Adolescence is a crucial phase of psychological, physiological and social development, characterized by profound changes in mood, relationships and identity. During this period, sadness, irritability and feelings of inadequacy may be part of normal development, but in some cases they constitute a true depressive disorder.
Adolescents may not recognize or spontaneously communicate their distress, but many young people directly report sadness, irritability, anhedonia or suicidal thoughts when questioned appropriately and confidentially.
Depression in adolescence is a multifactorial condition. In addition to genetic predisposition and neurobiological factors, such as alterations in serotonergic, noradrenergic and dopaminergic circuits, stressful life events and environmental factors play an essential role:
Particular vulnerability has been observed in adolescents with low self-esteem, pathological perfectionism and negative cognitive styles, such as self-blame and rumination. Depression is more frequent in girls; differences in suicide mortality between boys and girls vary according to age, country and method, although boys have higher death rates in many populations.
Depressive symptoms in adolescence may resemble those in adults, but often present more atypically. Classic mood symptoms—sadness, anhedonia, guilt and hopelessness—are often accompanied by:
A minority of adolescents with depression will subsequently develop bipolar disorder; risk is greater in the presence of a family history of bipolar disorder, previous hypomanic symptoms, mixed features or treatment-associated activation. In severe presentations, suicidal ideation, plans or attempts may occur, and suicide is among the leading causes of death in young people.
Diagnosis is clinical and is based on history and behavioral observation. The diagnostic criteria for depressive disorders derive from the same nosological categories used in adults, such as Major Depressive Disorder, but must be applied with consideration of age-specific modes of presentation; Bipolar Disorders are a separate category and must be assessed independently. Assessment may be supported by screening scales such as the Children's Depression Inventory or an age-adapted Beck Depression Inventory.
Treatment should be prompt and individualized. In mild to moderate presentations, psychotherapeutic treatment is preferred:
Antidepressants in minors require specialist indication, informed consent and close monitoring, particularly during the first weeks and after dose changes, because studies show an increase in suicidal thoughts or behaviors in some young people, without demonstrating that the medication inevitably causes suicidal behavior.
The prognosis of adolescent depression varies according to severity, duration, comorbidity and family support. In cases treated early, remission is possible, but the risk of recurrence is high, especially when the disorder is associated with a family psychiatric history or substance misuse.
The most important complication is suicide risk. Suicide is among the leading causes of death in adolescence, but its ranking varies according to age group, sex, region and statistical source.
Risk assessment should consider in particular:
Alcohol and other substance use is an important risk factor for suicidal behavior and must be assessed systematically, but its frequency varies among studies and populations and cannot be described by a fixed proportion applicable to all adolescents.
Appropriate clinical management, longitudinal monitoring, and school and social support are essential to prevent chronicity and reduce suicide risk.