Affective Disorders—Current Status and Controversies

  • Kandasamy Preeti
  • Rajeev Jairam
  • Shoba SrinathEmail author


Affective disorders are common during childhood and adolescence and often pose a challenge in clinical settings. The clinical presentation of affective disorders varies with the developmental age of the child and the classical symptoms increase with age and severity. From a developmental perspective, the disruptive mood dysregulation disorder as a new diagnostic category in DSM 5 addresses this concern as well as the unparalleled increase in pediatric bipolar diagnoses. Use of developmentally appropriate assessments has helped address some of the controversies centred around diagnosis of depression in the young. However, there is sparse evidence of effectiveness of pharmacological and psychological means of treatment and controversies continues to exist regarding effective management of affective disorders in children and adolescents in bringing about a more favourable outcome. This chapter focuses on the current status and particularly controversies related to diagnosis of preschool depression, disruptive mood dysregulation disorder, pediatric bipolar and the differences in pattern of comorbidities across western and Indian literature; current insights into the course and outcome of affective disorders and controversies regarding management of affective disorders.


Affective disorders Depression Bipolar disorder Controversies Children Adolescents 


  1. Akiskal, H. S., Maser, J. D., Zeller, P. J., et al. (1995). Switching from ‘unipolar’ to bipolar II. A 11-year prospective study of clinical and temperamental predictors in 559 patients. Archives of General Psychiatry, 52, 114–123.CrossRefPubMedGoogle Scholar
  2. American Academy of Child and Adolescent Psychiatry. (2004). Practice parameter for the use of electroconvulsive therapy with adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 43, 1521–1539.CrossRefGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., DSM-5). Washington, D.C.: American Psychiatric Association.Google Scholar
  4. Angold, A., & Costello, E. J. (1993). Depressive comorbidity in children and adolescents: Empirical, theoretical, methodological issues. American Journal of Psychiatry, 150(12), 1779–1791.CrossRefPubMedGoogle Scholar
  5. Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.CrossRefPubMedGoogle Scholar
  6. Axelson, D., Birmaher, B., Strober, M., Gill, M. K., et al. (2006). Phenomenology of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63(10), 1139–1148.Google Scholar
  7. Bhargava Raman, R. P., Seshadri, S. P., Janardhan Reddy, Y. C., Girimaji, S. C., et al. (2007). Is bipolar II disorder misdiagnosed as major depressive disorder in children? Journal of Affective Disorders, 98, 263–266.CrossRefPubMedGoogle Scholar
  8. Biederman, J., Mick, E., Faraone, S. V., Van Patten, S., Burback, M., & Wozniak, J. (2004). A prospective follow-up study of pediatric bipolar disorder in boys with attention-deficit/hyperactivity disorder. Journal of Affective Disorders, 82(1), S17–S23.CrossRefPubMedGoogle Scholar
  9. Birmaher, B., Brent, D., & AACAP Work Group on Quality Issues. (2007). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1503–1526.Google Scholar
  10. Bredt, D. S., Furey, M. L., Chen, G., Lovenberg, T., et al. (2015). Translating depression biomarkers for improved targeted therapies. Neuroscience and Biobehavioral Reviews, 59, 1–15.CrossRefPubMedGoogle Scholar
  11. Cheung, A. H., Emslie, G. J., & Mayers, T. L. (2006). The use of antidepressants to treat depression in children and adolescents. Canadian Medical Association Journal, 174, 193–200.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Copeland, W. E., Shanahan, L., Egger, H., Angold, A., & Costello, E. J. (2014). Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. American Journal of Psychiatry, 171, 668–674.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Demeter, C. A., Youngstrom, E. A., Carlson, G. A., Frazier, T. W., et al. (2013). Age differences in the phenomenology of pediatric bipolar disorder. Journal of Affective Disorders, 147(1–3), 295–303.Google Scholar
  14. Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. (2002). Attachment based family therapy for adolescents—a treatment development study. Journal of the American Academy of Child and Adolescent Psychiatry, 41(10), 1190–1196.CrossRefPubMedGoogle Scholar
