Abstract
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Disruptive mood dysregulation disorder (DMDD) presents numerous challenges for patients, families, and clinicians. Research on the phenomenology, epidemiology, and neurobiology of DMDD has consistently outpaced studies of interventions for this relatively new diagnostic construct (Pan and Yeh 2023; Wiggins et al., 2021). Patients with DMDD often struggle with a wide range of symptoms and family stressors. Potential considerations for intervention often include irritability, aggression, as well as anxiety, hyperactivity, inattention, depressive symptoms, and substance use related to co-occurring disorders (Søndergaard et al., 2024). Thought leaders in our field had anticipated that the DMDD diagnostic construct would facilitate nuanced treatment planning for young patients with chronic irritability and emotional outbursts. Recent concerning data suggests that this anticipation has not yet been fulfilled (Findling et al., 2022). Addressing present gaps in both knowledge and knowledge translation focused on evidence-based treatment planning for DMDD are key goals for improving the lives of families struggling with DMDD.
In this issue, Dr. Zhang and colleagues address this key area with a systematic review and meta-analysis of interventions for DMDD (Zhang et al., 2024). This article examines five studies of behavioral interventions and six studies of pharmacological treatments. Notably, only four of these studies were randomized controlled trials. Stimulant medications, citalopram, atomoxetine, and aripiprazole have initial promise for improving irritability in patients with DMDD. However, this literature remains underdeveloped, and it is imperative that rigorously designed randomized controlled trials are conducted. Family based behavioral interventions such as adaptations of dialectical behavioral therapy appear to have therapeutic effectiveness and are central for treatment planning considerations in clinical practice. Other critical areas for future research include combined and sequential approaches with pharmacological and nonpharmacological treatment modalities (Zhang et al., 2024).
Another contribution in this issue provides additional insights regarding phenotypes and co-occurring conditions in adolescents with bipolar disorder (Farrow et al., 2024). The relationship and correlates of eating disorders and bipolar disorder in adults have already been extensively considered. However, there are no prior studies that have characterized eating disorders in adolescents with bipolar disorder. Further understanding in this area is important for treatment planning in this complex population who are often treated with medications that impact metabolic functioning and weight (Lyu et al., 2024). In the present study by Dr. Farrow and colleagues, 36% of adolescents with bipolar disorder had eating disorder symptoms, and this patient group had greater depressive symptom severity compared with adolescent patients with bipolar disorder without eating disorder symptoms (Farrow et al., 2024). These findings underscore the importance of screening for eating disorder symptoms and comprehensive treatment planning in adolescents with bipolar disorder.
Neuroinflammation is frequently pondered and studied as a correlate of depression. Assessments of C-reactive protein (CRP) are appealing as these would be applicable and scalable for clinical practice. In this issue, Dr. Schwartz and colleagues report on a study that did not find a relationship between baseline measures of CRP and future symptom severity (Schwartz et al., 2024). This issue also includes important findings from a large randomized, double-blind placebo controlled and active-controlled study of levomilnacipran. Levomilnacipran had a favorable safety and tolerability profile. Levomilnacipran did not have statistically significant improvements in depressive symptom severity when compared with placebo (Radecki et al., 2024). This study highlights the importance of ongoing biomarker development and novel design for clinical trials of antidepressants in adolescents (Saito et al., 2023).
We hope you enjoy this issue of Journal of Child and Adolescent Psychopharmacology.