The Treatment of Preschool Mood Disorders

Research output: Contribution to journalReview article

Abstract

Pediatric mood disorders are a genuine concern within the clinical setting, and they cause significant morbidity among children and adolescents. Evidence supports the presence of mood disorders in even very young, preschool-aged children, but they can be difficult to diagnose accurately in this population. They may present somewhat differently, especially with regards to duration and timing of mood symptoms. For example, clinically significant depression may be missed in this age group when using the strict 2-week duration criterion, and clinicians will identify these significant cases more successfully when using a proposed 1-week duration criterion. Mood disorders in the preschool population may also present with more non-specific symptoms (i.e., irritability), and developmental aspects encountered in this age group may also contribute to diagnostic uncertainty. There is considerable controversy surrounding the diagnosis of mood disorders, especially bipolar disorder, in young children. Children seem to present more often with fairly rapid cycling between mood states, and this seems especially true with preschool-aged children. This can lead to misdiagnosis and incorrect treatment decisions. Evidence examining these diagnostic issues is limited, but it supports the validity of mood disorder diagnoses in this young population. Evidence regarding treatment in this age group is even more limited. Treatment of mood disorders in the preschool age should begin with psychosocial interventions, first. These include parent-training, psychoeducation, and cognitive-behavioral therapy. Medication studies in this age group are lacking, and those available are largely open label trials or case series. When medication is necessary, special attention to dosage should be made, with starting doses cut in half from regular pediatric dosing recommendations to avoid adverse effects. Fluoxetine should be considered as first-line pharmacotherapy in preschool children with depression, due to the available safety and efficacy data in school-aged children. Atypical antipsychotics have the most evidence supporting their use in the treatment of bipolar disorder in preschool-aged children and should considered first, in cases where pharmacotherapy is necessary. While there is a definite need for additional research in both the diagnosis and treatment of preschool mood disorders, clinicians should use what available evidence there is to aide them in treating this very young population.

Original languageEnglish (US)
Pages (from-to)57-72
Number of pages16
JournalCurrent Treatment Options in Psychiatry
Volume2
Issue number1
DOIs
StatePublished - Mar 1 2015

Fingerprint

Mood Disorders
Preschool Children
Age Groups
Bipolar Disorder
Therapeutics
Population
Depression
Pediatrics
Drug Therapy
Fluoxetine
Cognitive Therapy
Diagnostic Errors
Antipsychotic Agents
Uncertainty
Morbidity
Safety
Research

Keywords

  • Antidepressants
  • Atypical antipsychotics
  • Bipolar disorder
  • Cognitive-behavioral therapy
  • Depression
  • Mood disorders
  • Parent–child interaction therapy
  • Preschool
  • Psychoeducation

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

The Treatment of Preschool Mood Disorders. / DeFilippis, Melissa; Wagner, Karen.

In: Current Treatment Options in Psychiatry, Vol. 2, No. 1, 01.03.2015, p. 57-72.

Research output: Contribution to journalReview article

@article{1d3969ab9194405ab8b8967fce9fad89,
title = "The Treatment of Preschool Mood Disorders",
abstract = "Pediatric mood disorders are a genuine concern within the clinical setting, and they cause significant morbidity among children and adolescents. Evidence supports the presence of mood disorders in even very young, preschool-aged children, but they can be difficult to diagnose accurately in this population. They may present somewhat differently, especially with regards to duration and timing of mood symptoms. For example, clinically significant depression may be missed in this age group when using the strict 2-week duration criterion, and clinicians will identify these significant cases more successfully when using a proposed 1-week duration criterion. Mood disorders in the preschool population may also present with more non-specific symptoms (i.e., irritability), and developmental aspects encountered in this age group may also contribute to diagnostic uncertainty. There is considerable controversy surrounding the diagnosis of mood disorders, especially bipolar disorder, in young children. Children seem to present more often with fairly rapid cycling between mood states, and this seems especially true with preschool-aged children. This can lead to misdiagnosis and incorrect treatment decisions. Evidence examining these diagnostic issues is limited, but it supports the validity of mood disorder diagnoses in this young population. Evidence regarding treatment in this age group is even more limited. Treatment of mood disorders in the preschool age should begin with psychosocial interventions, first. These include parent-training, psychoeducation, and cognitive-behavioral therapy. Medication studies in this age group are lacking, and those available are largely open label trials or case series. When medication is necessary, special attention to dosage should be made, with starting doses cut in half from regular pediatric dosing recommendations to avoid adverse effects. Fluoxetine should be considered as first-line pharmacotherapy in preschool children with depression, due to the available safety and efficacy data in school-aged children. Atypical antipsychotics have the most evidence supporting their use in the treatment of bipolar disorder in preschool-aged children and should considered first, in cases where pharmacotherapy is necessary. While there is a definite need for additional research in both the diagnosis and treatment of preschool mood disorders, clinicians should use what available evidence there is to aide them in treating this very young population.",
keywords = "Antidepressants, Atypical antipsychotics, Bipolar disorder, Cognitive-behavioral therapy, Depression, Mood disorders, Parent–child interaction therapy, Preschool, Psychoeducation",
author = "Melissa DeFilippis and Karen Wagner",
year = "2015",
month = "3",
day = "1",
doi = "10.1007/s40501-015-0036-7",
language = "English (US)",
volume = "2",
pages = "57--72",
journal = "Current Treatment Options in Psychiatry",
issn = "2196-3061",
publisher = "Springer International Publishing AG",
number = "1",

