Despite the clarity of diagnostic criteria, identifying depression in teens isn’t always straightforward. At every age, depression can look different from person to person, with some people experiencing emotional symptoms and others having more physical ones.  

As an added complication, depression can interfere with people’s thinking, so they may not be fully aware of their symptoms or may have trouble finding the right words to describe them.  

For lots of adolescents, there is yet another layer.  Many have a hard time trusting adults with their thoughts and feelings. For some, the desire for privacy involves actively hiding what they’re going through.  

Melody M. Ott, LCSW and her colleagues at Wellbeing Counseling & Wellness are skilled in interpreting the signs of depression in teens and young adults. Here are a few of their top recommendations. 

Look Past the Cheery Exterior 

“We often see kids that look as happy as can be on the outside, especially when they’re with their friends,” Ott explains. “But deep down, it’s a totally different story. We see this pattern a lot with high achievers—the kids who have good grades and are in five clubs and play sports. On the outside, things look great. But they tell you, ‘I think about killing myself every day.’” 

Anxiety often rides along with this kind of depression, Ott says. It’s not uncommon to see substance use, too, because teens may be trying to relieve the anxiety by self-medicating. It can be tricky to diagnose without knowing which questions to ask, or without an instrument that guides you through the right questions. 

Pay Attention to the Doom-Colored Glasses

“Another thing we notice is kids who see the whole world through a pretty hopeless lens,” she says.  

Negative interpretation biases, as these thought patterns are sometimes called, can create a self-reinforcing cycle in teens with depression. In a 2020 study involving 122 children and teens ages 9 to 14, researchers presented a series of 10 situations which could be interpreted positively or negatively. Young people diagnosed with major depression disorder interpreted the events in a more negative way than those who did not have depression (Sfärlea et al., 2020).  

“Kids with depression can have a hyperfocus on things that are negative, almost as though they have a metal detector on the beach that only finds the rusty nail, and not the ring,” Ott points out. The tendency toward negative interpretations can amplify sadness and a sense of hopelessness, which may deepen the depression over time. 

Check on Teens with Big Feelings 

Persistent sadness, hopelessness, and guilt are aspects of the diagnostic criteria for depression. But powerful emotions of all types can be an indication of vulnerability to depression. Ott describes teens like these as “the big feelers.” Their acute sensitivity can often be at odds with family dynamics, especially when caregivers, parents, and educators emphasize emotional control or repression.  

“Some kids are highly sensitive to criticism, rejection, and failure—and that can drive depression,” she notes. “Another thing we see is really big mood swings. This can be confusing to parents, who may be worrying that their child could have bipolar disorder, which isn’t usually the case.” 

When teens are used to big emotions, they may start to confuse contentment and numbness. “They’re so used to highs and lows that contentment looks like a little blip on the radar,” she says. “They’re not used to a normal range of emotion.” 

Ask About Anger and Control    

For some teens, a lack of agency can lead to depression. “So many feel like they don’t have any control over any part of their lives. These kids can easily become combative with their families,” Ott says. “It’s kind of like they’re desperately grasping for any kind of control. The message is, ‘I’m hurting.’ So they light their emergency flare.” 

Researchers have identified conflicted anger as a central part of adolescent depression. They describe it as “anger, blame, and envy directed toward others that lead to disruptions in interpersonal relationships, confusion over responsibility, and self-directed anger…and depressive affects” (Henriksen et al., 2021).  

For that reason, when an angry teen walks through the door, Ott says it’s time to start checking for depression.  

Find Out About Academic Ups and Downs  

“A lot of the time, what brings kids to us is that they start doing really poorly in school. Maybe they’ve always had a little trouble with their grades, so the change is small. But more often, there’s a big change. And big changes get more attention,” explains Ott.  

Parents often notice a change in motivation, which can look like laziness or boredom. Underlying that loss of motivation, other symptoms of depression may be hard at work.  

“Not only can kids stop caring about school, they don’t care about the effects of bad grades,” she says. For that reason, disciplinary measures such as “grounding” students or taking away privileges and possessions may not inspire change or correct depression-related behaviors. “By the time I see some kids, they have nothing left but a mattress on the floor because they’re being punished for something they really cannot control.”

Notice When Someone Is Suddenly Solo     

Researchers have identified social isolation as a factor in the development and persistence of depression among adolescents.  

In a 2022 review of 12 studies, researchers found a strong association between depression, anxiety, and social isolation in children and teens. Depression was also linked to lower scores on tests involving verbal comprehension, poorer school performance, and decreased ability to learn new skills such as reading and writing (Almeida et al., 2022). 

“Isolating can look like a kid playing a lot of video games or becoming addicted to their various social media platforms,” Ott says. “They’re not really getting the kind of social connection they need in those settings, even though it might look like they are.” 

Key Messages    

Rates of depression are growing among adolescents. This trend can be frightening for teens and parents—and overwhelming for clinicians and educators responsible for evaluating the condition in teens. Knowing how depression shows up day to day can help practitioners evaluate with greater confidence and target interventions to individual areas of need.  

Look for signs like these when you’re assessing for depression: 

• superficial happiness with hidden sadness  
• perfectionism 
• hyperfocus on negativity 
• conflicted anger 
• emotional peaks and valleys 
• academic fluctuations 
• lack of agency and motivation 
• social isolation  

Speaking to clinicians and educators, Ott offers one other piece of advice: “We all need to be talking to each other about what we’re seeing out there,” she urges. “Nothing gets better until we all share what we know.” 

If you’d like to speak with a WPS Assessment Consultant about mental health, achievement, and adaptive functioning assessments, we’re here for you. Or if you’d like to share your expertise with WPS, reach out to our Marketing team about opportunities to contribute to the WPS Blog.  

Research and Resources: 

Almeida, I. L. L., Rego, J. F., Teixeira, A. C. G., & Moreira, M. R. (2021). Social isolation and its impact on child and adolescent development: A systematic review. Revista Paulista de Pediatria, 40, e2020385. https://doi.org/10.1590/1984-0462/2022/40/2020385 

Henriksen, A. K., Ulberg, R., Tallberg, B. P. U., Løvgren, A., & Johnsen Dahl, H. S. (2021). Conflicted anger as a central dynamic in depression in adolescents: A double case study. International Journal of Environmental Research and Public Health, 18(12), 6466. https://doi.org/10.3390/ijerph18126466 

Ott, Melody, LCSW. (2023). Personal interview. 

Sfärlea, A., Buhl, C., Loechner, J., Neumüller, J., Asperud Thomsen, L., Starman, K., Salemink, E., Schulte-Körne, G., & Platt, B. (2020). "I am a total…loser" - The role of interpretation biases in youth depression. Journal of Abnormal Child Psychology, 48(10), 1337–1350. https://doi.org/10.1007/s10802-020-00670-3