Every year around results season, my clinic in Delhi sees the same conversation arrive. A parent sits down, often without the child at first, and says some version of the same sentence.

"He was fine. He was always a good student. Now he won't come out of his room."

I want to write about this carefully, because there is a real thing happening in India and it is not being met with a real response.

The number worth sitting with

In 2024, the National Crime Records Bureau recorded 14,488 student deaths by suicide in India — 8.5% of all suicides in the country, and a rise of about 4.3% on the previous year. The 2023 figure, 13,892, was already the highest in a decade.

Student deaths are rising faster than the national suicide rate overall. Among those under 18, "failure in examination" was recorded as the cause in more than a thousand cases.

I am not going to dress that up. It is one of the clearest signals we have that something in the way this country asks young people to earn their future is going badly wrong.But I also want to say the part that gets left out, because it is the part that matters clinically:

A great deal of what sits underneath those numbers is depression. 

And depression is treatable.

Not always easily. Not always quickly. But treatable — with an evidence base, with options, and with a genuine expectation of getting better. The tragedy in India is not primarily that we lack treatments. It is that almost nobody reaches them.

The gap nobody talks about

The National Mental Health Survey found that 7.3% of 13–17 year olds in India were living with a mental disorder. And it found a treatment gap for common conditions like depression and anxiety above 85% — meaning fewer than one in six people who need care receive any.

For teenagers it is worse than that headline suggests. A fifteen-year-old cannot refer themselves. They need a parent to notice, to accept what they are seeing, to find someone, to pay, and to keep bringing them back. Every one of those is a place where it stops.

And it usually stops at the first one. 

Because the early signs of adolescent depression look almost exactly like the things we have been taught to call laziness.

How to tell exam stress from something else

Some stress before a big exam is normal and even useful. I do not want to medicalise a nervous teenager the week before boards.

Here is roughly how I separate them.

Ordinary exam stress:

  • Rises as the exam approaches and falls after it
  • The teenager still enjoys things when they get a break — friends, food, a match, a film
  • Sleep is disturbed close to the exam, not for months
  • They are worried about the exam
  • They can be reassured, at least for a while

Depression:

  • Does not lift when the pressure does — results came out weeks ago and nothing has changed
  • Anhedonia — nothing is enjoyable any more, including things they used to love. This is the single most important sign and the most commonly missed
  • Sleep and appetite change persistently, in either direction
  • They are worried about themselves: that they are a failure, a burden, that they have ruined everything, that there is no point
  • Withdrawal from friends, not just from studyIrritability and anger — in teenagers, depression very often looks like a short temper rather than sadness. Parents read this as attitud
  • eIt has been going on for two weeks or more, most of the day, most days

Warning signs that need a same-week appointment, not a wait-and-see:

  • Any talk of not wanting to be here, of everyone being better off without them, or of things being pointless
  • Giving away things that matter to them
  • A sudden, unexplained calm after a long low period
  • Any self-harm at all

If you are seeing those, please do not wait for the next holiday or the next term to sort it out. And if you need to talk to someone tonight, Tele-MANAS is free and available 24 hours on 14416.

What actually treats teenage depression

Let me set out the honest order of things, because the internet is full of people selling step three to families who have not been offered step one.

First: assessment. A proper psychiatric assessment of an adolescent takes time and it involves the parents and the teenager separately as well as together. It is looking for depression, but also for anxiety, ADHD, learning difficulty, substance use, bullying, and the things at home that nobody has said out loud. Quite often the exam is not the problem. The exam is where the problem became visible.

Second: psychotherapy. For mild to moderate adolescent depression, structured psychotherapy — CBT, interpersonal therapy — is the first-line treatment, and it works. Family involvement improves outcomes. This is not the soft option; it is the evidence-based one.

Third: medication, when it is warranted. Antidepressants have a real role in moderate to severe adolescent depression. They also need care in this age group — closer monitoring in the first weeks, honest conversation about side effects, and a clear plan. Many Indian parents are frightened of them, sometimes for reasons that are not medically sound and sometimes for reasons that are. That conversation deserves patience rather than a prescription pushed across a desk.

Fourth: Where TMS comes in — and where it doesn'tTranscranial magnetic stimulation is a non-invasive treatment that uses focused magnetic pulses to change activity in the brain circuits involved in depression. There is no anaesthesia, no sedation, no medication involved, and the person sits in a chair awake and goes home afterwards. It has been used in adults with depression for years, and MBI has been offering it in Delhi for some time.

What changed recently: TMS has now been cleared in the United States as an adjunctive treatment for major depressive disorder in adolescents aged 15 to 21. That is a meaningful regulatory step. It reflects a body of evidence in this age group that had been accumulating for years without formal recognition.Now the honest boundaries, because this is exactly the kind of thing that gets oversold.Adjunctive means alongside, not instead of. It sits with therapy and, where appropriate, medication. It does not replace them.

It is not a first step. If your child has not yet had a proper assessment and a course of therapy, that is where to start, not here.

It is not a cure and it is not universal. Some people respond very well, some partially, some not at all. Anyone who quotes you a success rate without qualifying it is selling.It does not treat a crisis. If a young person is acutely unsafe, that needs urgent psychiatric care, not an outpatient course of anything.

I am not claiming it prevents suicide. The clearance is for depression. The evidence does not support a prevention claim in adolescents, and I will not make one.What it does offer, for the right teenager, is a treatment that works differently from a tablet, has no systemic side effects, does not cause weight gain or sexual side effects or emotional blunting, and does not interfere with studying.And it is barely used in adolescents in India at all.

The real obstacle is not the evidence

A standard TMS course means attending on most weekdays for about two weeks.For an adult that is difficult. For a fifteen-year-old, with school, and parents who work, and a clinic somewhere across the city, it is a logistics problem before it is a clinical one. Clearance answers does this work. It does not answer can this family actually complete it.

This is why I follow the work on accelerated protocols — condensed schedules that deliver a course in days rather than weeks — more closely than almost anything else in the field. For a country with fewer than one psychiatrist per 100,000 people, access is the binding constraint, not efficacy. A treatment that a family cannot attend is not a treatment.

What I would say to a parent reading this

If your child has been withdrawn for weeks, is not enjoying anything, is not sleeping or eating as they were, and is speaking about themselves in a way that frightens you — that is not a discipline problem and it is not a character flaw. It is a medical problem with medical answers, and the earlier it is looked at properly, the more straightforward it usually is.

You do not need to know what is wrong before you come. That is our job.

And to any young person who has ended up reading this: an exam result is information about one afternoon. It is not information about you, and it is not information about the rest of your life. The people who tell you otherwise are wrong, and there are more of us who know that than you would guess right now.