While nearly all adolescents struggle at times with moodiness, sadness, and down days, studies show that diagnosable depression is present in 4-5% of adolescents. Increased rates of suicide and substance abuse occur in teens with unrecognized and under-treated depression. Suicidal thoughts among teens  during the COVID pandemic has increased between 40% and 60%. Completed suicides among this age group are up between 25% and 40% depending on the part of the country one examines.

The consequences of depression during the teen years can be very serious. Depression at any age includes inability to feel pleasure and low motivation. This complicates social life and peer relationships. Depressed adolescents can turn to substances or sexual behaviors to provide relief from depression, to escape its effects on daily life, or in an effort to just be able to feel something. All of this comes at a time when important aspects of self-awareness and identity are usually developing, which are easily distorted by depression and its symptoms. 

Depressed adolescents are not able to participate adequately in learning or school, during a stage of life when they need to acquire key skills. While most adolescents consume a lot of social media, depressed adolescents may isolate themselves so that social media and its distractions become their only connection with the world.

Because the teenage years are already a time of rapidly shifting family relationships and boundaries, concerned parents and family members may have a particularly difficult time helping to monitor the severity of a teen’s depression and their adherence to a medication or talking therapy treatment plan. This leaves teens at greater risk.

Psychotherapy (talk therapy) and antidepressant medication are the main approaches to treating adolescent depression. Family therapy can also be an important approach. These can be quite effective for many, but for others, these efforts do not sufficiently address the problem.

Successful talking therapy requires a good relationship between patient and therapist, complete honesty on the part of the patient, and a commitment to progressive change and problem solving. This can be a challenge at any age but especially so for teens. One of the recognized problems with talk therapy in teens is that they can find it very difficult to talk about what they are struggling with in a fully honest manner. Some are held back by shame or embarrassment, while others so crave an hour of acceptance and positive feedback from someone that they focus on making things seem good while disguising their pain and the  true severity of what they are experiencing. 

Confidentiality is essential to how talk therapy works. Most people, and especially teens, would have even more trouble being honest with a therapist if what they said might be relayed to the other people in their lives. By the same token, however, parents often have so little information about what their depressed teen is struggling with or working on in therapy that they are unable to contribute in a meaningful way.

Antidepressants must be taken daily and often at the same time of day
to work. Teens have irregular schedules, their sleep wakes cycles vary, and they may become distracted and forgetful. All of this complicates taking antidepressant medication consistently and regularly.

Monitoring progress can also be difficult. The same issues that make complete reporting impossible with psychotherapy are relevant to medication management sessions as well. In addition, many teens do not really know what “good” feels like, so they and their doctors struggle to understand if medications are working optimally or have achieved the goal of complete remission of depression symptoms.

Most antidepressants used for treating teen depression are used “off-label.” What this means is that the antidepressant was approved by the FDA for use in adults, but not specifically approved for use in teens, whose neurochemistry is somewhat different. All antidepressants also carry a risk of increased suicidal thinking and behavior while starting the medication.

Yes. Multiple published studies show that TMS can be a safe and effective treatment for teenagers. There appears to be no difference in effectiveness between teens and adults, meaning TMS helps about 70% of those who try it. Like medication, TMS use is still “off-label” for this age group. However, TMS is not known to increase suicidal thinking, nor to cause the side effects common with antidepressants like weight gain, sexual dysfunction, and sedation.

Some insurance plans limit TMS use to those over 18 based on the “off-label” issue, but this may be appealed as antidepressant medication use in teens is also “off-label.” We can work with you to see what your options may be.

We suggest involving your child’s therapist and doctor in such discussions. It’s best to approach the idea in as straightforward a manner as possible. Ask if your child’s current treatment plan is working and if progress is being made. Is there a possible need to change their medication regimen? If so, TMS has a much higher probability of positive results compared with trying a new antidepressant after others have failed (70% vs 18%). We do offer a no-obligation, no-cost assessment in which the adolescent can be evaluated, meet the team, and ultimately decide if they wish to proceed or not. Even for those who decide not to pursue TMS at the current time, exploring options can be comforting, as it provides realistic hope about the possibility of ultimate success in treating depression.