Therapy for Depressed Kids and Teens

Is your child often moody, withdrawn, sad, or irritable? Are they stopping activities they used to enjoy?

It’s that dreaded feeling that your child has lost their spark, and you are unable to reach them. You want to help, but every attempt to do so feels like you’re pushing them further away. You might start to notice one of the hallmarks of depression: a “narrowing” of behavior and thinking. They may focus more on negative thoughts or ideas, feeling like they’re stuck or unable to see the positive side of things. They may have a lower interest in activities they once enjoyed, difficulties in school or relationships, and a general sense of hopelessness. They may withdraw into their own space, stop sharing details about their lives, and act unexpectedly short or irritable. It’s important to recognize these signs early, as they can help guide the next steps toward support and recovery. Fortunately, depression is very common, perhaps the most familiar mental health problem in our culture. That means there has been lots of attention from researchers and clinicians in treating it, so you have lots of helpful treatment options.

How is depression treated with kids and teens?

Cognitive Behavior Therapy (CBT) is considered a best practice for treating depression, but a child’s age, developmental level, and specific symptoms all shape what treatment looks like. In many cases, therapy focuses on helping kids recognize unhelpful thought patterns, learn problem-solving skills, and re-engage with meaningful activities (this last part is called Behavior Activation). For younger children, this might involve more parent-based approaches to support changes at home. For older adolescents, I often employ what is called an Acceptance and Commitment Therapy (ACT) approach. This is a cousin of Cognitive Behavior Therapy, from a theoretical perspective, and I find it to be more accessible, flexible, and modern for some teens. ACT focuses more on flexible perspective taking, increasing resilience, taking effective action, and discovering your priorities/values. There is also some newer research supporting the idea that ACT leads to more measurable changes in behavior outside of sessions, which is of utmost importance to me. Therapies like these are intended to be short-term (around 3-6 months) and aim to impart coping skills that persist long after therapy has ended. There are other evidence-based approaches as well, though it may be harder to find someone who is trained in how to do them (e.g., Interpersonal Psychotherapy).

Medication is sometimes considered when symptoms are more severe or when therapy alone isn’t enough. For children and teens, this decision is made carefully and ideally involves a psychiatrist or pediatrician who understands youth mental health. Not every child with depression needs medication, and for many families, it’s helpful to try therapy first. If medication is part of the picture, it’s usually one piece of a larger support plan.

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It’s normal for kids and teens to have ups and downs, especially during times of stress or change. But if your child seems down, irritable, or withdrawn for more than a couple of weeks, and it’s affecting daily life, it may be more than just a phase.
Depression can look different in kids than in adults. You might notice irritability, appetite changes, fatigue, or sleep changes (e.g., staying up later, waking up in the middle of the night) before you notice classic symptoms like sadness or “beating oneself up.” They may spend hours on screen time and not feel rejuvenated or rested afterwards, or they may avoid discomfort or easy tasks.
Learned helplessness is a dominant theory in depression, which posits that a person “learns” to be depressed by way of being repeatedly defeated or discouraged into a passive and withdrawn state. In some ways, depression is your mind’s way of protecting you from further disappointment by “receding” into a narrow psychological or behavioral space. As such, stressful life events, trauma, health conditions, and ongoing family or school difficulties all play a role, but genetic vulnerability also matters.
Depression is referred to as “episodic” for a reason, and many episodes simply fade within 6 months. It is unclear why this is the case, but it is probably due to a change in circumstances within that period (e.g., shifting friend groups, changing school expectations or stressors, changes in perspective/maturity, etc.). However, it is estimated that 30% of depressed youth experience suicidal ideation, so there are risks to taking a “wait-and-see” approach.