Background <p>The prevalence of depression among adolescents has been steadily increasing in recent years. Exergames hold the potential to provide a positive entertainment experience, yet their utilization among adolescents with depression remains limited. This study aims to investigate the perceptions and requirements regarding exergames in adolescents with depression, with the goal of designing tailored exergame intervention programs for clinical applications.</p> Methods <p>Semi-structured interviews were conducted with adolescents with depression (<i>n</i> = 33) at a tertiary psychiatric hospital from September to November 2024. Data were analyzed using Colaizzi's seven-step method to ensure a rigorous and systematic qualitative analysis. The study adhered to the COREQ checklist when reporting qualitative research.</p> Results <p>The perceptions and requirements of adolescents with depression regarding exergames were categorized into three themes and seven sub-themes: (1) characteristics of physical activity (lack of exercise motivation and low levels of physical activity); (2) willingness to use exergames (a preference for exergames over traditional exercise, a desire to alleviate depressive symptoms through exergaming and a tendency to engage in exergames collaboratively rather than individually); (3) expectations for exergames (emphasizing the need for safety and tangible benefits from exergames participation).</p> Conclusions <p>While exergames are widely utilized among adolescents, their application in adolescents with depression remains under-explored. This study indicates that adolescents with depression have a positive attitude towards exergames and perceive them as potential interventions to increase physical activity and alleviate depressive symptoms.</p> Trial registration <p>Chinese Clinical Trial Registry, ChiCTR2400090678. Registered on 11th October 2024.</p>