Mood disorders in children and adolescents

This article reviews our current understanding of depressive and bipolar disorders in children and adolescents. It highlights issues related to causality, assessment and treatment. Early onset depression arises as a consequence of interrelated predisposing and precipitating factors, which together lead to alterations to biological and psychological functioning and result in depression. Assessment needs to be carefully and thoroughly undertaken by a clinician with experience in child and adolescent psychiatric disorders. Following a brief psychoeducational intervention, further treatment should be initially with psychotherapeutic approaches. Cognitive and interpersonal therapies are supported by the best evidence. Pharmacological treatments may be associated with increases in suicidal ideation and behaviours and should be initiated only by those with specialist training and experience in child and adolescent mental health problems. Early onset bipolar disorder remains a controversial area of practice, with uncertainty over the application of diagnostic criteria, validity of the disorder and its relationship with other disorders such as ADHD. For those adolescents and, rarely, children with true bipolar disorder, the longer-term outcome for early-onset bipolar disorder appears to be similar to that for adults, although younger sufferers are more likely to have a more rapid cycling clinical picture than adults. There is very little research evidence investigating response to medication, although there is some evidence for the efficacy of lithium, valproic acid and carbamazepine in the treatment of early-onset mania. Major advances relate to the pharmacological treatment of depression in this age-group. Data on the adverse events found with SSRIs have been re-analysed and have resulted in warnings about the appearance of suicidal behaviour in the early stages of treatment. This has in turn resulted in regulatory authorities suggesting that extreme care should be taken when treating early onset depression with medication in this age group.