When Adolescent Struggles Become Something More

"I just feel empty all the time." This is how a sixteen-year-old once described their experience during our first session in my Colchester practice. Her parents had initially dismissed her struggles as "typical teenager behaviour," but something deeper was happening. What they were witnessing wasn't just adolescent moodiness—it was depression.

Depression in young people is often misunderstood, partly because we expect teenagers to be moody, emotional, and unpredictable. While mood fluctuations are indeed a normal part of adolescent development, persistent low mood that interferes with daily functioning requires attention and support.

The Hidden Nature of Youth Depression

Unlike adult depression, which often presents with obvious sadness, depression in young people can be surprisingly subtle and varied. In my work with adolescents and young adults, I've learned to look beyond the stereotype of the tearful, withdrawn teenager. Depression in young people might look like:

Irritability and anger: Rather than sadness, many young people experience depression as constant frustration, snapping at loved ones, or feeling enraged by minor inconveniences.

Academic decline: A previously motivated student suddenly stops completing homework, their grades drop, or they express feeling "stupid" despite evidence to the contrary.

Social withdrawal: Gradually pulling away from friends, declining invitations, or spending increasing amounts of time alone in their room.

Physical complaints: Headaches, stomach problems, or chronic fatigue that don't have clear medical explanations.

Risk-taking behaviours: Some young people unconsciously attempt to feel something—anything—through dangerous activities, substance use, or self-harm.

Emotional numbness: Perhaps most concerning, many describe feeling "nothing at all"—no sadness, but no joy, excitement, or connection either.

The UK Context: Rising Rates and Systemic Pressures

Recent data from NHS Digital reveals that depression rates among young people in the UK have increased significantly. The 2023 Mental Health of Children and Young People Survey found that 18% of young people aged 17-19 had a probable mental health disorder, with depression being a major component.

This rise isn't happening in a vacuum. Young people in the UK face unprecedented pressures:

• Academic stress from an increasingly competitive education system
• Social media comparison and cyberbullying
• Economic uncertainty about their futures
• Climate anxiety and global instability
• The lingering effects of pandemic disruption during crucial developmental years
• Family financial stress affecting household dynamics

Understanding the Adolescent Brain

To work effectively with depression in young people, we must understand the remarkable changes happening in the adolescent brain. The prefrontal cortex, responsible for emotional regulation, decision-making, and future planning, isn't fully developed until around age 25. Meanwhile, the limbic system, which processes emotions and responds to stress, is hyperactive during the teenage years.

This neurobiological reality means that young people genuinely experience emotions more intensely than adults and have less capacity to regulate these feelings. What might seem like an overreaction to adults can feel genuinely overwhelming to a teenager whose brain is still learning how to manage intense emotional states.

The Psychodynamic Understanding of Youth Depression

From a psychodynamic perspective, depression in young people often relates to:

Identity formation struggles: Adolescence involves answering the question "Who am I?" When this process feels overwhelming or when external pressures demand a premature answer, depression can emerge as a way of "pressing pause" on development.

Loss and grief: Young people experience many losses during adolescence—childhood innocence, parental protection, certainty about the future. Sometimes depression represents unprocessed grief for these losses.

Internalised criticism: Many young people develop harsh internal critics, often based on early experiences or cultural messages about worth and success. Depression can be understood as this critical voice becoming dominant.

Attachment difficulties: Relationships with parents naturally change during adolescence, but for some young people, this process activates deep fears about abandonment or rejection.

The Difference Between Low Mood and Clinical Depression

It's crucial to distinguish between normal adolescent emotional fluctuations and depression that requires professional intervention. Consider seeking support when:

Duration: Low mood persists for more than two weeks without improvement Intensity: The emotional distress feels overwhelming and unmanageable Impact: Daily functioning is significantly affected—school, relationships, self-care Physical symptoms: Sleep, appetite, or energy levels are consistently disrupted Hopelessness: The young person expresses feeling like things will never improve Self-harm or suicidal thoughts: Any indication of wanting to hurt themselves or not wanting to be alive

