Overview of Mood Disorders in Children and Adolescents

What are mood disorders?

A category of mental health problems that includes 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 have 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 underdiagnosed mental health problems. Mood disorders in adolescents 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.

What causes mood disorders?

What causes mood disorders in adolescents 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. Mood disorders may be caused by a chemical imbalance in the brain, on its own or along with environmental factors, such as unexpected life events and/or chronic stress.

Mood disorders can run in families and are considered to be "multifactorially inherited," meaning that many factors are involved. The factors that produce the trait or condition are usually both genetic and environmental, involving a combination of genes from both parents. If a mother passes a mood disorder trait to her children, a daughter is more likely to have the disorder. If a father passes a mood disorder trait to his children, a son is more likely to have the disorder. 

Who is affected by mood disorders?

Anyone can feel sad or depressed at times. But mood disorders are more intense and difficult to manage than normal feelings of sadness. Children, adolescents, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder, although it is not a guarantee that this will happen. 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. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage, depending on your coping skills and resiliency.

Females in the general population are 70% more likely to experience depression than males. Once a person in the family has this diagnosis, the chance for his or her siblings or children to have the same diagnosis is increased. In addition, relatives of people with depression are also at increased risk for bipolar disorder.

The chance for bipolar disorder in males and females in the general population is about 2.6%. Once a person in the family has this diagnosis, the chance for his or her siblings or children to have the same diagnosis is increased. In addition, relatives of people with bipolar disorder are also at increased risk for other forms of depression.

What are the different 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.

  • Persistent depressive disorder (dysthymia). A chronic, low-grade, depressed or irritable mood for at least 1 year.

  • Bipolar disorder. Manic episodes (period of persistently elevated mood), interspersed with depressed periods, or periods of flat or blunted emotional response. 

  • Disruptive mood dysregulation disorder. A persistent irritability and extreme inability to control behavior exhibited in children under the age of 18. 

  • Premenstrual dysmorphic disorder. This includes depressive symptoms, irritability, and tension before menstruation. 

  • 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.

What are the symptoms of mood disorders?

Adolescents, depending on their age and the type of mood disorder present, may show different symptoms of depression. The following are the most common symptoms of a mood disorder. But each adolescent and adolescent may show 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 (for example, insomnia, or 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 (for example, headache, stomachache, or 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 adolescent's health care provider for a diagnosis.

How are mood disorders diagnosed?

Mood disorders are real medical conditions. They are not something an adolescent 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 adolescent'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 adolescent's health care provider based on:

  • Your adolescent's age, overall health, and medical history

  • Extent of your adolescent's symptoms

  • Type of mood disorder

  • Your adolescent'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 adolescent and family. Treatment may include one, or more, of the following:

  • Medications (especially when combined with psychotherapy has shown to be very effective in the treatment of mood disorders in children and teens)

  • Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the adolescent (focused on changing the adolescent's distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the adolescent's environment and how to avoid them)

  • Family therapy

  • Consultation with the adolescent'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 adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by adolescents with mood disorders.