and need to be familiar with local services and support for teenagers. The teenagers in this study emphasised the importance of trust; this is a reminder to professionals to explicitly discuss confidentiality with them.

Families with limited financial and emotional resources found seeking and accessing support particularly difficult. These families need extra support from professionals. More broadly, continued efforts to normalise mental health problems and to reduce stigma will be helpful.

The study may not have included some disadvantaged groups such as parents who do not speak English. The lead author is planning to explore the barriers to help-seeking among young people from minority ethnic backgrounds with mental health problems .

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This NIHR Alert is based on: Radez J, and others. Adolescents' perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study. European Child & Adolescent Psychiatry 2021; doi:10.1007/s00787-020-01707-0

A review of research into help-seeking by young people: Radez J, and others. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry 2021;30:183-211

Research exploring why parents do or do not seek help for their children: Reardon T, and others. Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study. European Child & Adolescent Psychiatry 2018;27:1023-1031
Funding: Two authors were funded by NIHR Research Professorship; another by an NIHR Post-Doctoral Fellowship.
YoungMinds is a charity offering mental health support for young people, parents and those who work with young people.

The Anna Freud National Centre for Children and Families provides mental health and wellbeing resources for young people.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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Why don't teenagers get help for anxiety and depression? - NIHR Evidence

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This is a plain English summary of an original research article Shame, stigma, and a lack of knowledge about mental health problems, are some of the barriers that prevent young people from seeking professional help for anxiety and depression . New research has identified many of these barriers.

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Teenage blues vs. depression: How to tell the difference : Inside Children’s Blog

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Being a kid isn’t easy business. Children and teens face new challenges and social pressures often. Not to mention, their growing bodies are changing Shana Schuler, PhD, provides tips for parents on how to tell the difference between “teenage blues” and depression.