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