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As the 2019 coronavirus disease (COVID-19) pandemic spreads around the United States and the world, families are facing unprecedented disruptions to their lives and routines. The COVID-19 crisis has also complicated our access to regular sources of support, purpose, enjoyment, and comfort. Teens in particular are especially affected, having been removed from daily contact with peers, barred from other preferred activities, and pressed into close quarters with parents and siblings.

“Because of their stage in life, teens may have a harder time adjusting to these restrictions than adults or younger children, and may be at increased risk for mood problems, including depression,” says , clinical assistant professor in the at ����TV Langone and member of its Child Study Center. “For teens who are already struggling with mood problems, it is even more important to recognize the impact of the COVID-19 crisis and find ways to get support.”

Together with the Department of Child and Adolescent Psychiatry’s WonderLab, Dr. Lewandowski offers suggestions for parents and teens to help cope with depression during this difficult time.

Mood Maintenance and Prevention: An Activity a Day

Whether your teen was struggling with a mood disorder before the COVID-19 pandemic, is facing typical challenges in adjusting to unfamiliar circumstances, or is somewhere in between, they—and everyone—can benefit from caring for their mood intentionally.

A general daily checklist of mental health “nutrition” can help maintain positive mood, Dr. Lewandowski says. These mental health nutrients include the following:

• social contact with friends or family, including virtual face-to-face contact, not just text or chat
• productive or meaningful activities, such as attending to school or extracurricular responsibilities, or even efforts to safely provide support or assistance to others during the COVID-19 crisis
• physical activity, since remote school and work means that teens must plan other opportunities to activate their bodies
• fun activities that are intentional and have enjoyment as their only purpose
• a consistent sleep routine, since regular bedtimes and wake-up times help maintain sleep hygiene and mood when school and work schedules become more irregular

“Balanced attention to these mental health nutrients generally will help support a positive mood,” Dr. Lewandowski says. Teens should focus on the activities that bring them the greatest mood benefit. “Variety is beneficial as it helps keep us from becoming tired of any one activity,” he adds. “Take a daily dose of these ingredients whether or not you ‘feel like it’ or feel you ‘don’t need it today.’”

Coping with Depression

Negative emotions, if not managed effectively, can increase risk for more significant mood problems. “Negative moods often lead us to make choices to reduce distress in the short-term, but which may make matters worse, and can lead to a downward spiral into depression,” Dr. Lewandowski says. “Often, this includes withdrawing from friends and family, procrastinating, brooding or thinking too much, or blowing up and losing our cool in important conversations and relationships.”

Just like the mood “nutrition” plan, state-of-the art psychotherapies for depression, such as behavioral activation, emphasize intentional engagement in naturally mood-boosting activities, Dr. Lewandowski says. “In behavioral activation, teens are guided to understand how life circumstances negatively affect their mood, and then how those negative moods have guided them to unhelpful actions that are keeping their depression going. Teens are supported to reengage in activities and efforts that are naturally antidepressant, which may include increased participation in enjoyable activities.”

A Behavioral Activation Approach to Depression

The first step in behavioral activation, Dr. Lewandowski says, is to label the problem. “Notice how important parts of life have been impacted by the COVID-19 pandemic,” he says. “Assess what has gotten harder in relationships with friends and family, school performance, and in other important activities, as well as what continues to go well.”

Parents can help their teen reflect on the following questions: How you are currently managing your low mood? How does your mood influence choices, behaviors, and actions? What is the intended goal of these choices, and what are the actual consequences of them? Do they help make you feel better and improve your situation, or do they cause your mood to get worse or negatively impact your circumstances?

“Identify activities, choices, and actions that have the potential to improve mood,” Dr. Lewandowski says. “Evaluate what activities or actions improve mood or the situation, even a little bit. This might be an enjoyable activity, or engaging in an important task one that has gone unattended. It might be a step to improve a relationship or correct a problem.”

Help your teen commit to taking these actions even though she or he may lack motivation or energy. “We stay stuck in depression if we delay action until the day we feel motivated,” Dr. Lewandowski says. “To feel better later, action must come first.”

Have your teen take small realistic daily steps to improve or maintain mood and build up to bigger goals. “Break down goals into realistic steps that feel attainable,” Dr. Lewandowski adds. “Identify the practical challenges and barriers of the situation, but beware the greatest barrier of all, the voice that says ‘I don’t feel like it.’”

When to Seek Help for Depression

Emotional distress, including worry, sadness, and irritability are normal and expected responses to a crisis like the COVID-19 pandemic. Normally, these feelings rise and fall as our attention and activities shift throughout the day. “Mood problems, such as depression, may become a concern if these transient feelings last longer and impact teens’ ability to handle their roles and responsibilities,” Dr. Lewandowski says. “If you suspect your teen may be depressed, it is worthwhile to consult a professional.”

In addition to low mood and chronic irritability, hallmarks of emerging depression are loss of energy, loss of interest in previously enjoyed activities and relationships, and loss of motivation to manage responsibilities. “Depressed teens may stop looking forward to things with the same enjoyment or anticipation, and their mood may become less responsive to positive experiences or the encouragement and support of others,” Dr. Lewandowski says. “The emergence of suicidal thinking or appearance or worsening of substance use is also cause to seek professional support.”