DEPRESSION IN TEEN GIRLS AND WOMEN
By Alexis Anderson, DO
Holistic Psychiatry for Teen Girls and Women | Bozeman and Telehealth Throughout Montana
Depression is common in girls and women, it is treatable, and it is often missed. Beginning in early adolescence, girls are diagnosed with depression about twice as often as boys, and that difference continues into adulthood. Yet many teenagers are told they are “just moody,” and many women are told they are “just stressed” or, in midlife, “just menopausal.”
Neither explanation is enough. Depression has biological, psychological, and social roots, and hormones are one thread among several. A good evaluation looks at all of them.
What does depression look like in teen girls?
Depression in teenagers does not always look like sadness. Parents often notice:
Irritability, anger, or frequent tearfulness
Pulling away from friends and family
Losing interest in activities she used to love
A drop in grades or trouble concentrating
Sleeping far too much or too little
Changes in appetite or weight
Frequent headaches or stomachaches with no clear medical cause
Harsh self-criticism, perfectionism, or feeling like a failure
Hopelessness, or talk of death or of not wanting to be here
A hard week is not depression. What matters is how long it lasts, how much it interferes with her life, and whether it is a change from how she usually is.
What does depression look like in women?
Many women describe:
Persistent sadness, emptiness, or hopelessness
Loss of interest or pleasure
Irritability or feeling unusually reactive
Exhaustion, or a sense of moving through mud
Trouble concentrating or making decisions
Changes in sleep or appetite
Guilt, shame, or feelings of inadequacy
Withdrawing from relationships and activities
Feeling unlike themselves
Thoughts of death or suicide
Many women keep functioning on the outside while feeling empty on the inside. Meeting every responsibility does not mean you are not depressed.
Why are girls and women more vulnerable?
No single cause explains it. Researchers point to a combination of factors.
Biology. Estrogen and progesterone act on brain systems that regulate mood, sleep, and the stress response. Some girls and women appear to be more sensitive to hormonal change, and risk seems to rise at times of reproductive transition: puberty, the days before a period, pregnancy and the postpartum period, and the menopausal transition.
Psychology. Perfectionism, harsh self-criticism, and a habit of dwelling on problems make depression more likely and harder to climb out of.
Life circumstances. School and social pressure, family conflict, trauma, loss, caregiving, demanding work, and limited support all contribute.
Sleep and physical health. Poor sleep, thyroid problems, anemia, chronic illness, and some medications can cause or worsen depression.
These factors feed one another. Poor sleep lowers resilience, stress worsens sleep, and a sensitive nervous system feels both more strongly.
Hormones and depression across a woman’s life
The teen years
Puberty is when the gap between girls and boys in depression first appears. Hormonal change is part of the explanation, but adolescence also brings rapid brain development, new social pressures, and a shifting sense of identity. Blaming hormones alone would be a mistake. A pattern that clusters around the same point in her cycle each month is useful information, and worth tracking together.
Premenstrual mood symptoms and PMDD
Some girls and women develop significant mood symptoms in the week or so before a period that ease once bleeding starts. When these symptoms are severe, the condition may be premenstrual dysphoric disorder (PMDD). A history of significant premenstrual mood symptoms is also associated with greater vulnerability to depression later, during perimenopause.
Perimenopause
During perimenopause, estrogen levels fluctuate considerably rather than falling in a smooth line. Research identifies the menopausal transition as a window of vulnerability to depressive symptoms and major depressive episodes, especially for women who have had depression before [1, 2].
Whether perimenopause independently raises the risk of a first-ever episode is less certain [3, 4]. A first episode can occur during perimenopause, but it should not automatically be blamed on hormones. Night sweats, insomnia, stress, caregiving, and loss often play a part, and so does the rest of a woman’s life.
Is it depression, or something else?
Several conditions look like depression or occur alongside it: anxiety, ADHD, bipolar disorder, trauma-related conditions, thyroid disease, anemia, sleep disorders, substance use, and medication effects. In teens, bullying, learning difficulties, and family stress can also look like depression.
Telling them apart matters because treatments differ. For example, it is important to consider bipolar disorder before starting an antidepressant.
It is also possible to have more than one of these at once. Low mood, irritability, and poor sleep can be real and distressing without meeting the criteria for major depression, and major depression should never be minimized because it has an obvious trigger.
How depression is evaluated
In my practice, evaluation is unhurried and starts with listening.
For teen girls, the first session is with your daughter. The second is with you, her parents. In the third, we typically meet as a family, and I share my impressions and treatment recommendations.
For women, the first visit is a long conversation about your symptoms, history, sleep, medical conditions, medications, stress, and goals. When it is relevant, I also ask about premenstrual, pregnancy, postpartum, and menopausal history.
Screening questionnaires can help, but they do not replace a clinical evaluation. I also ask directly about safety.
How depression is treated
Treatment is individualized to the diagnosis, severity, medical history, and your preferences. In my practice, every appointment includes psychotherapy, and medication is offered when it is helpful, never on its own.
Psychotherapy
Cognitive behavioral therapy (CBT) helps identify the thought and behavior patterns that keep depression going and builds practical skills for mood, sleep, and stress. Psychodynamic psychotherapy explores how past experiences, relationships, and self-worth shape the way you feel now. For teens, family therapy can help everyone understand what is happening and change patterns at home that make depression harder to treat.
