Brief: This research paper cover the basics of Depressive and Manic disorders and their treatment.
Mood Disorders in Adolescence (and children)
Depression and mania have been reported in children and adolescent for many years, however it is not entirely known as to why there seems to have been an increase in recent decades. Until the 60’s or 70’ depression and mania were denied in children – the dominant theory was psychoanalytically and it was considered that these disorder could only occur in adults. In 1970 their existence was officially recognized
This suggests that historical reports would be under-representative of actual levels. However it leaves the question open as to whether rates have actually increased.
Depression belongs to the Unipolar disorder, Mania and Manic Depression are Bipolar disorders.
Unipolar disorders include:
- Major Depressive Disorder (MDD)
- Dysthymic Disorder
Bipolar Disorders include:
- Bipolar I Disorder
- Manic episode may/may not include a depressive episode. This is more severe than BPII
- Bipolar II Disorder
- May include hypomanic episode – less severe than BPI, often no significant interference in life
- Cyclothymic Disorder
- The counterpart of Dysthymic Disorder
- Bipolar Disorder NOS
Major Depressive Episode (MDD)
To be clinically diagnosed with MDD one must experience 4 symptoms (from a list) that are experienced for 2 weeks during which time the symptoms must be experienced all the time or nearly everyday. The symptoms include:
- Depressed Mood
- When weight gain is developmentally normal (such as with adol. Girls entering puberty, a lack of typical weight gain may be considered a ‘weight loss’.
- Insomnia or Hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feeling of worthlessness or excessive or inappropriate guilt
- This is very common symptom in adolescents and mothers
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thought of death; recurrent suicidal ideation without a plan; a suicide attempt or plan
- Considered by lecturer to really be three separate categories
The mean length of an untreated MDD episode is around 7 – 9 months, and 90% will remit with 2 years. There is also a 40% risk of relapsing with 2 years, and a 75% risk of relapsing in 5 years. Further, 20 – 40% develop Bipolar disorder the longer one has MDD the more risk they have of developing a Bipolar disorder.
For DD the mean length of an untreated episode is 4 years. DD increases the risk of MDD, as well as Bipolar disorder and substance abuse. 70% of untreated DD’s develop double-Depression within 2 years; 13% develop a manic problem, and 15% develop a substance abuse problem.
A manic episode is abnormally or persistently elevated, expansive or irritable mood for at least 1 week (less if under doctor supervision i.e. in hospital). Mania must meet at least 3 symptoms (4 if mood is irritable). Mania is often dangerous as those in an experience often get themselves into trouble easily – psychotic features are sometimes present.
- Distinct period of abnormally and persistently elevated, expansive or irritable mood
- Inflated SE or grandiosity
- Decreased need for sleep
- More talkative; pressured speech
- Flight of ideas or subjective experience that thoughts are racing
- Increase in goal-directed behaviour or psychomotor agitation
So where do depressive disorder come from? The are inconclusive results supporting the Biochemical Model. There is convincing evidence with adult populations that genetic are a factor – though the lecturer claims that there is a lack of well documented studies for adolescence (though, it would seem that genes are genes in adulthood and adolescence…). The psychosocial model has some support also:
- Family environment (disorder parents increase disordered kids)
- Social Skills deficit (…depression leads to no friends, which leads to … which comes first?)
- Cognitive models
- Behaviour and cognition. Depression leads to distorted cognition and negative world and future views; negative attributions and lowered self-esteem.
- Life Stress Model
- Newer model those with depression have more life-stressors that bring out the depression.
Bipolar Depression in child/adol will typically exhibit episodes of depression before they exhibit a manic episode. Signs of pre-depression Bipolar include feeling very slowed down, like you’re made of lead, too much sleeping, hallucinations or strange beliefs in the past, sever worthlessness, and a family history of bipolar disorder. Bipolar is rare in children less than 15 years, though there is a more common similar condition with no formal name. In children bipolar cycling is faster than in adults (kids may cycle multiple times a day, adults may cycle over a period of days), the episodes are shorter, and mania and depression are often mixed up together in children. For this reasons it is often misdiagnosed.
Bipolar is present in around 1% of adults; it’s more common in females. It’s prevalence in children and adol’s seems to be up to 5%.
It is more typical to have a comorbid disorder with a Bipolar Disorder than not. ADHD is the most common comorbid diagnosis (around 90% of adults), but ODD and CD are also common, as it substance abuse.
By definition a Bipolar disorder is an ongoing illness. 20 – 30% of young people who present with a severe depressive episode will experience a manic episode in later life.
Treating Bipolar disorder is difficult – and almost certainly required drugs. Drugs help prevent relapse, reduce long-term morbidity, promote long-term development.
Lithium is common, but has significant side effects – yet lower relapse rate from 90% to 40%; Epilim has less side effects and is so used instead of lithium. As with other disorders, Psychoeducation, relapse prevention (avoid all-nighters) family works and reintegration into community are focused on (as is substance use/abuse). Often Bipolar suffers must work hard when well to ‘pick up the pieces’ or ‘clean up the mess’ they made during their episode.