Mental and behavioral health

Overview of mood disorders

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A category of mental health problems that include all types of depression and bipolar disorder, mood disorders are sometimes called affective disorders.

During the 1980s, mental health professionals began to recognize symptoms of mood disorders in children and adolescents, as well as adults. However, children and adolescents do not necessarily experience or exhibit the same symptoms as adults. It is more difficult to diagnose mood disorders in children, especially because children are not always able to express how they feel. Today, clinicians and researchers believe that mood disorders in children and adolescents remain one of the most under-diagnosed mental health problems. Mood disorders in children also put them at risk for other conditions (most often anxiety disorder, disruptive behavior, and substance abuse disorders) that may persist long after the initial episodes of depression are resolved.

Causes

What causes mood disorders in children is not well known. There are chemicals in the brain that are responsible for positive moods. Other chemicals in the brain, called neurotransmitters, regulate the brain chemicals that affect mood. Most likely, depression (and other mood disorders) is caused by a chemical imbalance in the brain. Life events (such as unwanted changes in life) may also help cause this chemical imbalance.

Affective disorders aggregate in families and are considered to be multi-factorially inherited. Multi-factorial inheritance means that "many factors" are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to environmental factors, produce the trait or condition. Often one gender (either males or females) is affected more frequently than the other in multi-factorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender.

Who is affected?

Anyone can feel sad or depressed at times. However, mood disorders are more intense and difficult to manage than normal feelings of sadness. Children who have a parent with a mood disorder have a greater chance of also having a mood disorder. However, life events and stress can expose or exaggerate feelings of sadness or depression, making the feelings more difficult to manage.

Sometimes, life's problems can trigger depression. When parents get divorced, a loved one dies, a break up with a girlfriend or boyfriend happens, or grades are slipping, coping with the pressure may be difficult. These life events and stress can bring on feelings of sadness or depression, or make a mood disorder harder to manage.

The chance for depression in females in the general population is 5 to 9 percent and for males is 3 to 4 percent. Once a person in the family has this diagnosis, the chance for their siblings or children to have the same diagnosis is 7 to 19 percent. In addition, relatives of persons with depression are also at increased risk for bipolar disorder (manic depression). The chance for siblings or children of a person with depression to have bipolar illness is 0.3 to 2 percent.

The chance for manic depression (or bipolar disorder) in males and females in the general population is 1 percent. Once a person in the family has this diagnosis, the chance for their siblings or children to have the same diagnosis is 4 to 18 percent. In addition, relatives of persons with manic depression are also at increased risk for depression. The chance for siblings or children of a person with manic depression to have depression is 6 to 28 percent.

Some other mood disorder statistics:

Seven to 14 percent of children will experience an episode of major depression before the age of 15
Twenty to 30 percent of adult bipolar patients report having their first manic episode before the age of 20
Out of 100,000 adolescents, 2,000 to 3,000 will have a mood disorder, of which eight to 10 will commit suicide

The National Institute of Mental Health, part of the National Institutes of Health report the following:

Research indicates that depression onset is occurring earlier in life today than in past decades.
Early-onset depression often persists, recurs, and continues into adulthood. Depression in youth may also predict more severe illness in adulthood.

Types of mood disorders

The following are the most common types of mood disorders experienced by children and adolescents:

Major depression - a period of a depressed or irritable mood or a noticeable decrease in interest or pleasure in usual activities, along with other signs, lasting at least two weeks.
Dysthymic disorder (dysthymia) - a chronic, low-grade, depressed or irritable mood for at least one year.
Bipolar disorder (manic depression) - manic episodes (period of persistently elevated mood), usually interspersed with depressed periods.
Mood disorder due to a general medical condition - many medical illnesses (including cancer, injuries, infections and chronic medical illnesses) can trigger symptoms of depression.
Substance induced mood disorder - symptoms of depression that are due to the effects of medication or other forms of treatment, drug abuse, or exposure to toxins.

Symptoms:

Children, depending upon their age and the type of mood disorder present, may exhibit different symptoms of depression. The following are the most common symptoms of a mood disorder. However, each child and adolescent may experience symptoms differently. Symptoms may include:

Persistent feelings of sadness
Feeling hopeless or helpless
Having low self-esteem
Feeling inadequate
Excessive guilt
Feelings of wanting to die
Loss of interest in usual activities or activities once enjoyed
Difficulty with relationships
Sleep disturbances (i.e., insomnia, hypersomnia)
Changes in appetite or weight
Decreased energy
Difficulty concentrating
A decrease in the ability to make decisions
Suicidal thoughts or attempts
Frequent physical complaints (i.e., headache, stomach ache, fatigue)
Running away or threats of running away from home
Hypersensitivity to failure or rejection
Irritability, hostility, aggression

In mood disorders, these feelings appear more intense than adolescents normally feel from time to time. It is also of concern if these feelings continue over a period of time or interfere with an adolescent's interest in being with friends or taking part in daily activities at home or school. Any adolescent who expresses thoughts of suicide should be evaluated immediately.

Other signs of possible mood disorders in adolescents may include:

Difficulty achieving in school
Constant anger
Rebellious behaviors
Trouble with family
Difficulty with friends and peers

The symptoms of mood disorders may resemble other conditions or psychiatric problems. Always consult your child's physician for a diagnosis.

Diagnosis

Mood disorders are real medical conditions. They are not something a child will likely just "get over."

A child psychiatrist or other mental health professional usually diagnoses mood disorders following a comprehensive psychiatric evaluation. An evaluation of the child's family, when possible, in addition to information provided by teachers and care providers may also be helpful in making a diagnosis.

Treatment for mood disorders:

Specific treatment for mood disorders will be determined by your child's physician based on:

Your child's age, overall health, and medical history
Extent of your child's symptoms
Type of mood disorder
Your child's tolerance for specific medications or therapies
Expectations for the course of the condition
Your opinion or preference

Mood disorders can often be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment may include one, or more, of the following:

Medications (especially when combined with psychotherapy have shown to be very effective in the treatment of mood disorders in children and teens)
Psychotherapy (most often cognitive-behavioral and interpersonal therapy) for the child (focused on changing the child's distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the child's environment, and how to avoid them)
Family therapy
Consultation with the child's school

Parents play a vital supportive role in any treatment process.

Prevention of mood disorders:

Preventive measures to reduce the incidence of mood disorders in children are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children with mood disorders.