Common Triggers and Risk Factors

While depression can emerge without clear triggers, common risk factors in young people include:

• Family history of mental health difficulties
• Significant life changes or losses
• Bullying or social rejection
• Academic pressure or failure
• Relationship difficulties
• Trauma or abuse
• Chronic illness or disability
• LGBTQ+ identity in unsupportive environments
• Perfectionism and high achievement pressure

The Therapeutic Relationship: Creating Safety for Healing

Working therapeutically with depressed young people requires particular sensitivity. These young people have often heard many well-meaning but unhelpful suggestions ("just think positive thoughts," "focus on what you have to be grateful for") that can leave them feeling more isolated and misunderstood.

In the therapy room, I focus on creating a space where their experience makes complete sense. This means:

Normalising their struggles: Helping them understand that depression isn't a character flaw or personal failing, but a meaningful response to overwhelming circumstances.

Exploring the function of depression: Rather than seeing depression as purely pathological, we explore how it might be serving them—perhaps providing protection from further disappointment or giving them permission to rest when life feels too demanding.

Understanding family dynamics: How does depression fit within their family system? Sometimes young people unconsciously carry family anxiety or distress, and their depression serves as a signal that something needs attention.

Processing developmental challenges: Adolescence involves navigating complex tasks—separation from parents, identity formation, peer relationships, future planning. Depression often emerges when these developmental challenges feel overwhelming.

Supporting Young People at Home

For families:

Listen without fixing: When a young person shares their struggles, resist the urge to immediately offer solutions. Sometimes they need to be heard before they can consider change.

Maintain routine gently: While depressed young people may resist structure, maintaining some predictable rhythms around meals, sleep, and family connection can be grounding.

Watch for warning signs: Changes in sleep, appetite, social connections, or academic performance may indicate worsening depression.

Take care of yourself: Supporting a depressed young person is emotionally demanding. Ensure you have your own support systems.

Avoid comparisons: Statements like "your sister never had these problems" or "when I was your age" typically increase shame rather than motivation.

The Role of Medication

While therapy forms the foundation of treatment for youth depression, medication may sometimes be appropriate. In the UK, NICE guidelines recommend that antidepressants should only be prescribed to young people alongside psychological therapy and after careful consideration of risks and benefits.

This decision should always involve the young person, their family, and mental health professionals working together. The goal is not to medicate away normal adolescent experiences, but to provide relief when depression is severe enough to impair functioning significantly.

School and Educational Support

Depression significantly impacts learning and school engagement. Young people with depression may:

• Have difficulty concentrating in lessons
• Struggle with memory and information processing
• Feel overwhelmed by academic demands
• Experience increased absence due to physical symptoms
• Withdraw from social aspects of school life

Effective support requires collaboration between families, schools, and mental health services. This might include adjustments to academic expectations, provision of quiet spaces, flexible attendance arrangements, and staff training on recognising and responding to mental health difficulties.

Building Resilience: More Than Just Positive Thinking

Recovery from depression involves more than eliminating symptoms—it's about building genuine resilience and self-compassion. This includes:

Emotional literacy: Helping young people understand and name their emotional experiences rather than being overwhelmed by them.

Meaning-making: Exploring what gives their life purpose and connection, even in small ways.

Relationship skills: Learning to communicate needs and maintain connections even when depression makes them want to withdraw.

Self-compassion: Developing a kinder internal voice that can provide support during difficult times.

Future orientation: Gradually rebuilding the capacity to imagine and work toward future goals.

Hope in the Darkness

Depression can feel hopeless, both for young people experiencing it and their families watching them struggle. However, with appropriate support, the vast majority of young people can and do recover from depressive episodes.

What matters most is that they don't face this alone. Whether through therapy, family support, peer connections, or professional intervention, recovery is possible when young people feel understood, supported, and given the time and space they need to heal.

If you're a young person reading this and recognising yourself in these descriptions, please know that your struggles are valid, help is available, and this difficult period doesn't define who you are or what your future holds. If you're supporting someone through youth depression, remember that your patience, understanding, and willingness to seek appropriate help can make all the difference.