The specialist:
The chief of the Pediatric Mood and Anxiety Disorders Program at Mount Sinai, Dr. Vilma Gabbay, is a psychiatrist who specializes in treating mood and anxiety disorders in children and adolescents, ranging from depression to bipolar disorder.
Who’s at risk:
As recently as 20 years ago, doctors thought that mood disorders like major depression and bipolar only existed in adults. “Now we’re increasingly aware that mood disorders are very common before adulthood and most often have an onset during adolescence,” says Gabbay.
“These pediatric mood disorders can manifest as an alteration in mood, whether as depression — as a low-level mood — or bipolar, which alternates between low mood and high feeling,” says Gabbay.
Recent studies have found that as many as 15%-18% of teens have experienced a mood episode by age 18.
In the pediatric population, the brain is still developing, so doctors look out for symptoms that are red flags of psychiatric distress. “We won’t always know the exact diagnosis until the adolescent reaches adulthood, but it’s essential to be alert for the early signs,” says Gabbay.
“What parents and schools really want to look out for is any change from well-being, often without trigger.” For teens, some of the most important warning signs include social withdrawal, isolation and sudden decline in school performance.
Depressive and manic episodes present differently. “Depression can manifest with sadness, tearfulness, diminished capacity to enjoy pleasurable activities, irritability and physical symptoms including increased or decreased appetite, sleep disturbances and fatigue,” says Gabbay.
“Teens with bipolar disorder can have depressive episodes followed by manic episodes marked by high feeling of irritability, decreased need of sleep, increased energy, behaving strangely in the classroom, impulsivity, being more talkative, and excessive involvement in pleasurable activities.” In severe cases, mania can cause psychosis and distorted thinking.
Mood disorders often arrive during puberty, when changes in the brain occur along with a rush of hormones. “The risk factors are a family history of mood disorders, a tendency toward anxiety, and stressors like trauma and bullying,” says Gabbay. “Stress itself can trigger a mood disorder, not in everyone, but in many teens.”
Signs and symptoms:
Recognizing the warning signs of mood disorders is the cornerstone of treatment and even preventing episodes from occurring again in the future. “Many parents come to me and ask what they need to pay attention to,” says Gabbay.
“Some things to look for are social withdrawal, diminished ability to enjoy, decline in academic performance, concentration difficulties, and irritability — someone who was easygoing is suddenly irritable, and not only with his or her parents.”
Tearfulness, sadness, changes in appetite, and sleeping patterns are also common symptoms.
Teens themselves can find these unexplained changes overwhelming. “What’s most striking is the sense of emotional or psychic pain that they feel that they cannot point to,” says Gabbay.
“They’ll say, ‘I just can’t take it anymore,’ which can lead to thoughts of suicide. And that’s why parents and school staff need to work together to recognize the symptoms and get help for teens.”
Traditional treatment:
Like psychiatric diseases, mood disorders are now diagnosed based on the clusters of symptoms laid out in the DSM-IV, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.
“Currently, the DSM IV sets out nine symptoms of major depressive disorder,” says Gabbay. “In order to be diagnosed, teens would need to have five of the nine symptoms. The core symptoms are irritable mood, sadness and the inability to enjoy pleasurable activities,” she said.
In the future, doctors hope to develop biomarkers that could confirm the diagnosis of psychiatric diseases based on blood work or other testing, such as brain imaging.
Treatment options for teens are similar to ones available for adults. “Usually we use a multi-modal approach that combines therapy with the teen and family, working with the school to reduce stress and medications in more severe cases,” says Gabbay.
“Cognitive behavioral therapy [CBT] is an effective therapy that can help train patients to think more positively and challenge negative thoughts about themselves, their future and how others view them.” Studies have found that CBT is equally successful to medication in the long run, but they are currently taken in tandem because CBT takes time and drugs can kick in faster.
When left untreated, mood disorders can have devastating consequences, including school dropout, drug abuse and suicide.
“Parents and schools have to work together because mood disorders are almost an epidemic,” says Gabbay. “The goal of early identification and treatment is first to ensure teens’ safety, help them resume normal life as soon as possible, and prevent future episodes.” A school psychologist can provide an initial evaluation and help families find affordable care.
Research breakthroughs:
Doctors are constantly working to improve available treatment options. “I am conducting an NIH-funded study that examines omega-3 fatty acids as a potential alternative treatment for adolescents with depression, an approach that has already been shown to have some effectiveness in adults,” says Gabbay.
“Omega-3 is known to have anti-inflammatory properties that affect neurotransmitters in the brain known to play a role in mood disorders.” Most teens in New York and the U.S. as a whole don’t consume enough omega-3, essential fatty acids that the human body requires.
“This study is still in progress, and while some adolescents improved a great deal during the trial, we do not know yet if they were treated with omega-3 or placebo,” says Gabbay.
Questions for your doctor:
A common question for parents is, “Can my teenagers function normally as they grow up?” Teens phrase that question differently: “Will I feel better?” “A return to normal life is the goal of early treatment,” says Gabbay. “For many teens, adequate and early treatment can facilitate a full recovery and prevention of future episodes so they can reach their full potential as adults.”
What you can do.
Get informed.
The National Alliance for Mental Illness (nami.org) is a very good resource for both parents and teens.
Don’t be ashamed.
“A psychiatric disorder is a medical disorder that can kill,” says Gabbay. “It’s nothing to be embarrassed about, but parents and teens need to seek help.”
Get enough sleep.
Sleep deprivation is associated with mood disorders, so be sure to get at least eight hours of sleep a night.
Cut your risk.
Exercising for 20-30 minutes, four to five times a week, and staying away from drugs and alcohol can help prevent depressive and manic episodes.
By the Numbers:
15-18% of adolescents have had a depressive episode or a mood disorder by age 18.
Around 5% of teens have a mood disorder.
One in four Americans face mental illness in any given year.
Most teens sleep six hours a night, but need to sleep at least eight.
