Adolescent Mental Health and Behavioral Disorders
Depression and anxiety
Major depressive disorder requires at least two weeks of depressed mood or irritability, or anhedonia, plus four or more symptoms such as sleep change, appetite change, fatigue, guilt, poor concentration, psychomotor change, or suicidal ideation. Adolescents often present with irritability rather than sadness. Anxiety disorders are common and may mimic physical illness. Use a validated screen such as the PHQ-A and GAD-7, but diagnose with a clinical interview.
Safety
Ask directly about suicidal ideation, plan, intent, access to means, and past attempts. A positive suicide item requires immediate risk assessment and safety planning, not just a routine referral. Self-harm is often non-suicidal but still signals risk. Confidentiality yields to imminent danger.
Other disorders
ADHD requires symptoms before age 12 in multiple settings with impairment; bipolar disorder requires mania, not just mood swings; psychosis requires referred evaluation; OCD and PTSD are underrecognized. SSRIs are first-line for moderate to severe depression and anxiety; fluoxetine and escitalopram are commonly used. Monitor closely after starting because of activation and the black-box warning.
Traps
Do not dismiss irritability as normal adolescence. Do not diagnose bipolar disorder from irritability alone. Do not start medication without a safety plan. Do not promise absolute confidentiality.
Worked example
A 15-year-old scores 18 on the PHQ-A and answers yes to self-harm. Ask about plan and means, involve the caregiver for safety, arrange same-day behavioral health evaluation, and document.