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Depression is a very common mental health problem in adolescence. Although over the past decades a number of psychological interventions for depression in adolescence have been developed and empirically evaluated, recent systematic reviews and meta-analyses suggest that there is considerable room for improvement of their effectiveness. This is particularly true for the treatment of adolescents with “complex” depression, that is, those where depression is embedded within broader personality and relational problems, often related to a history of attachment trauma. Mentalization-based treatment (MBT) may be particularly effective in these cases, as it has a strong focus on temporary and long-term impairments in mentalizing (i.e., the capacity to understand the self and others in terms of intentional mental states), which are very typical of adolescents with depression. This article outlines a continuum of severity of depression as seen from a mentalizing perspective, ranging from the mild to moderate to the more severe end of the spectrum. This is followed by a summary of the mentalizing approach to understanding depression along the spectrum of severity, the empirical evidence supporting this approach, and a description of the basic principles of MBT for depression. We close with some thoughts about the future of MBT in the treatment of depression in adolescents.