Chapter Ten

Overview of Mood Disorders

  • Mood disorders (also known as affective disorders) involve disturbances in mood as the central feature.

    • Examples: sadness, happiness, anger.

  • Children can suffer from extreme emotional states such as excessive unhappiness, irritability, or mood swings.

  • Mood disorders are among the most common, chronic, and disabling illnesses in young people (Kessler et al., 2012).

Types of Mood Disorders

  • Two major types of mood disorders as per DSM-5:

    • Depressive disorders

    • Bipolar disorders

Depressive Disorders

  • Depressive Disorders Overview

    • Symptoms include pervasive unhappy mood, loss of interest (anhedonia), and disturbances in emotional regulation.

    • Clinical depression is marked by more severe symptoms compared to the occasional blues or mood swings.

    • Anhedonia and dysphoria are common in cases of severe depression.

    • Common expressions of depressive symptoms can vary with age, ranging from withdrawal in infants and preschoolers to irritability and anger in older children and adolescents.

Major Depressive Disorder (MDD)

  • MDD characterized by:

    • Minimum duration of 2 weeks with depressed mood, loss of interest, and additional symptoms causing distress or impairment in functioning.

    • Symptoms include:

    1. Depressed mood

    2. Loss of interest/pleasure in activities

    3. Weight changes

    4. Sleep disturbances

    5. Fatigue or loss of energy

    6. Feelings of worthlessness

    7. Diminished ability to think or concentrate

    8. Recurrent thoughts of death or suicide.

  • Diagnosis requires ruling out other conditions that could explain symptoms.

Persistent Depressive Disorder (P-DD)

  • P-DD (Dysthymia) involves a chronic depressed mood persisting for at least one year in children.

  • Symptoms are less severe than MDD but long-lasting, including somatic symptoms and cognitive distortions.

Disruptive Mood Dysregulation Disorder (DMDD)

  • DMDD features persistent irritability and severe temper outbursts that are out of proportion to the situation.

  • Symptoms must begin before age 10 and are characterized by chronic irritable mood between outbursts.

Associated Characteristics of Depressive Disorders

  • May exhibit intellectual and academic dysfunction, cognitive biases, low self-esteem, social and family issues.

  • Depressive disorders can co-occur with conduct disorders and anxiety.

  • Depression often leads to impairments in social functioning and school performance.

Theories of Depression

  1. Psychodynamic Theories: Depression results from loss (actual or symbolic) that transforms aggression into depressive affect.

  2. Attachment Theory: Insecure early attachments can predispose depression by distorting views of self and others.

  3. Behavioral Theories: Linked to lack of positive reinforcement and deficits in behavioral skills.

  4. Cognitive Theories: Depressogenic thinking; negative views of self and the world contribute to depression.

  5. Self-Control Theories: Deficits in self-directed behavior towards goals.

  6. Interpersonal Theories: Impaired interpersonal functioning can contribute to the onset of depression.

  7. Socio-environmental Theories: Stressful life events and social support as protective factors.

  8. Neurobiological Theories: Genetic influences, neurotransmitter dysregulation associated with mood disorders.

Causes of Depression

  • Genetic predisposition accounts for 30-45% of heritability.

  • Family history of mood disorders increases risk significantly.

  • Environmental factors such as stressful life events, family dynamics, and emotional regulation issues can elevate vulnerability.

Treatment of Depression

Psychosocial Interventions:

  • Cognitive-Behavioral Therapy (CBT): Most effective for youths; focuses on changing negative thought patterns and increasing engagement in enjoyable activities.

  • Interpersonal Psychotherapy for Adolescent Depression (IPT-A): Focuses on improving social and familial interactions.

  • Effective approaches have included family involvement and emotional education.

Pharmacological Interventions:

  • SSRIs as first-line treatment, effective for many but with concerns about side effects, particularly focusing on suicidal ideation in young users.

  • Treatment must be tailored to individual needs including monitoring for side effects.

  • Incorporation of psychosocial strategies with medication is critical for effective management.

Bipolar Disorder (BP)

  • Affects around 0.5% to 2.5% of youths in community samples, symptoms marked by alternating manic and depressive episodes.

  • Symptoms can include manic behaviors, disruptions in mood, and significant impairment in daily functions.

  • Early onset often leads to recurrent episodes and complex presentations, making diagnosis challenging.

  • Treatment includes medications (mood stabilizers and atypical antipsychotics) along with psychosocial interventions, but research on effective treatments for children is still evolving.

Conclusion

  • Awareness and attention to mood disorders in young people have increased, but challenges remain in diagnosis, treatment, and prevention. Effective strategies and multi-faceted approaches involving both therapeutic and pharmacological strategies show promise in combatting these disorders.