Dear Sage: Typical teen, or clinically depressed?

A 10th grade girl enters our high school office and asks to talk to someone. She was referred by one of her friends, who also receives services with us. Almost 25 percent of the students we see are referred by a friend.

The girl reports feeling overwhelmed and not able to handle her school work. She frequently needs to go to her car and cry.  She has been more tired than usual but can’t get any restful sleep. She has been feeling like this for the past month. She also reports pulling away from her friends and wanting to be alone most of the time.

Our therapist assesses her for risk of self harm or suicidal behaviors. The student is offered therapy and agrees to allow us to call her parents. We recommend weekly therapy and will monitor her symptoms as well as risky behaviors.

Depression is not a sign of weakness and cannot be willed away. Just as a broken arm requires medical attention, so does depression. Sadly there is still a great deal of shame and stigma associated with mental health. Acknowledging this fact can open up discussions about how your child might be feeling. Remind your child that people may not understand or might be misinformed, but that there is no reason to feel embarrassed or ashamed. Teens should also know that it is their choice whether or not they want to tell people about their diagnosis, but that it is not something that they need to hide. 

The 10th grade student began to trust her therapist and understand that her depression was not her fault, nor something to be ashamed of. The therapist used cognitive behavioral therapy techniques, such as tracking dysfunctional thoughts on a thought record form, and devising healthier, more psychologically flexible patterns of thinking. Within a few months the student was getting out of the fog known as depression. A professional who validates what someone is feeling can start the process of healing. 

Teen depression is not uncommon. The Centers for Disease Control and Prevention (CDC) reports that 3.2 percent of children, ages of 3 and 17 (approximately 1.9 million) are diagnosed with depression each year.

It’s important to differentiate between a depression disorder and normal adolescent  mood swings.

Common depression symptoms include:

  • Anger and irritability. Many teens act aggressively when depressed.
  • Somatic/physical complaints: Headaches, muscle aches and stomach disorders are the most common and are easier to communicate to parents
  • Withdrawal from friends and family: Often they pull away from the people who support them the most
  • Sleeping too much or not enough. Yet they may never feel rested and wake up tired
  • Fatigue: A constant weariness can occur because they are always fighting to feel OK
  • Negative self-talk: It can occur without the teen being aware of the extent they are doing it
  • Difficulty concentrating: the brain becomes foggy and simple tasks become impossible
  • Declining grades: Due to the lack of energy and ability to concentrate

For the symptoms to be warrant a diagnosable disorder three important factors must be considered.

  • Severity:  The more pronounced the above symptoms are the more likely that the problem is depression and not a passing mood.
  • Duration: A diagnosis of depression requires the symptoms last at least two weeks without a break.
  • Domains: The problem must exist in at least two areas of the teens life — home, school and social areas.

For more information go to

Liz Schoeben is a licensed Marriage and Family Therapist. In 2017, she founded CASSY SoCal (, which partners with the Palos Verdes Unified School District to provide students with comprehensive mental health services. 



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