Front Matter

Contributors

Foreword

Alan F. Schatzberg, M.D.

Preface

Manpreet Kaur Singh, M.D., M.S.

Acknowledgments

Manpreet Kaur Singh, M.D., M.S.

1 Principles of Assessment of Mood Disorders in Childhood

Manpreet Kaur Singh, M.D., M.S.

2 DSM-5 Diagnosis of Mood Disorders in Children and Adolescents

Anna Van Meter, Ph.D.

3 Addressing Clinical Diagnostic Challenges in Pediatric Mood Disorders

Gabrielle A. Carlson, M.D.

4 Principles of Treatment of Mood Disorders Across Development

Isheeta Zalpuri, M.D.

Manpreet Kaur Singh, M.D., M.S.

5 Neuroscience of Early-Onset Depression

Uma Rao, M.D.

Tiffany Lei, B.S.

6 Neuroscience of Childhood-Onset Bipolar Disorder

Amber C. May, M.D.

Sally M. Weinstein, Ph.D.

Julie Carbray, Ph.D.

Mani N. Pavuluri, M.D., Ph.D.

7 Evidence-Based Psychotherapies for Pediatric Depressive Disorders

Pilar Santamarina, Ph.D.

M. Melissa Packer, M.A.

8 Evidence-Based Psychotherapies for Pediatric Bipolar Disorders

David J. Miklowitz, Ph.D.

9 Pharmacotherapy for Pediatric Depression

Gyung-Mee Kim, M.D., Ph.D.

Raghu Gandhi, M.D.

Kathryn R. Cullen, M.D.

10 Pharmacotherapy for Pediatric Bipolar Disorders

Luis R. Patino, M.D., M.Sc.

Melissa P. Delbello, M.D., M.S.

11 Longer-Term Management of Mood Disorders in Youth

Rasim Somer Diler, M.D.

Boris Birmaher, M.D.

12 Assessment, Prognosis, and Treatment of Subthreshold Mood Symptoms

Danella Hafeman, M.D., Ph.D.

Meredith Spada, M.D.

13 Management of Suicidal Youth

Stephanie Clarke, Ph.D.

Erica Ragan, Ph.D.

Michele Berk, Ph.D.

14 Management of Common Co-occurring Conditions in Pediatric Mood Disorders

Daniel Azzopardi-Larios, M.D.

Cathryn A. Galanter, M.D.

15 School-Based Interventions for Pediatric-Onset Mood Disorders

Shashank V. Joshi, M.D.

Nadia Jassim, M.F.A.

16 Preventative and Emerging Pharmacological and Nonpharmacological Treatments

Daniel P. Dickstein, M.D.

Paul E. Croarkin, D.O., M.S.

Appendix A: Resources and Readings

Manpreet Kaur Singh, M.D., M.S.

Appendix B: Quick Reference Facts for the Treatment of Pediatric Mood Disorders

Manpreet Kaur Singh, M.D., M.S.

Index

Volunteer Program Coordinator, Kings County Hospital Center, Brooklyn, New York

Assistant Professor, Department of Child and Adolescent Psychiatry, Stanford University, Stanford, California

Endowed Chair in Early Onset Bipolar Disorder; Director, Child and Adolescent Bipolar Spectrum Services (CABS); Professor of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania

Clinical Professor of Psychiatry and Nursing, Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois

Professor of Psychiatry and Pediatrics, Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony Brook, New York

Clinical Instructor, Department of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California

Associate Professor of Psychiatry; Division Chair, Child and Adolescent Psychiatry; Director, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, Minnesota

Associate Professor and Child and Adolescent Psychiatry Division Head, Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota

Professor of Psychiatry and Pediatrics and Dr. Stanley and Mickey Kaplan Professor and Chair, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio

Director, PediMIND Program, Bradley Hospital; Associate Professor, Brown University Departments of Psychiatry and of Human Behavior and Pediatrics, East Providence, Rhode Island

Director, Inpatient Child and Adolescent Bipolar Spectrum Services (In-CABS); Co-Director, Child and Adolescent Bipolar Spectrum Services (CABS); Associate Professor of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania

