# Depression and Suicide in Adolescents

> Depression and suicide in adolescents for NEET-PG Paediatrics covering teenage presentation, risk assessment, safety planning and first-line treatment.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/depression-and-suicide-in-adolescents
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Nelson Textbook of Pediatrics; Kaplan and Sadock's Synopsis of Psychiatry
- How to cite: "Depression and Suicide in Adolescents", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/depression-and-suicide-in-adolescents

## Direct answer

Depression in adolescents often presents as irritability, withdrawal and falling school performance rather than overt sadness, and suicidal thoughts must be asked about directly. Risk assessment covers ideation, plan, intent, access to means and past attempts, with a safety plan and urgent referral when risk is high. Psychological therapy such as cognitive behavioural therapy is the first step, and fluoxetine is added for moderate to severe depression.

## What you must remember

- **Teenage presentation:** Irritability, anhedonia, sleep and appetite change, falling grades, substance use and self-harm, often more than sadness.
- **Screening tool:** The Patient Health Questionnaire for adolescents, PHQ-A, is a validated screen used at routine visits.
- **Asking about suicide:** Direct questions do not increase risk and are part of the standard assessment.
- **Means restriction:** Access to pesticides, medicines and firearms raises risk, so restricting access is a core safety step.
- **Risk factors:** Previous attempt, family history of suicide, substance use, bullying, hopelessness and psychiatric comorbidity.
- **First-line treatment:** Cognitive behavioural therapy or interpersonal therapy, with fluoxetine added for moderate to severe depression.
- **Boxed warning:** Antidepressants carry a warning about suicidal thoughts in young people, so early review is essential.
- **Urgent referral:** Imminent risk, a specific plan or self-harm needs same-day psychiatric review.

## A stepwise approach from risk assessment to treatment

Suicide risk is assessed at every visit for an adolescent with depression, not only when thoughts are disclosed. The steps below set out a practical sequence for a clinician.

1. **Ask directly and in private:** Enquire about thoughts of death, self-harm and suicide plans with the young person interviewed alone.
2. **Grade the risk:** Classify it as low, moderate or high, based on ideation, plan, intent, previous attempts and access to means.
3. **Restrict means:** Secure medicines, pesticides, sharp objects and firearms, and involve the family in doing so.
4. **Create a safety plan:** Write down warning signs, coping steps, trusted contacts and emergency numbers, and review it at each visit.
5. **Start treatment:** Offer psychotherapy first, and add fluoxetine for moderate to severe depression with close monitoring in the early weeks.
6. **Escalate when needed:** Arrange same-day psychiatric review for high risk, with admission if safety cannot be ensured at home.
7. **Review and follow up:** Reassess at short intervals, because risk can change quickly in adolescents.

## Where the exam tries to catch you

Questions here usually test whether the examinee recognises depression behind irritability and knows the safety steps.

- **Trap:** Avoiding the word suicide for fear of increasing risk. — **Correct:** Direct questioning does not increase risk, and it is the standard of care.
- **Trap:** Attributing irritability and falling grades to normal adolescence. — **Correct:** Irritability can be the main depressive symptom in teenagers, so screen for depression.
- **Trap:** Starting an antidepressant and not reviewing it. — **Correct:** The boxed warning on suicidality calls for close early follow-up after starting or changing a dose.
- **Trap:** Assessing suicide risk once at the first visit. — **Correct:** Risk changes, so it is reviewed at every contact.

## Frequently asked questions

### Which screening tool is used for depression in adolescents?

The Patient Health Questionnaire for adolescents, known as PHQ-A, is a validated screening tool for depression in adolescents. The young person can complete it at routine visits. A positive screen should be followed by a clinical interview to confirm the diagnosis and assess suicide risk.

### Should a clinician ask an adolescent with depression about suicidal thoughts?

Clinicians should ask an adolescent with depression about suicidal thoughts directly and privately, without a parent present. Asking does not increase the risk of suicide, and avoiding the question can miss a high-risk teenager. The answers guide the risk grade and the safety plan.

### What is the first-line treatment for depression in adolescents?

The first-line treatment for depression in adolescents is psychological therapy such as cognitive behavioural therapy. For moderate to severe depression, fluoxetine is added alongside psychotherapy. Response is reviewed closely, because antidepressants carry a boxed warning for suicidality in young people.

### What is the boxed warning on antidepressants in young people?

Antidepressants, including fluoxetine, carry a boxed warning that they can increase suicidal thoughts and behaviour in children, adolescents and young adults, especially in the early weeks of treatment. Adolescents starting or changing a dose need close review. Families should be told to report new agitation or worsening mood promptly.