Mood Disorders, Bipolar Disorder and Teenage Depression

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I. What are Mood Disorders?

"But when the melancholy fit shall fall
Sudden from heaven like a weeping cloud,
That fosters the droop-headed flowers all,
And hides the green hill in an April shroud;
Then glut thy sorrow on a morning rose."

John Keats, Ode on Melancholy

We have all felt sad, or melancholy, from time to time. But there is a point where the ache of sadness becomes chronic and insufferable, a mountain of pain to its victim. Mood disorders, predominantly Depression and Bi-polar syndromes, are said to strike one in seven of the population.

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.

-Adapted from an article of the same name in the
NARSAD Research Newsletter, Winter 1996.

The two principal classifications for mood disorders are bi-polar (also known as manic-depression) and depression alone. Bi-polarity is characterized by wild mood swings ranging from deep sadness and depression to euphoric and manic type behavior. Depression is defined as a deep overriding sadness and feelings of despair. These feelings are all pervasive and don't disappear in time.

Children and adults who suffer from mood disorders cannot cope well in society. When depressed, they experience a loss of interest and lack of enjoyment in life. 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.

Bi-polar disorder is classified in two categories: Bi-polar I and Bi-Polar II. Bipolar I Disorder is considered the classic form of manic depression, with full Manic Episodes and Major Depressive Episodes. Bipolar II Disorder involves Major Depressive Episodes and Hypomanic (non-full-blown Mania) Episodes. Since a significant portion of those suffering with manic depression do not have full manic episodes, the classification was divided into Bipolar I and Bipolar II. However, Bipolar II is often a first step to Bipolar I.

Bi-polar disorder appears to run in families, and there is some evidence that a biological vulnerability towards bi-polarity could be inherited. However, not everyone with this genetic vulnerability has the illness. Major depression also seems to appear generationally, but it too can occur in persons with no family history of the disease. An important factor that the research has uncovered is that major depressive disorder is associated with a neuro-chemical imbalance in the brain.

II. What are the symptoms of a mood disorder

Depression symptoms include:

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

Depression Checklist

III. How are Depression and Bi-polar Disorders Diagnosed?

Depression and Bi-Polar Inventories

Inventories or checklists are diagnostic tools used by doctors to help them diagnose depression. One of these diagnostics is called the Beck's Depression Inventory, a series of questions that is presented to the patient to help the doctor's assess the extent of the patient's problem, and if a diagnosis of depression is warranted. There are a number of such inventories that are used besides the Beck's Inventory: Goldberg Depression Inventory, Goldberg Mania Inventory, and the Young Mania Scale, being the most commonly used diagnostics. Doctors interview the patient and the patient's caregivers to help them assess the extent of the illness. Assessment includes a full medical history and physical examination.

V. How are Mood Disorders Treated?

Treatment of Mood Disorders includes:

Medication.
Psychotherapy.
Combined treatment of medication and psychotherapy.

The treatment is geared to treat the more severe symptoms. The choice of treatment is based on a variety of factors, among them the history of the illness and the severity of the episodes. The severity of the illness is assessed using some of these general definitions:
A. Severe depression is present when a person has nearly all of the symptoms of depression, and the depression almost always keepthem from doing their regular day-to-day activities.

B. Moderate depression is present when a person has many symptoms of depression that often keep them from doing things that theyneed to do.

C. Mild depression is present when a person has some of the symptoms of depression, and it takes extra effort to do the things they need to do.
The severity of Bi-polar disorder is assessed by clinical history and descriptions of the latest episodes: both Depression and Mania.

Medications

The following medications are used to treat
Depression and Bi-polarity:

Medications Specific to Bi-Polar Disorder

More information about specific medications

Outpatient Facilities
A. Outpatient facilities have therapeutic staff on-hand to offer therapy and support to patients on a part-time basis. This can be helpful in the treatment of depression and Bi-polar.

Professionals to Seek Out

1. See your physician or pediatrician
   
2. Consult with your clergy to assist in spiritual
   and practical guidance
   
3. Consult with an educational consultant to help
   you find the right program for your child.
   
4. Consult with a therapist or counselor.
   
5. Consult with an Educational Advocate to help you
   with your current school situation
   
6. Consult with an Educational Consultant to find the
   right program for your child.

Find out more about Educational Consultants

Programs

1. Inpatient: hospitalization
   
2. Outpatient
   
3. Day Treatment
   
4. Residential Programs
   

a. Emotional Growth School
Emotional Growth 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.
Find out more about Outdoor Therapy

b. Therapeutic Residential Boarding School
These schools are usually fully accredited schools with emotional growth programs. They stress holistic education: growth of the person through holding children responsible for their actions. There is no rehabilitation or physicians on staff.

c. Therapeutic Wilderness Program
A Therapeutic Wilderness program does not necessarily have academics; their goal can be to introduce the children to a different role. These programs use Outdoor Therapy to help build low self-esteem. They make obtainable goals for them to reach. The programs vary but they are about 6 to 8 weeks long. It is a very structured program with a goal of teaching the children coping skills and raising their self0esteem. Children go from this program to mainstream back into their public school or attend a small structured boarding school.
Find out more about Therapeutic Wilderness Programs

d. Residential Treatment 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. Outdoor therapy is sometimes used to facilitate building social skills and self-esteem. Recovery programs are also available. Residential Treatment schools are secure schools.
Find out more about Residential Treatment Schools

Which program is right for my child?