Psychiatric Annals

Feature Articles 

Pharmacotherapy for Child and Adolescent Mood Disorders

Manpreet K. Singh, MD, MS; Jonathan C. Pfeifer, MD, MS; Drew Barzman, MD; Robert A. Kowatch, MD, PhD; Melissa P. DelBello, MD, MS

Abstract

Mood disorders, which include depressive and bipolar disorders, commonly manifest with abnormalities in cognition, affective regulation, and vegetative behaviors. Furthermore, children and adolescents diagnosed with mood disorders are at high risk for suicide attempts, self harm, recurrent syndromal or subsyndromal mood symptoms, co-occurring psychiatric disorders, psychosocial and academic problems, and substance use. The presentation and developmental course of pediatric mood disorders, as well as rates of co-occurring disorders vary with age and pubertal status. Because of these complexities, children and adolescents with mood disorders require a multifaceted treatment approach including pharmacotherapy, psychotherapy, and family intervention. Early identification and treatment of pediatric mood disorders is essential to prevent the chronicity of symptoms and associated complications. Evidence-based treatments that guide clinical decision making for pediatric mood disorders are essential. This review will provide a summary of controlled pharmacotherapy trials for the treatment of mood disorders in children and adolescents.

ABOUT THE AUTHORS

Manpreet K. Singh, MD, MS; Jonathan C. Pfeifer, MD, MS; and Melissa P. DelBello, MD, MS, are with the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Singh; Drew Barzman, MD; and Robert A. Kowatch, MD, PhD, are with Cincinnati Children’s Hospital Medical Center, Division of Child and Adolescent Psychiatry, Cincinnati, Ohio.

Address reprint requests to: Melissa P. DelBello, MD, MS, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670559, Cincinnati, OH 45267-0559; fax 513-558-3399; or e-mail: delbelmp@email.uc.edu.

Dr. Singh has disclosed the following relevant financial relationships: AstraZeneca, Otsuka, and Pfizer: Subinvestigator. Dr. Pfeifer has disclosed no relevant financial relationships. Dr. Barzman has disclosed the following relevant financial relationships: AstraZeneca, Cincinnati Children’s Hospital Medical Center, and Pfizer; Research Grant Recipient; AstraZeneca: Speakers’ Bureau; and AstraZeneca, Eli Lilly, Janssen, National Institutes of Health, and Pfizer: Subinvestigator. Dr. Kowatch has disclosed the following relevant financial relationships: Abbott Laboratories: Consultant; Child and Adolescent Bipolar Foundation and Creative Educational Concepts: Consultant/Member of Advisory Board; Current Psychiatry: Editor; Bristol-Myers Squibb; National Institute on Chemical Dependency; National Institute of Mental Health, and Stanley Research Foundation: Research Support Recipient; and Abbott Laboratories and AstraZeneca: Speakers’ Bureau. Dr. DelBello has disclosed the following relevant financial relationships: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Pfizer: Consultant; AstraZeneca, GlaxoSmithKline, Pfizer: Speakers’ Bureau; and Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Johnson and Johnson, Pfizer, and Shire: Research Support Recipient.

EDUCATIONAL OBJECTIVES

  1. Identify core diagnostic features of pediatric depressive and bipolar disorders.
  2. Review current pharmacological treatment strategies for pediatric mood disorders.
  3. Discuss pharmacological treatment strategies for psychiatric comorbidities of mood disorders for children and for adolescents at high risk for developing mood disorders.

Abstract

Mood disorders, which include depressive and bipolar disorders, commonly manifest with abnormalities in cognition, affective regulation, and vegetative behaviors. Furthermore, children and adolescents diagnosed with mood disorders are at high risk for suicide attempts, self harm, recurrent syndromal or subsyndromal mood symptoms, co-occurring psychiatric disorders, psychosocial and academic problems, and substance use. The presentation and developmental course of pediatric mood disorders, as well as rates of co-occurring disorders vary with age and pubertal status. Because of these complexities, children and adolescents with mood disorders require a multifaceted treatment approach including pharmacotherapy, psychotherapy, and family intervention. Early identification and treatment of pediatric mood disorders is essential to prevent the chronicity of symptoms and associated complications. Evidence-based treatments that guide clinical decision making for pediatric mood disorders are essential. This review will provide a summary of controlled pharmacotherapy trials for the treatment of mood disorders in children and adolescents.

ABOUT THE AUTHORS

Manpreet K. Singh, MD, MS; Jonathan C. Pfeifer, MD, MS; and Melissa P. DelBello, MD, MS, are with the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Singh; Drew Barzman, MD; and Robert A. Kowatch, MD, PhD, are with Cincinnati Children’s Hospital Medical Center, Division of Child and Adolescent Psychiatry, Cincinnati, Ohio.

