Worrying about a teenage child is par for the course. It’s hard not to worry when teenagers’ moods swing dramatically from one day to the next, when slamming doors is a daily occurrence, and when alcohol is very possibly in the picture.

Like it or not, these are common realities for most teenagers. So what kind of behavior is cause for concern?

The National Institute of Mental Health (NIMH) lists the following signs of depression:

  • Persistent sad, anxious or “empty” feelings
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness and/or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Insomnia, early–morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Of course, most teens experience some of these symptoms on a regular basis. According to NIMH, depression in adolescence frequently co-occurs with other disorders such as anxiety, disruptive behaviors, eating disorders, or substance abuse.

But Michael Carr-Gregg, Ph.D., a psychologist specializing in adolescent mental health and author of four books, including Surviving Adolescents, says the very best thing parents can do is look for changes in their child’s normal behavior.

Normal behavior is different for every child. What might be normal behavior for your older child is likely not normal for your younger child, and vice versa. The key is to know the norm and to notice changes. As Carr-Gregg says, “Be the world expert on your kid.”

Depression can occur for any number of reasons as a response to any number of factors. Some adolescents have a difficult time adjusting to the typical changes and pressures that come with the transition from childhood to adulthood. This depends on the specific circumstances and the adolescent's natural inclinations. Are teens more at risk for depression today than in years past? Possibly, says Carr-Gregg. “It’s very hard to say whether the actual incidence of the illness is increasing, or whether we are getting better at picking it up,” he says. “I suspect a bit of both.”

Factors behind depression in teens can include early childhood adversity, cumulative adverse experiences, nonsupportive school or familial environments, and parental depression. And Carr-Gregg says the adversity young people experience increases dramatically during mid- to late adolescence, especially for girls. In fact, according to NIMH, by age 15, girls are twice as likely as boys to have experience a “major depressive episode.”

Carrie Silver-Stock, MSW, LCSW, a licensed mental health counselor and author of the new book, Secrets Girls Keep: What Girls Hide (& Why) and How to Break the Silence, says social pressure and hormones can be a major cause of distress for adolescents. “There’s tremendous pressure to fit in and be liked,” she says. “It can be a very hard time because they’re learning how to make decisions independently, and they have changes in their hormones—physiological changes going on in their bodies.”

Silver-Stock, who founded Girls With Dreams, an online learning community for adolescent girls to learn from and share with one another in a supportive environment, agrees that parents can be most effective by knowing their children well and paying attention—by being good detectives, she says. “Girls especially try to put on this act of having it all together, and sometimes they might not even realize they’re depressed,” Silver-Stock cautions.  

Carr-Gregg explains that in addition to social pressure and hormones, poor interpersonal skills coupled with negative thought processes can create difficulties for adolescents negotiating changing relationships with peers and families. Tweens and teens are searching for autonomy while at the same time trying to fit in—and it can be challenging to manage these tasks while simultaneously trying to succeed in a competitive academic and social environment.

The bottom line is that children are pressured by both peers and adults to grow up faster than they should. Why? Carr-Gregg points to driving factors such as the following: early puberty and sexualization, a higher incidence of parental separation, a decline in ritual (both tradition and spirituality), the 24/7 nature of peer communication, bullying, and disconnected communities.

“My clients are under pressure to have a great body, be very fit, to binge drink, have multiple sexual partners, and compete academically both at school and at university,” Carr-Gregg says.

How to Help
  • Be an expert on your child. Watch for changes in behavior
  • Make your home a safe place to share feelings and concerns
  • Recognize and applaud your adolescent’s strengths

Carr-Gregg and Silver-Stock both agree that extracurricular activities, or “islands of competence,” can serve as protective factors against depression. According to Carr-Gregg, adolescents who have identified islands of competence, such as art, music, sports, dance, or drama, seem to do better than adolescents without.

“Activities can really help to build self-esteem and confidence and give kids another peer network,” Silver-Stock says.

Identifying areas in which adolescents have competence also helps with identity formation, and it gives structure, meaning, and purpose to children’s lives, Carr-Gregg says.

Experts caution, however, not to overextend adolescents with too many extracurricular activities. There is a point at which these activities leave little room for downtime and reflection and only serve as an additional pressure.

It can be challenging to determine whether a teenager’s behavior is worthy of worry. If you are concerned about your teenager’s mental or emotional health, talk to your family doctor.