Mood disorders in teenage girls

This article reviews our current understanding of depressive and bipolar disorders in teenage girls. It highlights issues related to causality, assessment and treatment. Early onset depression arises as a consequence of inter-related 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 mental health problems. 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 increased suicidal ideation and behaviour and should only be initiated 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 rapidly 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.