Visiting Associate Professor, State University of New York Downstate, Brooklyn, New York

Child and Adolescent Psychiatry Fellow, Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota

Assistant Professor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania

School Mental Health Team, Division of Child and Adolescent Psychiatry, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, Stanford, California

Associate Professor and Director, School Mental Health Team, Division of Child and Adolescent Psychiatry, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, Stanford, California

Associate Professor, Department of Psychiatry, College of Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea

Medical Student, School of Medicine, University of California, Irvine, California

Chief Fellow, Division of Child and Adolescent Psychiatry, Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois

Professor and Director of Child and Adolescent Mood Disorder Program, Department of Psychiatry, Semel Institute, UCLA School of Medicine, Los Angeles, California

Lab Manager, Stanford Pediatric Emotion and Resilience Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

Assistant Professor of Clinical Medicine, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio

Director, Brain and Wellness Institute, Adult, Adolescent and Child Psychiatry, Chicago, Illinois

Clinical Assistant Professor, Department of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California

Professor of Psychiatry and Human Behavior, and Pediatrics; Vice Chair for Child and Adolescent Psychiatry; Fellow, Center for the Neurobiology of Learning and Memory, University of California, Irvine, California; Director of Education and Research in Psychiatry, Children’s Hospital of Orange County, Irvine, California

Clinical Psychologist, Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic of Neurociències, Hospital Clínic, Barcelona, Spain

Associate Professor and Director of the Pediatric Mood Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Child and Adolescent Psychiatry Fellow, University of Pittsburgh Medical Center, Western Psychiatric Hospital, Pittsburgh, Pennsylvania

Assistant Professor, The Feinstein Institute for Medical Research, Manhasset, New York; The Zucker Hillside Hospital, Department of Psychiatry Research, Glen Oaks, New York; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, New York

Assistant Professor of Clinical Psychology, Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago

Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Depression is the number one public health morbidity problem in the world. Although we know a great deal about depression, most clinicians may not realize that mood disorders commonly begin in childhood or adolescence. Despite the importance of early recognition, until now there has been no available definitive reference for the diagnosis and treatment of mood disorders in youth. In the past two decades alone, we have made significant gains in our understanding of mood disorders in youth and their underlying etiologies. With advancements in technology and novel tools in neuroscience, we now understand how the brain develops and are forming an understanding of how psychopathology impacts normal brain development. Clinical Handbook for the Diagnosis and Treatment of Pediatric Mood Disorders is an essential resource, synthesizing the available body of evidence now established in this field. Using a developmental neuroscience perspective, this book provides a foundation from which novel methods of studying the characteristics and impact of mood disorders across the life span can emerge.

Youth with mood disorders experience a number of challenges that can delay their ability to receive appropriate diagnosis and treatment. With increased recognition that mood disorders occur and are common in youth today, any such delays can have rippling consequences that may affect transitions into adulthood or last a lifetime. Dr. Singh assembled a team of leading experts in pediatric mood disorders with the charge to provide the most contemporary approaches to diagnosing and treating youth with mood disorders. The book takes a head-on approach to the challenges experienced by youth today, providing practical and evidence-based solutions to problems such as varying presentations of mood symptoms across development, co-occurring conditions, polypharmacy, and the complex course and outcome frequently observed when mood disorders start in childhood. The text consists of 16 chapters spanning basic and clinical neuroscience, preventive strategies, and current and emerging somatic and psychosocial treatments for patients. It leverages empirical knowledge to allow clear delineation, definition, and treatment of mood symptoms in ever more effective ways, providing exceptional teaching on complex topics.

The book balances a synthesis of evidence-based knowledge with case-based examples and historical perspectives to engage readers about the clinical relevance of the concepts covered. The teaching is comprehensive yet usable, with knowledge drawn from multiple disciplines but presented in an understandable format. It encourages using a collaborative team-based approach to address the complexities associated with pediatric-onset mood disorders. The book will appeal to learners along a wide continuum, from the novice seeking a jump start in working with youth populations to the experienced clinician interested in brushing up on the most state-of-the-art evidence.

