By Dr Daniel S. Cohen · Updated: 29 April 2026
Summary
Anxiety and depression are the most frequent mental health problems in adolescence. They coexist so often that many clinicians approach them as a single affective-internalising axis: in a very high proportion of cases, anxiety symptoms precede depressive ones, and a poorly treated picture evolves into the other.
Early detection changes the adolescent’s trajectory: it protects academic performance, social relationships and reduces the risk of future comorbidities —including, in the most severe cases, the risk of suicidal behaviour, which has risen in Spain in recent years.
Why early detection matters
Recent epidemiological data are consistent:
- The global prevalence of anxiety disorders in adolescents (10-19 years) is around 6.5 %, and that of depressive disorders around 2.6 %. Both figures have been rising since the COVID-19 pandemic, especially in girls.
- Up to 1 in 4 adolescents report clinically significant depressive symptoms at some point during adolescence.
- In Spain, suicide is the second leading cause of death among 15- to 19-year-olds, and 2024 data reflect a worrying increase in suicide deaths in under-20s compared to the previous year.
- The Spanish national suicide prevention helpline (024) received over 146,000 calls in 2024. Girls aged 12 to 15 are the most represented age group among callers.
Behind each of these figures lies a key clinical fact: most cases are recognised and treated better the earlier they are identified.
Anxiety in adolescents
Anxiety can be likened to fear: it is a normal adaptive response that becomes pathological when it is disproportionate, persistent or appears without a real trigger. It manifests through:
- Autonomic symptoms: psychomotor restlessness, tachycardia, sweating, chest tightness, sense of suffocation.
- Cognitive symptoms: fear, anticipatory worry, hypervigilance.
- Behavioural symptoms: the most typical response in anxiety disorders is inhibition or avoidance.
In adolescence, symptoms often include irritability, dizziness, chest pain, insomnia, fatigue and social fears. It is the stage at which depersonalisation and derealisation can appear —feeling strange in relation to oneself or perceiving the environment as unreal— and at which social phobia and panic attacks typically debut.
The most relevant anxiety disorders according to the DSM-5-TR are generalised anxiety disorder, separation anxiety (more typical of childhood, persistent in some cases), specific phobias, social phobia, selective mutism and panic attacks with or without agoraphobia.
The female-to-male ratio in adolescence is approximately 3:1.
Depression in adolescents
Adolescent depression does not present like adult depression. The hallmark adult symptoms —vital sadness, anhedonia, psychomotor slowing— may be present, but other features often predominate:
- Marked persistent irritability, instead of explicit sadness.
- Drops in academic performance without an apparent cause.
- Progressive isolation: staying home, withdrawing from friendships, abandoning hobbies.
- Somatic complaints (headaches, abdominal pain, fatigue) without a clear medical cause.
- Sleep and appetite changes, in either direction.
- Risk-taking behaviour: substance use, self-harm, sexual risk-taking.
- Drop in self-esteem with disproportionate self-demand or feelings of worthlessness.
The diagnosis is clinical and requires experience: scales and questionnaires support clinical assessment but do not replace it. The condition has a real impact on academic performance, relationships, psychosocial development and, in severe cases, on suicide risk.
The overlap: anxiety and depression in the same patient
This is one of the clinical keys of the adolescent picture:
- Around 33 % of adolescents with an anxiety disorder also present with a depressive disorder.
- In most cases, anxiety symptoms precede depressive symptoms.
- A severe untreated anxiety disorder carries a high risk of evolving into major depression.
That is why, in clinical practice, both axes are always assessed in parallel: well-treated early anxiety is one of the best protective factors against later adolescent and adult depression.
Other frequent comorbidities
Beyond the anxiety-depression axis, three comorbidities are clinically relevant:
- ADHD, present in 20-40 % of adolescents with anxiety disorders. Impulsivity and self-regulation difficulties amplify emotional distress. More information in the article on ADHD in children and adolescents.
- Eating disorders, particularly when there is perfectionism, cognitive rigidity or social anxiety. More information in the article on eating disorders.
- Problematic substance use (alcohol, cannabis), frequent in adolescents with poorly treated depression or anxiety. Treating anxiety and depression demonstrably reduces substance initiation in vulnerable adolescents.
Sleep disorders (present in up to 90 % of anxiety cases) and persistent somatoform symptoms are also frequently associated.
