abandoning the diagnosis will endanger severely depressed children

doi:10.1136/bmj.329.7479.1396

BMJ 2004;329:1396 (11 December), doi:10.1136/bmj.329.7479.1396

Commentary

abandoning the diagnosis will endanger severely depressed children

Quentin Spender, consultant¹

¹ Chichester Child and Adolescent Mental Health Services, Chichester PO19 6PQ spender@sghms.ac.uk

The first 150 words of the full text of this article appear below.

As a family therapist, I applaud Timimi's broadly systemic approachto childhood unhappiness.¹ In my experience, young people aged14-16 are most likely to present to clinicians with depression,and he is right to emphasise the sociocultural roots of theirunhappiness. However, I am concerned at the underemphasis onpossible consequences of depression, such as school failure,social withdrawal, antisocial behaviour, substance misuse, familydisharmony, and suicide, which are more than just potentialcomorbidities.

I agree that psychoeducation is an important component of treatment.This includes acknowledging that some life experiences can bemore difficult than others, particularly losses; that sleepcan be improved by exercise; that mood can be improved by activityscheduling; and that an emphasis on the positive is more likelyto help than a focus on the negative. But I cannot see thatthis is enough; nor do I think that child mental health professionalscan . . . [Full text of this article]

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