Address reprint requests to: Melissa P. DelBello, MD, MS, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670559, Cincinnati, OH 45267-0559; fax 513-558-3399; or e-mail: delbelmp@email.uc.edu.

Dr. Singh has disclosed the following relevant financial relationships: AstraZeneca, Otsuka, and Pfizer: Subinvestigator. Dr. Pfeifer has disclosed no relevant financial relationships. Dr. Barzman has disclosed the following relevant financial relationships: AstraZeneca, Cincinnati Children’s Hospital Medical Center, and Pfizer; Research Grant Recipient; AstraZeneca: Speakers’ Bureau; and AstraZeneca, Eli Lilly, Janssen, National Institutes of Health, and Pfizer: Subinvestigator. Dr. Kowatch has disclosed the following relevant financial relationships: Abbott Laboratories: Consultant; Child and Adolescent Bipolar Foundation and Creative Educational Concepts: Consultant/Member of Advisory Board; Current Psychiatry: Editor; Bristol-Myers Squibb; National Institute on Chemical Dependency; National Institute of Mental Health, and Stanley Research Foundation: Research Support Recipient; and Abbott Laboratories and AstraZeneca: Speakers’ Bureau. Dr. DelBello has disclosed the following relevant financial relationships: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Pfizer: Consultant; AstraZeneca, GlaxoSmithKline, Pfizer: Speakers’ Bureau; and Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Johnson and Johnson, Pfizer, and Shire: Research Support Recipient.

EDUCATIONAL OBJECTIVES

  1. Identify core diagnostic features of pediatric depressive and bipolar disorders.
  2. Review current pharmacological treatment strategies for pediatric mood disorders.
  3. Discuss pharmacological treatment strategies for psychiatric comorbidities of mood disorders for children and for adolescents at high risk for developing mood disorders.

Mood disorders, which include depressive and bipolar disorders, commonly manifest with abnormalities in cognition, affective regulation, and vegetative behaviors. Furthermore, children and adolescents diagnosed with mood disorders are at high risk for suicide attempts, self harm, recurrent syndromal or subsyndromal mood symptoms, co-occurring psychiatric disorders, psychosocial and academic problems, and substance use. The presentation and developmental course of pediatric mood disorders, as well as rates of co-occurring disorders vary with age and pubertal status. Because of these complexities, children and adolescents with mood disorders require a multifaceted treatment approach including pharmacotherapy, psychotherapy, and family intervention. Early identification and treatment of pediatric mood disorders is essential to prevent the chronicity of symptoms and associated complications. Evidence-based treatments that guide clinical decision making for pediatric mood disorders are essential. This review will provide a summary of controlled pharmacotherapy trials for the treatment of mood disorders in children and adolescents.

ABOUT THE AUTHORS

Manpreet K. Singh, MD, MS; Jonathan C. Pfeifer, MD, MS; and Melissa P. DelBello, MD, MS, are with the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Singh; Drew Barzman, MD; and Robert A. Kowatch, MD, PhD, are with Cincinnati Children’s Hospital Medical Center, Division of Child and Adolescent Psychiatry, Cincinnati, Ohio.

Address reprint requests to: Melissa P. DelBello, MD, MS, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670559, Cincinnati, OH 45267-0559; fax 513-558-3399; or e-mail: delbelmp@email.uc.edu.

Dr. Singh has disclosed the following relevant financial relationships: AstraZeneca, Otsuka, and Pfizer: Subinvestigator. Dr. Pfeifer has disclosed no relevant financial relationships. Dr. Barzman has disclosed the following relevant financial relationships: AstraZeneca, Cincinnati Children’s Hospital Medical Center, and Pfizer; Research Grant Recipient; AstraZeneca: Speakers’ Bureau; and AstraZeneca, Eli Lilly, Janssen, National Institutes of Health, and Pfizer: Subinvestigator. Dr. Kowatch has disclosed the following relevant financial relationships: Abbott Laboratories: Consultant; Child and Adolescent Bipolar Foundation and Creative Educational Concepts: Consultant/Member of Advisory Board; Current Psychiatry: Editor; Bristol-Myers Squibb; National Institute on Chemical Dependency; National Institute of Mental Health, and Stanley Research Foundation: Research Support Recipient; and Abbott Laboratories and AstraZeneca: Speakers’ Bureau. Dr. DelBello has disclosed the following relevant financial relationships: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Pfizer: Consultant; AstraZeneca, GlaxoSmithKline, Pfizer: Speakers’ Bureau; and Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Johnson and Johnson, Pfizer, and Shire: Research Support Recipient.

EDUCATIONAL OBJECTIVES

  1. Identify core diagnostic features of pediatric depressive and bipolar disorders.
  2. Review current pharmacological treatment strategies for pediatric mood disorders.
  3. Discuss pharmacological treatment strategies for psychiatric comorbidities of mood disorders for children and for adolescents at high risk for developing mood disorders.

10.3928/00485713-20070701-04

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