Mood Disorders in Children and Adolescents

Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders. In any of these disorders, a serious change in mood shapes your child’s emotional state. Unlike a normal bad mood a child feels occasionally, a mood disorder involves thoughts and feelings that are intense, difficult to manage, and persistent. A mood disorder is a real medical condition, not something a child will likely just "get over” on his own.

Today, clinicians and researchers believe that mood disorders in children remain one of the most underdiagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don’t always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.

The most common mood disorders in children and adolescents include:

• Major depression. A depressed or irritable mood, lasting at least two weeks.
• Persistent depressive disorder (dysthymia). A chronic, low-grade, depressed or irritable mood for at least 1 year.
• Bipolar disorder. Periods of persistently elevated mood followed by periods of depressed or flat emotional response.
• Disruptive mood dysregulation disorder. A persistent irritability and extreme inability to control behavior.
• 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, and chronic medical illnesses, can trigger symptoms of depression.
• Substance-induced mood disorder. Symptoms of depression due to drug use, the effects of a medication, or exposure to toxins.

Girls are at least twice as likely as boys to develop depression. Boys and girls are equally likely to develop bipolar disorder and obsessive-compulsive disorder.

The causes of mood disorders are not well understood. Imbalances in brain chemicals play a role. Environmental factors, such as unexpected life events and/or chronic stress, can also contribute to a mood disorder.

Mood disorders often run in families, so there is a genetic component, too. Children who have relatives with depression are at increased risk for depression. In addition, a family history of bipolar disorder may predispose a child to have bipolar disorder or other mood disorder.

Sometimes, extreme stress or a life event can “turn on” a gene, causing the disorder to develop. This can happen especially with depression.

Children show symptoms differently, according to their age and biological makeup. Symptoms also vary according to the type of mood disorder. Overall signs of a mood disorder may include:

• Sad, depressed, irritable, angry, or elevated mood that appears more intense than the child usually feels, lasts for a longer period of time, or occurs more frequently
• Trouble with family, including difficult behavior
• Lack of motivation or pleasure in previously enjoyed activities
• Changes in sleep or eating patterns or weight
• Frequent physical complaints, such as headaches, stomachaches, or fatigue
• Loss of energy or fatigue
• Difficulty achieving in school
• Worthlessness, guilt, or low self-esteem
• Severe recurrent temper outbursts
• Increased energy or bursts of energy with racing thoughts or fast speech
• Rebellious or high risk behavior
• Running away or threats of running away from home
• Difficulty with friends and peers
• Expressions of suicidal thoughts, which should be evaluated immediately

If you believe your child is struggling with a mood disorder, you can ask your pediatrician for a referral to a therapist or child psychiatrist. An accurate diagnosis of the mood disorder, as well as any other conditions, is a crucial first step in managing the disorder effectively. At The Children’s Hospital of Philadelphia, a specialist will perform a comprehensive evaluation. The evaluation may assess:  

• Your child’s overall health and medical history
• Your child’s symptoms
• Your child’s behavior at home, at school, and with peers
• Environmental factors that might be stressors in your child’s life
• Input from teachers or guidance counselor about issues at school
• Your child's past experiences with specific medications or therapies
• Your opinion or preference for treatment options

Mood disorders can be treated with evidence-based treatments, especially with early recognition of the problem. Treatment can help manage the episode, reduce the severity of symptoms, and help to prevent future episodes. It can also enhance your child’s normal growth and development and improve his or her quality of life and relationships.

A CHOP specialist will design a personalized treatment plan based on your child’s symptoms and other factors unique to her situation. The plan may include:

Individual therapy

• The specialist will identify key problems in your child's life and help your child learn how to manage these stressors. The specialist may also use a variety of techniques to help your child manage the symptoms of the mood disorder, including
  • Cognitive-behavioral. This approach involves changing problematic thoughts, feelings, and behaviors that your child may be experiencing.
  • Interpersonal therapy. This technique focuses on building social skills and helping children with difficult relationships in their lives.

Family therapy

Families play a vital supportive role in any mood disorder. Families, including parents or guardians, can learn methods to help their child manage mood and behavior problems. The specialist may also explore potential stressors in a child’s life and patterns of interaction within the family. A consultation with your child’s teachers or guidance counselor may also be advised.

Medications

A variety of medications are very effective in treating mood disorders by altering the brain chemicals involved.  Depending on the mood disorder and your child’s symptoms, medications may reduce the severity or frequency of symptoms, decrease problematic behaviors, improve functioning, and prevent future episodes.

Many children who receive early and adequate treatment for their mood disorder may improve significantly and keep their condition managed with ongoing intervention or support . If the episodes recur, they can usually be managed with therapeutic support, including medications, therapy, and additional resources. Despite the mood disorder, children and adolescents are able to grow, develop, and have meaningful life experiences, especially when their mood disorder is managed appropriately and adequately.

Depending on your child’s personalized treatment plan, your child and family may continue to meet with the specialist for a number of weeks or months. The focus of individual and family therapy may change over time, depending on your child’s age, progress, and needs. Medication needs may also change over time depending on a number of factors. At CHOP, a specialist will monitor and manage your child’s condition closely.

Children with mood disorders have a complexity to their condition that includes biology, genetics, factors like stress and physical health, family and peer dynamics, behavior and thought patterns, and sometimes other conditions operating alongside the mood disorder. This complexity means the accuracy of the diagnosis and assessment of your child is crucial and shapes the treatment approach. The right treatment then determines how effectively the mood disorder is managed—and how well your child flourishes in every domain: home, school, and among peers. The team at CHOP is specially trained to recognize, diagnose, and treat the full range of mood disorders in children. They design a personalized plan for your child based on the latest thinking and approaches to care. Their skill set leads your child to long-term success.