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Mood disorders differ from the normal ups and downs of childhood and the moodiness of adolescence; they persist over time and seriously interfere with school performance and social and family functioning. Adolescents suffering from mood disorders are at least 3 times more likely than those without mood disorders to abuse drugs, fight or carry weapons, and engage in risky behaviors such as unprotected sex. More than half of all adolescent suicide attempts are associated with mood disorders. Mood disorders in childhood and adolescence have often been misdiagnosed or underdiagnosed. In fact, childhood depression was not officially recognized in the United States until 1975 when participants of a National Institute of Mental Health Conference modified adult depression diagnostic criteria to allow for childhood stages of language and cognitive development.1

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Bipolar disorder in childhood and adolescence is now recognized as a distinct illness that occurs independent of highly comorbid disorders, such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder. Without the duration criterion for diagnosis, the diagnosis of bipolar disorder became possible. The legitimacy of this diagnosis has been demonstrated by tracking adolescents who were diagnosed with bipolar disorder but later stopped taking lithium on their own: They had a 3 times greater rate of relapsing into mania than those who complied with their medication.2 Standardized testing may be helpful, but the initial diagnosis of a mood disorder in childhood or adolescence must be based on careful interviews with patients and their parents, and the diagnosis must be confirmed by careful follow-up over time, sometimes months to years.

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Standardized psychological tests may be helpful but should not be relied upon to establish a diagnosis. Few pediatricians ask adolescents about their mental health; they are more likely to ask girls than boys, but rates of mental health symptoms are equivalent or greater in boys.3 Because 28% of high school students report having experienced a period of depressed mood lasting more than 2 weeks (major depression), 14.5% report having had serious thoughts of suicide, and 6.9% report having made a suicide attempt, all in the past 12 months,4 every physician who sees young people should know the signs and symptoms of mood disorders in children and adolescents and routinely incorporate mental health questions into their clinical histories during their annual health maintenance visit. Mental health screening should include, at the minimum, questions about suicide ideation, plans, and intentions. See Chapter 93 for more information on this topic, including Table 93-1, which provides the American Psychiatric Association’s definitions of the 3 broad categories for diagnosing a mood disorder.

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Major Depression and Dysthymic Disorder

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Major depression and dysthymic disorders are further discussed in Chapter 93. This discussion is focused upon the adolescent patient.

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Epidemiology

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Depressive disorders affect approximately 2.8% of children and 8.3% of adolescents at any given time.4-6 The incidence of ...

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