Child and Adolescent Mood Disorders

Pediatric mood disorders are common, with prevalence of major depression rising from 1-2% in childhood to 8-15% in adolescence, with female predominance after puberty. Bipolar disorder typically presents in adolescence or young adulthood. Disruptive Mood Dysregulation Disorder (DMDD), introduced in DSM-5, describes children with severe, persistent irritability and frequent temper outbursts, distinct from bipolar disorder. Suicide is a leading cause of death in adolescents, requiring vigilant assessment.

First-line treatment for moderate-to-severe pediatric depression is cognitive behavioral therapy (CBT) or interpersonal psychotherapy for adolescents (IPT-A), with SSRIs (fluoxetine first-line, sertraline, escitalopram) reserved for severe cases or treatment failure. Combination of CBT and SSRI is more effective than either alone in moderate-to-severe cases. SSRIs carry a black-box warning for suicidality in pediatric populations, requiring close monitoring during titration.

Bipolar disorder treatment includes second-generation antipsychotics (aripiprazole, risperidone, olanzapine, quetiapine) and lithium for adolescents, with psychotherapy and family-focused therapy. DMDD is treated with parent management training, school accommodations, and CBT. Pharmacotherapy for DMDD is limited; stimulants for comorbid ADHD, SSRIs for comorbid depression and anxiety, and atypical antipsychotics for severe aggression are commonly used. Family-focused therapy and school coordination are essential.