  15. Dougherty, L. R., Smith, V. C., Bufferd, S. J., et al. (2014). DSM 5 disruptive mood dysregulation disorder: Correlates and predictors in young children. Psychological Medicine, 21, 1–12.Google Scholar
  16. Emslie, G. J., Mayes, T., Porta, G., Vitiello, B., et al. (2010). Treatment of resistant depression in adolescents (TORDIA): Week 24 outcomes. American Journal of Psychiatry, 167(7), 782–791.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Essau, C. A. (2008). Comorbidity of depressive disorders among adolescents in community and clinical settings. Psychiatry Research, 158, 35–42.CrossRefPubMedGoogle Scholar
  18. Geller, B., Tillman, R., Bolhofner, K., & Zimerman, B. (2008). Child bipolar I disorder: Prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome. Archives of General Psychiatry, 65, 1125–1133.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Geller, B., Tillman, R., Craney, J. L., & Bolhofner, K. (2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61, 459–467.CrossRefPubMedGoogle Scholar
  20. Goldstein, B. I., & Young, L. T. (2013). Toward clinically applicable biomarkers in bipolar disorder: Focus on BDNF, inflammatory markers and endothelial function. Current Psychiatry Reports, 15(12), 425.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Hazell, P., & Jairam, R. (2012). Acute treatment of mania in children and adolescents. Current Opinion in Psychiatry, 25(4), 265–270.Google Scholar
  22. Jairam, R., Hanstock, T., Cahill, C., Hazell, P., Walter, G., & Malhi, G. (2008). The changing face of bipolar disorder: Adolescence to adulthood. Minerva Pediatrica, 60(1), 59–68.PubMedGoogle Scholar
  23. Jairam, R., Srinath, S., Girimaji, S. C., & Seshadri, S. P. (2004). A prospective 4–5 year follow-up of juvenile onset bipolar disorder. Bipolar Disorders, 6(5), 386–394.Google Scholar
  24. Jairam, R., Prabhuswamy, M., & Dullur, P. (2012). Do We Really Know How to Treat a Child with Bipolar Disorder or One with Severe Mood Dysregulation? Is There a Magic Bullet? Depression Research and Treatment, 2012, 967302.Google Scholar
  25. Kovacs, M., Lopez-Duran, N. L. (2012). Contextual emotion regulation therapy: A developmentally based intervention for pediatric depression. Child and Adolescent Psychiatric Clinics of North America, 21(2), 327–343.Google Scholar
  26. Kovacs, M., Obrosky, D. S., Gatsonis, C., & Richards, C. (1997). First-episode major depressive and dysthymic disorder in childhood: Clinical and sociodemographic factors in recovery. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 777–784.CrossRefPubMedGoogle Scholar
  27. Krishnakumar, P., & Geetha, M. G. (2006). Clinical profile of depressive disorder in children. Indian Paediatrics, 43, 521–526.Google Scholar
  28. Lewinsohn, P. M., Clarke, G. N., Seeley, J. R., & Rohde, P. (1994). Major depression in community adolescents: Age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 809–818.CrossRefPubMedGoogle Scholar
  29. Lopes, M. (2013). Sleep complaint as a biomarker of bipolar disorder in children and adolescent. Sleep Medicine, 14, s1, e185–e186.Google Scholar
  30. Luby, J. L. (2010). Preschool depression: The importance of identifying depression early in development. Current Directions in Psychological Science, 19(2), 91–95.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Luby, J. L., Gaffrey, M. S., Tillman, R., et al. (2014). Trajectories of preschool disorders to full DSM depression at school age and early adolescence: Continuity of preschool depression. American Journal of Psychiatry, 171(7), 768–776.CrossRefPubMedPubMedCentralGoogle Scholar
  32. March, J. S., Silva, S., Petriycki, S., Curry, J., et al. (2007). Treatment for adolescents with depression study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64(10), 1132–1143.CrossRefPubMedGoogle Scholar
  33. McCain, J. A. (2009). Antidepressants and suicide in adolescents and adults: A public health experiment with unintended consequences? Pharmacy and Therapeutics, 34(7), 355–378.PubMedPubMedCentralGoogle Scholar
  34. Masi, G., Toni, C., Perugi, G., Travierso, M. C. et al. (2003). Externalizing disorders in consecutively referred children and adolescents with bipolar disorder. Compr Psychiatry, 44(3), 184–189.Google Scholar
