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Dealing with a depressed teen

When my husband and I raised my two teenage cousins, we learned how moody, irritable and distracted teens can be. We also found that although they were often difficult to talk to or understand, our conversations with them helped us do our best in our parenting role.

Teen behavior can be confusing. They sometimes stop eating, eat more, sleep more, sleep less or cry for no apparent reason. Because all of these behaviors can be signs of depression, how do you know if your teenager is depressed, hormonal or just down for a day? Will she grow out of it or is it something serious?

The teen years can be difficult as young people establish identities, learn to make decisions, test boundaries and cope with peer pressure and fluctuating hormones. You worry whether they will make good choices and whether their behavior is “just normal teen behavior” or something more.

Teen depression may be tricky to spot, especially with other behavior problems and mental health conditions such as anxiety or attention-deficit/hyperactivity disorder.

If your child is accustomed to talking with you about feelings and what is happening in his life when he is feeling good, he may be more inclined to open up when he is down. Talking to your child often, when things seem fine and when you suspect a problem, helps you develop a sense of what is normal for your child.

Everyone has the blues occasionally, so what is the difference between temporary sadness and depression? It is common to be temporarily derailed by a loss or a failure, for teens and adults alike; however, depression is a persistent condition that goes on for two weeks or longer, interferes with normal activity and rarely goes away on its own.

In teens, warning signs include sadness, irritability, anger, a sudden change in grades, frequent absences from school, talking about or attempting to run away, loss of interest in family and friends, conflicts with family and friends, out of proportion sensitivity to rejection or failure, extreme pessimism, neglected appearance, reckless behavior and substance abuse.

Persistence of these problems and their effect on your teen’s ability to function are reasons to suspect depression. I recommend talking with your teen, discussing the need to get help and making an appointment with a health care provider right away.

The health care provider will ask your teen questions necessary to rule out other conditions that require different treatments. It is important to let her answer, but when she is not able to answer, fill in if you can.

Depression is usually treated with medications and counseling. You may be wondering how to fit counseling sessions into an already packed family schedule or worried about side effects from antidepressants. In 2008, a National Institute of Mental Health study reported that medication combined with cognitive behavioral therapy (CBT – a type of counseling) is the most cost effective and best teen depression treatment over the short term (12 weeks). Over 36 weeks, medication alone, CBT alone and medication and CBT combined were equally effective.

I advocate for a combined approach. Medication can help jumpstart your teen’s recovery, and counseling (be it CBT or another type of counseling) can help your teen develop tools to avoid depressive episodes and reduce or eliminate the need for future medication.

Love your kids, let them learn, grow and test their wings, but also let them know you are there to help when they want or need you. Teens who have that sense of security at home have a great foundation for treating depression.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section. Send your comments and column suggestions to

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