Mood Disorders

History

Orthodox Psychoanalytic Perspective
- depression was viewed as phenomenon of superego and mature ego functioning
- depression in the superego acts as punisher for ego
- because a child’s superego is not fully developed, it was believed that children could not have depression
Masked Depression
- added to controversy of existence of distinct disorder of childhood depression
- says that sad moon usually required for depression may not be present but may be masked by other problems such as
  - hyperactivity
  - delinquency
- masked depression resulted in underdiagnosing of depression in children
Issues with Masked Depression
- there was no defined way to decide if a particular symptom was a sign of depression or not
- this ambiguity can lead to misinterpretation of symptoms, often attributing them to other behavioral or developmental issues, ultimately delaying appropriate treatment.
Developmental Perspective
- behaviors that led to diagnosis of depression might be only transitory developments common among children in certain age groups
- highlighted the need to differentiate transient episodes which may be common among children from long-lasting expressions
- Depression as a symptom involves 1 or 2 depressive behaviors that may be viewed as typical for developmental stage
- Depression as a syndrome involves a combination of symptoms that significantly impair daily functioning and may include changes in mood, sleep patterns, appetite, and overall energy levels.

Definition: Mood disorders are mental health conditions characterized by significant changes in mood, which can be either depressive or manic.

Range of Mood Disorders: Mood disorders include a spectrum from extreme sadness (depression) to extreme elation (mania).

Types of Mood Disorders

Mood disorders are sometimes described as

Unipolar - one mood is experienced, typically depression
Bipolar - both moods are experienced, depression and mania

Major Depressive Disorder (MDD):
- A state of persistent sadness or low mood that lasts for a long time.
- Symptoms include
  - depressed or irritable mood
  - loss of interest or pleasure
  - change in weight or appetite
  - sleep problems
  - motor agitation or retardation
  - fatigue or loss of energy
  - feelings of worthlessness of guilt
  - difficulty thinking, concentrating or making decisions
  - thoughts of death or suicidal thoughts/behaviors
- Diagnosing Requirements:
  - DSM-5 requires 5 or more symptoms present
    - one of the symptoms MUST be depressed (or irritable) mood or
    - loss of interest or pleasure
  - Symptoms must persist for
    - at least two weeks and
    - must cause significant distress or impairment in youths functioning
- MDD is characterized by one or more depressive episodes with remission of symptoms between episodes
Persistent Depressive Disorder (Dysthymia)
- a more chronic form of depression
- many of the symptoms of MDD are present, perhaps in a less severe form, but are more chronic meaning they persist for a longer period of time
- Symptoms and Diagnosing Requirements
  - depressive episodes are present for 1 year AND
  - 2 or more of the below symptoms
    - depressed or irritable mood
    - poor appetite/overeating
    - sleep disturbance
    - low energy or fatigue
    - loss of self-esteem
    - concentration or decision making problems
    - feelings of hopelessness
    - symptoms must cause significant distress or impairment
- Double Depression is a term used to describe instances in which both chronic and less severe depression (dysthymia) AND major depressive episodes are present
- Dysthymia typically develops PRIOR to the occurrence of a major depressive episode
Disruptive Mood Dysregulation Disorder (DMDD)
- added to the DSM-5 in attempt to address problems with confusion and overdiagnosis of bipolar disorder in children
- Symptoms include
  - persistent irritability
  - frequent outbursts (extreme and physical aggression)
- Diagnosing Requirements
  - symptoms must be present most of the day and nearly every day
  - age of onset is before 10 years old and diagnosis is not intended to be given before age 6 or after age 18
  - symptoms may be confused with bipolar presentation, BUT children with DMDD symptom pattern are more likely to later develop
    - unipolar depressive disorders or
    - anxiety disorders rather than a bipolar disorder
Mania:
- An abnormally elevated mood, often accompanied by feelings of euphoria or intense energy.
- Symptoms may include
  - high energy
  - reduced need for sleep
  - impulsive behaviors.
- Diagnosing Requirements:
  - A manic episode must
    - last at least one week or
    - require hospitalization.
  - Symptoms must include at least three of the following:
    - inflated self-esteem
    - decreased need for sleep
    - talkativeness
    - distractibility
    - increased goal-directed activities
    - engaging in activities with a high potential for painful consequences.

Lesions: Areas of damage in the internal organ or structure; more information needed.
Elation: A state of intense joy or happiness, often tied to manic episodes in mood disorders.Additional PointsThe discussion on mood disorders will continue in the next session, focusing on the symptoms, causes, and treatments available for these conditions.

Issues With Diagnosing Depression

Kazdin Study
- The Kazdin Study highlights the challenges faced in diagnosing depression accurately, particularly due to overlapping symptoms with other mood disorders.
- shows that the method employed can affect how depression is viewedand categorized, leading to potential misdiagnoses that may hinder appropriate treatment.

Co-Occurring Disorders

2/3 of youth diagnosed with MDD also meet criteria for at least one other disorder

Anxiety disorders, most commonly seperation anxiety disorder
Conduct disorders and oppositional defiant disorder may also co-occur among depressed YOUTH
alcohol and substance abuse are common among ADOLESCENTS
other common co-occurring disorders include
- disruptive behavior disorder
- eating disorders
- ADHD

Epidemiology of Depression

Depression is the leading cause of disability in young people

MDD is the most frequently diagnosed mood disorder
80% of youth with unipolar disorders experience MDD
10% of youth experience dysthymia without MDD
10% of youth experience double depression

Prevalence Rates

12% MDD among children and adolescents
4-25% lifetime prevalence among children and adolescents

Oregon Adolescent Depression Project (OADP)

estimated that by age 19, 28% of adolescents will have experienced an episode of MDD
- 35% females
- 19% males
this suggests that 1 out of every 4 young people experience a depressive disorder at some point during childhood/adolescence
There were issues with children and adolescents who exhibit depressive symptoms but DON’T meet the diagnostic criteria
- these were not included in prevalence estimates in this study but its important to note that these children exhibit impairments and are also at greater risk for future disorders

Age & Sex

depression is less prevalent in young children than in adolescents regardless of gender
USUALLY no gender differences for children younger than 12 yoa
- BUT when there is a difference, we typically see higher rates in boys than girls
Among children older than 12 yoa
- depression is more common in girls
- begins to approach 2:1 female to male ratio
Prevalence of depression may emerge by age 12, peak between ages 13-15 and decrease or stabilize into the 20’s and after

Socioeconomic, Ethnic and Cultural Considerations

lower socioeconomic status is associated with higher rates of depression
- most likely influenced by
  - income
  - limited parental education
  - chronic stress
  - family disruption
  - environmental adversities
  - racial/ethnic discrimination
Higher rates of depression reported among Latinx youth
- ethnic minority youth may face stressors that can contribute to development of depression
  - discrimination
  - ethnic/racial socialization practices
Discrimination and Parent-Child Conflict were associated with higher levels of depression