The Treatment of Preschool Mood Disorders

Opinion statement 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.