}

TY - JOUR

T1 - The Treatment of Preschool Mood Disorders

AU - DeFilippis, Melissa

AU - Wagner, Karen

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Pediatric mood disorders are a genuine concern within the clinical setting, and they cause significant morbidity among children and adolescents. Evidence supports the presence of mood disorders in even very young, preschool-aged children, but they can be difficult to diagnose accurately in this population. They may present somewhat differently, especially with regards to duration and timing of mood symptoms. For example, clinically significant depression may be missed in this age group when using the strict 2-week duration criterion, and clinicians will identify these significant cases more successfully when using a proposed 1-week duration criterion. Mood disorders in the preschool population may also present with more non-specific symptoms (i.e., irritability), and developmental aspects encountered in this age group may also contribute to diagnostic uncertainty. There is considerable controversy surrounding the diagnosis of mood disorders, especially bipolar disorder, in young children. Children seem to present more often with fairly rapid cycling between mood states, and this seems especially true with preschool-aged children. This can lead to misdiagnosis and incorrect treatment decisions. Evidence examining these diagnostic issues is limited, but it supports the validity of mood disorder diagnoses in this young population. Evidence regarding treatment in this age group is even more limited. Treatment of mood disorders in the preschool age should begin with psychosocial interventions, first. These include parent-training, psychoeducation, and cognitive-behavioral therapy. Medication studies in this age group are lacking, and those available are largely open label trials or case series. When medication is necessary, special attention to dosage should be made, with starting doses cut in half from regular pediatric dosing recommendations to avoid adverse effects. Fluoxetine should be considered as first-line pharmacotherapy in preschool children with depression, due to the available safety and efficacy data in school-aged children. Atypical antipsychotics have the most evidence supporting their use in the treatment of bipolar disorder in preschool-aged children and should considered first, in cases where pharmacotherapy is necessary. While there is a definite need for additional research in both the diagnosis and treatment of preschool mood disorders, clinicians should use what available evidence there is to aide them in treating this very young population.

AB - Pediatric mood disorders are a genuine concern within the clinical setting, and they cause significant morbidity among children and adolescents. Evidence supports the presence of mood disorders in even very young, preschool-aged children, but they can be difficult to diagnose accurately in this population. They may present somewhat differently, especially with regards to duration and timing of mood symptoms. For example, clinically significant depression may be missed in this age group when using the strict 2-week duration criterion, and clinicians will identify these significant cases more successfully when using a proposed 1-week duration criterion. Mood disorders in the preschool population may also present with more non-specific symptoms (i.e., irritability), and developmental aspects encountered in this age group may also contribute to diagnostic uncertainty. There is considerable controversy surrounding the diagnosis of mood disorders, especially bipolar disorder, in young children. Children seem to present more often with fairly rapid cycling between mood states, and this seems especially true with preschool-aged children. This can lead to misdiagnosis and incorrect treatment decisions. Evidence examining these diagnostic issues is limited, but it supports the validity of mood disorder diagnoses in this young population. Evidence regarding treatment in this age group is even more limited. Treatment of mood disorders in the preschool age should begin with psychosocial interventions, first. These include parent-training, psychoeducation, and cognitive-behavioral therapy. Medication studies in this age group are lacking, and those available are largely open label trials or case series. When medication is necessary, special attention to dosage should be made, with starting doses cut in half from regular pediatric dosing recommendations to avoid adverse effects. Fluoxetine should be considered as first-line pharmacotherapy in preschool children with depression, due to the available safety and efficacy data in school-aged children. Atypical antipsychotics have the most evidence supporting their use in the treatment of bipolar disorder in preschool-aged children and should considered first, in cases where pharmacotherapy is necessary. While there is a definite need for additional research in both the diagnosis and treatment of preschool mood disorders, clinicians should use what available evidence there is to aide them in treating this very young population.

KW - Antidepressants

KW - Atypical antipsychotics

KW - Bipolar disorder

KW - Cognitive-behavioral therapy

KW - Depression

KW - Mood disorders

KW - Parent–child interaction therapy

KW - Preschool

KW - Psychoeducation

UR - http://www.scopus.com/inward/record.url?scp=85065195455&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065195455&partnerID=8YFLogxK

U2 - 10.1007/s40501-015-0036-7

DO - 10.1007/s40501-015-0036-7

M3 - Review article

VL - 2

SP - 57

EP - 72

JO - Current Treatment Options in Psychiatry

JF - Current Treatment Options in Psychiatry

SN - 2196-3061

IS - 1

ER -