If you’re the parent of a teen, you may have already witnessed enough drama and extreme mood swings to rival an episode of “Real Housewives.” But how do you know if what you’re seeing is typical teenage angst or something more?

“Talk to your teen on a regular basis and do the best you can to know what’s going on in their life,” says Dr. Hilary Bowers, Director of Behavioral and Mental Health Services at Children’s Primary Care Medical Group. “By paying attention to their behavior, you will be able to recognize consistent or abrupt behavioral changes which could indicate an issue.”

Here are five behaviors that may indicate your teen needs to be evaluated for depression. Dr. Bowers stresses that these symptoms need to occur every day for more than two weeks in a row. “A few bad days does not equal mental illness,” she says.

1. Social withdrawal
Note if your teen starts to spend an excessive amount of time alone, losing interest in extracurricular activities and events at home or in school as well as hobbies and interests. “Maybe your teen is cancelling outings with friends, or eating meals in their room,” says Dr. Bowers.

2. Irritability, anger or hostility
This is common among teens diagnosed with depression. Your typically calm teen might be constantly angry or blame you with the statement “it’s all your fault!” These are aggressive behaviors that are out of character for your teen and could be indicative of underlying issues.

3. Sleep patterns
Monitor your teen’s sleep schedule and look for changes that include excessive sleep or a lack of sleep due to insomnia. “Sleep is incredibly important for teens,” says Dr. Bowers. “For teens with less than seven hours of sleep each night, studies show that everything gets worse – there is increased anxiety, increased depression, poor self-esteem, increased risky behaviors like drug and alcohol use and poor school attendance. Teens need eight to ten hours of sleep a night.”

4. Risky behaviors
Look for new or increased alcohol and drug use. Depressed teens may also engage in dangerous or high-risk behaviors like binge drinking or reckless driving. Dr. Bowers encourages parents to educate themselves about drug and alcohol paraphernalia so they can recognize the evidence. “Google vape pens so you know what they look like,” she says. Be familiar with the physical signs of substance abuse like red eyes, slurred speech and increased sleep.

5. Changes in appetite
Watch for increased or decreased eating as well as intense focus on body image, says Dr. Bowers. These could indicate an eating disorder.

If you feel your teen is exhibiting some or all of these behaviors and you have concerns, reach out to your CPCMG pediatrician to schedule an appointment. Please note that every CPCMG site will screen for depression at your child’s annual well visit.

The bottom line is to be present in your teen’s life, and express concern for the troubling emotions and behaviors you’re seeing. CPCMG is here to help you navigate these parenting challenges and can provide resources to help your teen maintain their emotional, mental and physical health.