Red flags: when it is urgent
Some signs require immediate clinical consultation, not deferred:
- Verbalisation of death thoughts, suicidal ideation or concrete plans.
- Presence of self-harm, whether new or repeated.
- Extreme isolation and abrupt withdrawal from social, academic or family life.
- Sudden, marked changes in behaviour or mood, especially with associated substance use.
- Total refusal to eat, severe sleep disturbance, abandonment of basic self-care.
Faced with any of these signs, urgent consultation with a psychiatrist or emergency services, or calling the 024 helpline —the Spanish public service for suicidal behaviour, free, confidential and available 24/7— is the appropriate clinical response.
How evaluation works in consultation
Evaluating anxiety or depression in an adolescent involves:
- Clinical interview with the adolescent, adapted to their age and developmental level, in a setting that allows them to speak privately.
- Family interview, to gather objective information on functioning at home, academic performance, sleep, appetite and family dynamics.
- School information, when it provides relevant data (academic changes, behaviour, absences).
- Differential diagnosis: ruling out somatic conditions, thyroid dysfunction, sensory deficits, substance use and other psychiatric pictures.
- Validated standardised questionnaires as a support to clinical assessment.
- Suicide risk assessment in all cases with relevant depressive symptomatology.
The diagnosis is clinical: no test, scale or blood work replaces it.
Treatment
Treatment of anxiety and depression in adolescents is multimodal and adjusted to the severity of the picture:
- Psychoeducation for the adolescent and family. It is the foundation of any treatment and includes explaining the picture, what to expect from treatment and what the family can do.
- Psychotherapy in first line. Cognitive-behavioural therapy (CBT) has the strongest scientific evidence for both adolescent anxiety and depression. Other adapted psychotherapies may be useful depending on the case.
- Pharmacological treatment, when needed. Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological option. They are reserved for moderate or severe cases, or when psychotherapy alone is insufficient. Indication, dose and duration are decided by a psychiatrist on an individualised basis.
- School and family intervention, especially when conflict exists in either environment.
- Treatment of comorbidities (ADHD, eating disorders, sleep, substance use) in parallel.
In clinical practice, coordinated work between psychiatrist, psychotherapist and family within the same approach clearly improves outcomes compared to fragmented care.
When to consult
Some signs warrant a professional evaluation without delay:
- Persistent sadness, irritability or anxiety lasting weeks, with daily-life impact.
- Marked changes in academic performance, sleep, appetite or social relationships.
- Progressive isolation or loss of interest in previously enjoyable activities.
- Frequent somatic complaints with no clarified medical cause.
- Suspicion of self-harm, suicidal ideation, substance use or risk-taking behaviour.
If your family or the adolescent recognises several of these signs, it makes sense to consult early with a psychiatrist experienced in adolescence. An early evaluation —whatever the final diagnosis turns out to be— brings clarity to the situation, opens therapeutic options and reduces the risk of chronicity.
Conclusion
Anxiety and depression in adolescence are common, treatable and, above all, highly responsive to early intervention. Early detection changes the young person’s trajectory: it protects academic performance, relationships and psychosocial development, and reduces the risk of future comorbidities and suicidal behaviour. Coordinated work between psychiatrist, psychotherapist and family within the same approach clearly improves outcomes.
If there is active suicide risk, do not wait: the 024 helpline (free, confidential, 24/7) and hospital emergency services are the appropriate resources in Spain.
Clinical references
- Sánchez Mascaraque P, Cohen DS. Ansiedad y depresión en niños y adolescentes. Adolescere 2020. Access
- Madigan S et al. Changes in Depression and Anxiety Among Children and Adolescents From Before to During the COVID-19 Pandemic. JAMA Pediatrics. Access
- Trends in depressive and anxiety disorders among adolescents and young adults (10-24) from 1990 to 2021. Global burden of disease study analysis. Access
- Impact of the COVID-19 pandemic on long-term trends in youth depression and anxiety. Discover Mental Health. 2025. Access
- Spanish Ministry of Health. Annual Report 2024 — 024 Helpline for Suicidal Behaviour. Access
About the author: Dr Daniel S. Cohen. Psychiatrist in Madrid, specialist in child and adolescent psychiatry and adult psychiatry. Medical Director of Clínica Colev. Registration No. 28/4003040 (ICOMEM). Consultations in English, French, Hebrew and Spanish. View professional profile.