What Works? Psychopharmacological Strategies for Pediatric Mood Disorders: A Conversation With Melissa DelBello, MD

BRAIN TRUST: CONVERSATIONS IN PSYCHOPHARMACOLOGY

-Series Editor Joseph F. Goldberg, MD

Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with child and adolescent psychiatrist Melissa DelBello, MD, to discuss the role of psychopharmacology in pediatric mental health treatment. Their conversation emphasized early identification and intervention for mood and related disorders in young patients.

DelBello addressed common concerns regarding medication safety in children, noting that when prescribed by clinicians with appropriate expertise, psychotropic medications “can be life-saving” and used in ways that minimized adverse effects while maximizing efficacy.¹ She cautioned against excessive polypharmacy and inadequate duration of therapeutic trials, which could undermine optimal outcomes.

DelBello also underscored the developmental consequences of untreated psychiatric illness. She explained that childhood and adolescence represent critical periods for achieving social, academic, and interpersonal milestones. The onset of major depression, bipolar disorder, psychosis, anxiety, or attention disorders during these years could disrupt developmental trajectories, with enduring functional sequelae. She drew parallels to untreated medical conditions affecting growth, arguing that failure to address early psychiatric symptoms could similarly alter long-term outcomes.

Goldberg raised the question of whether earlier intervention might mitigate chronicity and comorbidity, echoing the sentiment of many practitioners wishing they could have seen a patient just in time to prevent a disorder worsening. DelBello supported a positive view on early intervention, suggesting that timely treatment could prevent abnormal neurodevelopment and reduce downstream complications. She emphasized that early-phase intervention was often more effective than treatment initiated after recurrent episodes and accumulated morbidity.²

The discussion also highlighted substance use risk in youth with bipolar disorder, particularly in the context of family history. DelBello described proactive psychoeducation targeting adolescents before college transition. She advised candid discussions about biological vulnerability, for example, letting particular patients know that vulnerability is part of their “genetics and neurochemistry, and if you start using substances, you’re more likely to get addicted faster.” Framing risk in neurobiological terms appeared to enhance insight and facilitate harm-reduction strategies.

Goldberg and DelBello advocated for developmentally informed, longitudinal care models that prioritized early recognition, individualized risk assessment, and judicious pharmacotherapy to improve long-term psychiatric and functional outcomes.

Dr Goldberg is a clinical professor of psychiatry at The Icahn School of Medicine at Mount Sinai in New York, NY and the immediate-past president of the American Society of Clinical Psychopharmacology.

Dr DelBello is a child and adolescent psychiatrist with the Cincinnati Children's Hospital Medical Center and professor and chair of the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine.

References

1. Altuwairqi Y. Trends and prevalence of psychotropic medication use in children and adolescents in the period between 2013 and 2023: a systematic review. Cureus. 2024;16(3):e55452.

2. Brown E, Stainton A, Chanen A, et al. Early intervention across mental health services. Tasman Psych. 2024:3491-3518.