Medication
Antidepressants can be an important part of treatment, particularly for moderate to severe depression. In adolescents, a large clinical trial found that combining CBT with an antidepressant worked better than either alone for many teens [5]. Antidepressants carry an FDA boxed warning about increased suicidal thoughts in children, teens, and young adults up to age 24, which is why close monitoring, especially in the first weeks, is part of treatment [6].
For women, medication is chosen after considering symptoms, previous response, side effects, sleep, anxiety, medical history, other medications, and the possibility of bipolar disorder. It is not chosen simply because a woman is in perimenopause.
Hormonal care for women
Menopause hormone therapy is not an antidepressant and is not approved to treat depression, although estrogen appears to help some perimenopausal women, particularly when depression occurs alongside hot flashes and night sweats [7, 8]. Decisions about it belong with your OB/GYN or menopause specialist. I do not prescribe it, and I coordinate with your clinician so that psychiatric and hormonal care are not considered in isolation.
Sleep and daily life
Sleep deserves direct attention. Regular sleep, exercise, time outdoors, social connection, and less alcohol all support recovery. They are valuable, but lifestyle changes alone are not enough for significant depression.
How parents can help
If you are worried about your daughter:
Start with what you have noticed, without judgment. For example: “I’ve noticed you seem down lately. I’m not upset. I’m just worried about you.”
Listen more than you advise.
Ask directly whether she has thoughts of hurting herself or ending her life. Asking does not put the idea in her head, and it often brings relief.
Keep routines for sleep, meals, and movement steady.
Seek an evaluation sooner rather than later. You do not need to wait for a crisis.
When to seek psychiatric care
Consider an evaluation when symptoms:
Last more than two weeks
Interfere with school, work, relationships, or daily functioning
Make it hard to feel pleasure or connection
Change sleep or appetite significantly
Include hopelessness, worthlessness, self-harm, or thoughts of death
Keep getting worse despite support and self-care
Raise concern about bipolar disorder or another psychiatric condition
You do not need to decide whether it is “bad enough,” or whether it is “hormonal” or “psychiatric.” That is what an evaluation is for.
When to seek urgent help
Thoughts of suicide, self-harm, feeling unable to stay safe, severe agitation, or losing touch with reality need immediate attention. Call or text 988 to reach the 988 Suicide & Crisis Lifeline at any time. If you or someone else is in immediate danger, call 911 or go to the nearest emergency department.
Frequently asked questions
Can a teenager have depression, or is it normal moodiness? Teenagers do have mood swings. Depression is different: it lasts longer than a couple of weeks, feels heavier, and interferes with school, friendships, and daily life. If you are unsure, an evaluation can help sort it out.
Can hormones cause depression in women? Hormonal changes can contribute, especially around puberty, the premenstrual days, pregnancy and the postpartum period, and perimenopause. They are rarely the only cause, and depression should be treated as depression, not dismissed as “just hormones.”
Do I have to take medication? No. Many people improve with psychotherapy alone, particularly with mild to moderate depression. Medication is one option, discussed openly along with its benefits, risks, and alternatives. In my practice it is never offered without psychotherapy.
Do you provide care across Montana? Yes. I practice from Bozeman and see teen girls and women by secure video throughout Montana. Patients must be physically located in Montana at the time of each appointment.
The most important takeaway
Depression in girls and women is real, common, and treatable. It is not a character flaw, and it is not “just hormones” or “just stress.” Good care takes symptoms seriously and looks at the whole person: biology, history, relationships, and the life around her. Reaching out earlier usually makes recovery easier.
About the author
Alexis Anderson, DO, is a Yale- and UCSF-trained psychiatrist who practices in Bozeman, Montana, providing psychotherapy and psychiatry for teen girls and women by telehealth throughout Montana. She completed adult psychiatry residency at Yale University and child and adolescent psychiatry fellowship at the University of California, San Francisco, and has been in private practice since 2008. Every appointment includes psychotherapy, with medication when it’s helpful.
Learn more about Dr. Alexis Anderson.
Looking for psychiatric care for your teenage daughter or for yourself? Dr. Anderson meets weekly with each teen girl, meets regularly with parents, and offers family therapy when it helps. She also works with women experiencing depression, anxiety, insomnia, and the mood changes of hormonal transitions.
Explore psychiatric care throughout Montana.
Explore psychiatric care for teen girls and women in Bozeman.
References
Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069–1085.
Bromberger JT, Kravitz HM, Chang YF, et al. Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychological Medicine. 2011;41(9):1879–1888.
Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry. 2006;63(4):375–382.
Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard Study of Moods and Cycles. Archives of General Psychiatry. 2006;63(4):385–390.
March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004;292(7):807–820.
Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics. 2018;141(3):e20174082.
Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry. 2001;58(6):529–534.
Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: a randomized clinical trial. JAMA Psychiatry. 2018;75(2):149–157.
This article is for educational purposes and does not provide individual medical advice or establish a physician-patient relationship. Treatment decisions should be made with a qualified healthcare professional who can evaluate your individual circumstances.