An expert opinion on the pharmacological interventions for Disruptive Mood Dysregulation Disorder (DMDD)

ABSTRACT

Introduction

Disruptive Mood Dysregulation Disorder (DMDD) was officially introduced as a new diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), under the category of depressive disorders.

Areas Covered

A comprehensive overview and a critical commentary on the currently investigated psychopharmacological approaches for the treatment of DMDD have been here provided.

Expert Opinion

Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When ineffective or partially effective, psychopharmacological strategy is recommended. Overall, pharmacological strategy should be preferred in those individuals with psychiatric comorbidities (e.g. ADHD). Indeed, so far published studies on pharmacological strategies in DMDD are scant and heterogeneous (i.e. age, assessment tools, symptomatology profile, comorbidity, and so forth). Therefore, DMDD psychopharmacological guidelines are needed, particularly to guide clinicians toward the patient’s typical symptom profile who could benefit from psychopharmacological strategy.

KEYWORDS:

• Bipolar disorder
• Disruptive Mood Dysregulation Disorder
• irritability
• pharmacotherapy
• temper outburst
• youths

Article highlights

• Disruptive Mood Dysregulation Disorder (DMDD) is a diagnostic entity introduced in the DSM-5 with the aim to reduce the high rate of pediatric bipolar disorder diagnoses and, hence, reducing the antipsychotic prescriptions.

• DMDD has two core elements: chronic irritability and temper tantrums. It has a high comorbidity especially with ADHD, ODD, CD, ASD

• Although DMDD entered the clinical practice, there are no protocols and guidelines, nor consensus among experts, in both diagnostic assessment and treatment.

• Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When insufficient, psychopharmacological intervention is recommended.

• Our recommendation is to start with the treatment of associated comorbidities. If ADHD is present, use psychostimulants. If these are not enough to manage the symptoms, atypical antipsychotics (risperidone or aripiprazole) can be augmented.

• If anxiety and/or depressive disorders are present, SSRIs (citalopram) could be recommended.

• If there is a comorbid ASD, risperidone could be recommended for the management of aggressive behaviors and irritability.

• Lithium (particularly sulfate) could represent a good tolerable and valuable pharmacological strategy that could be further investigated in RCTs and real-world observational studies.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.