Pediatric mood disorders (unipolar depression and bipolar disorder) are serious, common, persistent and recurrent medical conditions. The US National Institute of Mental Health (NIMH) and World Health Organization (WHO) estimate that in the U.S. depression is the leading cause of disability and worldwide it is the 2nd leading contributor to the global burden of disease for persons 15–44 years old.1
Mood disorders have several non-modifiable risk factors including family history, gender and race. Major depression and suicide are associated with fewer serotonin transporter sites in the prefrontal cortex of the brain. Lower norepinephrine levels are associated with dysphoria and apathy. CNS dopamine levels are also reduced in depression. Prior to puberty, the prevalence of depression is higher in boys than girls; after puberty, the rates in girls are about twice those in boys. Native Americans have higher rates of depression, while Asians report fewer depressive symptoms than Caucasians.
Mood disorders have a high rate of co-morbidity with both mental health and medical problems. For example, many children and adolescents suffering from ADHD, anxiety or substance abuse also suffer from depression and vice versa. Depressive disorders are also common among patients with chronic medical conditions including any condition causing chronic pain, obesity, endocrine disorders, inflammatory disorders, cancer, anemia, viral infections, and brain injury. Depression can also be caused by medications including antihypertensive medications and oral contraceptives. Depression recurs in 70% of those affected. Therefore, even patients who have improved should actively pursue activities to promote positive moods and prevent recurrences.
Mainstream therapies such as medications, cognitive behavioral therapies, electroconvulsive therapy and vagal nerve stimulators have been discussed extensively in other reviews 2–5. Furthermore, given the side effects and stigmatization of standard antidepressant medications, many families turn to complementary therapies. In fact, depression is one of the most common reasons adolescents and adults seek complementary therapies 6.
Therefore, the focus of this review is the fundamental lifestyle approaches and complementary therapies that enhance mental health, particularly those that help achieve and maintain healthy moods. The emerging term to describe the use of lifestyle and complementary therapies in combination with traditional, scientific medicine is integrative medicine. Integrative medicine is informed by science and is based on four core concepts:
- Patient-centered care (individualized, consistent with patient values and goals)
- Sustainable, healing environment
- Comprehensive approach to therapies
- Health promotion and wellness; promotion of the innate healing potential.
Health: Physical and Mental
Mental health is closely tied to physical health. A successful athlete exhibits strength, flexibility, endurance, coordination, focus, resilience, teamwork and sport-specific skills. Similarly, a mentally healthy person exhibits confidence, courage, cheerfulness, coping abilities, hardiness, and focused attention. It’s not that the fit athlete never stumbles or that she always hits a home run, but that barring a catastrophe, she can get up and try again. Similarly, a mentally healthy person occasionally experiences sadness, worry, misery, exhilaration, ecstasy and the full range of human emotions, recognizing that “into each life, some rain must fall” but views the rain as a challenge rather than an insurmountable obstacle. Holistic physicians also consider spiritual health as a critical element of overall health. Table 1 shows some of the characteristics of physical, mental and spiritual health.
Because the mind-body connection is real, promotion of mental health, including healthy moods, relies on very similar strategies to those promoting physical health.
Therapeutic options for achieving healthy moods fall into four major categories: