Chapter 50: Mood Disorders in Children & Adolescents

The content examines disruptive mood dysregulation disorder characterized by severe irritability and recurrent emotional outbursts, major depressive disorder presenting with depressed or irritable mood alongside anhedonia and neurovegetative symptoms, and persistent depressive disorder involving chronic depression lasting more than one year. A critical developmental distinction emphasized throughout is that irritability often replaces sadness as the primary mood presentation in younger patients, with depression prevalence increasing substantially during adolescence, particularly among females. The chapter establishes that mood disorders in this population result from multifactorial etiology involving genetic predisposition, neurobiological dysregulation of serotonergic systems and the hypothalamic-pituitary-adrenal axis, structural and functional brain abnormalities, elevated inflammatory markers, and environmental stressors including parental psychopathology, maltreatment, peer victimization, and socioeconomic adversity. Clinical presentations encompass depressed or irritable mood, loss of pleasure, sleep and appetite disturbances, psychomotor agitation or retardation, fatigue, concentration difficulties, negative self-appraisal, and suicidal thoughts or behaviors. Treatment combines psychotherapeutic and pharmacological interventions, with cognitive behavioral therapy and interpersonal psychotherapy demonstrating strong efficacy, while selective serotonin reuptake inhibitors such as fluoxetine and escitalopram serve as first-line medications. Combination psychotherapy with medication shows superior outcomes for moderate to severe presentations, whereas treatment-resistant cases may warrant augmentation strategies or emerging interventions including ketamine and transcranial magnetic stimulation. The chapter addresses FDA black box warnings regarding antidepressant-associated suicidality risk in youth, underscoring the necessity of informed consent and vigilant clinical monitoring. Prognosis involves significant relapse and recurrence rates, with early-onset depression predicting chronic course, heightened comorbidity, substance use vulnerability, academic and social impairment, and elevated suicide risk. Suicide emerges as a leading cause of adolescent mortality, with risk factors encompassing depression, psychiatric comorbidity, family conflict, impulsivity, firearm access, trauma exposure, bullying, and sexual minority status. Protective factors including secure family attachment, school belonging, and restricted access to lethal means substantially reduce suicide risk in vulnerable youth.