Understanding mood disorders in adolescents: signs, causes, and support for ages 14-18

Mood disorders are a group of mental health problems, sometimes called affective disorders, that refer to a disruption of the emotional state. They can affect anyone, but adolescents can be particularly vulnerable to their symptoms as they struggle with academic pressures, changes in their bodies and hormones, and difficulties socialising. In this article, consultant child and adolescent psychiatrist Dr Gonzalo Salazar de Pablo discusses the signs and causes of mood disorders in adolescents, and how to support them.

What are mood disorders?

Mood disorders are characterised by two or more weeks of significant changes in mood, as opposed to fleeting emotions that change situationally. The moods can range from extreme happiness (mania) to extreme sadness (depression), and manifest as changes in behaviour and performance.

Kinds of mood disorders include:

• Major depression. A depressed, hopeless, and irritable mood, accompanied by a loss of engagement or a withdrawal from regular interests
• Bipolar disorder. Mood switches (episodes) between mania and depression at differing intensities. Further categorised as Bipolar I and Bipolar II.
• Disruptive mood dysregulation disorder. Adolescent-specific and characterised by chronic, intense irritability, frequent outbursts of anger, and difficulty controlling inappropriate behaviour.
• Premenstrual dysmorphic disorder. Mood becomes erratic, tense, or depressive significantly before the menstrual period.
• Substance-induced mood disorder. A change of mood as caused by medications, drug/alcohol abuse, or exposure to toxins (e.g. toxic mould syndrome).
• Persistent depressive disorder (dysthymia). A chronic, low mood that is similar to depression, slightly less severe in its manifestation but lasts at least two years.

What causes mood disorders in adolescents?

Mood disorders can be caused by many factors. Biologically, they occur when there is an imbalance of hormones and neurotransmitters in the brain, leading to signals that are incorrectly sent or received – adolescents can be quite susceptible to experience this, as they are growing up and their brains are still developing, and most turbulently so in the ages between 14 and 18 years old. There may be genes that are passed down through their families that predispose them to developing mood disorders, or a family history of depression and mental health conditions. They can also happen due to shocking life events, childhood trauma, and consistent stress.

Some things that could incite a mood disorder in a child or teenager include:

• Parental divorce or separation
• Being bullied or having friendship troubles
• Death of a family member or friend
• Familial financial struggles
• Academic pressures

It can be hard for adolescents to cope with these situations, and they can bring on feelings of depression, ire, or mania to such an extent that these feelings become difficult to manage.

What are the signs of mood disorders in adolescents?

Adolescents with mood disorders may be having negative, aggressive, or exaggerated thoughts, that are more intense than they usually have and last longer or more frequently. They may be sensitive to failure or rejection, have low self-esteem, or have suicidal ideation. Externally, they can exhibit behaviours such as:

• Picking fights or acting out against peers, siblings, and adults
• No longer interested in or retreating from usual activities and socialising, and not expressing pleasure when doing so
• Changes in sleep and eating patterns (either too much or too little)
• Fatigue and restlessness
• Changes in performance at school, likely a decline
• Disruption, disregard, and disorder of their belongings or spaces
• Complaints about headaches and stomach aches

How are mood disorders in adolescents treated?

If you think your child is struggling with a mood disorder, getting them diagnosed will require them to be seen by a therapist or child psychiatrist. Every mood disorder requires a different treatment plan, so an accurate diagnosis is pivotal before their condition can be managed.

A specialist will conduct an evaluation that consists of questions to your child about their behaviour and feelings, and how long they’ve been feeling and acting this way. They will likely also consider the family’s medical history and environmental factors around your child that could be stressors. They can also ask from input from you and other adults in their life such as teachers and school counsellors.

To treat mood disorders, there are options for medicinal prescriptions or therapies.

Medicinal treatments will prioritise regulating the activity of neurotransmitters in the brain to mitigate the mood that causes the symptoms, such as antidepressants (like SSRIs), mood stabilisers, and antipsychotics (used primarily to manage mania as in bipolar disorder). PMDD can be managed with the contraceptive pill in order to control oestrogen and progesterone production. Depending on the mood disorder and your child’s symptoms, medications may reduce the severity or frequency of symptoms, decrease problematic behaviours, improve functioning, and prevent future episodes. It is important to be diligent with the prescription and to take only as much as advised and when advised by the psychiatrist, as too much or too little can see the mood return to the disordered state, or even worsen it.

Medications work quite well for managing mood disorders and are found to be even more effective when used in conjunction with therapy. There are several kinds of therapy, and it may take a bit of trial and error to find what works best for your child:

• Cognitive behavioural therapy, which works by helping patients make sense of overwhelming problems by breaking them down into smaller, manageable parts, and dismantling negative thought cycles – a sort of “reprogramming” of how their circumstances are viewed. In group CBT sessions, adolescents will be able to interact with others who have similar issues, helping to add perspective and a new context to personal hardships.
• Eye movement desensitisation and reprocessing (EDMR) therapy is specifically beneficial for those who have gone through trauma that has triggered the mood disorder.
• Family therapy, which may help to address and process familial events that may have triggered the mood disorder, as well as help you and your family learn about what is plaguing your child and how to best support them so that you can overcome it as a family.

Children and teenagers with mood disorders may have times of stability and times when symptoms return. Long-term, continuous treatment can help them stay healthy and control symptoms. Addressing the issue whilst they are still young means that these adolescents can go into adulthood with confidence and competence at managing their emotions, as well as equipping them with tools to face disruptive or damaging moods should they reoccur in the future.

If you believe your child or teenager is struggling with a mood disorder, you can consult with Dr Salazar de Pablo via his Top Doctors profile.