When a teenager stops hanging out with friends, sleeps all day, or says they feel worthless, it’s easy to brush it off as teenage moodiness. But for one in five adolescents, this isn’t just a phase-it’s clinical depression. And left untreated, it can derail school, relationships, and even lives. The good news? There are proven ways to help, and two of the most effective are family therapy and medications. But which one works best? And do they have to be used alone?

What Does Depression Look Like in Kids and Teens?

Depression in children and teens doesn’t always mean crying all the time. A 12-year-old might lash out at siblings, skip school, or suddenly get terrible grades. A 16-year-old might withdraw, spend hours on their phone, or talk about being a burden. These aren’t just bad days. They’re signs that the brain’s chemistry and emotional wiring are out of balance. The DSM-5, the standard guide doctors use, defines it as persistent sadness, loss of interest, fatigue, changes in sleep or appetite, and thoughts of death or suicide lasting at least two weeks.

What makes adolescent depression different from adult depression is how much it’s tied to family dynamics. A teen’s sense of safety, worth, and connection often comes from home. When parents are critical, distant, or stuck in old patterns of blame, it deepens the depression. That’s why simply giving a pill isn’t always enough.

Family Therapy: More Than Just Talking

Family therapy isn’t about blaming parents or forcing everyone to sit in a circle and share feelings. It’s a structured, evidence-based approach that treats the family as the system that either supports healing or keeps the depression going. There are several types, but two stand out: Attachment-Based Family Therapy (ABFT) and Strategic Family Therapy.

ABFT focuses on repairing the emotional bond between parent and child. Many teens with depression feel unseen or misunderstood. ABFT helps parents learn to listen without fixing, to validate pain without judgment. In one 2022 study, teens in ABFT showed a 40% greater drop in suicidal thoughts compared to those getting standard care. Parents reported feeling less helpless and more connected after just 10 weeks.

Strategic family therapy works differently. It looks at how the family tries-and fails-to solve problems. For example, if a teen stays in bed all day, and the parent keeps nagging, the cycle just gets worse. The therapist might suggest something counterintuitive: “Ask your teen to keep being depressed for the next week, so the whole family can understand how hard it is.” Sounds strange, but it breaks the pattern. It forces everyone to see the problem differently.

These therapies usually last 12 to 16 weeks, with weekly 60- to 90-minute sessions. The goal isn’t to fix the teen-it’s to fix how the family talks, reacts, and connects. And it works best when both parents and the teen show up, not just one.

Medications: When Pills Make Sense

For moderate to severe depression, medication can be life-changing. But not all antidepressants are safe for kids. Only two SSRIs-fluoxetine (Prozac) and escitalopram (Lexapro)-are FDA-approved for teens. Others carry a black box warning: they can increase suicidal thoughts in the first few weeks of use.

That doesn’t mean you shouldn’t use them. It means you need to be careful. Fluoxetine is typically started at 10 mg a day, then increased to 20 mg if needed. Escitalopram starts at 5 mg, often going up to 10-20 mg. The full effect takes 4 to 6 weeks. Side effects? Headaches, nausea, insomnia, or jitteriness. About 1 in 5 teens stop because of these. But for many, the relief is worth it.

One study found that teens on fluoxetine were twice as likely to improve compared to those on a placebo. And when combined with therapy, the results are even stronger. The key is monitoring. Doctors recommend weekly check-ins for the first month, then monthly for at least a year. If a teen says, “I’m better, I don’t need this anymore,” that’s when you need to be most careful-withdrawal can cause mood crashes.

Family Therapy vs. Medication: Which Is Better?

There’s no one-size-fits-all answer. But here’s what the data shows:

Family therapy shines when the problem is rooted in the home. A 2009 NIH study found teens with healthy family functioning had 3 times higher recovery rates after a year than those with high conflict. Medication helps when symptoms are overwhelming-when a teen can’t get out of bed, can’t eat, or is thinking about ending their life. But without addressing the family environment, the depression often comes back.