This handbook is a readable, timely guide to the clinical assessment and management of the mood disorders, addressing the increasing demand for clinicians to provide evidence-based care and helping to translate the rapid advances in neuroscience into real-world clinical practice. It is a must for anyone interested in pediatric mood disorders.

Alan F. Schatzberg, M.D.

Mood disorders are increasingly being diagnosed and treated in youth with improved awareness that these disorders commonly have their onset in childhood and adolescence. We have learned much about mood disorders from the experience of adults with these disorders, around two-thirds of whom report symptom onset in childhood or adolescence and, on average, suffer a decade or more with symptoms before receiving an accurate diagnosis or adequate treatment. This lag in identification and treatment has resulted in progression of the severity of mood disorders, often making it even more challenging to treat these conditions. Contextualizing the early roots of mood disorders is imperative not just for clinicians working with children and adolescents but also for clinicians providing treatment for adults. Emerging evidence also suggests that in youth offspring of parents with mood disorders, there is an increased risk of developing mood and other psychiatric conditions compared with the general population, and that there may be a differential response to psychotropic medications (toward increased side effects) based on this family risk. Moreover, clinicians and trainees frequently have questions about how to investigate common risk factors for developing lifelong mood problems. Inspired by these questions, we assembled a team of experts in child psychiatry to write a handbook for a wide readership of trainees and professionals interested in understanding pediatric-onset mood disorders.

The first of its kind, this handbook strives to deliver a readable contemporary guide to the assessment and management of childhood-onset mood disorders. Despite the increasing prevalence of mood disorders in youth, there are no available clinical handbooks for mental health professionals and trainees to use as a reference in this field. This book is intended to fill this critical gap, with expert reviews provided by clinicians and researchers who are proven leaders in this field. Our goal in writing it was to provide both an up-to-date resource that captures the rapid and dramatic advances in the field and an evidence-based framework that permits easy integration into practice.

The handbook includes controlled treatment trials and U.S. Food and Drug Administration–approved interventions for pediatric mood disorders, taking into account more than a decade of clinical research and clinical treatment experience by clinicians practicing in North America and abroad. The format, approach, and style balance evidence-based practice with a breadth of clinical experience to provide the most up-to-date ways of understanding and treating mood disorders with onset in childhood. Because of rapid advancements in the field and in our understanding of brain development, we used a developmental framework whenever possible. This book has three major scientific, clinical, and teaching objectives:

Finally, given what is known and what remains to be learned in this field, we provide the best practical wisdom available with humility that our knowledge and practice are continually evolving.

Manpreet Kaur Singh, M.D., M.S.

There are many people to thank along the journey to develop this handbook. The chapter authors and coauthors deserve special appreciation for their expertise, exceptional teaching, and service to the field. Without this village of talented clinician-scholars, this handbook would not have been possible. The editorial staff at American Psychiatric Association (APA) Publishing—and, in particular, John McDuffie—have my appreciation for their careful reading, technical skill, and support. Dr. Laura Roberts deserves special mention for her encouragement and confidence in the project, as a leader both at APA Publishing and in our Department of Psychiatry and Behavioral Sciences at Stanford. We also appreciate the insights and feedback provided by our colleagues and trainees at Stanford and from around the world. Their feedback helps us see our blind spots and makes us better educators. Marianne Thompson, a kindred childhood friend and accomplished artist, provided the cover art. A special thanks to my parents, Baljeet and Pashaura, for walking the walk, and to my husband, Mandeep, my mother-in-law, Jagdish, and our three children, Kirpa, Himmet, and Ganeev, for their unwavering support on the home front to ensure that this handbook received the time and care needed to make it as good as it could be.

Last, but certainly not least, this project was inspired by the youth and families we evaluate and treat every day, who challenge us to ask the following fundamental questions that, in turn, drive our efforts: What will generations to come say about us? Did we seize the possibilities of our time? Did we answer why sustained sadness is experienced in childhood and continues into adulthood for some but not others? Did we drive science forward as far as it could go to benefit the many and not just the few? We hope this handbook inspires you to be curious about youth who present with mood symptoms and to consider how your efforts today might create hope for youth tomorrow.

Manpreet Kaur Singh, M.D., M.S.