Here to Talk About It: Mental Health in Teens

Teenager writing in a journal

“Mental health distress had been worsening, in general,” says Caroline Barrett, M.D., primary care physician at the Center for Women’s Health, when asked about trends in mental health over the last decade. “And then the pandemic worsened that.”

With her special focus in adolescent care, Dr. Barrett notes the pandemic has caused massive disruption to school and family life for young people. As a result, the number of teens seeking mental health services has been on the rise.

“In my practice, I haven’t seen a difference in the type of things bringing people in,” says Dr. Barrett. “It’s more the frequency.” Common conditions she sees in adolescents include depression, generalized anxiety disorder, social anxiety, gender dysphoria, and eating disorders, among others.

A call-to-action to address adolescent mental health

Late last year, the U.S. Surgeon General issued an advisory on the urgent need to address the pandemic-related teen mental health crisis. According to the CDC, suicide is currently the third-leading cause of death in adolescents.

In Oregon, beginning at age 14, kids can be seen for mental health, drug, or alcohol treatment without parental consent. However, Dr. Barrett says she always encourages teens to bring their parent or guardian, because that relationship is critical to improvement.

“My preferred method of treating adolescents is to chat with both of them in the room, then have the parent leave and talk more with the teen, and then bring the parent back in to summarize what the treatment plan is,” she says. Dr. Barrett includes a disclosure that anything discussed with her remains confidential, except if there is a concern for safety or self-harm.

Mental health treatment looks similar - but different - in teens

Treatment for mental health conditions varies depending on both diagnosis and severity.

“The most common options for treatment are two-fold: pharmacotherapy and psychotherapy,” says Dr. Barrett. While psychotherapy is almost always recommended, Dr. Barrett says that providers are more cautious when using medications with teens. The two medications approved for use in adolescents are Prozac and Lexapro; both come with a black box warning for increased suicidal ideation in the teen population.

For psychotherapy, the best-known evidence-based treatment is Cognitive Behavioral Therapy (CBT). In this approach, the teen works with a therapist to “retrain the brain,” helping to improve behaviors that lead to negative thoughts.

“There are many factors,” says Dr. Barrett. “Sleeping well, eating well, meditation, breathing exercises, therapy, and medicine. A lot of people may want the medicine to just fix everything, but it doesn’t work that way.”

Reach out to your provider

Whatever the approach, the first step is to connect with a provider regarding your concerns.

“The most important thing I want people to know is that these are treatable illnesses. Come in. There is help to be offered,” says Dr. Barrett. “If parents see their kids isolating more, seeming more irritated or stressed, bring them in. For teens, if you’re struggling, we’re here to talk about it.”

Teen mental health resources