Treatments and drugsBy Mayo Clinic staff
Many types of treatment are available. In some cases, a primary care doctor can prescribe medications that relieve depression symptoms. However, many teens need to see a psychiatrist or psychologist or other mental health counselor. A combination of medications and psychological counseling (psychotherapy) is very effective for most teens with depression.
If your teen has severe depression or is in danger of self-harm, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.
Here's a closer look at depression treatment options.
Because studies on the effects of antidepressants in teens are limited, doctors rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for teen depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with adults, other medications may be prescribed at the doctor's discretion (off label), depending on your teen's needs.
Talk with your teen's doctor and pharmacist about possible side effects, weighing the benefits and risks. In some cases, side effects may go away as the body adjusts to the medication.
Antidepressants and increased suicide risk
Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, children, adolescents and young adults under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, people in these age groups must be closely monitored by loved ones, caregivers and health care providers.
If your teen has suicidal thoughts while taking an antidepressant, immediately contact your doctor or get emergency help.
For most teens, the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior.
Carefully monitor your teen's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for teens with depression, your teen's doctor may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your teen does not have a large amount of pills available at once.
Finding the right medication
Everyone's different, so finding the right medication or dose for your teen may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts.
If your teen has bothersome side effects, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression. Encourage your teen not to give up.
If antidepressant treatment doesn't seem to be working, your teen's doctor may recommend a blood test called cytochrome P450 (CYP450) to check for specific genes that affect how the body processes antidepressants. This may help identify which antidepressant might be a good choice. However, these genetic tests have limitations and may not be widely available.
Antidepressants and pregnancy
If your teen is pregnant or breast-feeding, some antidepressants may pose an increased health risk to her unborn or nursing child. If your teen becomes pregnant or plans to become pregnant, make certain she talks to her doctor about antidepressant medications and managing depression during pregnancy.
Psychotherapy, also called psychological counseling or talk therapy, is a general term for treating depression by talking about depression and related issues with a mental health provider. Psychotherapy may be done one-on-one, with family members or in a group.
Through these regular sessions, your teen can learn about the causes of depression, how to identify and make changes in unhealthy behaviors or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals. Psychotherapy can help your teen regain a sense of happiness and control and help ease depression symptoms such as hopelessness and anger. It may also help your teen adjust to a crisis or other current difficulty.
Hospitalization and other treatment programs
In some teens, depression is so severe that a hospital stay is needed, especially if your teen is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your teen calm and safe until symptoms are better managed. Day treatment programs also may help. These programs provide the support and counseling needed while your teen gets depression symptoms under control.
- Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Sept. 13, 2012.
- Adjustment disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Sept. 13, 2012.
- Depression. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/index.shtml. Accessed Sept. 14, 2012.
- A family guide: What families need to know about adolescent depression. http://www.nami.org/Template.cfm?Section=Child_and_Adolescent_Action_Center&template=/ContentManagement/ContentDisplay.cfm&ContentID=24806. Accessed Sept. 14, 2012.
- FAQs on child and adolescent depression. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/cs/child_and_adolescent_depression_resource_center/faqs_on_child_and_adolescent_depression#What%20causes%20depression%20in%20children?. Accessed Sept. 14, 2012.
- Overview of treatment for adolescent depression. http://www.uptodate.com/index. Accessed Sept. 14, 2012.
- Depression in adolescents: Epidemiology, clinical manifestations, and diagnosis. http://www.uptodate.com/index. Accessed Sept. 14, 2012.
- McCaffrey R, et al. Garden walking and art therapy for depression in older adults: A pilot study. Research in Gerontological Nursing. 2011;4:237.
- McDowell AK, et al. Practical suicide-risk management for the busy primary care physician. Mayo Clinic Proceedings. 2011;8:792.
- Understanding major depression. National Alliance on Mental Health. http://www.nami.org/Template.cfm?section=Search&Template=Search/SearchDisplay.cfm. Accessed June 20, 2012.
- Schreiber J, et al. Suicidal ideation and behavior in adults. http://www.uptodate.com/index. Accessed Sept. 14, 2012.
- Carpenter DJ. St. John's wort and S-adenosyl amethione as "natural" alternatives to conventional antidepressants in the era of the suicidality boxed warning: What is the evidence for clinically relevant benefit? Alternative Medicine Review. 2011;16:17.
- Understanding suicide: Fact sheet 2012. Centers for Disease Control and Prevention. http://www.cdc.gov/ViolencePrevention/pub/Suicide_factsheet.html. Accessed Sept. 14, 2012.
- When you fear someone may take their life. American Foundation for Suicide Prevention. http://www.afsp.org/index.cfm?page_id=f2f25092-7e90-9bd4-c4658f1d2b5d19a0. Accessed Sept. 14, 2012.
- Cizza G, et al. Clinical subtypes of depression are associated with specific metabolic parameters and circadian endocrine profiles in women: The power study. Plos One. 2012;7:e28912. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0028912. Accessed June 19, 2012.
- Pae C, et al. Atypical depression: A comprehensive review. CNS Drugs. 2009;2:1023.
- McPhee SJ, et al. Current Medical Diagnosis & Treatment. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=13381. Accessed June 20, 2012.
- Parker G, et al. Will a new genotyping test help the clinician predict response to antidepressant drugs? Australasian Psychiatry. 2010;18:413.
- Hourani LL, et al. Influence of spirituality on depression, posttraumatic stress disorder, and suicidality in active duty military personnel. Depression Research and Treatment. 2012;2012:e1. http://www.hindawi.com/journals/drt/2012/425463/. Accessed Aug. 28, 2012.
- Depression and complementary health practices: What the science says. National Center for Complementary and Alternative Medicine. Dec. 2011. http://nccam.nih.gov/health/providers/digest/depression-science.htm. Accessed May 10, 2012.
- Croarkin PE (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 3, 2012.
- Olsen MW (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 6, 2012.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 8, 2012.
- Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression. Journal of Psychiatric Practice. 2012;18:233.
- Tanyi RA, et al. The effects of psychoneuroimmunology (PNI) based lifestyle intervention in modifying the progression of depression in clinically depressed adults. International Journal of Psychiatry in Medicine. 2011;42:151.
- Wu J, et al. Acupuncture for depression: A review of clinical applications. The Canadian Journal of Psychiatry. 2012;57:397.
- Chi J, et al. Tai chi and reduction of depressive symptoms for older adults: A meta-analysis of randomized trials. Geriatrics & Gerontology International. In press. Accessed Aug. 28, 2012.
- Chan MF, et al. The effectiveness of music listening in reducing depressive symptoms in adults: A systemic review. Complementary Therapies in Medicine. 2011;19:332.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 24, 2012.