Therapy or Medication for Teen Depression: Choosing What’s Right for Your Teen
What You Need to Know About Teen Depression
The teen years are full of emotional ups and downs. While all teens experience low moods, teen depression is a mental health condition that impacts how teens, feel, think, and behave. Teens with depression are not just sad. They are often dealing with emotional numbness, low self-worth, overwhelm, and difficulties with motivation that impact their performance in school and sports. Teens with depression may have difficulties starting or maintaining friendships and might isolate themselves from the things they used to enjoy. If you’re a parent who suspects that your teen might be depressed, you may be wondering if medication or therapy is the better option for treating your teen’s depression. While treatment decisions ultimately depend on the individual, understanding how therapy and medication work to treat teen depression can help you make an informed decision about what is right for your teen.
Understanding Teen Depression
Although teen and adult depression are the same mental health condition, teens may exhibit signs and symptoms differently than adults. Because teens often express sadness and emotional difficulties differently than adults, the way they communicate that they are struggling is different. Common signs of teen depression are:
Increased irritability, grumpiness, or hostility
Lashing out more for what seems like no reason
Withdrawing from social activities and relationships
Drops in academic performance
More complaints of unexplained headaches, stomach aches, or other physical pain
Problems with sleep
New or increased substance use
Changes in appetite (eating either too much or too little)
Having low energy or motivation to do things
Non-suicidal self-injury like cutting, burning, or hitting
Suicidal ideation or preoccupations with death and dying
If you notice these signs in your teen, it is important to seek care for teen depression as soon as you can. Early treatment can help teens get better and avoid long-lasting or chronic depression.
How can therapy help teens with depression?
Psychotherapy for teen depression takes place between a teen and a licensed mental health provider such as a Licensed Social Worker. Ideally, therapists who treat teen depression specialize in providing a unique, developmentally friendly approach to help teens engage in therapy and fully participate to maximize the benefit of therapy for long term symptom relief. Therapy for teen depression usually takes place once per week and treatment may last several months. While therapy can be used to effectively treat teen depression, recovery takes time and parents and teens should be patient and not expect immediate results.
Types of therapy for teen depression
There are many different evidence-based therapy approaches for teen depression that have been shown to be effective at reducing symptoms and preventing the reoccurrence of depression after treatment is complete.
Cognitive Behavioral Therapy. CBT for teen depression is a well-studied, evidence-based form of psychotherapy that helps teens identify and change negative thought patterns and beliefs that may keep them stuck in depressive states. CBT provides teens with depression with skills that help them take action to improve their mood and solve problems that might otherwise keep them stuck in a cycle of low mood and withdrawal.
Interpersonal Therapy for Adolescents. IPT-A is another evidence-based psychotherapy that focused on relational aspects of depression. IPT-A guides teens to consider the different relational components in their lives and develop skills to improve relationships, leading to an improvement in mood over time.
Dialectical Behavioral Therapy. DBT is an evidence-based, skills focused type of psychotherapy that helps teens manage intense emotions and build lives that are worth living. DBT was originally created to help people with borderline personality disorder who engage in high-risk behaviors. While true DBT is often delivered in a comprehensive, structured format that includes both individual and group therapy as well as parent skills training, DBT skills are often integrated into other approaches to assist teens with depression who may not require an intensive approach. Teens do not have to be suicidal or engaging in self-harm to benefit from learning DBT skills in therapy.
Emotions Focused Therapy for Youth. EFT-Y is an evidence-based psychotherapy that works directly with emotions and the ways that they impact mood. Unlike CBT and DBT for teen depression, EFT-Y allows for deeper introspection and targets the underlying emotional processes that contribute to teen depression in the first place. Instead of managing symptoms, EFT-Y gets to the root of the problem. For teens with depression who have benefitted from CBT or DBT skills but are looking to move beyond surface level stabilization, EFT-Y offers a roadmap for deeper understanding.
Family Therapy or Parent Skills Training. Teen depression often impacts the whole family unit. In some cases, teen depression is a normal response to conflict or difficulties within their family. Parent skills training or family therapy can help improve the home environment so that teens can continue to grow and thrive outside of session.
Benefits of Therapy
Teaches skills that can stabilize teens initially
Addresses root causes of teen depression
Builds long term emotional resilience that lasts long after therapy ends
Improves systemic and environmental factors that contribute to depression
Encourages a proactive approach to managing symptoms through increased insight
Teaches important coping tools
No medication side effects
Limitations of Therapy
While therapy can help stabilize a crisis situation, it is not an immediate solution for longer term mental health problems such as teen depression
May not be sufficient to address severe depression on its own
Requires teens to implement skills and changes in behavior to be successful
Teens need to participate in a meaningful way on a consistent basis to see results
Medication for Teen Depression
There are a variety of medications approved to treat teen depression. These medicines have been scientifically proved to be effective at reducing symptoms of depression. Research shows that 60% of teens who opt to treat depression with medication experience benefits within 12 weeks. Medication for teen depression is only appropriate if teens have a clinical diagnosis of depression from a qualified healthcare provider.
Benefits of Medication
Relatively fast symptom relief. Some teens report improvements within just a few weeks of consistently taking antidepressants
Can help teens whose symptoms of depression are interfering with their day to day lives get back on track
Can be used alongside therapy for powerful benefits
Risks and Considerations
All medications carry side effects and medicines for teen depression are no different. Side effects might include nausea, dizziness, headache, changes in sleep, or other unwanted effects
Antidepressant medications are often a process of trial and error. Teens might need to try multiple medicines before they find the one that works best for them.