  35. Masi, G., Perugi, G., Toni, C., Millepiedi, S., et al. (2006). Attention-deficit hyperactivity disorder—bipolar comorbidity in children and adolescents. Bipolar Disord, 8(4), 373–381.Google Scholar
  36. Narayan, Cl, & Shekhar, S. (2015). The mental Health Care Bill 2013: A critical appraisal. Indian Journal of Psychological Medicine, 37(2), 215–219.CrossRefPubMedPubMedCentralGoogle Scholar
  37. National Institute for Clinical Excellence (NICE). (2005). Depression in children and young people: Identification and management in primary, community and secondary care. National Clinical Practice Guideline No., 28.Google Scholar
  38. Pfeifer, J. C., Welge, J., Strakowski, S. M., Adler, C. M., & DelBello, M. P. (2008). Meta-analysis of amygdala volumes in children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 47(11), 1289–1298.CrossRefPubMedGoogle Scholar
  39. Pravin, D., Rajkumar, R. P., Prabhuswamy, M. Y., Srinath, S., Girimaji, S., & Seshadri, S. P. (2005). Course and outcome of bipolar affective disorder in children. Journal of Indian Association for Child and Adolescent Mental Health, 1(2), 5.Google Scholar
  40. Rajeev, J., Srinath, S., Girimaji, S., Seshadri, S. P., & Singh, P. A. (2004). Systematic chart review of the naturalistic course and treatment of early-onset bipolar disorder in a child and adolescent psychiatry center. Comprehensive Psychiatry, 45, 148–154.CrossRefPubMedGoogle Scholar
  41. Rajeev, J., Srinath, S., Reddy, Y. C. J., Shashikiran, M. G., Girimaji, S. C., Seshadri, S. P., et al. (2003). The index manic episode in juvenile-onset bipolar disorder: The pattern of recovery. Canadian Journal of Psychiatry, 48, 52–55.CrossRefPubMedGoogle Scholar
  42. Rao, U., & Chen, L. A. (2009). Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders. Dialogues in Clinical Neuroscience, 11, 45–62.PubMedPubMedCentralGoogle Scholar
  43. Roy, A. M., Lopes, V., & Klein, R. G. (2014). Disruptive mood dysregulation disorder: A new diagnostic approach to chronic irritability in youth. American Journal of Psychiatry, 171, 918–924.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Srinath, S., Prabhuswamy, M., Reddy, Y. C. J., Girimaji, S. R., Seshadri, S. P. (2008). Clinical practice guidelines for the treatment of children and adolescents with affective disorders. Indian Journal of Psychiatry, 238–248.Google Scholar
  45. Srinath, S., Reddy, Y. C. J., Girimaji, S. C., Seshadri, S. P., & Subbakrishna, D. K. (1998). A prospective study of bipolar disorder in children and adolescents from India. Acta Psychiatrica Scandinavica, 98, 437–442.CrossRefPubMedGoogle Scholar
  46. Stalets, M. M., & Luby, J. L. (2006). Preschool Depression. Child and Adolescent Psychiatric Clinics of North America, 15(4), 899–917.CrossRefPubMedGoogle Scholar
  47. Strober, M., Lampert, C., Schmidt, S., & Morrell, W. (1993). The course of major depressive disorder in adolescents: I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 34–42.CrossRefPubMedGoogle Scholar
  48. Strober, M., Morrell, W., Lampert, C., & Burroughs, J. (1990). Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: A naturalistic study. American Journal of Psychiatry, 147, 457–461.CrossRefPubMedGoogle Scholar
  49. Strober, M., Schmidt-Lackner, S., Freeman, R., Bower, S., Lampert, C., & DeAntonio, M. (1995). Recovery and relapse in adolescents with bipolar affective illness: A five-year naturalistic, prospective follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 724–731.CrossRefPubMedGoogle Scholar
  50. Tourian, L., LeBoeuf, A., Breton, J. J., et al. (2015). Treatment options for the cardinal symptoms of disruptive mood dysregulation disorder. Journal of Canadian Academy of Child and Adolescent Psychiatry, 24(1), 41–54.Google Scholar
  51. Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132, 132–149.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Yen, S., Stout, R., Hower, H., Killam, M. A., et al. (2015). The influence of comorbid disorders on the episodicity of bipolar disorder in youth. Acta Psychiatrica Scandinavica, 17.Google Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  • Kandasamy Preeti
    • 1
  • Rajeev Jairam
    • 2
  • Shoba Srinath
    • 1
    Email author
  1. 1.Department of Child and Adolescent PsychiatryNational Institute of Mental Health and Neurosciences, NIMHANSBangaloreIndia
  2. 2.ICAMHS, Mental HealthSWSLHD
 Campbelltown HospitalCampbelltownAustralia

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