By K. M. Asano

S E R I E S C O N S U L T A N T Anne S. Walters, Ph.D. Emma Pendleton Bradley Hospital Warren Alpert Medical School of Brown University

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Foreword: Dr. Anne S. Walters, Ph.D.. ......................................... 6 Chapter 1: History of Mood Disorders. ...................................... 11 Chapter 2: Understanding Causes of Mood Disorders. ................ 25 Chapter 3: How People Are Affected by Mood Disorders.............. 35 Chapter 4: Treatment Options for Mood Disorders. .................... 53 Chapter 5: How to Live With Mood Disorders. ............................ 71 Chapter Notes. ....................................................................... 86 Series Glossary of Key Terms. .................................................. 88 Further Reading. .................................................................... 90 Internet Resources.................................................................. 91 Organizations to Contact......................................................... 92 Index..................................................................................... 93 Author’s Biography / Credits................................................... 96 CONTENTS KEY ICONS TO LOOK FOR: Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments, and much more! Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.


Dr. Anne S. Walters, Ph.D.

Almost one in seven children and adolescents in the United States has a diagnosable mental illness, according to the National Institute of Mental Health (NIMH), the leading federal agency for research on mental disorders. That’s more than the number of children and adolescents suffering from cancer, AIDS, and diabetes combined. NIMH

research has found that almost 50 percent of these young people will experience an episode of mental illness before the age of eighteen. The rate of mental illness is even higher among young adults between the ages of eighteen and twenty-five. This is not a uniquely American problem, however. The World Health Organization (WHO) reports that mental disorders are the leading cause of disability among young people in all regions of the world.


The most common behavioral health diagnoses in children include attention deficit hyperactivity disorder (ADHD), behavior problems, anxiety, and depression. Some of these conditions commonly occur together. For example, about three in four children (73.8 percent) between the ages of three and seventeen who have been diagnosed with depression also suffer from anxiety, and almost one in two (47.2 percent) exhibit behavioral problems, according to the Centers for Disease Control and Prevention. What do these numbers mean? To start, it means that mental illness is very common. Most of you reading this will have at least one friend or family member who either is currently struggling or has struggled in the past with a psychiatric illness. That number may even include you and may mean that you have symptoms of both anxiety and depression. In addition, mental illness is becoming more common. Suicide rates have increased in children and adolescents over the past ten years, and this is a major concern at present for professionals in the behavioral health field. No one is sure what has caused these increases, though some speculate it is related to “cultural trends.” A combination of factors such as social media and technology advances or the opioid crisis may all play contributing roles. Other professionals have wondered about how violence in our schools might impact youth


mental health, and still others have pointed to the potential effects of decreased sleep on these illnesses. Despite there being more widespread information about the prevalence of mental health issues for children and adolescents, only slightly more than half of these children receive treatment. What gets in the way? One of the barriers to seeking treatment is the fear that others will find out. Children, adolescents, and even parents fear the stigma of being identified as having a mental illness. Despite progress in the diagnosis and treatment of these illnesses, the stigma that surrounds mental illness is still very profound, even today. Parents fear that their children will experience shame. As long as this stigma exists, it affects the likelihood that children or their families will seek help. Other barriers include doctor and hospital wait lists, concern about medical expense, a shortage of available mental health providers, and lack of knowledge about treatment options. Some of the movements toward reducing stigma have been helpful in this regard. Notable examples are actress Glenn Close and her foundation aimed at reducing the stigma for those with bipolar disorder, or Olympic athlete Michael Phelps speaking out about his own depression. The good news in all of this is that in recent years, evidence-based treatment has become available. The term “evidence based” refers to treatment that has been tested via research and


proven to be effective for various types of mental illness. For example, we know that a form of treatment called “Coping Cat” utilizes a cognitive behavioral form of treatment that is effective for childhood anxiety, and that effectiveness is improved with the use of certain medications as well. Cognitive behavioral therapy (CBT) targets the way that we negatively interpret or perceive situations, and teaches us to “restructure” those thoughts, leading to different feelings and experiences. We know CBT is helpful because researchers have performed studies comparing patients who get this form of treatment with patients that receive other forms of treatment. Our readers will learn more about all these topics in the volumes ahead. We hope that having more information will help you to combat the stigma that surrounds mental illness, and therefore reduce the length of time it takes a child and family to seek treatment. Our hope is that this series will spark conversation and provide important information for children, parents, and school personnel about the various diagnoses that are most common in childhood and adolescence. With this series, we hope you will understand much more about mental illnesses, what is involved, and what to do to help those who might be suffering like family, friends, or even you.



infer: to make a conclusion from reasoning or evidence , rather than from explicit statements mood: a temporary state of mind or feeling psychiatrist: a medical professional who has received training in mental health and can help diagnose and treat mood disorders