Combining Both: The Gold Standard

The Agency for Healthcare Research and Quality reviewed over 30 studies and found that combining therapy and medication leads to the best outcomes. Teens who got both fluoxetine and cognitive behavioral therapy (CBT) were 71% more likely to improve than those on medication alone.

Family therapy adds another layer. A 2023 study showed teens who got ABFT plus fluoxetine had the lowest relapse rate after 12 months-just 18%. Those on meds alone? 41% relapsed. Why? Because meds change brain chemistry. Therapy changes how the teen sees themselves and how the family responds to them.

Think of it like this: Medication calms the storm inside. Family therapy teaches the teen and their parents how to build a shelter so the storm doesn’t keep coming back.

What If Family Therapy Doesn’t Work?

It’s not magic. Some families struggle to show up. Parents may feel ashamed, angry, or deny their role. Teens may refuse to talk. Therapists who take sides or don’t know how to handle conflict can make things worse.

Real-world feedback tells the story: On Reddit, 68% of teens said family therapy helped-only when both parents were truly engaged. In NAMI forums, 74% of parents said communication improved within 3 months. But 41% of dissatisfied users blamed resistant family members. And 29% said the therapist took the teen’s side, which made parents feel attacked.

If family therapy isn’t working, don’t give up. Try a different therapist. Look for someone trained in ABFT or structural family therapy. Some clinics now offer telehealth versions, which are easier to fit into busy schedules. And if the family is too fractured to participate, individual CBT or interpersonal therapy can still help.

What About Other Options?

Exercise, sleep, and sunlight matter. A 2023 study found that teens who walked 30 minutes a day, five times a week, saw depression scores drop by 30%. Spirituality and gratitude practices-like writing down three things you’re thankful for each day-also helped in small trials.

There’s also digital therapy. The FDA approved a new app called reSET-O in 2023 that guides teens through CBT exercises and syncs with their therapist. Early results show 72% of teens finish the program, compared to just 58% for in-person therapy.

But none of these replace therapy or medication when depression is serious. They’re supports, not substitutes.

How to Get Started

If you suspect your child or teen is depressed, start with their pediatrician. Ask for a depression screening. The U.S. Preventive Services Task Force recommends screening all teens 12 and older-every year.

If depression is confirmed, here’s what to do next:

1. Ask if a therapist trained in family therapy is available. Look for ABFT or structural therapy specialists.
2. If symptoms are severe (suicidal thoughts, self-harm, inability to function), ask about fluoxetine or escitalopram.
3. Don’t wait. Early intervention cuts long-term risk by half.
4. Monitor closely for the first 4-6 weeks, especially if starting meds.
5. Keep a journal: What changed? Who spoke up? What felt worse?

And remember: You’re not alone. The SAMHSA National Helpline (1-800-662-4357) gets over 650,000 calls a year from families just like yours. They can connect you to local therapists, support groups, and sliding-scale clinics.

What’s Changing in 2026?

Things are moving fast. In 2024, the National Institute of Mental Health gave $4.7 million to expand ABFT in 15 community clinics. Early results? 58% fewer suicidal thoughts in 12 weeks.

There’s also a growing push to make family therapy the first step-not the last resort. By 2030, experts predict it’ll be the top treatment for nearly half of all teen depression cases. Why? Because it’s cheaper long-term. Medication alone costs $18,200 per quality-adjusted life year. Family therapy? Just $12,500.

But here’s the catch: There aren’t enough therapists. Only 8,500 certified child and adolescent family therapists serve 42 million U.S. teens. Waitlists are 12 to 18 months long in many places.

So if you can get in now-do it. Don’t wait for the perfect therapist. Start with someone who knows what they’re doing, even if they’re not the “best.” Progress matters more than perfection.

Final Thoughts

Depression in kids and teens isn’t a weakness. It’s a signal. A sign that something’s broken in how they feel, how they’re treated, or how their brain works. The right treatment-whether it’s family therapy, medication, or both-can fix it. But it takes courage. Courage to show up. Courage to listen. Courage to try something new.

There’s no perfect answer. But there’s a better one. And it starts with not waiting.