Objective To systematically evaluate and synthesize the illness perceptions and experiences of adolescents with depression, and to provide a reference for developing precise intervention strategies.Methods We systematically searched qualitative studies on the illness experiences of adolescents with depression across relevant databases from inception to January 2025.Methodological quality of the included literature was assessed using the Critical Appraisal Checklist for Qualitative Research from the Joanna Briggs Institute, and the meta-aggregative methodology was used to analyze and integrate the findings from the included literature. Results Thirteen studies were included. Twenty-three findings were extracted, categorized into 9 groups, and synthesized into 3 overarching themes: adolescents with depression face multiple challenges; complex psychological experiences related to self-harm and suicide among adolescents with depression; internal adjustment and external support utilized by adolescents with depression.Conclusion Adolescents with depression encounter multiple challenges, including lack of emotional support and social withdrawal. It is recommended to establish a trinity collaborative intervention system involving family, school, and society, to enhance the prioritization of adolescent mental health and depression awareness, and to focus on the psychological needs of adolescents.