1 chapter

History of Mood Disorders

Understanding what mood is, and what mood disorders entail, is essential to finding new and better ways to help those who suffer from mood disorders. In psychology, a mood is defined as an emotional state of mind or mental focus. It is not the same as emotions or feelings. A mood is much less specific, less intense, and less likely to be brought on by a single small instance or occurrence. They are typically described as being either positive or negative, which is why people tend to say they are in either a good mood or a bad mood. Mood also has some key differences from temperament or personality traits, both of which are much more constant. Someone may have a natural disposition to be a worrier or to look for worst case scenarios to prepare for, but that doesn’t necessarily mean that person’s mood is bad. Nevertheless, personality traits such as optimism and neuroticism can make someone more predisposed or vulnerable to a certain mood. Someone who always looks at the bad things in life or someone who forces a smile and a laugh, even when he or she is in pain, does not necessarily have a mood disorder.


A mood is an emotional state of mind. Mood is not the same as personality. Personality is much more constant, whereas mood can change.

Long-term highs and lows in mood, such as clinical depression and bipolar disorder, will often be classified as types of mood disorders. “Modern approaches to [mood disorders]—be they biological, cognitive, or social—have focused on just about everything but mood,” explains Jonathan Rottenberg, a professor of psychology at the University of South Florida and author of The Depths: The Evolutionary Origins of the Depression Epidemic:


Behavioral Disorders: Mood Disorders

In part, this is because the study of mood had little momentum for most of the twentieth century. Researchers had little interest in the topic; skeptics questioned whether something as evanescent as mood could ever be studied with precision or objectivity . . . The emerging field known as affective science now benefits from an enviable wealth of measurement tools, with standard techniques for measuring the moods that people report; systems for measuring behavior in the lab and in the field; and new ways to monitor the physiology of mood and emotions, from functional brain scans to miniature sensors that monitor the body as people go about their everyday lives. 1 Unlocking the Mystery of Mood While it is true that mood is an internal, subjective state of mind that varies from one individual to the next, it can often be inferred from posture, speech, choices, and other behaviors. People react in a certain way in response to moods, and there are signals that others can pick up on that hint at whether we are feeling good or bad. A person can have a change in mood because of an unexpected event, good or bad, such as a death, divorce, loss of a friendship, marriage, or arrival of a baby. Positive events can lift mood. Negative events can cause a drop in mood. People can have particular moods for no apparent reason, such as waking up feeling grumpy or just feeling “off” without explanation. Whatever triggers mood changes, people are facing a growing epidemic of shifting, fluctuating, up-and-down mood swings. “Adult rates of depression and anxiety [and others] have tripled since 1990 and over eight percent of those who consult medical doctors today complain of excessive stress,” writes Julia Ross, the executive director of a clinic that treats mood disorders. “Even our children are


History of Mood Disorders

People with mood disorders experience multiple issues. They often miss work or have poor school performance.

in trouble, with at least one in ten suffering from significant mood disorders. Our mood problems are increasing so fast that by 2022 [it is estimated] they will outrank AIDS, accidents, and violence as the primary cause of early death and disability.” 2 Mood disorders are still some of the leading causes of illness, missed work, poor school performance, hospitalization, financial problems, relationship and family issues, and even increased suicide rates. We have come a long way in the last 100 to 150 years regarding how scientists define mood, how mood disorders are viewed, and what can be done to help people. Treatments are based on learning from the past, seeing what did and did not work, and developing even better treatments, therapies, and medications. Mood disorders are nothing new. In fact, they have been around since humans first walked the planet, but these ailments were not always known and understood the way they are now. French psychiatrist Jean-Pierre Falret printed an article in 1851 in which he wrote about something he called la folie circulaire , which translates to “circular insanity.”


Behavioral Disorders: Mood Disorders

The article talks in great detail about people switching through major changes in mood. Observed patients would cycle between depressive lows to energetic highs, in a seemingly endless cycle of changing moods from one extreme to the next. Falret’s article is considered to be the first documented identification of a mood disorder ever reported in a scientific setting.

Natural worriers are not necessarily always in a bad mood. A person who always imagines a worst-case scenario does not necessarily have a mood disorder.


History of Mood Disorders

In 1851, French psychiatrist Jean-Pierre Falret observed and documented major mood swings, which he called “circular insanity.”

Human Mood and Disordered Moods

It is obvious that people’s moods have shifted and changed over the last few decades. While modern conveniences have made life easier in some ways, in many other ways there is greater pressure, higher stress, and more pessimism. But despite the increased stresses of modern high-pressure lifestyles, researchers don’t fully understand why growing numbers of people are now so unresponsive to traditionally reliable remedies like long vacations, talking with friends or loved ones, journaling or meditation, psychotherapy, and spiritual counsel. As Julia Ross explains in The Mood Cure :


Behavioral Disorders: Mood Disorders

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