Many adolescent affective disorders are rooted in biological vulnerability to stress and a predisposition to mood variations that are latent in childhood. As these stress-sensitive children encounter the normative helplessness and struggle for autonomy of adolescence, they may use violence, explosive rage, self-starvation, grandiose self-idealization, drug abuse, and suicidal behavior to relieve psychological helplessness and tension. They may begin a lifelong cycle of failure, disruption, and rejection by family and schools. The author describes adolescent depression and its biological underpinnings, deprivation syndromes, and manic-depressive illness, as well as the concept of affective violence in organic affective syndromes and episodic dyscontrol syndromes. These disorders call for multimodal treatment in which appropriate medication facilitates psychosocial intervention.