More on Adolescent Mood Disorders

What are Mood Disorders?

Many teenagers will feel sad, down, or a little depressed now and again. However, when this sadness and depression reaches a point where they feel it all or most of the time over a long period of time, it can become incapacitating. A teen with severe depression may become so overwhelmed by the pain of these feelings, that he or she begins to feel there is no escape. The risk of suicide becomes paramount. Mood disorders, predominantly depression and bi-polar disorder are thought to affect one in seven people. Because teens are already moody and unpredictable due to other changes and pressures in their lives, parents must know how to differentiate between the normal struggles of adolescent growth and serious emotional problems.

How Prevalent are Mood Disorders in Children and Adolescents?

7-14% of children will experience an episode of major depression before the age of 15. 20-30% of adult bipolar patients report having their first episode before the age of 20.

Out of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 will commit suicide.

The two psychiatric classifications for mood disorders are depression and bi-polar disorder. Bi-polar disorder used to be referred to as manic-depression, but this label has fallen out of favor in the psychiatric community. A teen with bi-polar disorder will exhibit extreme mood swings ranging from lows - depression - to highs - mania.

Depression is defined by feelings of sadness, despair, and discouragement. The severity of depression can range from the "blues" to incapaciting depression (can't get out of bed). Teens with depression report feelings of low self esteem and guilt, and they will often, withdraw people and isolate themselves. Parents will notice changes in their sleep habits and eating habits.

Bipolar disorder is defined by extreme swings between depression (above) and mania. Mania is chracterized by excessive energy - teens will often need little or no sleep and will seem very energized - or a high or euphoria that seems unusual or extreme. Teens with mania will sometimes take great risks, believing themselves to be invulnerable to injury or danger. This is more than happiness or joy - it is a pronounced and extreme sense of ephoria that does not seem to be based on anything in the child's reality. In extreme cases, the teen may even suffer from delusions about his or her abilities or prowess.

It is difficult for teens with mood disorders to participate in society. When they are depressed, they lose interest in activities they used to enjoy. They may find it difficult to relate to family members or peers. For a person with bi-polar disorder, the manic swings can create a disruptive influence on all aspects of their life and the lives of everyone around them. During manic episodes, some people go on spending binges or exhibit other behaviors that have long-term consequences.

Bi-polar disorder appears to run in families, and there is some evidence of a genetic component. Major depression also seems to appear in members of the same family, but it too can occur in persons with no family history of the depression. Research shows that major depressive disorder is associated with a neuro-chemical imbalances in the brain.

Symptons of Depressive Disorders

Bi-polar symptoms include all of the above, with these additional indications of the manic phase of the disorder:

Diagnosing Depression and Bi-polar Disorders

Inventories or checklists are used by doctors to help them diagnose depression. The Beck's Depression Inventory is a series of questions that is presented to the patient to help assess the extent of the problem, and if a diagnosis of depression should be made. Other tests used to diagnose depression are Goldberg Depression Inventory, Goldberg Mania Inventory, and the Young Mania Scale. A qualified doctor should interview the patient and family members to help them assess the seriousness of the mood disorder. Doctors will take a full medical history and complete a physical examination.

Treating Mood Disorders

Treatment of mood disorders includes medication (phamarcological treatment), therapy, or a combination of medication and therapy.

Ttreatment is geared to treat the more severe symptoms and is based on many factors, such as the length of the illness and the severity of depressive or manic episodes.

Severity of Mood Disorders

Severe depression is diagnosed if the teen shows most of the symptoms of depression, and the depression has kept them from most normal activities over a period of time.

Moderate depression is characterized by many symptoms of depression and the inability to take part in many normal activities.

Mild depression is characterized by some of the symptoms of depression, and difficulty doing the normal activities (e.g., can go to school, but has lost interest in extracurricular activities; has to put in an extra effort to do normal activities)
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For bipolar disorder, the doctor will assess the severity by taking a clinical history and considering the patient's or family members' descriptions of the latest episodes of depression and mania.

Medications for Depression and Bipolar Disorder

The following medications are used to treat Depression and Bi-polarity. These medications can only be prescribed by a medical doctor. Many patient advocates advise that you consult a specialist, such as a psychiatrist, rather than your family doctor, before taking psychotropic medications. Patients are advised to learn as much as they can about a medication so they are aware of the risks and side-effects associated with these treatments. The drug names in parentheses are the generic names.

ANTIDEPRESSANTS (Selective Serotonin Reuptake Inhibitors, SSRI)
Celexa (citalopram)
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)

ANTIDEPRESSANTS
(Tricyclics)
Anafranil (clomipramine)
Elavil (amitriptyline)
Norpramin (desipramine)
Pamelor (nortriptyline)
Aventyl Sinequan (doxepin)
Surmontil (trimipramine)
Tofranil (imipramine)
Vivactil (protriptyline)

ANTIDEPRESSANTS
(Others)
Effexor (venlafaxine)
Desyrel (trazodone)
Ludiomil (maprotiline)
Parnate (tranylcypromine)
Wellbutrin (bupropion), Zyban

Medications for Bipolar Disorder

Depakote
Lithium
Prozac
Wellbutrin
Zoloft

Programs to Treat Depression or Bipolar Disorder

Residential Treatment Centers (inpatient hospitalization)
Day Treatment (therapy)
Residential Schools and Programs (therapeutic boarding schools)

Emotional Growth schools or therapeutic boarding schools are highly structured environments that stress academics and teach coping skills through the use of conflict resolution. Children learn they can make choices and learn to accept responsibility through the use of modeling behavior and outdoor therapy. The length of stay is between 9 and 18 months, at which time they either return to the mainstream or attend a boarding school, if possible. Parents are involved with the school staff and the children throughout the child's attendance at the school. A great benefit of these therapeutic boarding schools is that your teen can be treated for the depression while continuing to earn academic credit.


For teens with mild depression, a therapeutic wilderness program may help. These programs use Outdoor Therapy to help build low self-esteem and teach kids coping skills. These wilderness therapy programs have flexible lengths of stay, with the average stay being 6 to 8 weeks. Children go from this program to mainstream back into their public school or attend a small structured boarding school.

A Residential Treatment Program or School provides a full professional staff that includes therapists, psychologists, and psychiatrists. They also have a small academic program. Many of the children in the program have been recommended there by mental health agencies that make the placements. It is a highly structured environment whose emphasis is on treatment and learning coping skills and independent living. Chemical dependence education and rehabilitation is also provided.