All suicidal behaviors reflect a cry for help and must be taken seriously. The management of the depressed teenager begins at the first interview with the creation of a therapeutic alliance. It is important that the interview be conducted in a relaxed manner, preferably in a room other than a formal examination room. The teenager may have to be brought back the next day or on a number of successive days to adequately address problems. The physician must inspire confidence and trust, and be aware of his or her own biases.
Teenagers can be oppositional and negative when depressed.
They may have very fragile self-esteem and project their feelings onto the physician. It is important to understand this behavior as part of the depression and treat it accordingly. The teenager is an active participant in the treatment process and the physician must identify the problem to the patient and parent, offer hope and reassurance, outline treatment options and arrive at a mutually agreed-upon treatment plan. A family assessment should be undertaken to evaluate what support may be available from family members and what resources are available in crisis. Often, both may be required.