depressive disorders/bipolar disorders

when was depressive disorders recognized in children

in the 1980s, previous beliefs concluded that children lacked the superego to have depression

depression developmental manifestations

it often presents differently

• irritability: common in children/adolescents 

• somatic complaints: Children are more likely to exhibit physical symptoms like frequent headaches, stomachaches, and fatigue.

• Behavioral Changes: A drop in academic performance, social withdrawal, increased sensitivity to rejection, and vocal outbursts (crying, yelling)

• Anhedonia: A loss of interest in play or social activities

major depressive disorder core feature

first depressive episode must last for at least two weeks.

characterized by depressed mood OR anhedonia, plus four additional symptoms 

MDD symptoms domains: affective 

Sadness, emptiness, hopelessness, irritability, excessive guilt.

MDD symptoms domains: cognitive  

Difficulty concentrating, indecisiveness, recurrent thoughts of death or suicide.

MDD symptoms domains: somatic/neurodivergence 

significant weight/appetite change, insomnia, hypersomnia, psychomotor agitation or retardation, loss of energy or fatigue.

key point of MDD:

There 227 possible symptom combinations—-meaning no two cases look exactly the same, but all cause significant distress or impairment.

Persistent Depressive Disorder (PDD - Dysthymia): core feature 

A chronic, low-grade depressive or irritable mood that persists for at least one year in youth.

how is PDD different from MDD/

PDD is less acute but more chronic. It represents a lingering, baseline of negative affect.

A child can be diagnosed with both MDD and PDD if they meet criteria for both simultaneously, a condition referred to as "double depression."

Disruptive Mood Dysregulation Disorder (DMDD): Core Feature:

Severe, reoccurring temper tantrums that are out of proportion to the situation. Between outbursts, the child's mood is persistently irritable or angry.

how is DMDD different from Bipolar disorder 

DMDD was introduced in the DSM-5 to address the over-diagnosis of pediatric bipolar disorder.

Unlike bipolar disorder, DMDD does not involve mania or hypomania. The irritability is chronic, not episodic. It is considered a depressive disorder due to the central role of negative mood.

homotypic continuity for depression?

very high. A child with MDD is at high risk for MDD in adolescence

and adulthood.

recurrence of depression

Depression is often a recurrent disorder. The first episode is a

powerful predictor of future episodes, with rates of recurrence as high as 70%

within five years

depression comorbidity

Depression is highly comorbid with anxiety disorders (often preceding it),

substance use disorders (often due to self-medication), and behavioral disorders like ADHD and ODD.

depression in the diathesis-stress model

pre-existing vulnerabilities (diatheses) interact with life stressors to trigger an

episode.

• genetic vulnerabilities (diathesis): heritability is 30-40%. specific genes related to serotonin 

frontla lobes in relation to depression

Reduced activity in the left prefrontal cortex, associated with positive affect and motivation.

limbic system in relation to depression

Hyperactivity in the amygdala (emotional reactivity) and disruptions in the hippocampus (stress regulation and memory).

reward circuitry in relation to depression

The brain's reward system (e.g., ventral striatum) is less responsive to positive stimuli, leading to anhedonia and low motivation.

environmental stressors: depression

Family Factors: Parental depression (modeling negative behaviors, creating a stressful environment), family conflict, criticism, and insecure attachment.

ACEs and Trauma: Maltreatment, abuse, and neglect

Peer Factors: Bullying, peer rejection, and a lack of close friendships.

Psychological Vulnerabilities (The Cognitive Diathesis):

Temperament: temperament is high in negative emotionality and low in positive emotionality/effortful control = greater risk.

Response Styles Theory:

Highlights the role of rumination—a repetitive focus on one's negative feelings, their causes, and their consequences

very common in adolescents and females

Learned Helplessness:

The belief that one has no control over difficult events, causing the person to “give up”

This is a "control problem, not a competence problem."

Treatment

• Cognitive-Behavioral Therapy (CBT): gold standard . challenges negative thoughts and increases behavioral activation

• interpersonal therapy: focus on social functioning 

• SSRIs 

• Combined Treatment: CBT + SSRI is the most effective approach

resilience factors

supportive relationships, cognitive flexibility high self esteem, healthy lifestyle

bipolar disorder: core fetaures

characterized by the occurrence of one or more manic or hypomanic episodes, usually alternating with major depressive episodes.

It is the epitome of a cyclical and episodic disorder.

manic episode

A period of abnormally elevated or irritable mood WITH abnormally increased energy. must last at least one week.

symptoms of manic episodes 

• Inflated self-esteem or grandiosity.

• Decreased need for sleep (e.g., feels rested after only 3 hours).

• More talkative than usual or pressure to keep talking.

• Flight of ideas or racing thoughts.

• Distractibility.

• Increase in goal-directed activity or psychomotor agitation.

• Excessive involvement in activities that have a high potential for painful

consequences (e.g., unrestrained buying sprees, sexual indiscretions).

Developmental Presentation: bipolar disorder

In youth, mania often presents as severe, chronic irritability with "affective storms" (prolonged, aggressive temper outbursts), rather than the classic euphoric mood seen in adults.

This presentation led to the diagnostic confusion that the creation of DMDD was intended to address.

what is the difference between bipolar disorder and DMDD

The key difference is episodicity. Bipolar disorder involves clear discrete episodes of mood and behavior change (mania/depression) with a return to a baseline in between. DMDD involves a chronic, non-episodic irritable mood with frequent temper outbursts.

what is the difference between episodic disorders and chronic disorders

Episodic Disorders (e.g., MDD, Bipolar): have distinct episodes with a return to normal functioning in between.

Chronic Disorders (e.g., PDD, DMDD): ongoing symptoms that may fluctuate in intensity but are present for a long period (at least one year).

Explain the Diathesis-Stress Model as it applies to depression.

an individual’s pre-existing vulnerabilities (diathesis) will lie dormant until activated by a major stressor, causing the onset of the disorder

Beck's Model

Focuses on content—negative beliefs about the self, world, and future, processed through cognitive distortions.

Hopelessness Theory:

pathway where negative events lead to feelings of hopelessness through stable and global attributions.

Response Styles Theory:

Focuses on process—the maladaptive coping strategy of rumination maintains and worsens depression.

Learned Helplessness:

Focuses on a perceived lack of control over outcomes,

leading to motivational and behavioral deficits.