Requires close monitoring by parents and doctors in the initial stages of treatment to monitor for an increased risk of suicidal thoughts or actions.
What about the suicide risk association with antidepressants?
Parents are often concerned that antidepressant medication carries a black box warning for suicidal thoughts and actions. It is true that some studies noted an increase in suicidal thoughts and actions in children and teens prescribed these medicines. However, none of study’s participants took their own life and there is not a causal link between antidepressants and suicidal thoughts and actions. In clinical practice, it is rare for teens who begin taking antidepressants to become suicidal if they were not previously. Out of an abundance of caution, teens with depression who take medications to treat it are monitored closely by family and their healthcare providers in the early weeks of beginning treatment to ensure that no new risks arise.
Where to get more information
If you believe that your teen might benefit from taking medication to treat depression, it is important to talk to their physician to get more information and appropriately weigh the risks and benefits of treatment.
Therapy vs Medication: Which is Better?
Making the choice between using medication or therapy to treat teen depression can be a difficult one. There is no one size fits all approach, but there are several things you can consider when weighing your options.
Mild to Moderate Depression
If your teen has been diagnosed with mild to moderate depression by a qualified mental health provider, therapy is usually the first line treatment option. Therapy allows teens to build skills and improve mood over time without having to risk unwanted side effects of medication. If teen depression is not interfering with a teen’s daily life or is present at a low level, therapy may be your best option.
Mild to Severe Depression
Teens who have been diagnosed with moderate to severe depression are often treated with a combination of medication and therapy. Medication helps to address symptoms on a relatively quick timeline and therapy address a teen’s thoughts, emotions, and relationships to encourage long term, sustained changes.
Individual Factors
Every teen and family is different. What worked for a friend, family member, or even yourself as a teen might not work for your teen with depression. Some individual factors to consider are
Severity of symptoms and if they are interfering with your teen’s everyday life
Family history of moderate to severe depression or suicidality
Your ability to access healthcare and therapy
Your teen’s preferences and willingness to take medication and/or engage in therapy
Combining Therapy and Medciation
The good news is that teens with depression don’t have to choose between medication and therapy. It is considered best practice to combine medication and therapy when possible, especially for more severe symptoms. This approach has been shown to be more effective than either approach by itself. If your teen with depression has been in therapy for some time and is not seeing significant improvement, your teen’s therapist might suggest that they try taking medication to help stabilize their mood. Sometimes, teens are not purposefully disengaged in therapy. Untreated depression itself can make it difficult to have the energy to implement positive changes made in therapy. Teens whose depression is managed well by medication are more likely to benefit from therapy than those who are struggling with persistent low mood and other symptoms of teen depression.
How Teen Therapists Collaborate with Psychiatric Care Providers
Teen therapists work collaboratively with psychiatric care providers to ensure that teens are benefitting from medication. Teens may not always know how to answer questions about how they’ve been feeling or have little awareness about their emotions and behaviors over time. Teen therapists are experts at tracking moods over time, helping teens identify triggers, and looking holistically at a teen’s life to pinpoint specific contributing factors making depression better or worse. Teen therapists can work with psychiatric care providers to share information and give teens the best chance at quick and efficient recovery from depression while minimizing unwanted side effects.
Questions to Ask Your Teen’s Therapist
How severe is my teen’s depression?
Does my teen have any co-occurring diagnosis that may complicate treatment?
What is the best approach to treating depression based on my teen’s symptoms, goals, and preferences?
What can I do at home to reinforce changes being made in therapy?
Who do you recommend for a medication management or psychiatric care provider?
How will we know when therapy has been successful for treating depression and it’s time to graduate from care?
Questions to ask your teen’s doctor
Are there any other medical conditions or medications that could cause or contribute to mood instability in my teen?
What are the risks and benefits of treating teen depression with medication?
Who do you recommend as a teen therapist who treats depression?
If we choose to treat teen depression with medication, how likely is the risk of suicidal ideation?
How do we track and monitor for suicidal thoughts after beginning medication?
How will we know when it’s time to stop taking medication?
How Parents Can Support Their Teen with Depression
Do your best to create an environment where teens can openly explore their emotions and challenges. Try to avoid being dismissive, minimizing struggles, or making the conversation about your own fears and worries about your teen.
If you notice signs and symptoms of teen depression, seek professional help from a qualified mental health provider or your teen’s doctor sooner rather than later. Early treatment leads to better outcomes.
Stay involved in your teen’s treatment and be open to making changes in your parenting style or family dynamics that may support recover from depression.
Work collaboratively with your teen to figure out a way to check in regularly without overwhelming them so that you can stay connected, monitor for side effects, and celebrate wins as they progress in treatment.
Manage your own anxiety about the treatment and recovery process. Teen depression is a challenging and often debilitating condition that can impact the whole family. Successful treatment is possible, but recovery takes time. If needed, seek your own support from friends, other adults in your family, or a mental health professional.
Key Takeaways
Teen depression is a common but serious condition that requires prompt treatment from a professional. Often, teen depression is treated with a combination of medication and therapy. There is no single approach that works for every teen. Holistic, collaborative care that involves teens, parents, therapists, and psychiatric providers is the gold standard for treatment. Early intervention is important and successful treatment of teen depression is possible. Deciding between therapy and medication for teen depression doesn’t have to be an all or nothing choice. A combined approach initiated early appears to be the most successful approach. Many teens who experience depression learn to manage the illness successfully and go on to lead happy, healthy, full lives.
