Depression, bipolar disorder, and suicidal behavior in children

Résumé

Mood disorders represent the third most common psychiatric disorder among adolescents (Merikangas et al., 2010), with 14.3% of youth aged 13-18 diagnosed with a depressive disorder (major depressive disorder or dysthymic disorder) or bipolar disorder (bipolar I or II). Cognitive behavioral therapy (CBT) has strong empirical support as an effective treatment for child and adolescent depressive disorders (David-Ferdon & Kaslow, 2008) and is developing efficacy as an adjunct to psychopharmacological treatment for youth with bipolar disorder (Lofthouse & Fristad, 2004) and as a treatment for youth suicide attempters (Spirito, Esposito-Smythers, Wolff, & Uhl, 2011). Although the focus of this chapter is on cognitive behavioral interventions for mood disorders, research also supports the efficacy of psychopharmacological treatment of mood disorders in youth, particularly for bipolar disorder (Kowatch et al., 2005). Combining medication and CBT may be especially efficacious in the treatment of mood disorders in adolescents and may offer additional protection against suicidality (Birmaher et al., 2007; Treatment for Adolescents with Depression Study [TADS] Team, 2004). However, medication use is often less acceptable to youth and families, especially for younger children (Jaycox et al., 2006; Stevens et al., 2009). This may be particularly the case given recent evidence suggesting that increased suicidal ideation may be a side effect of antidepressant medication use in young people. Two meta-analytic studies examining randomized clinical trials of antidepressant medications in youth have found small but significant increases in suicide risk in antidepressant-treated groups (Bridge et al., 2007; Hammad, Laughren, & Racoosin, 2006). These findings underscore the utility of combined medication-psychotherapy interventions, where suicidality can be carefully monitored and addressed. In addition, medication and medication adherence can be particularly challenging for individuals, especially youth, with bipolar disorders (Case, 2011; Colom, Vieta, Tacchi, Sanchez-Moreno & Scott, 2005), further warranting adjunctive psychosocial intervention. In this chapter we have six goals: (a) to describe mood disorders in youth, (b) to outline existing evidence for the efficacy and effectiveness of CBT for youth mood disorders and suicidality, (c) to describe specific CBT interventions among youth with mood disorders and suicidality, (d) to introduce some essential treatment considerations in youth populations, (e) to outline the specific components included in some of the most prominent CBT protocols, and (f) to discuss future directions. We use the term mood disorders to describe the presence of symptoms that meet DSM-IV criteria for a depressive disorder (major depressive disorder, dysthymic disorder, depressive disorder not otherwise specified) or bipolar disorder (bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise specified). In addition, we use the term youth to describe individuals under the age of 18, children and pre-adolescents to describe individuals under the age of 13, and adolescents to describe individuals between the ages of 13 and 18. (PsycINFO Database Record (c) 2016 APA, all rights reserved) *Attempted Suicide *Bipolar Disorder *Childhood Development *Cognitive Behavior Therapy *Major Depression Comorbidity Drug Therapy Evidence Based Practice Interdisciplinary Treatment Approach Suicide